Payer Roundup—HHS dedicates $500M to navigator grants; BCBSMA supporting LGBTQ members

Below is a roundup of payer-centric news headlines you may have missed during the month of June 2024.

HHS announces $500 million for Navigators

Navigators, or people that help individuals sign up for health insurance coverage, earned a boost from the Department of Health and Human Services (HHS) on June 7.

HHS is awarding $500 million in grants over the next five years. This fall, HHS will award $100 million, the largest investment in the program to date. Since 2016, HHS has awarded more than $400 million to Navigators.

Reports released by HHS also show that the uninsurance rate has declined dramatically for many demographics from 2010 to 2022. For example, the uninsurance rate for Black Americans fell from 20.9% to 10.8% and Latinos from 32.7% to 18%.

BCBSMA, Folx Health partnership

Blue Cross Blue Shield of Massachusetts is expanding ties with Folx Health to offer more support for LGBTQIA+ members.

Folx Health offers gender-affirming care services, primary care, mental health, fertility and family building in its suite of care.

BCBSMA is one of the first health plans in the country with a team dedicated to gender-affirming care and the first plan to cover facial reconstruction surgery in the state the company said in a release. It also offers therapy for transitioning members and covers vocal cord surgery.

"Navigating the personal, emotional, and often confusing nature of the reproductive health and gender-affirming care landscape can be challenging," said Sandhya Rao, M.D., Blue Cross' chief medical officer, in a statement. "As demand for these services continues to grow, our job is to ensure our members have access to high-quality, equitable care and the resources they need to feel supported.”

Colorado signs payer transparency bill into law

Transparency in Healthcare Coverage was signed into law in Colorado June 5, requiring insurance carriers to comply with federal price transparency laws and make prices more easily available online.

“Coloradans deserve to have easy access to information on health insurance costs,” said Democratic State Senator Rhonda Fields in a statement. “Right now, too many health insurance carriers aren’t complying with federal price transparency laws. By addressing the problem at the state level, we can hold these companies accountable and help save Coloradans money on health care.”

The bill’s text can be found here (PDF).

Blue Cross members get lactation care services

Health tech company Aeroflow Health is offering online breastfeeding classes, private lactation appointments and care guides to Blue Cross Blue Shield members.

Care guides include education on breast pump cleaning among other topics, according to a news release.

“Blue Cross Blue Shield represents a large patient base in all 50 states. It has been a really rewarding journey and we are so proud to have established coverage for services that are so sought after by moms,” said Amanda Minimi, director at Aeroflow Health, in a statement. “We look forward to working with BCBS patients to educate them on their benefits, while making it easy to receive the support and supplies they need at each stage of motherhood.”

Vermont signs PBM reform into law

Vermont recently signed into law a bill (H.233) designed to rein in pharmacy benefit managers and lower prescription drug prices.

The National Association of Chain Drug Stores and the National Community Pharmacists Association supported the state’s new law.

The bill mandates PBMs receive a license from the Vermont Department of Financial Regulation and bans spread pricing and gag clauses, the organizations said.

CMS approves Oregon health program blueprint

Starting July 1, Oregon can establish a basic health program and receive federal funds, the Centers for Medicare & Medicaid Services announced June 7.

For people enrolled in the state’s section 1115(a) waiver program and with income at 138% to 200% of the federal poverty level, the members will be transferred to the BHP.

Under Section 1331 of the Affordable Care Act, states can create a BHP for its low-income residents so they can purchase healthcare through the health insurance marketplace even if they don’t temporarily qualify for Medicaid or CHIP coverage.

11 states adopt NAIC’s AI standards

Since February, nearly a dozen states have adopted AI responsibility standards set forth by the National Association of Insurance Commissioners (NAIC), according to an analysis by law firm McDermott Will & Emery.

The states are Alaska, Connecticut, Illinois, Kentucky, Maryland, Nevada, New Hampshire, Pennsylvania, Rhode Island, Vermont and Washington.

NAIC tells insurers they should be transparent with their AI usage, maintain a written program for AI systems and internal controls should be recorded, among other criteria.

Florida loses CHIP legal bid

The state of Florida, challenging a law guaranteeing 12 months of continuous coverage in the federal Children’s Health Insurance Program, had its legal challenge dismissed out of court.

Florida’s request for a preliminary injunction for the federal law’s provision was denied by the judge.

“The judge’s ruling is good news for children in working families in Florida and across the country who benefit from access to affordable health coverage through CHIP,” said Joan Alker, executive director of the Georgetown University Center for Children and Families at the McCourt School of Public Policy, in a statement.

Medigap enrollment falls

After enrolling more than 14 million individuals in 2020, Medigap enrollment decreased 1.4% in 2023, according to Mark Farrah Associates, a health insurance analysis company, and data filed with the National Association of Insurance Commissioners.

In 2022, Medigap enrollment declined less than 1%. UnitedHealth has the most members in Medigap at 4.3 million members, with Mutual of Omaha, CVS and Elevance Health rounding out the rest of the top four insurers.

“Med Supp plans collectively earned more than $35.3 billion in premiums and incurred $29.6 billion in claims during 2023,” the report said.

Interest rates propel insurers’ portfolio yields: credit agency

Higher interest rates have increased the portfolio yields of health insurers by almost 30 basis points from 4.47% to 4.74%, a recent report from credit agency AM Best revealed.

Net investment income grew by 9%, its second highest percentage growth in the last 10 years, in 2023 to more than $224 billion. Gross yield hit its highest levels since 2019.

“Insurance companies are looking to make profits on underwriting and investment returns are sort of on top of that,” John McGlynn, an AM Best analyst, told Fierce Healthcare.

Earlier this year, the Centers for Medicare & Medicaid Services (CMS) decreased Medicare Advantage benchmark payments by 0.16%. Health insurers hoped CMS would reverse this decision to decrease benchmark payments, as CMS agreed to do in previous years.

Underlying pressures on underwriting means investment income will be a larger percentage of net income, said McGlynn.

“It remains to be seen how they’re going to treat that with their strategy,” he said. “Are they going to be more aggressive with underwriting or treat that as bumper profit?”