CMS Finds Exchange Plans Don’t Measure Up To CHIP And Other ACA Developments

Implementing Health Reform. The Affordable Care Act (ACA) required the Centers for Medicare and Medicaid Services (CMS) by April 1, 2015 to review the benefits and cost-sharing in qualified health plans (QHPs) and certify that those plans offer benefits and cost-sharing that are at least comparable to those offered by the Children’s Health Insurance Program (CHIP). In the event that a state experienced a shortfall in federal CHIP funding, CMS was to establish procedures for enrolling children in a QHP certified by HHS as comparable. On November 25, 2015, CMS finally released its certification. CMS compared the second-lowest cost silver plan (SLCSP) in the largest rating area in each state to the CHIP benefits in that state. The review found that the average out-of-pocket spending in the SLCSP with financial assistance was higher than that for CHIP eligible children on a per-child basis in all states. The actuarial value of CHIP exceeded that of the SLCSP in all states except for Utah where they were equivalent. This means that families are expected to pay a higher percentage of expected health care costs in QHPs than in CHIP in all states except Utah. When premiums are taken into account, however, Utah’s average out-of-pocket spending for the SCLSP was higher than CHIP. The differences CMS found can be quite dramatic. In Washington state, for example, the plan actuarial value for the QHP was 48 percent while the actuarial value for the CHIP plan was 100 percent; premiums...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Following the ACA Insurance and Coverage Medicaid and CHIP benefits packages cost sharing qualified health plans States Source Type: blogs