Health-Exchange-Alert

The Supreme Court Friday (April 3) agreed to an extended briefing schedule in the high-profile lawsuit over the Affordable Care Act, now known as California v. Texas, in a move the Democratic AGs say could lead to oral arguments in October.

While the federal government refuses to open healthcare.gov for a special enrollment period during the coronavirus pandemic, several state-based exchanges that already created SEPs have extended their deadlines.

The Trump administration continues to dismiss the idea of opening up a special enrollment period (SEP) for healthcare.gov, and instead looks to provide cash payments to providers for treating the uninsured using the $100 billion in funding from the newly passed CARES Act.

Congress’ Medicaid advisers voted in favor what staff called modest but important recommendations to improve care for beneficiaries eligible for both Medicare and Medicaid -- one would create a special enrollment period for duals eligible for Medicare-Medicaid plans and another would propose Congress provide states with funding to put integrated care models in place.

CMS has agreed to withhold federal Medicaid reimbursements to states in cases where providers are serving Medicaid beneficiaries without being enrolled in state programs after an HHS Office of Inspector General report found 23 states hadn’t enrolled all providers as required by the 21st Century Cures Act.

The White House Wednesday (April 1) doubled down on its decision not to open healthcare.gov for a special enrollment period due to the coronavirus, telling Inside Health Policy that doing so would be moot since the marketplace already lets people who lost their jobs enroll via a SEP -- even though existing events that trigger a new enrollment window are more limited.

Consumer, labor and beneficiary advocacy groups are urging insurance companies to drop all cost-sharing for all services related to diagnosis and treatment of the COVID-19 and its symptoms.

A growing number of insurers have agreed to waive copays for all medical treatment related to COVID-19, not just for testing and diagnostic services which Congress mandated under the third stimulus bill.

A provision in the $2 trillion stimulus law lets hospitals and laboratories set prices on COVID-19 tests, and employers and insurers worry some providers might price gouge and balance bill patients.