ACAP Comment Letter on Adoption of the 2018 Risk Adjustment Program Methodology

September 7, 2018

Randy Pate, Deputy Administrator and Director
Center for Consumer Information and Insurance Oversight
Centers for Medicare & Medicaid Services
Department of Health & Human Services

Submitted electronically via

RE: CMS-9919-P

Dear Deputy Administrator and Director Pate:

The Association for Community Affiliated Plans (ACAP) respectfully submits comments in response to the proposed rule on the Patient Protection and Affordable Care Act; Adoption of the Methodology for the HHS-Operated Risk Adjustment Program for the 2018 Benefit Year Proposed Rule.

ACAP is an association of 62 not-for-profit and community-based Safety Net Health Plans (SNHPs) located in 29 states. Our member plans provide coverage to more than 20 million individuals enrolled in Medicaid, the Children’s Health Insurance Program (CHIP) and Medicare Special Needs Plans for dually-eligible individuals, including over 700,000 Marketplace enrollees. Nationally, Safety Net Health Plans serve almost half of all Medicaid managed care enrollees. Sixteen of ACAP’s Safety Net Health Plan members offer qualified health plans (QHPs) or a Basic Health Plan option in the Marketplaces in 2018 and one additional member expects to enter the QHP market in 2019.

Summary of ACAP’s Comments

ACAP has chosen to respond to the Department’s proposed rule concerning the adoption of the risk adjustment methodology for the 2018 benefit year, including use of the statewide average premium, given the relevance of the risk adjustment program to Safety Net Health Plans (SNHPs) and the consumers they serve. ACAP particularly appreciates the Department’s recognition of the importance of market stability; ACAP’s comments are focused on ensuring market stability for SNHPs and the consumers they serve.

Specifically, our comments are focused so as to ensure business stability for SNHPs and to not place undue burden or harm on consumers, in particular the low-income and vulnerable populations that are traditionally served by SNHPs.

  • Stability: ACAP supports the adoption of the methodology that would continue the operation of the risk adjustment program in a budget neutral manner for the 2018 benefit year (including the use of statewide average premium as the cost-scaling factor). Continuing with the formula as previously established will prevent further issuer uncertainty resulting from mid-year modifications to the risk adjustment methodology or operations.
  • Continued Discourse: ACAP urges the Department to continue thoughtful discourse that engages issuers moving forward. The risk adjustment formula may still need further changes and we would appreciate a thoughtful discourse in doing so.

View the full comment letter »