Risk Adjustment and Reinsurance: A Work Plan for State Officials
Wakely Consulting Group – Ross Winkelman, Mary Hegemann, Syed M. Mehmud, Tom Leonard, James Woolman; Julie Peper and Patrick Holland
Under the Affordable Care Act (ACA) much of the expanded coverage will be provided through health insurers offering products on the new health insurance exchanges. To ensure robust markets, exchanges must have in place processes for mitigating the financial risk to insurers associated with enrolling individuals with diverse health care needs. Building on an earlier analysis of proposed rules on reinsurance, risk adjustment and risk corridors, this work plan by the Wakely Consulting Group provides an outline for state officials on the decisions and actions necessary to implement the risk adjustment and reinsurance provisions of the ACA. The work plan includes various implementation timelines based on several scenarios that reflect the flexibility states have in administering these programs. This analysis includes details for those states that may elect to allow the U.S. Department of Health and Human Services to define and administer most of these risk mitigation programs, as well as for those states that choose to customize and administer these programs themselves. States will need to adjust work plans based on the goals, resources and other specifics of their health insurance marketplace.
Slides from a webinar on this topic are also available.