Risk Adjustment Suspension reversed by Trump

July 27-  In a reversal, the Trump Administration will resume risk adjusted payments to Health Insurers.  A few weeks ago we reported that the Administration was suspending payments to carriers under the risk adjustment payment program under the Affordable Care Act in the Individual and Small Group Markets. They now said they will restart the program that pays billions to insurers to stabilize health insurance markets.



3 recent articles covering the Trump administration’s decision to suspend Risk Adjustment payments to insurers which were intended to help insurers cover costs for sicker patients.  This will cause insurers to rethink and possibly refile their filed rates for Individual and Small Group plans for 2019.  Insurers were due to receive upwards of $10 billion dollars to offset high claimants in these markets.  This will certainly cause some turmoil and cause for debate and discussion.  In New York, Oxford has benefitted greatly from these payments, last year taking in around $250 million in payments from other carriers in New York state.  Risk adjustment payments are what also took down CareConnect, having to in essence pay over $100 million dollars to Oxford.  The risk adjustment payment programs are certainly a flawed methodology created by the previous administration, what the solution is.. no one is really certain of that, but this will certainly have some reaction to it and cause carriers to reconsider their intended filings for 2019.

We will keep you posted of new developments.