On June 20, Gov. John Carney signed enabling legislation (House Bill 193) moving Delaware a step closer to a reinsurance program beginning in 2020.

NEW CASTLE (Aug. 20, 2019) – The Department of Health and Social Services (DHSS) received approval today from the Centers for Medicare and Medicaid Services (CMS) for a 1332 State Innovation Waiver under the Affordable Care Act to create a reinsurance program beginning in 2020 as a way to reduce premiums by up to 20 percent in Delaware’s individual health insurance market.

Under Delaware’s reinsurance program, a portion of high-cost health care claims that drive up insurance rates for everyone on the individual market will be reimbursed through an estimated $27 million fund. The fund will use a mix of federal funding and assessments collected by the Delaware Department of Insurance from health insurance carriers. The Delaware Health Care Commission will administer the program.

Coupled with reduced rates already sought on the individual market in Delaware, the state expects a significant reduction in premiums for 2020. CMS authorized Delaware’s reinsurance program through 2024.

“We are grateful to CMS for approving Delaware’s 1332 State Innovation Waiver application that will enable us to establish a reinsurance program in our state,” said DHSS Secretary Dr. Kara Odom Walker, a practicing family physician. “We expect that the reinsurance program will further stabilize the individual health insurance market and make premiums more affordable for Delawareans who need such coverage.”

“The number one complaint/comment we receive from consumers at the Department of Insurance is the high cost of health insurance, especially from those who are not eligible for tax credits,” Insurance Commissioner Trinidad Navarro said. “With this new waiver program, people who earn above 400 percent of the federal poverty level, small business owners, and those who are not covered by their employers will save up to 20 percent on their health insurance premiums in the individual market. My office will continue to work to seek any and all means to help make health insurance more affordable for Delawareans.”

The CMS approval was the final step in a months-long process that included a recommendation from a working group that included DHSS, the Department of Insurance, legislators and other stakeholders, enabling legislation approved by Delaware’s General Assembly in June and signed into law by Gov. John Carney, and public comment periods at the state and federal levels.

Delaware is the 11th state to receive CMS approval for a reinsurance program. A March 2019 analysis by health care consultant Avalere found state-run reinsurance programs reduce premiums by almost 20 percent on average in their first year.

In addition to reducing premiums on the marketplace, the reinsurance program will benefit anyone who buys coverage on the individual market, including people who are not eligible for coverage at their workplace, those who are too young for Medicare or make too much money to be eligible for Medicaid, young people who have aged off their parents’ plans, or those who are self-employed.

In 2019, about 21,000 people enrolled for coverage on Delaware’s Health Insurance Marketplace. Open enrollment for 2020 will begin Nov. 1 and run through Dec. 15. To learn more about the marketplace, go to ChooseHealthDE.com.

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The Department of Health and Social Services is committed to improving the quality of life of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.

DHSS Secretary Dr. Kara Odom Walker says, “In the midst of the opioid crisis we are facing in Delaware and across the country, (these facilities) are another resource we can use to better serve our Medicaid clients in need of treatment for substance use disorder.”

NEW CASTLE (Aug. 5, 2019) – The Department of Health and Social Services received approval recently from the Centers for Medicare and Medicaid Services (CMS) for a waiver amendment allowing DHSS to use federal Medicaid funding for addiction-related treatment of individuals in substance use disorder (SUD) treatment facilities known as IMDs.

Delaware was the 25th state to receive approval of the SUD waiver by CMS. Previously, federal Medicaid funds could not be used to pay for addiction-related services at IMDs (institutions for mental disease) for individuals ages 21 to 64. Before the waiver, Delaware’s Medicaid program used state funds to pay for addiction-related services provided to Medicaid clients at IMDs. There are four IMDs in Delaware that provide addiction-related services: SUN Behavioral Delaware near Georgetown; Dover Behavioral Health in Dover; MeadowWood Behavioral Health near New Castle; and Rockford Center near Newark.

The IMD exclusion, which prohibits the use of federal Medicaid funds for care provided to most patients in mental health and substance use disorder residential treatment facilities with more than 16 beds, had been part of Medicaid since its enactment in 1965. Delaware’s waiver applies only to addiction-related services for Medicaid clients.

“We are grateful to CMS for granting us this waiver,” said DHSS Secretary Dr. Kara Odom Walker, a practicing family physician. “In the midst of the opioid crisis we are facing in Delaware and across the country, the IMDs are another resource we can use to better serve our Medicaid clients in need of treatment for substance use disorder.”

DHSS’ Division of Medicaid and Medical Assistance (DMMA) also received approval from CMS for an extension of its Medicaid demonstration project, Diamond State Health Plan, along with its SUD waiver amendment. Both approvals are effective from Aug. 1, 2019, through Dec. 31, 2023.

“We are very pleased to have approval of our demonstration waiver and the added SUD expenditure authority,” Delaware Medicaid Director Steve Groff said. “This will allow all Medicaid beneficiaries in Delaware to have access to high-quality SUD care.”

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The Department of Health and Social Services is committed to improving the quality of life of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.

DOVER, DE – Insurance Commissioner Karen Weldin Stewart today released Delaware’s Qualified Health Plan average rates for Plan Year 2017.

The Commissioner recommended approval of a 32.5 % average rate increase in the individual market for Highmark Blue Cross Blue Shield of Delaware. The approved average rate increase for the small group market for Highmark’s plans is 2.74%.

Aetna Life Insurance Company received an average of 22.8 % increase in the individual market and Aetna Health Insurance Company received an average increase of 23.6 %. In the small group market, Aetna Life received an average increase of 15.2 % and Aetna Health received an average increase of 19.7 %.

The Commissioner, after a thorough actuarial review of rate requests submitted by the insurers’ in June, submitted her approved rates to the Centers for Medicare & Medicaid Services (CMS) in August. CMS subsequently conducted a final review of the Aetna Health and Aetna Life requests and concurred with the Commissioner’s recommendations.

The Aetna Health rate reflects a 1.4% reduction of the insurer’s individual rate request made in June, and Aetna Life’s rate is a 1.1% reduction of its June request. In the small group market, Aetna Health’s rate reflects a 3.5% reduction of the original request, and Aetna Life’s rate is 3.4% less than requested.

The Commissioner originally reduced rates requested by Highmark BCBSD and submitted them to CMS. However, CMS urged Delaware and neighboring states to reconsider their submissions and accept Highmark’s original rates as filed. Several BCBS entities have left, threatened to leave, or reduced coverage in other states’ marketplaces for 2017. Aetna recently announced they are leaving the ACA exchanges in eleven different states, but will remain in Delaware for 2017. Given this fluid environment, and to maintain a stable and competitive marketplace in Delaware, the Commissioner and her actuaries agreed with CMS’s analysis and approved the original rates requested by Highmark.

The approved rates are average rates; some consumers may pay more, some less. Under Delaware law, the Commissioner evaluates the reasonableness of rates to ensure they are not excessive, inadequate or unfairly discriminatory.

As always, in all lines of insurance, the Department recommends consumers shop around for their insurance needs. Costs can vary substantially between insurers. For the Marketplace plans, please use only the official sites, https://www.healthcare.gov and http://www.choosehealthde.com.

The Department of Insurance held public information sessions in each county in June to receive comment on the proposed rate increases. Written comments can be found at http://www.delawareinsurance.gov/departments/rates/ratefilings.shtml . All 2017 rates with justifications, along with information regarding non-marketplace health plans and on- and off-marketplace dental plans, may be found on the Department’s Rate Filings page: http://www.delawareinsurance.gov/departments/rates/ratefilings.shtml

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Dover, DE–Insurance Commissioner Karen Weldin Stewart, CIR-ML, announced that the Delaware Department of Insurance will submit the 2015 rate filing requests covering plans to be offered on Delaware’s Health Insurance Marketplace to the Centers for Medicare & Medicaid Services, CMS, today. Commissioner Stewart reviewed the filings submitted by the insurers and successfully worked with one of the insurance companies to reduce the requested rate increase of some plans.

Commissioner Stewart stated, “The Department of Insurance is tasked with protecting consumers and we go about our work with the best interest of Delaware’s consumers in mind. The department strives to strike a balance between protecting consumers and ensuring that insurance carriers are able to generate the necessary revenues to meet their financial obligations. I am very pleased that one of the insurance companies worked with us to lower their requested rate increase from the rate originally submitted.”

The Commissioner also noted that, “Overall, we are pleased to see more plans offered on the market and the requested rate increases were generally lower than what some other states have seen.”  The Health Insurance Marketplace will offer 25 plans for individuals this year, four more than were available during this past enrollment period. There will be 16 small business group plans to choose from for 2015, up from 11 this year.

Rate filing requests from the insurance companies that will be offering plans on the Marketplace were received by the Delaware Department of Insurance in June and were reviewed by the department’s actuaries to see if the requested changes in rates were justified. The rate filings were posted on the Department of Insurance website in July and public comments were accepted for a two week period. The rate filings will now be submitted to CMS for review. CMS has the final authority to approve or deny the requested rates. A response from CMS is expected sometime in late October or early November, ahead of the start of the open enrollment period which begins November 15.

The open enrollment period for individuals who wish to purchase health insurance plans through the state/federal Health Insurance Marketplace will begin on November 15, 2014, and will end February 15, 2015. Consumers can utilize www.choosehealthde.com or call 1-800-318-2596 to get information or enroll in a plan for 2015. It should be noted that the Delaware Department of Insurance does not administer or provide customer support for the state’s website, www.choosehealthde.com, or the federal website, www.healthcare.gov.

For help with insurance matters, such as questions about your health insurance after you have enrolled in a plan, call the Delaware Department of Insurance at (302) 674-7300 or (800) 282-8611 for Consumer Services. Visit our website, www.delawareinsurance.gov, and “Like” the Department on Facebook at: www.facebook.com/DelawareInsurance. Follow us on Twitter @Delaware_DOI.

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Delaware Department of Insurance: “Protecting Delawareans through regulation and education while providing oversight of the insurance industry to best serve the public.”