DHSS Announces Organizations Selected to Operate Medicaid Managed Care Program

NEW CASTLE (July 12, 2022) – The Department of Health and Social Services (DHSS) announced today that it has selected three companies to operate its Medicaid Managed Care Program.

DHSS’ Division of Medicaid and Medical Assistance (DMMA) will continue its MCO partnership with Highmark Health Options Blue Cross Blue Shield, which began in 2015, and with AmeriHealth Caritas, which began in 2018. In addition, DHSS announced its intent to contract with Centene’s Delaware First Health.

“We are pleased to reach agreement with Highmark, AmeriHealth and Centene to provide these vital services to the Medicaid members we serve,” DHSS Secretary Molly Magarik said. “These companies not only will offer more choice to our Medicaid members, but they also understand Delaware’s commitment to value-based care, and to the critical services that our Medicaid members need and deserve. We appreciate the commitment of Highmark, AmeriHealth and Centene to providing a connection to care and support that will help our Medicaid members achieve their optimal health.”

In 2017, Gov. John Carney signed House Joint Resolution 7, which gave DHSS the authority to develop health care spending and quality benchmarks. The spending benchmark – a spending target – is linked to the growth rate of Delaware’s economy and includes all health care spending, including through Medicaid, Medicare and commercial insurers. The quality benchmarks are established periodically to offer strategic goals to improve the health of Delawareans and the care they receive.

Delaware’s Medicaid program serves about 300,000 members. Division of Medicaid and Medical Assistance Director Steve Groff said members will receive information during the next several weeks about their options in choosing a new plan for 2023. Open enrollment will begin Oct. 1.

DHSS Anuncia Organizaciones Seleccionadas para Operar el Programa de Atención Administrada de Medicaid

NEW CASTLE (Julio 12, 2022) – El Departamento de Salud y Servicios Sociales (DHSS) anunció hoy que ha seleccionado tres compañias para operar su Programa de Atención Administrada de Medicaid.

La División de Medicaid y Asistencia Médica (DMMA) del DHSS continuará su asociación de MCO con Highmark Health Options Blue Cross Blue Shield, que empezó en el 2015, y con AmeriHealth Caritas, que empezó en el 2018. Además, DHSS anunció su intención de contratar con Delaware First Health de Centene.

“Nos complace llegar a un acuerdo con Highmark, AmeriHealth y Centene para brindar estos servicios vitales a los miembros de Medicaid a los que servimos,” dijo la Secretaria del DHSS, Molly Magarik. “Estas compañías no solo ofrecerán más opciones a nuestros miembros de Medicaid, pero también entienden el compromiso de Delaware con la atención de salud basada en valor y con los servicios críticos que nuestros miembros de Medicaid necesitan y merecen. Agradecemos el compromiso de Highmark, AmeriHealth y Centene de brindar una conexión con la atención y apoyo que ayudarán a nuestros miembros de Medicaid a lograr una salud óptima.”

En 2017, el Gobernador John Carney firmó la Resolución Conjunta 7 de la Cámara de Representantes, que otorgó al DHSS la autoridad para desarrollar indicadores de calidad y gasto en atención médica. El punto de referencia de gastos – un objetivo de gastos – está vinculado a la tasa de crecimiento de la economía de Delaware e incluye todos los gastos de atención médica, incluso a través de Medicaid, Medicare y aseguradoras comerciales. Los puntos de referencia de calidad se establecen periódicamente para ofrecer objetivos estratégicos para mejorar la salud de los habitantes de Delaware y la atención que reciben.

El programa Medicaid de Delaware atiende cerca de 300.000 miembros. El Director de la División de Medicaid y Asistencia Médica Steve Groff, dijo que los miembros recibirán información durante las próximas semanas sobre sus opciones al elegir un nuevo plan para el 2023. La inscripción abierta comenzará el 1 de Octubre.

Commissioner Navarro Announces Health Insurance Marketplace Expansion

Consumers to have most options in history of Delaware Marketplace

After years of work to increase competition on the Delaware Health Insurance Marketplace, Insurance Commissioner Trinidad Navarro announced today that three health carriers intend to offer plans for the 2023 plan year – the most in the state’s history. AmeriHealth Caritas and Aetna CVS Health will join Highmark Blue Cross Blue Shield Delaware in offering coverage.

“Delaware’s Health Insurance Marketplace is more stable than ever before, with rates steadying and enrollment at an all-time high. The hard work we have put into this program is paying off, with multiple new carriers planning to offer 2023 coverage,” said Insurance Commissioner Trinidad Navarro. “I look forward to the benefits that increased competition will bring to our residents, and to continuing to improve healthcare accessibility and affordability across the state.”

From rising rates to insurer departure, the implementation of the Affordable Care Act in Delaware hasn’t always been smooth sailing. But with the state’s successful creation of a 1332 reinsurance program and federal threats of ending the critical program subsiding, rates have decreased more than 15% and remained stable, while enrollment has grown significantly.

“Today’s announcement is a testament to both the needs of Delawareans who have increasingly signed up for coverage, and to the strong regulatory environment we have built, which has helped insurers go from taking losses to being able to cover their expenses and consumers’ coverage needs.”

The announcement comes as carriers submit initial rate filings proposals pursuant to federal deadlines. These will undergo in-depth reviews by independent actuaries before the Insurance Commissioner approves and announces them later this year.

Department of Insurance 2021 Data Shows over $21M in Consumer Savings

Successes in serving residents continue

The Delaware Department of Insurance (DOI) today published performance and productivity data for 2021. While the pandemic necessitated continued operational adjustments, staff continued to focus efforts on consumer services and saw great success. The department also released an infographic of key statistics.

“Year after year, our DOI team delivers for Delaware. In the face of many changes and challenges due to COVID-19, we continued to prioritize consumer services, and never wavered from that commitment,” said Insurance Commissioner Trinidad Navarro. “This year in review provides just a glimpse into the incredibly vast and diverse array of work our team takes on, and I look forward to continuing to make a difference every day in 2022.”

Despite minimal in-person events, services directed to individual consumers and local businesses continued to thrive in 2021. The Delaware Medicare Assistance Bureau (DMAB) held more than 5,500 free one-on-one counseling sessions with residents, ultimately saving beneficiaries a combined $521,000 – an increase of more than $230,000 compared to 2020 savings. The Consumer Services Division managed over 3,000 complaints and inquiries, recovering nearly $700,000 for consumers. In the Legal Division, 274 settled arbitration cases resulted in awards totaling more than $640,000. These services, combined with $12.3 million in ACA plan refunds and $7.4 million in workplace safety savings, amount to over $21.5 million for Delaware’s insurance consumers in 2021.

A critical focus of the department during COVID-19 continues to be ensuring health insurer compliance with state and federal rules, coverage requirements, and initiatives to reduce burdens on hospitals and those seeking care. The Market Conduct team continued investigations into insurer’s Mental Health Parity compliance, resulting in $635,000 in fines. Throughout the ACA Special Enrollment Period, more than 21,000 residents took advantage of increased subsidies and savings from the American Rescue Plan, saving an average of 53% on their monthly premiums – a savings of $1.2 million in total. To protect consumers and create a nationwide network of strong regulation, Commissioner Navarro successfully worked to create the National Improper Marketing of Health Plans Working Group within the National Association of Insurance Commissioners.

Nationally, Commissioner Navarro and the department remain engaged in numerous industry organizations. The Commissioner was recently named Vice-Chair of the National Association of Insurance Commissioners’ Market Regulation and Consumer Affairs (D) Committee, a prestigious honor, in addition to being elected to the Executive Committee of the Northeast Zone and continuing to serve as Chair of the National Anti-Fraud Task Force. Delaware continues to participate in the Special Committee on Race and Insurance, the Healthcare Fraud Prevention Partnership, the National Insurance Crime Bureau Medical Task Force, the Delaware Valley Association of International Special Investigative Units, and other committees and groups.

In 2021, the General Assembly utilized virtual procedures for session. DOI pursued 14 pieces of legislation with our partners in Legislative Hall and engaged with more than 30 insurance-related bills, including legislation to regulate the multi-billion-dollar Pharmacy Benefit Manager industry, protecting consumers of auto and homeowner’s insurance, and making progress on issues like health care access and pharmaceutical costs. The DOI also continued to work on other legislative mandates, such as the Office of Value-Based Health Care Delivery.

In Market Conduct, 16 completed insurer examinations resulted in $1.2 million in fines, and several examinations are in progress. More than 50,000 licenses were issued, and licenses total more than 200,000. Across all lines of insurance, more than 30,000 rates and forms were processed and approved.

The Bureau of Examination, Rehabilitation and Guaranty oversees the financials of 136 domestic companies that manage $680.6 billion, and more than 2,000 other companies operating in the state. They completed 62 financial examinations, and have 49 exams in progress, in addition to completing nearly 3,500 other projects including Uniform Certificate of Authority Application amendments and Security Exchange Requests.

The Fraud Bureau worked to investigate many tips and reports, and 5 criminal cases of insurance fraud were indicted in addition to the collection of nearly $9,500 in civil penalties.

Going into 2022, businesses will see the fifth consecutive decrease in Workers’ Compensation premiums, an average reduction of more than 20%. The Workplace Safety team engaged more than 1,200 companies in earning additional savings in 2021.

The Captive Division, named a finalist for International Captive Domicile of the Year, received 70 new applications and has 759 licenses in effect.

View the 2021 Infographic

Jan. 15 is Last Day to Sign up for 2022 Coverage on Delaware’s Health Insurance Marketplace

NEW CASTLE (Jan. 12, 2022) – Delawareans have until Saturday, Jan. 15, to sign up for health coverage for 2022 through Delaware’s Health Insurance Marketplace. For those who enroll by the deadline and pay their first premium, coverage will begin Feb. 1, 2022. Enhanced federal subsidies, which began earlier in 2021 under the Biden administration, will continue for 2022. The subsidies have helped to reduce consumer costs by as much as 40%.

State residents can sign up for coverage at www.HealthCare.gov or CuidadodeSalud.gov or by calling 1-800-318-2596 (TTY: 1-855-889-4325). Free assistance in Delaware is available through:

  • Westside Family Healthcare at 302-472-8655 in New Castle County and 302-678-2205 in Kent and Sussex counties or enrollment@westsidehealth.org.
  • Quality Insights, Inc., (New Castle and Sussex counties) at 1-844-238-1189. Westside and Quality Insights each received federal funding for navigators to help people enroll for coverage.
  • Certified application counselors at Henrietta Johnson Medical Center in Wilmington and La Red Health Center in Georgetown.
  • State-licensed insurance agents and brokers are also available at no charge.

For additional contact information and other details about Delaware’s Health Insurance Marketplace, go to www.ChooseHealthDE.com.

To speed up the enrollment process, Delawareans should have the following documents or information ready:

  • Birth dates of those applying for coverage.
  • Social Security numbers of those applying for coverage.
  • Pay stubs, W-2 forms or other information detailing your family’s income.
  • Policy or member numbers for any current health insurance plans.
  • Information about any health insurance that is available to you or your family through a job.
  • Your log-in and account information if you have previously enrolled on the Health Insurance Marketplace.

Individuals who don’t act by Jan. 15 cannot get 2022 coverage unless they qualify for a Special Enrollment Period based on circumstances such as a loss of qualifying health coverage, change of income, birth or adoption of a child, a permanent move, marriage or divorce, or other qualifying factors.

The Biden administration has made increased access to health insurance and affordability a priority by using American Rescue Plan Act funds to increase tax credits and expand subsidies further into the middle class. For instance, a family of four (both parents in their 40s) making $50,000 are eligible for a credit of roughly $16,500, compared with $14,300 previously. A majority of Delaware marketplace enrollees will be eligible for financial assistance, which can help reduce the cost of monthly premiums and/or deductibles, and lower out-of-pocket health care costs.

Federal tax credits are available for those whose household income is between 138% and 400% of the Federal Poverty Level. For 2022 coverage, that’s between $17,775 and $51,520 for an individual, or between $36,570 and $106,000 for a family of four. For coverage in 2021, about 81% of enrollees in Delaware were eligible for tax credits, which help reduce the cost of the monthly premium.

For 2022, Highmark is offering 13 plans for individuals – four gold plans, three silver, three bronze, two platinum and one catastrophic. Two dental insurers – Delta Dental of Delaware, Inc. and Dominion Dental Services, Inc. – are offering a collective 12 stand-alone dental plans on the marketplace, seven with a low actuarial level (71.6%) and five with a high actuarial level (84.2%).

Since the start of this open enrollment on Nov. 1, 2021, more than 33,000 Delawareans have signed up for 2022 coverage on the marketplace and off the marketplace. Financial assistance is available to eligible enrollees only on the marketplace.

In addition to the Health Insurance Marketplace, some residents might be eligible for coverage through Delaware’s expanded Medicaid program, which is open year-round. More than 10,000 Delawareans receive coverage under the Medicaid expansion each year. To be screened for or to apply for Medicaid benefits, go to Delaware ASSIST.

Both the Health Insurance Marketplace and the Medicaid expansion have helped to reduce Delaware’s uninsured rate, decreasing from 10% in 2008 to 6.6% in 2019, according to the Census Bureau. That decline includes Delawareans who could not get coverage before the Affordable Care Act because of pre-existing conditions.