Delays impacting operations, including payments and insurance transactions

Earlier this month, one of the nation’s largest health care companies experienced a cybersecurity attack immobilizing much of the industry. Change Healthcare, a subsidiary of UnitedHealth Group that also operates as Optum Solutions, states that it interacts with 1 in every 3 patient records. Their systems are integral in many areas of pharmacy operations, provider claim processing, billing and cost estimation services, patient eligibility verifications, and other clinical decision supports.

On February 21, 2024, Change Healthcare locked their systems in an attempt to limit the impact of the cybersecurity attack discovered that day. The ongoing disruption has created adverse impacts for providers and pharmacies, generating delays for consumers, limiting the ability to process payments and consumers’ insurance, and requiring complex workarounds or movement to new systems. It is believed that the attack was completed by a foreign hacking group. Federal entities are involved in the investigation.

“The implications of this cyberattack are wide-reaching and not yet fully known. We hope that raising awareness of this issue will encourage consumers to be patient with any delays in clinical and pharmacy activities. Please know that all parties are working as hard as they can to continue operations despite this issue. If you are in urgent need of medication, or will be soon, please get in touch with your local pharmacy before visiting. You may need to use a different pharmacy, or plan to pay in cash,” said Insurance Commissioner Trinidad Navarro. “No timeline currently exists for resolution, and health care providers and pharmacies have been encouraged to remain disconnected from the impacted systems.”

Insurers have been in contact with the Delaware Department of Insurance about this issue and are in communication with contracted providers to inform them of available portals and processes. The Delaware Insurance Data Security Act has not yet been triggered, but all parties continue to watch the situation closely. Additionally, the department will be closely monitoring any potential prompt payment compliance issues that may arise as a result of this situation.

At this time, there is no indication that consumer data or insurer data has been impacted. However, consumers are still encouraged to engage in personal cybersecurity practices at an enhanced level. To protect from a cybersecurity attack, install anti-malware protection and use complex passwords that cannot be easily guessed. Do not click on suspicious links in emails or pop-ups, including those purporting to be from health care services, providers, insurers, and pharmacies. Residents might consider freezing their credit report to protect data.

View Change Healthcare’s Incident Page

Another banner year for consumer protection and insurer competition

In 2023, the Delaware Department of Insurance’s 101 team members served Delaware residents and seniors, attracted new companies, oversaw expansions of coverage and enhanced competition, and contributed substantial funds to the state. Today’s data release details how each team contributed to Delaware’s strong insurance environment.

“Each year, our team gathers and reports data on our efforts to give residents a look at our daily work,” said Insurance Commissioner Trinidad Navarro. “And while the numbers themselves are impressive, within them are tens of thousands of stories. Stories of finding affordable coverage for the first time, stories of storms and fires, stories of injustice, investigation, and resolution, and above all, a story of change. Our state is changing, and our department is changing with it to ensure we continue to protect our consumers and offer them a robust, affordable, competitive insurance market.”

The year began with the announcement of a record-setting Open Enrollment on the Delaware Health Insurance Marketplace, where 35,000 residents got covered, and 6,000 were eligible for plans costing $10 or less per month. As recently as 2022, Delaware consumers only had one insurer and 12 plans to choose from – but during 2023 enrollment, they had four carriers and more than 50 plans offering coverage. Premiums in the individual market have decreased roughly 12% since 2019.

DOI welcomed yet another new carrier to the Marketplace in 2023, and indications are that enrollment for 2024 has again broken enrollment records with likely more than 40,000 enrollees.

Health insurance rates are submitted alongside affordability standards data to the department’s Office of Value-Based Health Care Delivery, which endeavors to support a robust, high-quality primary care environment. As a result of this work, annual primary care investment is projected at over $40 million, an increase of nearly $13 million or 44% year over year. This includes a projected $7 million in direct, prospective payments to more than 775 providers engaged in care transformation.

In addition to supporting healthcare providers, the work of the department also provides substantial funding to the state. For the 2023 calendar year, the department’s work resulted in about $189 million in funds for the state and its funds, including $113 million for the General Fund, and $44.7 million for fire companies.

Strong results were again reported by resident-facing programs. Consumer Services staff processed a total of 4,228 complaints and inquiries. The Medicare Assistance Bureau hosted and participated in 66 public events, and held more than 5,000 one-on-one counseling sessions. Medicare beneficiaries saved an estimated $2.08 million dollars because of the free assistance offered by this team, an increase of over half a million dollars from last year. Helping residents address claim settlement issues outside of court, the Legal Division reported that of 419 cases, 236 settled pre-hearing. Completed arbitration cases resulted in awards totaling more than $611,000. The department also moved to a new office in New Castle County, which offers much improved accessibility to consumers, while also saving the department over $200,000.

Delaware continued to be a national presence in insurance regulation, with Commissioner Navarro being elected Chair of the Northeast Zone of the National Association of Insurance Commissioners. His tenure chairing the National Anti-Fraud Task Force, and Delaware’s leadership on the Improper Marketing of Health Plans Working Group has resulted in improved coordination of efforts across states, and progress in the drafting of an improved model law related to producer licensing. Locally, the Commissioner and staff participate in numerous committees, including the Behavioral Health Crisis Services Board, Delaware Health Care Commission, Foster Youth Drivers’ License and Insurance Working Group, EARNs Board, Non-Acute Long Stay Task Force, Plans Management Board, Primary Care Reform Collaborative, Retiree Healthcare Benefits Advisory subcommittee, and the State Employee Benefits Committee (SEBC).

In 2023 the seventh consecutive decrease in workers’ compensation insurance rates was approved, a double-digit average drop of 13.85% in the residual market and 10.03% in the voluntary market. These lower rates are just one component of several department efforts to help businesses. Nearly 1,000 employers are saving even more on their premiums by participating in the department’s Workplace Safety Program, saving approximately $5.6 million on premiums through safety credits.

Market Conduct staff completed 61 insurer interrogatories, 72 Level 1 market analyses, and 5 exams including 3 introductory PBM examinations. 13 examinations remain in progress.

The most recent data available from the Bureau of Examination, Rehabilitation and Guaranty shows oversight of the financials of 149 domestic companies that manage $769 billion in assets, and more than 2,149 other companies operating in the state. This represents 8 new domestics, 76 new licenses, and an increase of one billion dollars in assets managed. The team completed 34 financial examinations and have 22 exams in progress.

The Fraud Bureau processed 631 referrals, closing 12 criminal cases with 44 charges. They collected $15,525 in civil penalties last year and closed 574 cases. 607 cases are open.
Life and Health staff reviewed 5,782 filings, rates, forms, and advertisements. The Property and Casualty team reviewed 26,915 filings, rates, forms, and rules. In addition, the department issued 57,216 licenses in 2023, bringing total licensees to 253,438.

This past year, the Captive Bureau announced the launch of Delaware Captives 2.0 in conjunction with the Delaware Captive Insurance Association to continue to innovate and compete with other domiciles. 43 new captives were licensed in 2023, for a total of 670 licensed captives.

The department led and engaged with dozens policy efforts with partners in the legislature. Legal staff processed 15 new bulletins and 10 revised or reissued bulletins, 5 new regulations, and 4 exempt orders to regulations.

Staff also participated in outreach events, including the Positively Dover African American Festival, Clayton Fire Prevention Open House, Dover Days, Down Syndrome Walk, Middletown Peach Festival, Milford Freedom Walk Festival, New Castle Ice Cream Festival, the 55+ Expo, and of course, the Delaware State Fair. In addition to robust contributions to the Delaware Employees’ Charitable Campaign, the Department also participates in charitable events including blood drives, food insecurity donations, and breast cancer awareness.

Increased competition means more options for Delawareans, employers

For the second consecutive year, Delawareans will have access to increased options on the Health Insurance Marketplace, Insurance Commissioner Trinidad Navarro announced today, with 57 total plans offered by four insurers. In the 2024 plan year, consumers will have the opportunity to purchase plans from Celtic Insurance Company Ambetter Health of Delaware, a carrier new to the state’s marketplace, in addition to plans from Aetna Health, AmeriHealth Caritas, and Highmark Blue Cross Blue Shield of Delaware. As recently as the 2022 plan year, consumers had only one carrier and 12 plan options to choose from.

“Improving healthcare accessibility and affordability across our state is one of my top priorities, and I’m proud that our work has led both options and enrollments to an all-time high,” said Insurance Commissioner Trinidad Navarro. “In addition, our Office of Value-Based Health Care Delivery has confirmed carrier’s filings reflect compliance with our affordability standards, including increasing spending on primary care to lower overall cost of care. We look forward continuing to make progress in this work.”

Nearly 35,000 residents purchased plans on the Delaware Marketplace during last year’s open enrollment. After Advance Premium Tax Credits, premiums averaged $197. Nearly 6,000 residents were eligible for a premium of $10 a month or less. Enrollment numbers are expected to rise as Medicaid redeterminations continue following the end of the COVID-19 Public Health Emergency. A Special Enrollment Period for Marketplace plans is available for persons no longer eligible for Medicaid.

As always, Commissioner Navarro urges residents to be informed consumers and shop for the best plan for both their needs and their budget. 57 health plans and 12 dental plans are available to Delawareans for the 2024 plan year, and local navigators are available to assist in choosing the right plan. Open Enrollment takes place November 1 through January 15.

Be aware of non-compliant alternative health plans.

Individual Affordable Care Act (ACA) Marketplace Rates Announced

Following in-depth reviews by independent actuaries and the Office of Value-Based Health Care Delivery, rates for regulated 2024 health, dental, and small group insurance plans were also announced today.

Celtic Ins. Co. Ambetter Health of Delaware’s 24 new plans range in base cost, before premium tax credits or other subsidies, from $378 to $532. Aetna Health (as a PA Corp.) will increase rates by an average of 2%, with base rate for six plans ranging from $414 to $441. AmeriHealth Caritas will decrease rates an average of 4.52%. Base rates for their six Marketplace plans will cost $300 to $416. Highmark requested a rate increase, and an average increase of 3.2% was approved after an initial increase request of 4.9%. Their 18 Marketplace plans have base costs between $274 and $654.

Plans on the marketplace are spread among metal-level categories – bronze, silver, gold, platinum and catastrophic – and are based on how enrollees choose to split the costs of care with their insurance company.

Other ACA and ACA-Compliant Rates
Off-market individual offerings include six plans from Aetna Health (as a PA Corp.), which will increase an average of 2% in cost for the future year. AmeriHealth Caritas will decrease its plan’s rates an average of 4.52%. Highmark’s two off-market plan costs will increase an average of 3.2% after an initial request of 4.9%.

Delta Dental will increase rates by an average of 4.2% for two offered marketplace plans, and one off-market plan. Dominion Dental will decrease ACA premiums by 0.1% on their 10 plans.

Off-market small group plan options will increase for the coming plan year, with rate finalization occurring in October. Rate submissions show 62 plan options offered by six carriers: Aetna Health, Aetna Health (as a PA Corp), Aetna Life, Highmark, Optimum Choice, and United Healthcare.

About ACA Plans
All ACA-compliant health plans offer essential health benefits, including coverage of pre-existing conditions, prescriptions, emergency services and hospitalization, mental and behavioral health coverage, outpatient care, telehealth, lab services, and more.

Open enrollment for 2024 Health Insurance Marketplace plans begins November 1. Residents may qualify to enroll or change plans based on special circumstances throughout the year, such as income qualification, loss of health coverage, becoming a parent, or other qualifying factors.

Find out if you qualify for special enrollment.

Medicaid renewals began April 1;  

Members should verify contact information with DHSS, watch for renewal information 

The Delaware Department of Health and Social Services (DHSS) has resumed the standard eligibility renewal process for Medicaid and CHIP recipients as of April 1, 2023, as required by federal law. Annual renewals were not required from March 2020 to March 2023 during the federal Public Health Emergency designation. Federal legislation, signed into law on December 29, 2022, set a specific date to resume renewals, regardless of when the Public Health Emergency ends.  

As of January 2023, approximately 315,000 Delawareans were enrolled in Medicaid. With annual renewals underway, DHSS estimates 40,000 to 50,000 Delaware residents who were receiving continuous coverage due to the Public Health Emergency may no longer qualify for Medicaid or CHIP, also known as the Delaware Healthy Children Program, and may be disenrolled. 

Between April 2023 and April 2024, DHSS is reviewing every member’s eligibility and, where approved by state or federal rules, using available data sources to automatically renew members. If DHSS cannot auto-renew a person’s coverage using available and approved data sources, the member will receive a pre-populated renewal letter by mail. Delaware Medicaid and its Managed Care Organization partners are also using texts, email, and social media when available to enhance outreach efforts.  

A member can complete their renewal through a variety of ways: online through Delaware ASSIST, by phone, by mail, by fax, or at any Division of Social Services (DSS) office locations. Individuals who need assistance filling out their renewal can call the Division of Social Services Customer Service Unit at 1-866-843-7212. 

“Over the past three years, the state’s public assistance programs have been a crucial safety net for so many Delawareans,” said Molly Magarik, Secretary of the Delaware Department of Health and Social Services (DHSS). “As we are undertaking the monumental task of restarting eligibility renewals again, our goal is to ensure Medicaid members who continue to be eligible stay enrolled and that those who are determined to no longer be eligible get connected to affordable coverage.”  

The most important thing Medicaid and CHIP members can do is to update their mailing address, email and phone numbers with DMMA and sign up for electronic notifications. Contact the Change Report Center at (302) 571-4900, Option 2 or send changes via fax to (302) 571-4901. Changes and notification preferences can also be made at ASSIST Self Service https://assist.dhss.delaware.gov/. Individuals can find out more information about the renewal process at de.gov/medicaidrenewals. 

“There are many Delaware residents who qualified for Medicaid coverage for the first time during the Public Health Emergency who have never had to complete an annual renewal before,” said Steven Costantino, Director of Health Care Reform for DHSS. “This is why it is critical that we have the most accurate information available for each member, and that individuals on Medicaid watch out for communication and take the necessary steps to renew. We do not want anyone who is eligible for Medicaid to be disenrolled.”   

Health care providers and others who provide services to members can help by reminding their Medicaid members to look for and complete their Medicaid renewals this year and to encourage them to start exploring other coverage options if they believe they will no longer qualify for their current coverage. 

Special Enrollment Period Authorized for Health Insurance Marketplace  

To help individuals who are no longer eligible for Medicaid coverage, the federal government has authorized a Special Enrollment Period for the Health Insurance Marketplace. Individuals who lose their coverage through Medicaid and CHIP any time between March 31, 2023, and July 31, 2024, will be eligible for a marketplace special enrollment period. After a person is determined eligible for the marketplace, they will have 60 days to choose a plan, and their coverage will start the first day of the month after the plan is selected. 

Many enrollees can find plans on the Health Insurance Marketplace that cost less than $10 a month. Plans cover services like prescription drugs, doctor visits, urgent care, hospital visits, and more. 

Delawareans who no longer qualify for Medicaid should ensure that they do not experience a gap in health insurance coverage, but choosing the right private health insurance plan can seem daunting. Trinidad Navarro, the Commissioner of the Delaware Department of Insurance, suggests that a good first step would be to visit ChooseHealthDE.com to locate a local, federally registered/approved Navigator for assistance in enrolling in the Federally Facilitated Marketplace.   

In Delaware, assistance enrolling in the Health Insurance Marketplace is available from certified Health Insurance Marketplace Navigator teams at Westside Family Healthcare and Quality Insights. To be connected to a trained Navigator, call:  

• Westside Family Healthcare: New Castle County: 302-472-8655, Kent or Sussex counties: 302-678-2205 
• Quality Insights: 1-844-238-1189 

Some individuals who are found to be ineligible for Medicaid may be eligible for or already enrolled in Medicare. If that’s the case, the Department’s Delaware Medicare Assistance Bureau (DMAB) (302-674-7364) is ready to help with locating supplemental Medicare and Prescription coverage.   

“Our DMAB team is friendly, knowledgeable and approachable, and they are always there to help older Delawareans get the best possible coverage to supplement their Medicare plans,” said Commissioner Navarro. 

Be Aware of Potential Insurance Scams 

Additionally, Commissioner Navarro pointed out that buyers should beware of offerings that say they are “plans” that are actually not health insurance. 

“As a general rule, if an offer seems too good to be true — it probably is,” Commissioner Navarro said. “Please be careful when searching for insurance on the Internet as you may accidently access a website that looks like it is advertising health insurance when it actually is not.”   

For example, buyers may receive aggressive advertising from discount plans or discount cards offering discounts on health care for a monthly fee. Another example is so called “health sharing” plans, which allow buyers to join a group or association that will take a participant’s monthly payments, put them in a savings account or trust with other participants’ money, and then help pay some of the participant’s health care costs, as needed. Neither of these “plans” are health insurance plans, and participants do not have the same protections as they would under major medical health insurance. 

It has also been reported that scammers may be calling or texting individuals that receive Medicaid asking for money to help with the Medicaid renewal process. Scammers might pretend to be from a real organization or a government agency. They can use phone, text or email to try to steal money or something of value from you. If someone contacts you and requests money for help with your Medicaid renewal they are not a representative of DHSS. DHSS will never ask you for money or for your credit card information. 

The Delaware Department of Justice also reminds residents to be extra diligent about telephone scams by: 

• Never agreeing to pay any fine or other money over the phone, including by purchasing a money order or gift card at a store and providing the number to someone over the phone or by email. Government agencies do not take payments this way.  
• Not answering calls from unknown numbers or unfamiliar persons. Scams can be “spoofed” to appear to be coming from a local number, even though the call is originating from out of state or overseas. 
• Hanging up on aggressive callers, particularly those who threaten arrest. 

Consumers who believe they may have been scammed may call the Consumer Protection Unit’s toll-free Consumer Hotline at (800) 220-5424, or e-mail consumer.protection@delaware.gov. Consumers can also report scammers’ phone numbers to the National Do Not Call Registry and file complaints at www.donotcall.gov.   

For more information about the Medicaid renewal process, visit de.gov/medicaidrenewals. 

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