Md. hoping feds would move quickly on reinsurance waiver

Legislation expected to head to Gov. Larry Hogan’s desk this week could allow Maryland enough time to implement a tool aimed at reducing individual market premiums next year.

The legislation authorizing Maryland to seek a federal waiver to institute a reinsurance program has passed both the House and the Senate. There were no amendments to the House bill in the Senate.

The emergency legislation would take effect as soon as Hogan signed the bill, which he has indicated he will do.

“Here in Maryland we have worked together in a common-sense bipartisan manner,” Hogan said at a news conference Monday. “I look forward to signing these protections into law as soon as they reach my desk.”

Once the legislation is signed, the state could reasonably expect its application to be approved in time to affect rate-setting for the 2019 plan year.

Completing the waiver application would make Maryland eligible for pass-through federal funding for a reinsurance pool. For every $100 million in a reinsurance pool, insurers estimate that their rate requests would fall by about 7-to-8 percentage points.

Without any sort of reinsurance program in Maryland for next year, insurers in the individual health market have indicated that they could ask to raise premiums by 30 to 50 percent. Those rate requests are due at the beginning of May.

Typically, the Maryland Insurance Administration approves rate filings around the end of August, but there is still time to amend those filings before they become final. This happened last year when the federal government halted cost-sharing reduction subsidies and filings were amended in October.

A similar timeline could play out this year.

Once the legislation is signed, the Maryland Health Benefit Exchange, with the insurance administration, would have to complete the application to the Centers for Medicare and Medicaid Services. This would take about 30 days.

Before submitting the application, the state would have to have a 30-day public comment period and conduct at least two public hearings.

Once the application has been submitted, theU.S. Department of Health and Human Services and the Department of the Treasury would conduct a review to make sure the application is complete. They have up to 45 days to complete this review.

Following that determination, there is federal public notice and comment period before the secretaries of those departments issue a final approval. That can take up to 180 days.

Based on applications from other states, including Minnesota and Oregon, Maryland expects its application could be resolved more quickly.

“Any way we can use information that (the Center for Medicaid and Medicare Services) has already approved or that (Health and Human Services) and Treasury have already approved, we feel will make us more successful,” Michele Eberle, director of the Maryland Health Benefit Exchange, told a House of Delegates committee earlier this month.

Minnesota’s application was approved 173 days after its state legislation to seek a waiver became law. Oregon’s application, submitted after Minnesota’s, took 106 days.

Following a similar timeline, Maryland’s application could be ready around the beginning of September.