September 3, 2024
The NYS Council remains laser-focused on our work to expand and enhance access to care and continuity of care for New Yorkers who need services through the OASAS and OMH public mental hygiene system.
Our achievements to this point include major reforms including mandated rates and rate increases (Medicaid APG government rate, commercial rate mandate, Child Health Plus rate set at APG rate) and increased access to services (CCBHC Demo expansion, outpatient clinic rate increases, OASAS residential rate increases). In addition, we successfully compelled the state to enforce a contract provision between the state and insurers that holds the insurer to a high threshold for how much it needs to spend (of the money paid to the insurer by the state) on actual care for Medicaid beneficiaries. The state had failed to enforce the contract provision and our advocacy resulted in the state finally beginning to enforce the provision. As a result over $500M has been returned to the Offices resulting in across the board rate increases for OASAS and OMH programs and services. In addition, we have secured enacted legislation that pertains to the Medicaid managed care model contract, and timely payment.
The recent commercial rate mandate will unfortunately impact consumers and employers on the purchasing end of an insurance policy however in the budget language regarding the new mandate the state agreed to include language that ensures the plans can request increases that reflect any costs they incur as result of the new mandate by requesting it in future rate increase requests.
In the days ahead we will again focus our energies on securing a carve out of BH services from Medicaid managed care, and expansion of commercial mental health and SUD services for children, adolescents and youth who need them. We will also continue to lead the fight for provider viability through the continued reform of insurance practices (co-pays, high deductibles, copay waivers) and smart rate reform proposals.
—————————-
Crain’s Health Pulse, 9/3/2024
People who get their insurance through the individual and small group marketplace will see their premiums rise by an average of 12.7% and 8.4%, respectively, next year, the state Department of Financial Services announced Friday ahead of the long weekend.
The rate hikes are less than what insurance companies asked for but signal New York is well out of the post-pandemic days of meager raises for its underwriters.
The new individual rate is 4 percentage points below what insurers requested, saving $87 million for the roughly 260,000 New Yorkers with those plans, according to the department. Some New Yorkers who get their insurance through New York State of Health, the state’s health insurance marketplace, will see lower premiums thanks to federal tax credits, the agency said. Last year, 65% of people enrolled in individual plans through State of Health received credits.
Rates for small group plans, which cover businesses with fewer than 100 employees, are less than half the average 18.6% increase insurers requested. That will save $766 million for the 700,000 employees enrolled in small group plans, according to the agency. Tax credits, like the Small Business Health Care Tax Credit, could lower premiums for eligible small businesses.
The hikes do not apply to the 1.3 million New Yorkers enrolled in the Essential Plan, the state’s coverage option for lower-income residents, who are not charged a premium.
The rate increase for individual rates is roughly the same as last year’s 12.4% hike, and the small group rate bump is marginally higher than the 7.4% increase in 2024. The increases have begun to plateau in recent years after rising from record-lows in the aftermath of the Covid-19 pandemic. In 2021, the individual rate increase was 1.8% and in 2022 it was 3.7%.
Twelve individual plans and 13 small group plans requested to charge their customers more. The highest requested rate increase for individual plans was from Emblem Health, which asked for a 51% hike and was granted 35.6%.
The hikes insurance companies requested were a reflection of high health care costs driven by hospital price increases, prescription drug prices and taxes on insurance, said Eric Linzer, president and CEO of the New York Health Plan Association, which represents 26 insurance companies across the state. Pharmaceutical companies raised prices on 820 brand name drugs in 2024, according to Linzer.
“Unfortunately, the final approved rates fail to fully recognize these factors or account for the premium reductions the State has imposed the last several years,” he said in a statement.
He said several bills recently passed by state lawmakers would also impact health care costs but were not factored into the state’s final decision. Those included restrictions on the amount plans could charge copays or cost sharing, costs which would now be borne by insurance companies if approved by Gov. Kathy Hochul, according to senior vice president Leslie Moran. Another bill would place additional restrictions on insurance companies’ use of step therapy, in which plans require a person tries an often cheaper treatment option before the drug their doctor prescribed.
The association, which represents health insurance companies, pointed to rising prescription drug costs, including prices on 820 brand-named medications that went up this year.
There are also taxes on health insurance, which they say adds more than $1,000 to the cost of coverage for the average family and government-mandated benefits.
In the Capital Region, several insurers will see double-digit increases. CDPHP’s Individual plan is up 13.7%; while MVP is 17.9%.
The Department of Financial Services did not respond to a request for comment about its decisionmaking.
——————————
New York approves health insurance rate increases for individuals, small groups
Industry says NY’s health costs among nation’s highest
By Rick Karlin, Staff Writer, Albany Times UnionAug 30, 2024
ALBANY — Health insurance rates for many New Yorkers will rise an average of 12.7% for individual plans and 8.4 % for small group policies next year, according to the state Department of Financial Services.
United Health Care, one of the state and nation’s largest, was flat with no increase for individual coverage. Emblem’s HIP plan was approved for a 35.6% hike, although they requested a 51% increase.
For small group plans, covering employers with up to 100 people, the average increase was 8.4 %.
Those varied between 1% for United Healthcare to 21.7 % for IHBC.
About 260,000 New Yorkers are covered by individual plans and more than 700,000 are in small group plans.
New Yorkers are also enrolled in a variety of large group plans, including those in which the employer self-insures and hires a company to administer the benefits. Those rates, which also vary by plan, were not included in this latest release of rate approvals.
Rates can be impacted by other factors, such as the Small Business Health Care Tax Credit. There also are credits for individual plans.
Representatives of the insurance industry said the increases are driven by rising costs of health care, along with taxes and regulatory schemes that hinder efforts to save money on items like pharmaceuticals.
“New York’s health care costs are among the highest in the country, and several bills that lawmakers approved this session – including restrictions on plans’ ability to contain prescription drug costs, limitations on cost sharing, and new mandated benefits – will further increase costs for consumers, employers, and labor unions,” New York Health Plan Association President and CEO Eric Linzer said in a prepared statement.