Margaret Murray is founding CEO of the Association for Community Affiliated Plans (ACAP) and a member of our editorial advisory board. We spoke with her a couple of weeks ago. Here are some highlights of the interview that have been edited for length and clarity.
About ACAP
We were set up about 20 years ago by 14 health plans that were owned by community health centers, and some of that a lot of people know Neighborhood Health Plan in Massachusetts, Neighborhood Health Plan in Rhode Island, AlohaCare, CareOregon. And over time we have been evolved so that now we represent Medicaid plans that are nonprofit, or are owned by nonprofits, and focused on the low-income programs. All of our members serve Medicaid clients and about half also serve dual eligibles in Medicare in some fashion, and about a quarter also serve people in the [ACA] marketplaces.
The response of ACAP members to the COVID-19 outbreak
Many people are surprised to learn that Medicaid does impose cost sharing, both copays, and coinsurance. Sixteen impose some type of cost sharing on hospitalization. Sometimes it’s pretty significant — up to $140 a day in Arkansas. And so our plans and oftentimes our contracts require them to impose copays although they can choose not to.
So as this COVID pandemic was unfolding our plans were very seriously talking about this. And immediately, we said that we will not impose any copays on testing. Later that became the law. But we were out in front of that. And then similarly, on the treatment, our plans have come out and made a commitment that they will waive copays, deductibles, coinsurance —all of that—for the treatment of COVID, as well.
And then, in addition, they went a little bit further. They also said that they would waive prior authorization for anything related to the treatment and diagnosis of COVID. And then they went even further, and they said that they would waive early medication, refill limits on prescriptions.
And to the extent allowed by law, [they are] encouraging and supporting telehealth
The effect of the cost of COVID-19 care on ACAP members
It’s really too early to say. Oftentimes don’t get claims in for 30 days. It’s going to be a little bit of time before we see the claims. But we are very concerned about the impact since the plans are making this commitment. They’re waiving the copayments for the beneficiary, but it’s the providers who typically collected that and so the providers are being made whole and our plans are taking on that expense of the copays, which was not included in [their] rates, and then, of course, [also]the underlying payment for the treatment.
So one of the things that we are very concerned about is just the impact on our plans. And as I said, we clearly don’t know what that is yet, but we were glad to see that the Medicare Advantage rates that just came out this week are healthy and will hopefully support.
What her organization wants from the federal government
Going forward, as these things unfold in 2021, we would like to see a risk corridor in Medicare Advantage.
We’d also similarly like to see some type of reinsurance or risk corridors reestablished for the marketplace, for the quality of the Qualified Health Plans because our QHPs are also taking on
treatment costs that they did not necessarily expect.
Then for Medicaid, which is the bulk of our business, we want to make sure that the states continue to preserve actuarial soundness. Some states are starting to ask for waivers of actuarial soundness, which is very concerning to us because our plans have reserve requirements that the states impose.
If they’re paying out more than they’re getting in premiums, they may be out of compliance with the reserve requirements. So there’s a very big concern that the rates need to be actuarially sound for Medicaid
So those are the three things that we’d like to see the from federal government — enforce actuarial soundness and then allow and fund some type of reinsurance or risk corridors in both Medicare Advantage as well as the marketplace.