Maine Granted MLR Waiver As Carriers Threaten to Pull Out

[Winter_123]

Letter from Maine to Sebelius

Dear Secretary Sebelius:
After a careful review of the regulations implementing the new medical loss ratio standards, I
have concluded that an adjustment request pursuant to Section 2718 of the Public Health Service
Act is necessary until 2014. Assuming all of the reforms are fully implemented under the
Affordable Care Act, consumers in Maine will have new, affordable options for health insurance
coverage and a continued waiver will no longer be necessary.
This is a request for an adjustment to the medical loss ratio (MLR) standard for Maine's
individual health insurance market pursuant to Subpart C of the interim final regulation. The
adjustment would substitute Maine's 65% "pure" loss ratio for the 80% federal MLR. Unlike the
federal standard, Maine's standard does not include adjustments for quality improvement
expenses or taxes. The requested adjustment is for the reporting years 2011, 2012, and 2013.
The detailed information required by Subpart C is included on the following pages and
accompanying attachments.
Thank you for your attention to this request. I look forward to continuing to work with you to
ensure that federal health care reforms are fully implemented.
Very truly yours,​

Mila Kofman

 

[Mr. Bill]

 

[TxOnline]

Does Goldman Sachs own (or have a controlling interest in) Mega Life?

Doesn't Goldman Sachs get what they want from DC?



Do I smell a rat in the woodpile???

 

[AndreaSti]

Does Goldman Sachs own (or have a controlling interest in) Mega Life?

Doesn't Goldman Sachs get what they want from DC?



Do I smell a rat in the woodpile???

They just what they saying on Fox News last night - were you watching what I was watching

 

[somarco]

were you watching what I was watching

Were you watching it together?

 

[Yagents]

Info from Nahu. Nice to see FL on the list, can only be a good thing. More product, companies, competition.
---------------------
As for state attempts to change MLR requirements for their individual markets, HHS approved the first state-level MLR waiver for Maine last Tuesday. Important to note about the Maine request was that it included a great deal of specific data, and HHS went back to the state to request even more information. If Maine's request is any indication, states that are unable to obtain detailed information about market disruption potential from their carriers to submit with their application may have a very tough time getting an application approved. Florida sent in its waiver application this week, so right now New Hampshire, Kentucky, Nevada and Florida all have requests in the hopper. As many as 12 more states have publicly indicated that they too will apply, but are currently still in the information gathering stages. Kansas regulators will hold a hearing this week on a potential application.

 

[STIBROKER]

with the goats..........

Were you watching it together?

 

[Winter_123]

Info from Nahu. Nice to see FL on the list, can only be a good thing. More product, companies, competition.
---------------------
As for state attempts to change MLR requirements for their individual markets, HHS approved the first state-level MLR waiver for Maine last Tuesday. Important to note about the Maine request was that it included a great deal of specific data, and HHS went back to the state to request even more information. If Maine's request is any indication, states that are unable to obtain detailed information about market disruption potential from their carriers to submit with their application may have a very tough time getting an application approved. Florida sent in its waiver application this week, so right now New Hampshire, Kentucky, Nevada and Florida all have requests in the hopper. As many as 12 more states have publicly indicated that they too will apply, but are currently still in the information gathering stages. Kansas regulators will hold a hearing this week on a potential application.

It's about like zoning in the town that I grew up in. There is a comprehensive zoning plan which satisfies all who wanted to be "progressive" and get the state and federal funds that required you to have a zoning plan. However, I dont think a waiver request has been denied on anything in the last thirty years. Keeps everyone happy I guess. Just like Obama. He will have a comprehensive health reform plan on his resume, except you may not live in one of the 45 states that have a different type of plan. The irony is that Obamacare is based somewhat on the Maine model, yet Maine wants to opt out or waiver out of much of it.

Change you can believe in.