- Insurers offering health plans through the ACA marketplaces will only get 13% of the money they are supposed to receive this year through the risk corridors program, designed to cushion the risk for insurers taking on large numbers of potentially expensive enrollees.
- While insurers are owed a total of almost $2.9 billion for 2014, they will receive $362 million, the Centers for Medicare and Medicaid Services announced.
- According to a CMS official, the agency will pay what it can next year and the following year. The program expires after three years. However, the official acknowledged the agency's ability to pay in full depends on whether Congress will allow any additional funding.
The program was a strategy some insurers may have been counting on to mitigate their risks as they tested the waters of the new marketplaces. It was intended to move money from those companies with the least expensive patients to those with the most expensive patients.
As The Washington Post notes, the program itself was put at risk when a 2015 funding bill stipulated it would have to pay for itself, and the Department of Health and Human Services could not use any other funding to cover it. An additional setback occurred in August when CMS delayed payments as a result of numerous errors in the reporting information from insurers. About half of the participating insurers had to correct their data.
The senior CMS official who spoke anonymously to The Washington Post said the underpayments could cause “some isolated solvency and liquidity challenges” but did not get any more specific.
America's Health Insurance Plans (AHIP) has opposed the restrictions limiting the program’s funding.