Alaska Minnesota Iowa Stopgap Oklahoma

Comprehensive Premium Security Measure (ISM) Individual Health

Health Insurance Plan Insurance Market
Fund Stabilization
Program (OMSP)

Reinsurance Proposal
Reinsurance type Condition-specific Traditional Traditional Traditional
reinsurance reinsurance reinsurance reinsurance

Reinsurance All claims from policyholders

$50,000
with
– $250,000
one of 33 specific
$100,000
medical
– conditions
$15,000 – $400,000
corridor $3,000,000

Coinsurance rate 100% 80% / 20% 85% / 15% 80% / 20%

(Claims >$3 million:
100%)
Legislation HB 374 HF 5 No applicable state HB 2406
enacted November 7, 2016 April 4, 2017 legislation June 6, 2017
1332 State Innovation Waiver

Waiver status Submitted Dec. 29, 2016

Submitted May 5, Submitted June 12, Submitted August 16,
2017 2017 2017

Approved July 7, 2017 Approved September Submitted August 22, Withdrawn

22, 2017 2017 September 29, 2017

Signed October 16, Amended September

2017 22, 2017
Withdrawn October
23, 2017
State funding $55 million annually $271 million annually $0 $16 million in 2018
(51.6% of total) (61.9% – 66.3% of (0% of total) $230 million over five
total) years (14.2% of total)
Source of state $55 million in initial Dedicated funding No state funding Assessment on
funds funding from General from Health Care premiums charged by
Fund, then funded via Access Fund (financed all health insurers and
assessments on all via 2% provider reinsurers
insurers: assessment) and
· Health: 6% of General Fund
premiums net of
claims
· Title: 1% of gross
premiums
· Other: 2.7% of gross
premiums

1332 funding $51.6 million in pass- $138 – $167 million in $70 million in pass- $309 million in pass-
request through funding annual pass-through through funding for through funding in
(48.4% of total) funding reinsurance in 2018 2018
$830 million 2018- (100% of total) $1,395 million over
2022) $396 million total five years (85.8% of
(33.7% – 38.1% of waiver funding in total)
total) 2018

1332 funding $58.5 million (2018) $332

$130.7
million
million
(2018–2022)
(2018) $1.003 billion (2018–2022)
received

Individual Market
Marketplace Type[i]Federally-facilitated State-based State-partnership Federally-facilitated
Marketplace Marketplace Marketplace Marketplace

Medicaid Expanded Medicaid[ii] Expanded Medicaid[iii] Expanded Medicaid[iv] Did not expand
Expansion Status Medicaid

[i] Kaiser Family Foundation. “State Health Insurance Marketplace Types, 2017.” http://www.kff.org/health-reform/state-indicator/state-he

[ii] Expanded Medicaid September 1, 2015

[iii] Minnesota also has MinnesotaCare, the Basic Health Program (BHP) for individuals 138–200% FPL.

[iv] Expanded Medicaid with Section 1115 Waiver

New Hampshire Oregon Wisconsin Louisiana Health Maine
1332 Waiver Reinsurance Healthcare Reinsurance Guaranteed
Reinsurance Plan Program (ORP) Stability Plan Association Access
(WIHSP) (LHRA) Reinsurance
Association
(MGARA)

Traditional Traditional Traditional Traditional Traditional

reinsurance reinsurance reinsurance reinsurance reinsurance

$45,000 – $250,000 TBD – $1,000,000 $50,000 – $250,000 TBD $47,000 – $77,000

40% / 60% 50% / 50% TBD (50% – 80%) TBD 90% / 10 %

(Claims >$77,000:
100%)
HB 469 HB 2391 SB 770 HB246 LD 659June 2, 2017
July 10, 2017 July 5, 2017 February 27, 2018 HB274

Draft waiver released Submitted August 31, Draft waiver released March
Waiver13,description
2018 Waiver executive summary and actuarial anal
for public comment 2017 released April 2018
July 19, 2017

Waiver not submitted Approved October 19,

2017

Signed October 20,

2017

$32 million annually $90 million in 2018 $30 million in 2019 $24.8 million (17.2% $59.6 million in
(71.4% of total) $1.1 billion over ten of total) 2019W (63.0% of
years (68.5% of total) total)
Annually-determined 1.5% assessment on State general fund Assessment on all Assessment on health
assessment on health fully insured issuers, third-party insurers and third-
insurers per covered commercial major administrators, and party administrators
life, necessary to fund medical premiums MEWAs doing of $4 per covered
reinsurance pool business in Louisiana. person per month
Fee based on number (Individual, Small
of covered lives Group, Large Group,
(exluding Medicaid and Self-insured
managed care and markets); 90% of
Medicare Advantage enrollee premium for
covered lives). ceded enrollees
Assessment amount
TBD.

$12.8 million in pass- $35.66 million in 2018 $170 million in pass- $103.5 million in pass- $35 million in pass-
through funding for $356.6 million over through funding in through funding through funding in
reinsurance (28.6% of ten years 2019 (85% of total) (82.8% of total) 2019 (37.0% of total)
total) (31.5% to total)

$54.5 million (2018)

Federally-facilitated State-based Federally-facilitated Federally-facilitated Federally-facilitated

Marketplace Marketplace with Marketplace Marketplace Marketplace
Federal Platform
Expanded Medicaid4 Expanded Medicaid Did not expand Expanded Medicaid Did not expand
Medicaid Medicaid
 Idaho Complex
Medical Needs
Waiver

Condition-specific
Medicaid eligibility,
condition-specific
reinsurance

$25,000 –

At least 20%

S1150
April 6, 2017
1115/1332
Waiver
1332 waiver released
for public comment
November 1, 2017

1115 waiver released

for public comment
November 22, 2017

$16 million in 2019 for

state-funded high risk
pool
Net losses of state
reinsurance pool
funded by annually-
determined
assessment on
insurers

$0 for reinsurance.
$613 million in
1332/1115 waiver
funding

State-based
Marketplace

Did not expand

Medicaid