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CMS on Oct. 15 approved a Medicaid section 1115 demonstration waiver that it said will allow working-age Georgia adults who are currently ineligible for Medicaid to get such coverage “by participating in qualifying activities like work and education, as well as meeting premium and income requirements.” The “Pathways to Coverage” program will apply to people ages 19 to 64 with income up to and including 100% of the federal poverty level, and will run from July 1, 2021 to Sept. 30, 2025. CMS said it expects that “over 30,000 individuals will receive Medicaid coverage during the first year of the demonstration” and nearly 65,000 Georgians will enroll in Medicaid or receive Medicaid premium assistance for coverage through employer-sponsored insurance during the five-year demonstration. Visit https://go.cms.gov/2IDn7AF.

Health insurers across most markets saw their claims costs fall and their gross margins increase since the start of the COVID-19 pandemic and relative to 2019, according to a new analyst from the Kaiser Family Foundation. In addition, medical loss ratios in the Medicare Advantage market decreased 5 percentage points through the first six months of 2020 relative to the same period in 2019, and group market MLRs decreased by an average of 3 percentage points year over year. In the individual market, though, average MLRs held steady relative to 2019. “Although we cannot measure profits directly, all signs suggest that health insurers in most markets have become more profitable so far during the pandemic,” the report concluded. Read more at https://bit.ly/3lIc9Ie.

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AIS Health Staff

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