Michigan orders the extension of Affordable Care Act transitional policies through Dec. 31, 2023

The Affordable Care Act (ACA), the absolute titan-sized regulation that reshaped the topography of America’s health insurance landscape, is still “optional” for a subset of plans. The original ACA order included grandfathered exemptions for specific types of plans and some “transitional policies” with provisions that would sunset over time.

Every year or so, the Centers for Medicare & Medicaid Services (CMS) issues guidance that serves as a multi-phase “transitional policy” to continue some of these non-grandfathered insurance coverages. Michigan’s Department of Insurance and Financial Services (along with other states, but they’re the one who sent out the news release, so bear with us) has adopted these transitional guidelines every year, and this is no exception.

The continuation of these transitional policies allows them to operate through Dec. 31, 2024, and exempts them from following ACA provisions such as:

Fair health insurance premiums Guaranteed availability of coverage Guaranteed renewability of coverage Prohibitions on pre-existing condition exclusions or other discriminations based on health status Prohibitions of discriminations against individual participants and beneficiaries based on health status Non-discrimination in healthcare Comprehensive health insurance coverage Coverage for individuals participating in approved clinical trials Single risk pooling

Transitional policies also are exempt from some state laws in Michigan, such as standards about guaranteed renewability, network adequacy standards, open enrollment periods, and permissible rating factors.

As Anita Fox, the DIFS Director, noted in the bulletin, although an insurer may be granted this extension if they apply to CMS and file the requisite paperwork with the state, there is nothing that says insurers have to continue these policies. And there are plenty of ACA requirements the transitional plans still must adhere to, such as the prohibition against annual dollar limits on essential health benefits, mental health parity requirements, prohibitions on excessive waiting periods, or prohibitions on pre-existing conditions.

Insurance is an industry where state-by-state regulation isn’t always everyone’s favorite, but, as notices like this serve to remind us, it doesn’t always get less complicated even when Congress sets a federal standard.

submitted by /u/AgentSync_io
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