FAQ related to health insurance

What does the recent federal court decision hold with regard to Missouri’s contraception coverage law? 

Missouri Insurance Coalition brought suit seeking a declaration that Missouri’s Contraception Coverage Law was preempted by provisions of the Patient Protection and Affordable Care Act (ACA). The District Court determined that Section 376.1199.4, .5 and .6(1), (2) and (3) were preempted by the ACA. Click to read the Order.

What is the consequence of the District Court’s decision?

While the District Court’s Order remains in effect, when the department reviews the products or conduct of Missouri health insurers, it will read Missouri law as if those provisions that are preempted were absent from the statute.

What is the process by which the ACA’s market reform measures will be enforced in Missouri?  On March 15, 2013, the Centers for Medicare & Medicaid Services (CMS) announced that it would directly enforce the ACA’s individual and group market reform requirements with respect to health insurance issuers for plans issued or sold in Missouri. CMS explained that Missouri has not enacted legislation to enforce these provisions of the ACA and, in the absence of legislation, the department lacks authority to enforce the ACA’s market reforms.

What is the consequence of the CMS’s decision?

In the absence of statutory authority to enforce the market reform provisions of the ACA, CMS will exercise that regulatory authority in Missouri. Consequently, health insurers operating in Missouri will have two regulators, each operating and regulating within their own sphere of authority. CMS has indicated health insurance products are now required to be filed with CMS for review. This filing requirement would be in addition to existing filing obligations under Missouri law.

Will Missouri approve health insurance policy forms for use in a federally facilitated health benefit exchange?

No, Missouri law provides that the department may not “provide assistance or resources of any kind to … the federal government related to the creation or operation of a federally-facilitated health benefit exchange unless such assistance or resources are authorized by state statute … or such assistance or resources are specifically required by federal law.” Section 376.1186.5, RSMo Supp. 2012, emphasis added.

Does federal law specifically require, or does any state statute authorize, the department to approve health insurance policy forms that are for use in a federally-facilitated health benefit exchange?

No federal law specifically requires the department to review policy forms that are for use in a federally-facilitated health benefit exchange, nor does any state statute authorize the approval of such forms.