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Idaho to Move Ahead With State-Based Health Plans Without Waiting for CMS Waiver


The move comes more than 10 months after the state's governor first called for selling non-compliant plans.

Idaho insurance officials have decided not to wait for CMS and are letting insurers sell health plans that don’t fully comply with the Affordable Care Act (ACA). The controversial step comes almost a year after the state’s governor called for selling less expensive, non-compliant plans.

It was unclear late Friday whether state-based plans are currently being sold in direct competition with ACA-complaint plans. A call to the Idaho Department of Insurance was not returned. However, a release issued Thursday as open enrollment began seemed to imply this possibility. The list of questions it encouraged consumers to ask included, “Does my plan meet all requirements of the Affordable Care Act?”

In February, Blue Cross of Idaho unveiled 5 state-based plans it hoped to sell alongside ACA-complaint plans, including those that would subject consumers to medical underwriting. CMS rejected Idaho’s approach, saying regulators would not be “substantially” enforcing the ACA. As recently as September, Insurance Department Director Dean Cameron said the state was still in talks with CMS, with one issue to resolve.

Cameron has argued that CMS is hard-pressed to reject Idaho’s decision, given the administration’s posture in a Texas lawsuit to overturn the ACA.

The state has not sought a 1332 waiver, which gives states additional flexibility under the ACA.

Idaho regulators have said that too many residents have gone without health insurance because they can’t afford prices on the ACA exchanges, but they make too much money to qualify for federal premium subsidies.

Tuesday’s election results could further change the state’s insurance market. If voters approve a ballot initiative to expand Medicaid, some consumers who might have purchased short-term plans or state-based plans could be eligible for Medicaid.

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