Risk Adjustment Payments Will Resume

August 07, 2018

On July 24, the Centers for Medicare & Medicaid Services (CMS) posted a final rule indicating it will initiate $10.4 billion in risk adjustment transfers in September for benefit year 2017.

The Affordable Care Act (ACA) created the risk adjustment program to transfer funds in the individual and small group health insurance markets with lower-risk enrollees to health plans with higher-risk enrollees to spread the financial risk and help stabilize premiums. Earlier this summer, CMS announced the transfers were on hold due to litigation. Later this year, CMS intends to issue a new proposed rule on the risk adjustment methodology for the 2018 benefit.

This story originally appeared in the August 07, 2018 edition of WHA Newsletter