Patient advocacy groups are pushing bipartisan legislation that would require qualified health plans to accept premium payments from charitable organizations since CMS has so far refused to impose such a requirement. Patient organizations say CMS' silence on the issue leads plans to reject payments on behalf of chronically ill patients and threatens to undermine the goal of the Affordable Care Act.
CMS issued an interim final rule in March 2014 clarifying that QHPs must accept third-party payments from the Ryan White program and from tribal entities, but did not mandate that plans need to accept payments from charitable organizations. Advocates say this led to plans rejecting payments in at least 35 states.
When Congress passed the Affordable Care Act (ACA) in 2010, it took the historic step of preventing health insurers from discriminating against patients with pre-existing conditions. Unfortunately, guidance from the U.S. Centers for Medicare and Medicaid Services (CMS) is now risking those gains and keeping essential treatments and services out of reach for vulnerable patients who need them the most. In so doing, CMS has inadvertently turned not being able to afford your health insurance premium into the new ‘pre-existing condition.’ This is contrary to the intent of the ACA.
WASHINGTON, D.C. (May 5, 2016) – A group of leading national patient advocacy organizations today launched the Marketplace Access Project (MAP), a patient advocacy movement dedicated to protecting non-profit insurance premium assistance for individuals suffering from chronic and life-threatening illnesses. Guidance from the U.S. Centers for Medicare and Medicaid Services (CMS) allows health insurers to deny coverage to patients enrolled in qualified Exchange plans by rejecting the premium assistance patients receive from non-profit charities. MAP is urging Congress to pass the Access to Marketplace Insurance Act (H.R. 3742), bipartisan legislation that would protect non-profit patient assistance and allow charities to continue to be charitable.
Congress took an historic step to prevent health insurers from discriminating against patients with pre-existing conditions when it passed the Affordable Care Act (ACA). Unfortunately, recent guidance from the U.S. Centers for Medicare and Medicaid (CMS) may be inadvertently creating a new ‘pre-existing condition’ that is keeping essential treatments and services out of reach for patients who need them the most.