State Lawmakers to Reconvene Oct 26 About New Healthcare Plan
Both chambers of the Delaware General Assembly are being called back to Legislative Hall on October 26 to consider legislation that would add several layers of additional oversight as the State transitions to a new healthcare plan for its Medicare-eligible retirees and their dependents. The measure (SB 348) Will also create an ombudsperson to assist State pensioners with the transition and navigating the benefits under the Medicare Advantage plan.
In a release from the State Senate Majority Caucus:
Under a plan recommended by the Retiree Benefit Study Committee (RBSC) and enacted by the State Employee Benefits Committee (SEBC), the State of Delaware will transition from a publicly managed Special Medicfill Supplement Plan to a Delaware-specific Medicare Advantage Plan administered by Highmark Blue Cross Blue Shield on Jan. 1, 2023.
The transition followed numerous public meetings on how best to grapple with the exceedingly high cost that funding retiree health care will place on Delaware taxpayers as record numbers of state workers reach retirement age. The latest analysis from the RBSC indicates Delaware faces a current shortfall of nearly $11 billion that would have reached $37 billion by 2050 if the plan were left unchanged. This year alone, the State is expected to allocate nearly $785 million to keep its retiree healthcare system solvent.
It became clear this summer that some State pensioners were unaware of the SEBC and the RBSC鈥檚 public meetings and did not have a clear understanding of the forthcoming changes.
Members of the General Assembly then held a series of public meetings throughout the state to solicit public input and provide details about the new Medicare Advantage plan. During those meetings, State retirees raised concerns about the pre-authorizations for some non-emergency services required by the new plan, as well as questions about provider participation.
While the General Assembly does not have the power to undo the Carney Administration鈥檚 contract with Highmark, legislators have since secured a number of concessions to address the concerns raised by State retirees, including:
- A four-month delay in the implementation of pre-authorization for outpatient services,
- Quarterly reporting on denial rates and other aspects of the pre-authorization process
- An expansion of out-of-network access
- Additional customer service staffing at Highmark and the Delaware Department of Human Resources
- A commitment to add a number of performance guarantees to the final contract.
On Oct. 26, the General Assembly is expected to add further oversight to the transition process through the creation of a new SEBC subcommittee made up of State retirees, sitting legislators, union representatives, and other state officials, who will monitor Highmark鈥檚 performance during the three-year life of the current contract.
Senate Bill 348 also would create an ombudsperson in the Department of Human Resources who would focus specifically on assisting State pensioners with the transition and navigating the benefits under the Medicare Advantage plan.
SB 348 is expected to be filed in the coming days once input has been gathered from legislators and the public.
The Delaware Senate also will consider the confirmation of several Carney Administration nominees when it reconvenes on October 26.
