Under Section 1332 of the Affordable Care Act, states may apply for State Innovation Waivers to waive certain federal requirements with the goal of improving their health insurance markets. During the 2018 legislative session, the Maryland General Assembly passed House Bill 1795 – Establishment of a State Reinsurance Program. Governor Larry Hogan signed House Bill 1795 on April 5, 2018.
House Bill 1795, as an emergency measure, directs the Maryland Health Benefit Exchange to submit a State Innovation Waiver to the U.S. Secretaries of Health and Human Services and the Treasury to establish a State Reinsurance Program.
The purpose of the State Reinsurance Program is to mitigate the premium impact of high cost enrollees on carriers that participate in the individual market. The State Reinsurance Program has reduced rates from what they would have been without the program, creating some relief for Marylanders who have experienced high rate increases on their health insurance premiums.
For more information on State Innovation Waivers, visit the CMS Section 1332: State Innovation Waivers website.
Waiver Amendment Application – Final (pursuant to 2024 Access to Care Act)
Reinsurance Waiver Extension Application
1332 Waiver Extension Application Public Hearing Presentation
1332 Waiver Extension Letter of Intent to CMS (December 15, 2022)
Waiver Extension LOI Response from CMS (January 13, 2023)
Final Maryland 1332 State Innovation Waiver to Establish a State Reinsurance Program May 31, 2018
Maryland 1332 State Innovation Waiver to Establish a State Reinsurance Program UPDATED Aug. 15, 2018
Wakely Consulting Group Analysis on Reinsurance / Risk Adjustment Interaction – Draft
MHBE Board Resolution on Interaction Between Risk Adjustment and Reinsurance Programs
Enacting Legislation:
HB 1795 – Establishment of a State Reinsurance Program
SB 387 – Maryland Health Access Act of 2018
Authorizing Resolution:
MHBE Board Resolution on the State Reinsurance Program and Submission of a State Innovation Waiver Application – April 16, 2018
Section 1332 Waiver -Public Comment – Board Presentation – May 21, 2018
Resolution 1332 State Innovation Waiver Application – May 21, 2018
House Bill 1795 requires the Maryland Health Benefit Exchange to adopt regulations implementing the State Reinsurance Program. These regulations were required to effect by Jan. 1, 2019. As part of the regulatory process, the Maryland Health Benefit Exchange hosted a series of hearings to engage with the public to discuss the scope, design, and goals of these regulations. The Maryland Health Benefit Exchange staff considered all comments and feedback and incorporated input that was deemed appropriate. The final regulations are at COMAR 14.35.17.
None
July 16, 2024 Sixth Annual Reinsurance Forum
Pursuant to 31 CFR §33.120(c) and 45 CFR §155.1320(c), the Maryland Health Benefit Exchange afforded the public with an opportunity to provide meaningful comment on the progress of the State Reinsurance Program (SRP) on Tuesday, July 16, 12:00 – 1:00pm.
Presentation
Minutes
June 18, 2024 and July 3, 2024 Public Hearings on 1332 Waiver Amendment Application
MHBE will hold two public hearings to give the public an opportunity to provide meaningful comment on its draft 1332 waiver amendment application pursuant to Maryland Senate Bill 705 / House Bill 728 of 2024. If approved, the amendment would allow all Maryland residents to qualify to enroll in private plans on-Exchange, regardless of immigration status. To request accommodations, please use this form.
Waiver Amendment Hearing #1
Tuesday, June 18 · 1:00 – 2:00pm
Presentation Slides
July 3, 2024 Waiver Amendment Public Hearing #2
Wednesday, July 3 · 1:00 – 2:00pm
Time zone: America/New_York
Google Meet joining info
Video call link: https://meet.google.com/mjn-
Or dial: (US) +1 252-922-0052 PIN: 331 679 290#
July 18, 2023 5th Annual Public Forum
Pursuant to 31 CFR §33.120(c) and 45 CFR §155.1320(c), the Maryland Health Benefit Exchange afforded the public an opportunity to provide meaningful comment on the progress of the State Reinsurance Program (SRP) on Tuesday, July 18, from 1:00 -3:00 p.m.
Presentation
Minutes
July 14, 2022 Annual Public Forum Meeting
Pursuant to 31 CFR §33.120(c) and 45 CFR §155.1320(c), the Maryland Health Benefit Exchange is affording the public an opportunity to provide meaningful comment on the progress of the State Reinsurance Program (SRP).
Meeting Recording
Reinsurance Forum Presentation Slides
4th Annual Reinsurance Forum Meeting Minutes
The Department of Health and Human Services and the Department of the Treasury has determined that Maryland has been approved to modify the post-award forum procedures, and will be holding our forum virtually, as outlined in the requirements set forth in 45 CFR §155.1320(c)(2).
July 16, 2021 Annual Public Forum Meeting
Pursuant to 31 CFR §33.120(c) and 45 CFR §155.1320(c), the Maryland Health Benefit Exchange afforded the public an opportunity to provide meaningful comment on the progress of the State Reinsurance Program (SRP).
Reinsurance Forum Presentation Slides
Meeting Minutes
The Department of Health and Human Services and the Department of the Treasury has determined that Maryland has been approved to modify the post-award forum procedures, and the forum was held virtually, as outlined in the requirements set forth in 45 CFR §155.1320(c)(2).
June 17, 2020 Annual Public Forum Meeting
Pursuant to 31 CFR S33.120(c) and 45 CFR $155.1320(c), the Maryland Health Benefit Exchange afforded the public an opportunity to provide meaningful comment on the progress of the State Reinsurance Program (SRP).
Meeting Recording
Reinsurance Forum Presentation Slides
Meeting Minutes and Submitted Written Comments
May 2, 2019 Public Forum
MHBE hosted the first post-award forum regarding the State Reinsurance Program. The forum is an opportunity for the public to present meaningful comments on the progress of the State Reinsurance Program. Below are links to the presentation from the forum, the attendee sign-in sheet, and the minutes from the meeting:
Presentation on for the First Annual State Reinsurance Program Public Forum, May 2, 2019
Attendee Sign-In Sheet
Minutes
Written Testimony
2024 Waiver Amendment Application
June 18, 2024 and July 3, 2024 Public Hearings on 1332 Waiver Amendment Application
MHBE held two public hearings to give the public an opportunity to provide meaningful comment on its draft 1332 waiver amendment application pursuant to Maryland Senate Bill 705 / House Bill 728 of 2024. If approved, the amendment would allow all Maryland residents to qualify to enroll in private plans on-Exchange, regardless of immigration status. The public was invited to sign up for comment and/or request accommodations using this form.
2023 Waiver Extension Application
The final extension application is available here and the Federal public comment period ended on May 25, 2023. To submit a public comment to CMS, please email stateinnovationwaivers@cms.hhs.gov.
The draft application was posted for public comment until Friday, February 17, 2023.
As part of the waiver extension process, MHBE held a virtual public hearing on Wednesday, February 15, 2023. A recording of the hearing is available here.
Original 2018 1332 Waiver Application
As a requirement of the original State Innovation Waiver application process, the Maryland Health Benefit Exchange, in conjunction with the Maryland Insurance Administration, held four public hearings around the state from April 20 to May 20, 2018.
1332 Waiver Public Hearing Agenda
Presentation on “Maryland State Innovation Waiver Application: State Reinsurance Program, April 20-May 20, 2018”
July 16, 2024 Sixth Annual Reinsurance Forum
Pursuant to 31 CFR §33.120(c) and 45 CFR §155.1320(c), the Maryland Health Benefit Exchange afforded the public with an opportunity to provide meaningful comment on the progress of the State Reinsurance Program (SRP) on Tuesday, July 16, 12:00 – 1:00pm.
Presentation
Minutes
July 18, 2023 5th Annual Public Forum
Pursuant to 31 CFR §33.120(c) and 45 CFR §155.1320(c), the Maryland Health Benefit Exchange afforded the public an opportunity to provide meaningful comment on the progress of the State Reinsurance Program (SRP) on Tuesday, July 18, from 1:00 -3:00 p.m.
July 14, 2022 4th Annual Public Forum Meeting
Pursuant to 31 CFR §33.120(c) and 45 CFR §155.1320(c), the Maryland Health Benefit Exchange is affording the public an opportunity to provide meaningful comment on the progress of the State Reinsurance Program (SRP).
Meeting Recording
Reinsurance Forum Presentation Slides
4th Annual Reinsurance Forum Meeting Minutes
The Department of Health and Human Services and the Department of the Treasury has determined that Maryland has been approved to modify the post-award forum procedures, and will be holding our forum virtually, as outlined in the requirements set forth in 45 CFR §155.1320(c)(2).
July 16, 2021 Annual Public Forum Meeting
Pursuant to 31 CFR §33.120(c) and 45 CFR §155.1320(c), the Maryland Health Benefit Exchange afforded the public an opportunity to provide meaningful comment on the progress of the State Reinsurance Program (SRP).
Reinsurance Forum Presentation Slides
Meeting Minutes
The Department of Health and Human Services and the Department of the Treasury has determined that Maryland has been approved to modify the post-award forum procedures, and the forum was held virtually, as outlined in the requirements set forth in 45 CFR §155.1320(c)(2).
June 17, 2020 Annual Public Forum Meeting
Pursuant to 31 CFR S33.120(c) and 45 CFR $155.1320(c), the Maryland Health Benefit Exchange afforded the public an opportunity to provide meaningful comment on the progress of the State Reinsurance Program (SRP).
Meeting Recording
Reinsurance Forum Presentation Slides
Meeting Minutes and Submitted Written Comments
May 2, 2019 Public Forum
MHBE hosted the first post-award forum regarding the State Reinsurance Program. The forum is an opportunity for the public to present meaningful comments on the progress of the State Reinsurance Program. Below are links to the presentation from the forum, the attendee sign-in sheet, and the minutes from the meeting:
Presentation on for the First Annual State Reinsurance Program Public Forum, May 2, 2019
Attendee Sign-In Sheet
Minutes
Written Testimony
Final 2023 Reinsurance Annual Report
Final 2022 Reinsurance Annual Report
Final 2021 Reinsurance Annual Report
Oct. 12, 2021
Final Annual 1332 Waiver Report for 2020
Aug. 27, 2020
As outlined in the specific terms and conditions for Maryland’s 1332 State Innovation Waiver, the Maryland Health Benefit Exchange must publish the final annual report of the State Reinsurance Program.
Summary Carrier Accountability Report for Plan Year 2022
Summary Carrier Accountability Report for Plan Year 2021
Carrier-Specific Accountability Reports for Plan Year 2021:
Kaiser Permanente
CareFirst
Summary Carrier Accountability Report for Plan Year 2020
Carrier-Specific Accountability Reports for Plan Year 2020:
Kaiser Permanente
CareFirst
Summary Carrier Accountability Report for Plan Year 2019
Carrier-Specific Accountability Reports for Plan Year 2019:
Kaiser Permanente
CareFirst
Pursuant to COMAR 14.35.17.03(C), all carriers participating in the State Reinsurance Program (SRP) are required to submit an annual report to the Maryland Health Benefit Exchange (MHBE) that describes carrier activities to manage the costs and utilization of enrollees whose claims were reimbursed under the SRP, as well as efforts to contain costs.
Plan Year 2023 Reinsurance Program Carrier Accountability Report Instructions
2023 Reinsurance Program Carrier Accountability Report Template
Supplemental Template
The Maryland Health Benefit Exchange hosted four public hearings.
A summary presentation of proposed, incorporated comments can be viewed here.
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