UPDATE: General Assembly to Reconvene to Pass Medicare Advantage Oversight Legislation

Posted on 10-14-2022

General Assembly to Reconvene to Pass Medicare Advantage Oversight Legislation  

The Delaware General Assembly will reconvene 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.   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 January 1.   The transition is being made to address the unsustainable escalation of providing retiree healthcare benefits. The latest analysis indicates Delaware faces a current unfunded liability of nearly $11 billion that is projected to reach $37 billion by 2050 if nothing is done. This year alone, the state is expected to allocate nearly $785 million to keep the retiree healthcare system solvent.   It became clear this summer that some state pensioners did not have a full understanding of the forthcoming changes. Members of the General Assembly then held a series of public meetings throughout the state to solicit 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’s 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 October 26, the General Assembly is expected to add further oversight to the transition process through the creation of a new subcommittee made up of state retirees, sitting legislators, union representatives, and other state officials, who will monitor Highmark’s 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.
Wednesday afternoon, Senator Wilson; Senator Richardson and I joined a bipartisan coalition of legislators and concerned state pensioners at the RISE rally against the upcoming Medicare Advantage takeover. I will not stand idly by as our state retirees are left out to dry. We must ensure they continue to receive the best possible post-retirement healthcare coverage that they earned for their years of service to the people of Delaware!” Senator Lawson

I was proud to join legislative colleagues from across the political spectrum yesterday, rallying with state pensioners against the upcoming Medicare Advantage takeover of their healthcare. I pledge to stand with retirees and fight for the best possible health coverage possible. They put the time in and now we must fulfill our commitment to them.” Senator Wilson

“Photo courtesy of the Delaware State Senate Republican Caucus”