Published by Nephrology News & Issues
March 30, 2016

Insurance carriers in at least 34 states have begun to reject insurance premium payments from the American Kidney Fund (AKF) and many other health nonprofits on behalf of enrollees with chronic diseases, according to patient advocacy groups. AKF and others in the kidney community are asking the Centers for Medicare & Medicaid Services to issue rulemaking that would allow nonprofits to continue making so-called “third-party payments” to help individuals who cannot afford health coverage.

This issue came about when CMS released an Interim Final Rule in March 2014 that gave Marketplace Exchange insurers the discretion to deny third-party premium assistance from charitable groups, while requiring them to accept payments only from state and federal health programs, tribal programs, and the Ryan White HIV/AIDS Program. CMS stated recently that it will address nonprofit premium payments in future rulemaking.

“The existing CMS guidance does not address the unique and longstanding role of our nation’s health nonprofits in providing assistance to patients,” said LaVarne A. Burton, AKF president and CEO. “We have proposed to CMS a number of guardrails that would ensure nonprofit premium payments are made in a way that protects the integrity of the insurance marketplace.”

Insurance carriers have cited concerns that charitable assistance to chronically ill individuals will skew the Marketplace Exchange risk pool. AKF is assisting 6,400 people out of the 11 million who hold Marketplace Exchange plans. The rest of AKF’s 80,000 grant recipients are enrolled in Medicare Part B, Medigap, COBRA, employer group health and other commercial plans—and some insurers are beginning to refuse AKF’s payments for those insurance products, as well.  Some carriers are threatening to terminate the coverage of individuals who receive any charitable assistance for health premiums.

AKF is conducting a survey to monitor the impact of the insurance premium issue; visit www.kidneyfund.org/survey.

AKF won regulatory approval in 1997 to provide charitable assistance to patients who need help paying their health insurance premiums. AKF obtained approval from the U.S. Department of Health and Human Services Office of the Inspector General (OIG) that the program was in compliance with federal law. While contributions to the AKF program are made by a range of organizations, including providers, the OIG concluded that AKF had taken appropriate steps to establish a firewall between contributors and the individuals who receive assistance. The OIG further concluded that AKF’s program would “expand, rather than limit, beneficiaries’ freedom of choice” in selecting a dialysis provider. AKF assists patients who have demonstrated financial need.