Baltimore-based Evergreen Health Cooperative will shell out $24.2 million in risk adjustment fees to its largest competitor under the Affordable Care Act's Risk Adjustment Program, The Baltimore Sun reported.
Risk adjustment payments aim to temporarily level the financial playing field for payers absorbing newly insured, costlier members. In Maryland, Rockville-based Kaiser Foundation Health Plan of the Mid-Atlantic States will pay out $14.7 million in risk adjustment payments, and Hartford, Conn.-based Aetna will pay $11.8 million. The fees are due in August.
Maryland's largest insurer, Baltimore-based CareFirst Blue Cross Blue Shield, will receive $50.7 million, all but $1 million of that from payers' risk adjustment payments, The Baltimore Sun reported.
At the same time Evergreen is preparing for the payment deadline, it has pending litigation against the federal government, filed in June, regarding the payment, which represents more than a quarter of the payer's $85 million premium revenue this year.
Half of the 24 co-op health plans — like Evergreen — created under the ACA have closed, according to The Baltimore Sun. This Tuesday the Connecticut Insurance Department prohibited Wallingford-based HealthyCT to continue operations because of its inability to pay a $13.4 million risk adjustment.
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