NY regulators want insurer risk-adjustment program changed

ALBANY, N.Y. – New York insurance regulators say the federally mandated program for adjusting financial risk under the Affordable Care Act unduly affects the finances of newer and smaller insurers.

Department of Financial Services Superintendent Maria Vullo says in a letter to federal authorities there should be immediate changes in the risk-adjustment program, which transfers pooled funds to plans with higher-risk clients.

Another provision of the federal law prohibits insurers from denying coverage or boosting premiums for high-risk people with existing medical conditions.

Vullo says New York regulators are “very concerned” that smaller newer insurers will pay millions of dollars into the pool because they apparently have healthier clients, largely because they haven’t generated sufficient patient records yet.

The federal Centers for Medicare and Medicaid Services didn’t immediately reply to requests for comment.