District Court Rules In Favor Of New Mexico Health Plan In Risk Adjustment Case

U.S. District Court for the District of New Mexico last week ruled that HHS' use of a statewide average premium for the risk adjustment formula is “arbitrary and capricious” and thus violated the Administrative Procedure Act (APA) and should be remanded back to the agency, providing the first win for issuers suing the administration over the ACA program that requires plans with healthier consumers to pay into a pool distributed to those with a sicker population. Martin Hickey, former CEO...