Thursday, April 10, 2025
4/10/2025
The State Flexibility to Stabilize the Market Cycle II Grant Program - The South Dakota Division of Insurance (Division) provides regulatory oversight for all private health insurance companies operating in the state. South Dakota’s health insurance market has been significantly impacted with the implementation of the PPACA requirements. Participation in the State Flexibility to Stabilize the Market Grant Program Cycle II (hereafter referred to as “State Flexibility Grant Program Cycle II”) will allow the Division to adequately assess market activities, identify areas of potential change that may help to stabilize and strengthen the health insurance market in our state. The Division has established the following objectives if South Dakota is awarded funding from the State Flexibility Grant Program Cycle II. A. Perform a study of the healthcare insurance coverage plans currently offered in South Dakota to ensure adequate product option availability and affordability, with specific focus in two areas: i. Non-ACA compliant plans, such as short-term limited duration plans, association health plans, and healthcare sharing programs; and ii. Impact of merging the individual and small group markets. B. Perform a review of the effectiveness of the established Qualified Health Plan (QHP) rating areas. C. Explore compliance option and approaches to strengthen the internal review of plan formulary offerings. Although South Dakota completed a market analysis during the Cycle I funding opportunity, the market analysis completed in Cycle I focused on the State’s grandfathered and transitional plans and did not include the areas of focus listed above. The Division believes that the activities identified in South Dakota’s application cover all areas of reform as identified in the funding opportunity, Sections 2702, 2703, and 2707, Guaranteed Availability of Coverage, Guaranteed Renewability of Coverage and Non-Discrimination under Comprehensive Health Insurance Coverage, respectively. The market review with specific areas of focus specifically fall under Sections 2702 and 2703. Market analysis will provide an important foundation for any decisions made to help stabilize South Dakota’s health insurance market. In addition, we believe Section 2707, Non-discrimination under Comprehensive Health Insurance Coverage, would apply to the QHP rating area review and the plan formulary compliance review. At the time of this application, South Dakota received notice that it is eligible to receive a total of $669,329.35 to use toward completing the designated activities, split as baseline funding in the amount of $660,0000 and workload funds of $9,329.35. The anticipated 24-month performance period of the grant project is expected to be from April 1, 2021 until March 31, 2023. To achieve the objectives outlined above, the Division will require the assistance of subject matter experts (SMEs) outside of current staffing. Following South Dakota established request for proposal (RFP) process, grant funds will be used to contract with the required external SME(s) to complete the identified assessment and analysis. The RFP(s) issued will outline the detailed request for associated objective, an outline of the specific assessment or activity required to be completed, the expected deadline to complete, and a description of the final report(s) to be received by the Division. The completed analysis in these areas could provide a foundation for decisions regarding future contemplated programs (federal or otherwise) for flexibility and market stability and/or the approaches taken to ensure the availability of sufficient and affordable healthcare coverage in South Dakota. Candace (Candy) Holbrook SD Department of Labor and Regulation, Division of Insurance 124 S. Euclid Avenue, 2nd Floor Pierre, SD 57501 605.773.3563 candy.holbrook@state.sd.us
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).