Justice Department Appeals Moda Health Risk Corridor Decision

The U.S. Justice Department appealed a $214 million decision from February to pay Moda Health over money owed to the risk corridor program.

The Affordable Care Act (ACA) created the risk corridor program to pay insurers for losses incurred on ACA exchanges. The Centers for Medicare & Medicaid Services (CMS) hasn’t paid the full amount and still owes Moda and other payers money.

Insurers are looking for the full amount owed to them under the ACA’s risk corridor formula – not a pro rata share. Moda Health sought “hundreds of millions of dollars” after the CMS paid the plan slightly more than $11 million in 2014 and no payments in 2015 and 2016.

The CMS has not been able to make full payments because far more payers were owed from having higher ACA exchange costs than those that had lower costs were able to make up for. Congress declined to appropriate funds to cover the difference in 2015 and 2016.

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