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HHS Clarifies Foundations Can Make Payments to QHPs

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius has reiterated that charitable foundations are not prohibited from making payments on behalf of participants enrolled in qualified health plans (QHPs) through the health insurance marketplaces (exchanges). This confirmation was included in a May 21 letter that answered hospital associations’ calls for clarity on this issue. HHS previously noted that QHPs may accept payments from nonprofit foundations in a Feb. 7 FAQ and has restated numerous times that payments made on behalf of QHP enrollees must be based on financial, not health, status and must cover the entire policy year. However, the specific nonprofit language was omitted from a March interim final rule regarding third-party premium support.

In its comments on the interim final rule, America’s Essential Hospitals urged the Centers for Medicare & Medicaid Services to include the language requiring QHPs to accept third-party payments from private, nonprofit foundations when the agency finalizes the regulation. The association also asked CMS to allow hospitals to offer premium assistance support to QHP enrollees.

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About the Author

Gontscharow is a senior policy analyst for America's Essential Hospitals.

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