Regulatory Joe

ICHRA Reality Check: What Health Plans Need to Operationalize Now (feat. Lindsey Miller, Softheon)

ICHRA adoption is accelerating—but for health plans, the real challenge isn’t strategy. It’s execution. In this episode of Regulatory Joe, ClearFile’s Joe Boyle sits down with Lindsey Miller of Softheon to break down what ICHRA actually changes for health plans across enrollment, billing, member experience, and long-term individual market strategy. They explore where operational complexity is already showing up, why many plans may already have ICHRA members without knowing it, and how fragmented workflows across enrollment pathways, payment models, and communications are creating new pressure points. The conversation also dives into what it takes to operationalize ICHRA at scale—from data strategy and member identification to reconciliation processes and ecosystem coordination across employers, brokers, and technology partners. If you work in ACA product strategy, enrollment operations, billing, or regulatory compliance, this episode breaks down what to prepare for as ICHRA continues to grow. Subscribe to get all of Regulatory Joe’s insights or visit https://www.regulatoryjoe.com [https://www.regulatoryjoe.com]

What the 2027 NBPP Means for Catastrophic Plans and ACA Strategy (feat. Greg Fann)

In this episode of Regulatory Joe, Joe Boyle sits down with Greg Fann of Axene Health Partners to break down what the proposed 2027 NBPP could mean for catastrophic plans and ACA market strategy. The conversation explores how expanded eligibility could affect bronze plan relevance, low-premium positioning, and decision-making for issuers heading into the 2027 filing cycle. It also looks at where catastrophic plans actually fit in the ACA market today—and why this targeted policy change could create broader strategic implications than it may seem at first. Joe and Greg also discuss how carriers may respond, what to watch across state-level dynamics, and why this change is most relevant for a specific segment of the market rather than a broad affordability solution. If you work in ACA product strategy, pricing, regulatory filing, or exchange operations, this episode breaks down what matters most as you prepare for the 2027 cycle. Subscribe to get all of Regulatory Joe’s insights or go to https://www.regulatoryjoe.com.

ICHRA for Health Plans: What Issuers Need to Know

ICHRA can introduce operational risk long before it shows up in membership. For health plans, it functions as a new distribution pathway inside the individual market, which means added complexity across enrollment, billing, and premium flow—not a separate product strategy. This episode of Regulatory Joe focuses on where that complexity actually shows up, including enrollment pathways, payment coordination, lockbox flow, and internal ownership across product and operations teams. It also covers why early alignment matters, especially as plans prepare for filing season and evaluate ICHRA growth. If you’re responsible for individual market strategy, enrollment, or billing, this is where ICHRA decisions start to create real impact.

Breaking Down the 2027 NBPP: Key ACA Marketplace Changes to Watch

The PY2027 Notice of Benefit and Payment Parameters (NBPP) introduces several proposed policy changes that could reshape ACA marketplace strategy for health plans. In this episode of Regulatory Joe, Joe Boyle breaks down the most important provisions in the 2027 NBPP and what they could mean for issuer portfolio strategy, enrollment operations, and marketplace participation across states. The proposed rule was released later than usual in the regulatory cycle, creating a compressed timeline for issuers evaluating potential impacts ahead of the next filing season. Together, these proposals could influence how issuers approach plan portfolio design, enrollment verification workflows, and multi-state regulatory strategy as the ACA marketplace continues to evolve. For regulatory and compliance teams, the key question isn’t just what the rule says — it’s how these changes could affect operations, filings, and strategic positioning for plan year 2027. Episode Guide: * 00:00 Introduction: PY2027 NBPP overview and timeline * 02:00 Standardized plan design removal and ACA portfolio strategy * 07:20 Expanded catastrophic plan offerings * 10:00 SEP verification and enrollment changes * 13:05 State-based marketplace (SBM) expansion * 17:05 Network adequacy review flexibility for states Watch the episode for Joe’s breakdown of the provisions regulatory teams should be tracking now. Want more Regulatory Joe? https://www.regulatoryjoe.com [https://www.regulatoryjoe.com]

Ghost Enrollees in the ACA Marketplace Explained

Ghost enrollees in the ACA marketplace can distort enrollment reporting, affect risk adjustment transfers and increase CMS scrutiny. Even small pockets of unsupported enrollment can ripple through operations and financial reconciliation. In this episode of Regulatory Joe, Joe Boyle breaks down what ghost enrollees actually are — and what they are not. Low utilization alone isn’t the issue. The risk shows up when enrollment patterns, premium payment behavior, repeated plan switching or grace period activity don’t align with normal member behavior. EPISODE GUIDE: 00:00 Defining Ghost Enrollees and What’s Normal 02:00 Point of Sale and Broker-Driven Root Causes 05:00 How CMS Identifies Ghost Enrollee Patterns 10:00 How Health Plans Can ID Ghost Enrollee Patterns 12:00 Root Cause Review: Welcome Packets, Grace Periods, Reinstatement 16:00 Best Practices for Health Plans Subscribe for ongoing ACA compliance guidance built for health plans. Explore ClearFile: clearfilesolutions.com Dive into all of Regulatory Joe’s insights: regulatoryjoe.com