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Health Reform Highlights

Welcome to KidsWell’s Health Reform Highlights! This page is updated weekly with the latest health care reform activity across the nation!

 

This website provides the most up-to-date, comprehensive information on children's coverage and healthcare reform implementation in all fifty states and nationwide.

 

To find out more about what’s happening in each state, click on State Spotlight. Go to Federal Focus for federal health care reform news and national children’s health insurance coverage data. Check out the National Snapshot maps to get fifty state comparison maps of major health reform news and trends. Finally, search the Health Reform Hub, which has over 4,000 state and federal health care reform and children’s coverage news entries!

 

 

Update for May 14, 2013

Read past weeks' updates

Implementation and Opposition

Federal News

Other Public Coverage News

Governor Beshear is placing his bets on Medicaid expansion, confident that “Kentucky will come out ahead”!  He announced that the state is moving ahead to create nearly 17,000 new jobs and expand coverage to 308,000 Kentuckians.  Get the full scoop below!

 

For a printer-friendly version of this report, click here.

Implementation and Opposition

  • California: Covered California Board Convened

    Covered California (California’s Exchange) held a May 7thBoard Meeting to review draft regulations on the Assisters Program, recommendations as to financial partnerships and recommendations around agents and enrollment entities. The Board also approved the final version of the Qualified Health Plan model contract, but deferred voting on language with regard to performance penalties and credits until later in May. Under the approved resolution, Exchange staff will have the flexibility to make small clarifications and revisions to model contract language.
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  • California: Covered California Hosted Eligibility and Enrollment Webinar

    Covered California (California’s Exchange) held a May 10thEligibility and Enrollment webinar to review proposed state regulations. The webinar covered the programs guiding principles, key milestones and next steps, including finalizing regulations by early July.
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  • Colorado: Legislature Approved Exchange Funding Mechanisms

    The Colorado General Assembly approved HB 13-1245, a bill to fund the Colorado Health Benefit Exchange, through a mix of fees on plans offered in the Exchange and a tax credit for insurer contributions. HB 13-1245 proposes that the Exchange be allowed to assess a monthly fee on plans offered in the Exchange, limited to $1.80 per member per month, and tax credits for insurer contributions. Funding from HB 13-1245 would supplement revenue from a 1.4% fee assessed on plans offered in the Exchange approved by the Exchange board earlier in March. The bill now moves to Governor Hickenlooper for approval.
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  • DC: Health Benefit Exchange Convened Multiple Meetings

    During the week of May 6th, the Exchange Executive Board, along with one committee and one workgroup, convened:

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  • Georgia: Governor Signed Bill to Regulate Exchange Navigators

    On May 7, Governor Deal signed HB 198, a bill to provide for licensing of Exchange Navigators under the ACA by Georgia’s Commissioner of Insurance, into law.  HB 198 includes requirements that Navigators: establish background, experience, knowledge, and competency; complete 35 hours of training; and pass an examination, unless exempted by the Commissioner.  The bill also requires Navigators to be trained on Georgia’s Medicaid and CHIP programs.  Governor Deal has opted for the state to utilize a federally-facilitated Exchange.

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  • Georgia: Governor Signed Resolution to Create Joint Study Committee on Medicaid Reform

    On May 7, Governor Deal signed HR 107, which creates the Joint Study Committee on Medicaid Reform to study: Medicaid expansion under the ACA, current Medicaid policies and procedures, the efficiency and effectiveness of current programs, and models in other states, in order to determine appropriate levels of service and expenses to ensure program sustainability.  The Committee will be composed of six Senate members appointed by the Lieutenant Governor, six members of the House of Representatives appointed by the House Speaker, and six members appointed by the Governor (representing the Department of Community Health, hospitals, insurers, nursing homes, physicians, and consumers).  The Committee will issue its findings and recommendations to the General Assembly and the Governor, with suggestions for proposed legislation, before 2014.
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  • Hawaii: Connector Released RFA for In-Person Assisters

    The Hawaii Health Connector (Connector) released a request for applications (RFA) for eligible Marketplace Assister Organizations and individuals to join the Hi’i Ola Program (“Embracing Wellness”) to provide assistance to individual applicants and small businesses in comparing and selecting qualified health plans in the Exchange. The Hi’i Ola Program will consist of Navigators, In-Person Assisters, and Certification Application Counselors; however, the RFA released only applies to In-Person Assisters at this time. One year grants will be awarded, starting July 1, 2013 and ending June 30, 2014.   Applications will be accepted until June 9, 2013.

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  • Idaho: Exchange Held Meetings to Begin Initial Implementation of Exchange

    During the week of May 6, the Idaho Health Insurance Exchange held a public Board meeting, IT Subcommittee and Finance Subcommittee to hold discussions to begin the development of a state-based Exchange. As part of the IT Subcommittee meeting, an overview was provided on the components of the Exchange, (i.e., operations, call center, education and outreach, and financial management), high level process flows of these components, and a proposed two phased approach for its system integration implementation timeline. The Exchange proposes to release a systems integrator and call center request for proposal (RFP) in May and June 2013.
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  • Iowa: Legislature Expected to Extend 2013 Session Due to Medicaid Expansion Debate

    The Iowa Legislature has announced that the 2013 session will extend beyond the May 3rd end date,  partly for consideration as to whether the state should expand Medicaid as outlined in the ACA or implement Governor Brandstad’s alternative plan, the Healthy Iowa Plan.
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  • Kentucky: Governor Announced Medicaid Expansion

    Governor Steve Beshear announced that Kentucky would expand its Medicaid program under the Affordable Care Act. The expansion will create nearly 17,000 new jobs, generate $15.6 billion in economic output and expand access to 308,000 Kentuckians. On the announcement, Beshear noted, “We have now done exhaustive research—and our conclusion matched what most other states have found: by expanding Medicaid, Kentucky will come out ahead in terms of both health outcomes and finances. In fact, if we don’t expand Medicaid, we will lose money.” Beshear did not need legislative approval to expand Medicaid because rules for eligibility in Kentucky are set in regulation, not in statute. Legislative committees will review the amended regulations, but the Governor can implement the changes regardless of whether they are approved.

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  • Louisiana: Medicaid Expansion Bill Passed House Health Committee

    A bill proposing Medicaid expansion through an Arkansas-like model passed the Louisiana House Health Committee, according to the Times-Picayune. Similar to the Medicaid expansion bill passed by the Senate health committee last week, HB 233 was amended to reflect Arkansas’ approach, through which uninsured eligible individuals will receive assistance to purchase private coverage through the Exchange. The bill passed 10-9 with two Republican votes from Representatives Harvard and Pope. The bill will next go to the Appropriations Committee or the House floor.
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  • Michigan: House Proposed Medicaid Expansion Alternative with 4-Year Coverage Limit

    On May 9th, Michigan House Republicans Matt Lori and Al Pscholka, introduced HB 4714, which would expand Medicaid coverage to individuals up to 133% FPL, only if coverage can be limited to four years for “able-bodied adults.” The proposed bill would require the state to request a waiver from the federal government to impose a four year lifetime limit on coverage; the proposed 48-month cap would not apply to children, seniors or disabled adults. House Speaker Jase Bolger (R) voiced his support of the bill stating, "It goes entirely to our belief that government assistance is not an entitlement, nor is it a lifestyle, if you're an able-bodied adult." Several Democratic lawmakers criticized the proposal, including Representative Tim Greimel (D): “Kicking them off the program after four years is immoral."
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  • Montana: In Pursuit of Medicaid Expansion, Governor Vetoed Bill to Create Committee to Study Medicaid Reform

    On May 6th, Governor Bullock (D) vetoed HB604, a bill that aimed to create the Select Committee on Medicaid Innovation, Reform, and Expansion.  The final version of the bill was passed by the House and Senate on April 19th and April 16th, respectively, but, with the end of Montana’s legislative session in late April, the legislature will not have a chance to override the veto. The committee would have studied Medicaid expansion and other potential Medicaid reforms, and it would have reported back to the legislature on its findings in 2015. According to the Missoulian, the bill was introduced by opponents of expansion. Representative Livingston (R), who supported the bill, commented upon the bill’s introduction, “I want to have an alternative [to Medicaid expansion] ... I want to take time to engage in a dialogue. We can’t just jump in and do it.” Montana’s legislature adjourned this session without passing any of five bills introduced during the session aimed at expanding Medicaid. Governor Bullock supports expansion and has expressed interest in holding a special session to revisit the issue.
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  • Nevada: Silver State Exchange Board Held a Meeting

    The Nevada Silver State Exchange Board discussed network adequacy standards for standalone dental plans, inclusion of dental benefits in qualified health plans (QHPs), alignment of QHP services areas with rating areas developed by the Division of Insurance and approved by CCIIO, as well as public comment.  Meeting materials detail the different presentations and proposals.
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  • New Hampshire: Health Exchange Advisory Board Held a Meeting

    The New Hampshire Health Exchange Advisory Board met this week, with a focus on Navigators and consumer assistance.  The board discussed development of the consumer assistance model which will handle education and outreach, Navigator activity regulation, and a potential temporary Marketplace Assister program.  The board also discussed the coordination of the Navigator application and the early stages of the program’s implementation.
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  • New Mexico: CMS Sent Letter to Human Services Department Concerning Core Milestones for Becoming a State Based Exchange

    The Centers for Medicare and Medicaid Services (CMS) sent a letter to the New Mexico Human Services Department (HSD) noting that the initial deadlines for certain operational requirements had passed, and provided deadlines in late May for detailed plans regarding: 1) eligibility and enrollment functionality, 2) consumer outreach, education and assistance functionality, and 3) small business health options program functionality.  CMS noted that if the New Mexico HSD is unable to meet the eligibility and enrollment functionality deadline, the agency will work with the State to explore an alternative approach that would rely on the New Mexico Medicaid agency to conduct eligibility and enrollment assessments.
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  • Ohio: Governor Expressed Support for Medicaid Expansion Ballot Initiative

    At a May 9th rally for the National Alliance on Mental Illness Ohio, Governor Kasich (R) expressed support for Ohioans voting on Medicaid expansion through a ballot initiative if legislative efforts to pursue expansion fail. According to the Columbus Dispatch, he commented, "I'm for [Medicaid expansion] however we can get it," and noted, "There are times when you just have to be patient." Advocates have suggested putting Medicaid expansion to vote in November 2014 in response to the House and Senate removing Medicaid expansion from Governor Kasich’s proposed 2014-2015 budget.
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  • Oklahoma: Leavitt Partners Presented Initial Medicaid Expansion Recommendations to Expand Insure Oklahoma; CMS Rejected Insure Oklahoma Waiver Renewal

    At the Oklahoma Health Care Authority (OHCA) Board meeting, Leavitt Partners – hired to analyze Medicaid expansion options in the state – presented their initial findings. Leavitt Partners recommended expanding the Insure Oklahoma program to cover uninsured adults up to 138% FPL through a premium assistance model that encourages individuals to purchase private coverage through the Exchange.

     Leavitt senior analyst Michael Deily said that there would likely need to be “some revisions” made to Insure Oklahoma, which now covers approximately 30,000 people in the state, according to the Associated Press. The “revisions” may speak to an issue raised exchange earlier in the week, in which CMS notified OHCA that they would not renew the Insure Oklahoma waiver past December 31st, 2013, when it is currently set to expire. Mann noted that the rejection could change if Oklahoma makes some adjustments to the program, such as removing the program’s enrollment cap of 35,000 individuals. In fact, Mann said they would welcome a premium assistance expansion, “Since Insure Oklahoma includes a premium assistance model, you might want to consider extending your model to insurance products available in the individual and small business market.”

     Governor Fallin said the rejection is an attempt to “force citizens onto Obamacare health insurance plans,” according to Tulsa World. OHCA Deputy CEO Cindy Roberts, on the other hand, seemed optimistic about the likelihood that the state would considering revising the waiver, “If we made alternations, I think they [CMS] would [approve it]… it’s up to the state now. Are we willing to?”

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  • Texas: “Texas Solution” Bill to Expand Medicaid Expired in the House

    House Bill 3791, an alternative to Medicaid expansion that would have created several options to allow low-income childless adults in Texas subsidies to buy private insurance, expired in the lower chamber as the legislative session ended on May 9. HB 3791 previously passed out of the House Appropriations Committee on April 23rd. According to Think Progress, Representative John Zerwas (R), HB 3791’s backer, expressed frustration at the outcome, “I’m disappointed. It’s one of the biggest issues of the session and we didn’t really have the robust debate I thought we should have.” A non-binding Republican-backed rider that would have enabled state and federal officials to continue the conversation on expanding health coverage also failed.
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  • Utah: HHS Approved Plan for Alternate Exchange Partnership

    The Department of Health and Human Services (HHS) approved the State’s proposal to run the Small Business Health Options Program (SHOP) while the Federal government operates the individual Exchange.  Under the new model, Utah will maintain oversight over qualified health plans, including certification and compliance.  HHS will conduct precertification for Medicaid and CHIP eligibility, and manage tax credits through the individual exchange. HHS also approved Utah’s request not to include information about individual residents or businesses in a federal database, requiring the State to submit only aggregated data.
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  • Vermont: Green Mountain Care Board Convened and Received Update on Health Benefit Exchange

    On May 9th, the Green Mountain Care Board convened to discuss the FY14 Hospital Budget and hear a presentation on updates to the Health Benefit Exchange. Lindsey Tucker, Deputy Commission of the Department of Vermont Health Access delivered the presentation, which provided numerous updates. During her presentation, Ms. Tucker discussed the Navigator program, which has received grant applications from 29 organizations in response to the Exchange’s RFA. Regarding the customer support center, the state signed a contract with Maximus expanding the VT Medicaid Support Center to Exchange customers by adding 70 additional seats and extending hours. The Exchange is also designing tools for small businesses to help employers evaluate their coverage options.
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  • Virginia: Governor Signed Budget Bill Conditioning Medicaid Expansion on Reforms

    On May 3, Governor McDonnell signed into law a budget bill, HB 1500, which could provide for Medicaid expansion under the ACA under certain conditions, effective as early as July 1, 2014.  As a prerequisite to expansion, HB 1500 requires the Department of Medical Assistance Services to continue implementation of existing Medicaid reforms and to pursue and implement additional reforms, including a demonstration program for dual Medicare-Medicaid enrollees, program integrity efforts, service limits, and service delivery reforms.  If a newly created legislative Medicaid Innovation and Reform Commission determines that Virginia has met the specified conditions for Medicaid reform, the bill provides for Medicaid expansion without an additional vote by the General Assembly.
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  • Washington: Health Benefit Exchange Held Multiple Meetings

    During the week of May 6, 4 committees and workgroups of the Washington Health Benefit Exchange (HBE), as well as the HBE Board, convened:

    The HBE also continued its Countdown to Coverage Series Webinar Series with a presentation on Navigators/In-Person Assister Program on May 10th. The goal of the eight-part series is to help consumers understand the upcoming changes associated with the Affordable Care Act and the new options that will be available through the Exchange.

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Federal News

  • CMS & SAMHSA Released Information Bulletin on Implementing Behavioral Health Services for Children and Young Adults

    The Center for Medicare and Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) released an informational bulletin providing guidance to states to assist in the development of health care benefits that meet the needs of children and young adults with significant mental health conditions. In implementing these services, states will meet the requirements outlined in the Americans with Disabilities Act (ADA) and Medicaid’s Early Periodic Screening, Diagnostic and Treatment (EPSDT) benefits.
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  • CMS Released Proposed Rule to Reduce Medicaid Disproportionate Share Hospital Allotments

    The Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would direct the U.S. Department of Health and Human Services Secretary to implement a methodology to determine annual reductions to state Medicaid Disproportionate Share Hospital (DSH) allotments for FY 2014 and 2015 as directed under the ACA. The DSH Health Reform Methodology (DHRM) would take into consideration five factors to generate a state-specific reduction allotment amount. Additionally, the proposed rule would establish additional reporting requirements to implement the new DSH methodology. CMS also released a fact sheet providing an overview of the proposed rule and comments will be accepted until July 12, 2013.
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  • HHS Announced Funding Opportunity for Community Health Centers

    The U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) released a funding opportunity announcement (FOA) for community health centers to receive funding to support outreach efforts on insurance options made available through the ACA and providing eligibility and enrollment assistance to uninsured patients of health centers and residents in their approved service areas.  According to the FOA, HRSA will award an estimated $150 million under the FY 2013 Health Center Outreach and Enrollment Assistance Supplemental Funding initiative to eligible §330 funded community health centers. Applications will be received until May 31st.
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  • IRS Released Proposed Rule on Computation of Medical Loss Ratio

    The U.S. Internal Revenue Service issued a notice of proposed rulemaking and public hearing on proposed regulations providing guidance to Blue Cross and Blue Shield organizations, and other carriers, on computing and applying the Medical Loss Ratio provision as outlined under the ACA. Under this provision carriers are required to use 80% of paid premiums to go towards health care services and 20% to administrative costs. Comments will be accepted until August 12, 2013 and a public hearing will be held on September 17, 2013.
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  • Senator Harkin Removed Hold For CMS Nomination

    Senator Tom Harkin (D-IA), chairman of the Senate Committee on Health, Education, Labor and Pensions, lifted his hold on the nomination of Marilyn Tavenner for the Administrator of the Centers for Medicare and Medicaid Services. Senator Harkin’s hold was put in place due to the U.S. Department of Health and Human Services proposal to withdraw funds from the U.S. Prevention and Public Health Fund to implement provisions of the ACA. According to a statement made by Senator Harkin to President Barack Obama, he stated, “Regrettably, in recent days, the White House has made it clear that it will not reverse course with regard to its raid on the Prevention Fund. I do not want to interfere with the important work of [CMS]. I believe Ms. Tavenner is strongly qualified to be the next CMS Administrator, and that it is urgent to have an effective leader at the helm of CMS as we enter a critical stage in implementing the [ACA]. Accordingly, Mr. President, I am removing my hold on her nomination. However, as I do so, I repeat that it is deeply disappointing and disturbing that this White House apparently does not understand the importance of community-based prevention initiatives.”
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Other Public Coverage News

  • Mississippi: Governor Bryant Said Has Authority to Run State’s Medicaid Agency in Light of Senate’s Failure to Reauthorize

    Following a Senate stand-off over Medicaid expansion and the resulting failure to reauthorize the Medicaid program, Governor Bryant said he will run the state’s Medicaid program if there is no agreement on July 1st.  "As head of the Governor's Division of Medicaid, I will do all I can to continue and to provide Medicaid to the citizens who qualify in the state of Mississippi," the Governor said. He added, "that is my legal argument. If someone wants to challenge me in court, what is their argument?" However, State Attorney General Jim Hood said the Governor does not have the authority to run a government agency, according to the Associated Press. The Governor also noted that he will not hold a special session on Medicaid until he is convinced that Democrats will fund and reauthorize the Medicaid program.
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