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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 21, 2013

Read past weeks' updates

Implementation and Opposition

Federal News

Other Public Coverage News

Will Governor LePage turn a page on Medicaid expansion given the legislature’s recent backing of Medicaid expansion? Last week, two committees voted to incorporate expansion into a bill that will repay Maine’s hospital debt, a top priority for Gov. LePage. Get the full scoop below!

 

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

Implementation and Opposition

  • Arizona: Senate Approved FY 2014 Budget that Includes Medicaid Expansion

    The Republican-controlled Senate approved an $8.8 billion dollar FY 2014 budget that includes Medicaid expansion, according to the Associated Press. The Medicaid expansion plan, which was added as to the budget bill on the Senate floor, includes two new provisions: (1) the plan will expire on January 1, 2017 and (2) hospitals must review their uncompensated care after expansion is in place. Several other proposed additions, including an effort to block the hospital assessment financing mechanism, failed. The budget will next move to the House Appropriations Committee, where the prospects of it passing are unclear.

    The Senate’s budget approval comes on the heels of Brewer’s announcement that she will not sign any FY 2014 budget unless it includes Medicaid expansion provisions. She also told legislators not to send any new bills that do not focus on Medicaid expansion. Brewer’s spokesman Matthew Benson said, “We need them to focus on the budget and Medicaid and deal with these issues before sending any additional bills.”

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  • California: Covered California Hosted SHOP Webinar

    Covered California (California’s Exchange) hosted a May 14th Small Business Health Options Program (SHOP) Advisory Group Webinar to discuss SHOP go-live development highlights including plans to open the SHOP service center by August 2013, as well as key dates for the Exchange agents certification and training. The Exchange’s presentation also outlined the roles and responsibilities of the Exchange’s SHOP Administrator, Pinnacle Claims Management.
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  • California: Covered California Issued RFP for General Agent Services

    Covered California (California’s Exchange) issued a Request for Proposal to obtain services with qualified Health Insurance General Agents interested in providing sales support to agents in Covered California’s Small Business Health Option Program (SHOP).  The maximum amount of the award is $3,000,000 and the deadline for responses is June 11, 2013.
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  • California: Governor Brown Proposed Plans for State-Based Medi-Cal Expansion

    On May 14, Governor Jerry Brown (D) released his 2013-14 May Revision State Budget proposal.  Budget adjustments include plans to pursue a state-based approach for the expansion of Medi-Cal (California’s Medicaid program) for individuals up to 133% FPL. In January, the Governor proposed two options for expanding Medi-Cal: directly enrolling newly eligible Californians in Medi-Cal (the “state-based” approach) or building on counties’ existing health care systems (the “county-based” approach). Other notable adjustments include:
    • An additional $1.2 billion in Medi-Cal spending to implement Affordable Care Act provisions;
    • Plans to provide the newly eligible population with the same benefits as individuals already covered by the program;
    • Plans to cover all cost sharing not covered by the federal advance premium tax credits for pregnant women and the newly qualified immigrants present in the state fewer than five years; and,
    • Plans to keep the 10% cut to Medi-Cal provider reimbursements that currently stalled in litigation.
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  • DC: Health Benefit Exchange Authority Released Notice of Funding Availability for the In-Person Assister Program

    The Health Benefit Exchange Authority released a Notice of Funding Availability for the In-Person Assister Program. The program’s goals are multi-faceted and include: 1) reducing the number of uninsured by raising awareness about coverage options, facilitating enrollment in insurance affordability programs, and promoting the retention of coverage; 2) developing a knowledge workforce to educate consumers and small businesses on their options; and 3) coordinating with related programs and entities. The Request for Application will be released on or before May 24 and the application submission deadline will be 30 days from the date the RFA is issued. The program will make available up to $10 million in funding and the award period will run from July 2013 to December 31, 2014.
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  • Hawaii: Connector Held Board of Director’s Meeting on Exchange Timeline, SHOP and Navigators/ Assisters

    The Hawaii Health Connector held a board meeting to update on the implementation status of various components of the State-based Exchange, including awarding a contract for the call center, developing notices, establishing an appeals process, and integrating business operations for the eligibility & enrollment system. Additionally, the board reviewed a presentation on the development of the employer/employee choice model for the Small Business Health Options Program (SHOP), and an overview of the role of navigators, assisters, and application counselors and how they will be funded.
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  • Iowa: Department of Human Services Announced Public Hearings and Comment Period on Healthy Iowa Plan

    The Iowa Department of Human Services announced that it will hold four public hearings on June 3 and June 4 and will open a 30-day comment period on Governor Branstad’s alternative Medicaid Expansion proposal, the Healthy Iowa Plan. The Healthy Iowa Plan would replace the state’s 1115 IowaCare program, set to expire on December 31, provide coverage to individuals 19 to 64 years of age that are at or below 100% FPL, and require beneficiaries to contribute monthly payments (no more than 5% of their household income) to their "My Health Rewards" accounts to help pay for premiums and services to adopt preventative habits (e.g., smoking cessation services, nutrition counseling).

    The Iowa Democratic-Senate Conference Committee is currently reviewing a bill (SF 296), which they originally passed in March to expand Medicaid Expansion under the ACA.  The Republican-controlled House amended the bill in May, striking the proposal and replacing it with language to implement the Healthy Iowa Plan.

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  • Maine: Two Committees Voted to Recommend Medicaid Expansion Inclusion in Hospital Repayment Legislation

    Maine’s Legislature’s Joint Health and Human Services Committee voted 10-4 to recommend incorporating Medicaid expansion into a bill that will repay Maine’s hospitals a debt of $484 million, a top priority for Governor LePage.  The Health and Human Services Committee sent a letter of recommendation with the legislation to the Legislature’s Veterans and Legal Affairs Committee, where the bill was then approved 7-5. Linking Medicaid expansion to the hospital debt payback has been longstanding issue between the Governor and Democratic leadership, but these votes were the first procedural actions to tie the two together.
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  • Maryland: Exchange Advisory Board Met to Discuss Participating Insurers and Coverage Options for Pregnant Women

    The Maryland Health Benefit Exchange Advisory Board met to discuss a range of issues on May 15.  In an update on carrier participation in the Exchange, Tequila Terry, Director of Plan and Partner Management, indicated that Aetna, CareFirst, Coventry Health Care, Evergreen Health Cooperative, Kaiser Permanente, and UnitedHealthcare have submitted applications and been authorized to offer coverage.  Jesse Kopelke, Special Assistant for the Exchange, informed the Board that the Department of Health and Mental Hygiene (DHMH), in consultation with Exchange staff, had decided to require that pregnant women between 138% and 250% of the federal poverty level (FPL) transfer from Qualified Health Plans (QHPs) on the Exchange to Medicaid during their pregnancy and 60 days postpartum.  Other issues discussed included interim producer appointment procedures, the launch of the Exchange’s social media campaign in early June, IT, and public comments and Exchange staff recommendations on the role of web-based producers.
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  • Michigan: Senate Failed to Pass Medicaid Expansion Budget Plan

    On May 16, the Senate passed Department of Community Health Budget Bill, SB 198. The bill does not include Governor Snyder’s proposed allocation of $1.3 billion to expand Medicaid eligibility to individuals at 133% FPL, estimated to cover an additional 320,000 Michiganders in 2014. SB 198 will next go to the Appropriations Committee or the House floor. Although both state budget bills—HB 4328 and SB 198—do not include Medicaid Expansion, the expansion remains a possibility with 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."  HB 4714 is currently under review by the Committee on Michigan Competitiveness.
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  • Minnesota: MNsure Board Held First Meeting

    On May 17, the board of directors of MNsure, Minnesota’s state-based Exchange, held its first meeting.  Topics discussed included the transfer of authority to the board, the board’s governance approach, and the election of a Chair and Vice-Chair of the board. The board members were announced on April 30.
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  • Nebraska: Governor Approved Exchange Transparency Bill

    After a 47-0-2 approval by Nebraska’s unicameral legislature, Governor Heinman (R) approved LB384, the Nebraska Exchange Transparency Act. LB384, which was introduced in January, aims to: “provide state-based recommendations and transparency regarding the implementation and operation of an affordable insurance exchange” through the creation of the Nebraska Exchange Stakeholder Commission. The Commission would be tasked to “work with state and federal agencies and policymakers to provide recommendations regarding implementation and operation of the exchange,” create advisory groups, and produce an annual report. Nebraska’s Exchange will be federally facilitated, although the state will be conducting plan management functions.
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  • Nevada: Silver State Exchange Board Held Meeting

    The Nevada Silver State Exchange Board met on May 16. The board considered whether it should allow dental benefits to be embedded in QHPs or if it should prohibit them and whether the purchase of standalone dental should be required on the Exchange when an individual purchases a QHP that does not include dental benefits.
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  • New Mexico: Health Insurance Exchange Board Met to Discuss Next Steps of Implementation

    The New Mexico Health Insurance Exchange board held their second meeting to move forward with implementation.  The board voted to solicit a marketing firm to assist with a $20 million marketing, community outreach and educational campaign.  The board also voted to work with a contract attorney to assist with the initial six-month startup period. 
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  • New Mexico: Legislative Finance Committee Released Reports Discussing Implications of Expansion due to ACA

    The Legislative Finance Committee released two reports describing: 1) the effects of Medicaid expansion and Exchange coverage on patient access to care and 2) shifting of costs and utilization from non-Medicaid programs to Medicaid.  The report titled “Adequacy of New Mexico’s Healthcare Systems Workforce” states that the addition of 172,000 currently uninsured individuals will exacerbate New Mexico’s primary care provider shortage problem, and includes recommendations regarding workforce planning, recruitment, and training to help mitigate the problem.  The report titled “Cost and Outcomes of Selected Behavioral Health Grants and Spending” indicates that Medicaid expansion will lead to a shift in behavioral health services currently provided by the Behavioral Health Services Division to the Medicaid program, and suggests evaluating allocation of funds for the two programs as a result.
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  • New Mexico: NMHIX Board Voted to Switch from State-Based Marketplace to Bifurcated Model

    The New Mexico Health Insurance Exchange (NMHIX) board voted to alter the current plan of running a state-based exchange to an alternative partnership with the Federal government, similar to the approach recently approved in Utah.  The state will continue to operate the small business health options program (SHOP) Exchange, and will use a federally operated exchange for individuals in 2014.  Dr. J.R. Damron, chairman of the NMHIX board, stated that New Mexico would need more time to establish a computer system capable of enrolling consumers in the individual marketplace.
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  • New York: Exchange Held Webinar and Released FAQ Document for Agents and Brokers

    The New York Health Benefit Exchange held a webinar to update agents and brokers on the Exchange’s workflow, the Healthy NY program, and broker training and certification requirements.  Enrollment in Healthy NY, a state-supported private insurance program, will be limited to small businesses beginning in 2014, not individuals or sole proprietors.  Training for agents and brokers selling coverage in New York’s Small Business Health Options Program (SHOP) will begin in early August.  Manatt Health Solutions provided an overview of small business tax credits available under the ACA.  The Exchange also released a Frequently Asked Questions document for agents and brokers covering topics including carrier Exchange participation, commissions and contracting, employer SHOP eligibility, enrollment periods, and Navigators.
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  • Pennsylvania: Administration Announced Medicaid Expansion Would Not Occur Before January 2015

    Facing pressure from Democrats in the legislature to decide on Medicaid expansion, acting Secretary of the Department of Public Welfare, Beverly Mackereth issued a statement that even if Governor Corbett does decide to expand Medicaid eligibility, implementing the program would likely take until 2015.  "If everything goes right, and everything is agreed to, and the governor decides that the plan is sustainable and responsible for [Pennsylvania], the earliest that I'm hearing today -- very ambiguous, and please print it that way -- probably would be January 2015," she said. "And those are huge 'ifs.'” According to her department, an additional 643,000 adults would qualify Medicaid under expansion.
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  • Utah: Health System Reform Task Force Met to Discuss Dual-Exchange Model Implementation

    The Health System Reform Task Force met for the first time since last year to discuss implementation of the dual-model Marketplace approved by the Department of Health and Human Services (HHS) last week.  Patti Conner, director of the state's existing small business health insurance exchange, informed the Task Force that Avenue H, the State’s online marketplace, would require an overhaul to comply with federal regulations.  Updates would include updating the technology, developing a Spanish-language website, and incorporating two navigators for consumer assistance.
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  • Vermont: Exchange Awarded Maximus Call Center Contract

    Vermont Health Connect announced that Maximus was awarded the State’s contract to operate the health exchange call center to help individuals enroll in Medicaid and other public programs. The contract, worth $12.5 million, runs May 1, 2013 through June 30, 2014 and includes a one-year renewal option. Mark Larson, commissioner of the state’s health access department, commented, “Vermont Health Connect offers a new way for Vermonters to choose a health insurance plan that meets their needs and budget.” The call center expects to handle 260,000 customers and will work with navigators, registered brokers, and other stakeholders to help citizens sign up for coverage. The call center will also help customers determine their eligibility for premium subsidies.
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  • Vermont: Legislature Passed Bill to Provide Marketplace Financing and Create an Office of the Health Care Advocate

    On May 14, the Legislature passed bill H. 107, which began the legislative session as a streamlining of the state’s health insurance rate review process but became the vehicle for financing the operation of the Marketplace.  The bill also would create the Office of the Health Care Advocate to replace the Health Care Ombudsman’s Office, streamline the health insurance rate review process, and create a pilot program to test out the absence of prior authorizations. H. 107 is now with the Governor, who is expected to sign it.
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  • Washington: Health Benefit Exchange Board and Committees Held Multiple Meetings

    During the week of May 13, the Health Benefit Exchange Board and its Committees held nine meetings. Highlights from five included the:

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Federal News

  • CMS Announced Funding Opportunity for Second Round of Health Care Innovation Awards

    The Centers for Medicare and Medicaid Services announced a second round of funding for the Health Care Innovations Awards. The second round of the initiative will issue nearly $1 billion in awards and evaluation projects geared towards new payment and service delivery models aimed to enhance quality of care and lower costs for state Medicaid and Children’s Health Insurance Programs (CHIP). Letters of intent will be accepted until June 28 and applications are due August 15.
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  • CMS Released Guidance on Facilitating Medicaid & CHIP Enrollment and Renewal in 2014

    The Centers for Medicare and Medicaid Services released a letter to state health officials and Medicaid Directors providing five suggested target strategies to help facilitate enrollment and renewals for state Medicaid and the Children’s Health Insurance Program (CHIP) in 2014. One strategy included granting states the option to begin using the Modified Adjusted Gross Income (MAGI) methodology for open enrollment on October 1 to avoid needing to operate two sets of eligibility rules.


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Other Public Coverage News

  • Missouri: Departure of Medicaid Director Announced

    According to the Associated Press, Ian McCaslin, Missouri’s Medicaid Director as appointed by former Governor Blunt (R) in August 2007, confirmed that he has left his position as Medicaid Director and will be replaced in the interim by Jennifer Tidball, previously the Director of the Department of Social Services financial aid and administration services division. A memo from the Department Director Alan Freeman circulated stated that the agency would engage in a national recruiting effort to fill the position.
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  • West Virginia: Medicaid Announced Some Medicaid Beneficiaries to Pay Co-Pays

    West Virginia has indicated it will expand its use of co-pays in Medicaid – currently imposed on some prescriptions – to additional services and beneficiaries.  Details are emerging and the State is awaiting final federal regulations.
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