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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!

 

Let’s tip our caps to the Capital! D.C. Health Link extended its enrollment deadline to April 30 for folks who couldn’t finish before March 31. The District is also continuing to offer in-person assistance at locations throughout the area. Find out what the rest of the nation is up to with KidsWell’s state-by-state health reform highlights below!


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

Implementation and Opposition

  • Arkansas: Insurance Department Released 2015 Plan Management Guidance

    The Arkansas Insurance Department released a bulletin providing plan management guidance for issuers intending to offer plans on the state’s Partnership Marketplace in 2015. The bulletin addresses the timeline and standards for qualified health plan (QHP) certification, including network adequacy, cost sharing, and requirements regarding participation in the Health Care Independence Program (the Private Option).
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  • California: Covered California Board Discussed Final Enrollment Numbers, Benefit Design Issues and Plan Management Issues

    The Covered California (California’s State-Based Marketplace) Board discussed final enrollment numbers for the Marketplace’s first open enrollment period, approved 2015 plan designs, and discussed plan management issues. Peter Lee, Covered California’s Executive Director, noted that nearly 1.4 million Californians enrolled through the Marketplace by April 15, of which approximately 1.2 million individuals enrolled in subsidized plans. Mr. Lee also noted that more than 1.9 million individuals enrolled in Med-Cal (California’s Medicaid program), including approximately 650,000 individuals who transitioned from the state’s Low Income Health Program. Finally, the Board approved plan designs for 2015 and discussed the process for certifying and recertifying qualified health plans for the next open enrollment period.
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  • Colorado: C4HC Board Discussed Providing Non-QHP Insurance Products

    The Connect for Health Colorado (C4HC) Board reviewed materials and discussed the necessary authority for the Marketplace to establish a public benefit corporation for the purpose of providing non-QHP insurance products to Coloradans. According to an assessment prepared for C4HC, Colorado would not require legislation to establish this separate legal structure that would offer ancillary services and segregate state-sourced and federally-sourced funds. During this meeting, Board members also received presentations on marketing and outreach efforts, C4HC operational plans and timelines, and managing individuals churning between public and private health insurance coverage.
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  • D.C.: Exchange Extended Enrollment Deadline, Offered In-Person Health Insurance Assistance

    The D.C. Health Link announced a further enrollment extension for consumers who were unable to complete the application process by March 31.  D.C. residents who need help applying or started their applications online now have until April 30 to complete their enrollment. The Exchange will continue to offer in-person assistance at several locations throughout the District.
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  • Georgia: 150,000 Georgians Effectuated Marketplace Coverage

    According to a press release, Insurance Commissioner Ralph Hudgens reported that Georgia insurers had received 221,604 applications for insurance through the federally-facilitated Marketplace, as of March 31.  Insurers received premiums effectuating coverage for 107,581 policies covering 149,465 individuals; 104,242 of those individuals will receive subsidized coverage.  According to the press release, the Insurance Department surveyed the five insurers offering Marketplace coverage to gather the data.
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  • Hawaii: Exchange Extended Open Enrollment Until April 30

    The Hawaii Health Connector extended the enrollment grace period from April 15 to April 30.  As of April 12, the Connector completed 8,182 enrollments in the Individual Marketplace and 563 employers applied to the SHOP Marketplace.  The Customer Support Center received nearly 100,000 calls, while more than 265,000 individuals visited the Connector’s website.
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  • Maine: Lawmakers Approved Final Medicaid Expansion Attempt

    The Maine Legislature approved a final attempt to expand Medicaid coverage, passing a measure that would expand Medicaid for one year in the state while seeking a waiver from the federal government to use federal funds to purchase private insurance.  Should a waiver not be attained, the expansion would end. The House and Senate both passed LD 1578. The Governor is expected to veto, as with prior attempts.
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  • Maryland: Board Received Updates on IT Migration and Enrollment Extension

    The Maryland Health Connection Board received an update and proposed timeline for the transfer to the Access Health CT IT infrastructure that indicated the new system will be ready for the next open enrollment period. For the extension to the current enrollment period, Marketplace staff reported 18,679 individuals have registered for the "May 1 Coverage Campaign" and 4m000 individuals have enrolled through this campaign. The Marketplace Board also discussed 2015 plan certification standards, a reinsurance program proposal, and $49 million in deficiency funding the Marketplace received.
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  • Minnesota: MNsure Allowed Consumers with Technical Issues to Enroll Until April 22

    On March 24, MNsure announced the state will  be allowing consumers to enroll after the March 31 deadline as long as they either: complete an MNsure Enrollment Attempt Form; submit a paper application to DHS or county agency; have met with an in-person assistor prior to March 31; contacted the MNsure contact center regarding enrollment; e-mailed MNsure; and/or submitted an appeal. MNsure announced that consumers who completed the online enrollment attempt form have until 11:59 pm on April 22 to choose a Qualified Health Plan (QHP) or will be contacted with next steps by the Minnesota Department of Human Services if they are determined eligible for Medicaid. As of April 14, MNsure has processed more than 36,000 Enrollment Attempt Forms and determined 31,854 reflect genuine enrollment attempts.
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  • Minnesota: MNsure Discussed Updated Budget and New Lead IT Vendor

    The MNsure Board of Directors met to discuss the 2014 budget spending report by business area and an update from MNsure’s new lead IT vendor, Deloitte. The board also discussed: the role of the Minnesota Department of Human Services and their proposed interaction with MNsure by county, the proposed operating model and strategic imperatives for MNsure’s new Health Industry Advisory Committee, updates to MNsure’s proposed delegation of authority policy, and updated enrollment numbers and other metricsDraft minutes from the March 26 Board meeting were also made available.
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  • Missouri: Governor Launched Medicaid Expansion Website

    Governor Jay Nixon launched a new website, which shows how Missouri tax dollars are supporting Medicaid expansion in other states. The "We Paid For It" website is part of the Governor’s ongoing efforts to urge the State Legislature to expand Medicaid.
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  • Montana: Battle over Proposed Medicaid Expansion Ballot Initiative Continued

    The battle over Montana’s proposed ballot initiative for Medicaid expansion continued when Montana’s Supreme Court ruled that proponents of I-170, the proposed measure, can continue gathering voter signatures to put the item on the ballot in November according to the Associated Press. Opponents had filed a court order alleging that the fiscal note in the proposed language was incorrect. If the court had ruled in favor of the plaintiffs, the 2,000 signatures already collected would have been invalidated. Opponents of the Affordable Care Act are collecting signatures for a separate ballot initiative, I-171, which aims to prohibit the state from expanding its Medicaid program, creating a state-based Marketplace, and spending state funds to implement the Affordable Care Act.
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  • New York: 960,762 New Yorkers Signed Up for Coverage through NY State of Health

    NY State of Health, the state-based Marketplace, reported that 1,319,239 New Yorkers have submitted applications for coverage through NY State of Health, and 960,762 have signed up for coverage at the close of open enrollment.  According to the Associated Press, about 525,283 were determined eligible for Medicaid and 435,479 selected private health plans.  Over 94,000 New Yorkers signed up for coverage after March 31.
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  • Oregon: Cover Oregon Determined Two Paths Forward, Accepted Goldberg Resignation, and Hired Turnaround Consultant

    According to the Washington Post, Cover Oregon determined that it would either either switch to the federal exchange or stay with its current technology and hire a new contractor to fix it, ruling out the option to purchase another state’s Marketplace technology. The Cover Oregon Board formally accepted interim Executive Director Bruce Goldberg’s resignation effective immediately. The board also hired turnaround consultant Clyde Hamstreet to take over the director’s duties while the search for a permanent replacement continues.
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  • Washington: Operations Committee Discussed Latest Enrollment and Future IT Updates

    The Washington Health Benefit Exchange Operations Committee met to discuss the latest enrollment updates and four expected systems releases between Spring 2014 and Winter 2015.  Notably, the summer release will focus on APTC auto-enrollment for fall open enrollment and the winter release will focus on Medicaid plan selection.  As of March 31, the Exchange completed 147,000 Qualified Health Plan enrollments, while Medicaid enrolled 268,367 newly eligible, 135,485 previous eligible but not enrolled, and completed 408,086 redeterminations.
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Federal News

  • CBO Lowered Estimate of ACA Coverage Expansion Costs

    The Congressional Budget Office (CBO) estimated that over the next 10 years, the ACA’s expansion of health insurance coverage will cost $104 billion less than originally projected, largely because of the  slowdown of healthcare costs and lower-than-expected premiums. The cheaper premiums are primarily due to narrower networkers, lower payment rates for providers, and more care management. CBO also expects the federal government to see reduced savings of $61 billion for certain provisions  it delayed or reduced in scope, such as the individual and employer mandates and the excise tax on high-cost plans. Notwithstanding the new figures, the CBO did not provide an updated estimate on whether the ACA would overall reduce federal deficits, which was last affirmed in July.
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  • CMS Released Guidance Clarifying Family Planning and Family Planning Related Services

    In a State Medicaid Director letter, CMS clarified coverage provisions under the optional family planning-related services group, as provided by the ACA. Effective immediately, diagnosis and treatment of sexually transmitted infections will be eligible for Medicaid as family planning related services, regardless of whether family planning was the initial intent of the visit, and contraception visits for men will be treated as a family planning visit, equivalent to how it is treated for women.
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  • President Obama Announced 8 Million Have Signed Up for Marketplace Coverage

    Two days after the extended enrollment period came to a close, President Obama announced that 8 million individuals have signed up for private health coverage through federal- and state-run health insurance Marketplaces, claiming a big win for his signature law. The numbers exceed by 2 million the Congressional Budget Office’s projected enrollment figures, but insurers have questioned whether the percentage of young adult signups – coming in at 28% of total enrollees -- will offset costs brought by older, sicker enrollees.  The Obama Administration has noted that the 8 million tells only part of the story; firstly, it does not include coverage gained through Medicaid/CHIP, private exchanges, and other provisions, and secondly, it does not detail the proportion of enrollees who have paid their first premium.
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Other Public Coverage News

  • Florida: CMS Extended Low Income Pool for One Year

    According to a press release from the Agency for Health Care Administration, Florida reached an "agreement in principle" with CMS to extend the State's Low Income Pool (LIP), which provides support for safety net providers delivering uncompensated care to the Medicaid, underinsured and uninsured populations, for one year. A letter from CMCS Director Cindy Mann outlined the terms of the agreement reached to date. According to the Miami Herald, a spokesman for U.S. Senator Bill Nelson (D), who supports Medicaid expansion, suggested that the one-year limit was intended to incentivize Florida to expand, rather than rely on continued LIP funding.
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  • Minnesota: Department of Health Issued Request for Proposals to Support State Development of Accountable Health Care Model

    The Minnesota Department of Health (MDH) released a request for proposals for an organization to develop and distribute e-health “road-maps” for accountable care delivered in the following settings: long-term and post-acute care, local public health, behavioral health, and social services. Each road-map will contain a framework for how provider entities can use e-health to participate in the state’s accountable health care model. Up to $600,000 is available for this contract. Proposals are due to MDH on June 19, 2014.
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  • New Hampshire: Medicaid Enhancement Tax Deemed Unconstitutional

    County Superior Court Judge Philip Mangones issued a ruling that deemed the New Hampshire Medicaid Enhancement Tax as unconstitutional, citing that the tax – 3% of hospital revenues – treats hospitals differently from other providers that provide many of the same services. Up until 2010, the tax was returned to the hospitals via charity care payments and federal matching payments.  However, due to significant budget issues, the state began to move some of the tax revenue into the general fund, prompting the lawsuit from providers according to the Concord Monitor. The Governor and Attorney General have not made a decision on whether to appeal. The ruling will likely leave a $145.9 million hole in the state’s biennial budget.
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  • North Carolina: Medicaid ACO Implementation Estimated to Save $1 Billion Over Five Years

    Governor Pat McCrory estimated North Carolina could save $1 billion over five years if the Medicaid Accountable Care Organization (ACO) reforms are implemented.  If the state legislature approves the reforms and CMS approves the associated waivers, plan solicitation would begin in late 2014 and Medicaid beneficiaries would begin enrolling in ACOs in July 2015. North Carolina plans to ramp-up ACO enrollment with 40% of beneficiaries enrolled in ACOs by 2016 and 80% by July 2018 if the program proves.
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  • Texas: Medicaid Agency Released RFP for STAR Health MCO

    The Texas Health and Human Services Commission (HHSC) released a Request for Proposals (RFP) to contract with a Managed Care Organization to manage a statewide STAR Health Program, which provides comprehensive health coverage to the state’s foster care youth. HHSC’s mission is to 1) ensure continuous delivery of integrated physical and Behavioral Health Services, centralize Service Coordination, and effectively manage healthcare data and information; 2) ensure the STAR Health population is provided with a consistent source of healthcare through a Medical Home; and 3) continue to improve health care outcomes for children in foster care through enhanced quality of services. Proposals are due June 13, 2014.
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  • Vermont: Governor Shumlin Dismissed Memo Developed by Consultant on Alternative Financing for Single-Payer Health System

    Governor Peter Shumlin (D) dismissed a concept memorandum drafted by health care economist Ken Thorpe, hired by the Vermont Legislature earlier this year, that proposes relying on state and federal subsidies and the existing insurance system as an alternative to a single-payer system. According to VPR News, Shumlin said that Thorpe’s ideas are based on “a failed model of health care financing” given that it suggests raising taxes too high such that low-middle income Vermonters won’t be able to pay for rising health insurance premiums. Shumlin still plans to present his proposal to fund the single-payer system next year.
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