Affordable Care Act: State Action Newsletter

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May 20, 2011

North Dakota and Virginia Intend to Establish Health Insurance Exchanges

At least 35 states have decided whether to establish a health insurance exchange as addressed in the Affordable Care Act or whether to study related issues. Although some states are considering the governance and structure of their exchange, such as who will serve on oversight boards and which entity will run the exchange, a few states have taken different approaches. Lawmakers in North Dakota and Virginia adopted legislation to create state-based exchanges, without determining a lot of specifics on the structure and governance. Both states provide deadlines and assign entities (such as health and insurance agencies) to provide detailed recommendations about governance and structure that will be reviewed within the next couple of legislative sessions.

The North Dakota insurance commissioner and the Department of Human Services are responsible for a large portion of the planning and development of health benefit exchanges in the state. The commissioner and the department will work together and collaborate with appropriate contractors, agencies and the legislature to ensure that an exchange is up and running by Jan. 1, 2014. They will provide periodic updates to a legislative management team. Because the North Dakota Legislative Assembly meets every other year, if legislative action is required before Jan. 1, 2013, the commissioner and department are required to submit legislation for consideration during a special session. For any action needed after Jan. 1, 2013, the commissioner and department must propose legislation by Oct. 15, 2012, for the 2013 session. 

Lawmakers in Virginia created a state-based exchange to avoid a federally run one. Under their law, the governor and the secretary of Health and Human Resources will work with the General Assembly, experts and others to recommend a structure and governance of the exchange. The governor’s recommendations will be presented to the General Assembly by Oct. 1, 2011, allowing time for related bills to be considered during the 2012 session. 

States to Address “Dual Eligibles”

“Dual eligibles” (people who are eligible for both Medicare and Medicaid) are among the most chronically ill and costly individuals enrolled in both programs because many of them suffer from several chronic conditions and require long-term care. For states, Medicaid spending on these people is on average more than six times higher than on adult Medicaid beneficiaries who are not disabled.

The Federal Coordinated Health Care Office and the Center for Medicare and Medicaid Innovation (Innovation Center) recently selected 15 states—Calif., Colo., Conn., Mass., Mich., Minn., N.Y., N.C., Okla., Ore., S.C., Tenn., Vt., Wash and Wis.—to receive up to $1 million each through the Affordable Care Act to design integrated care models for this population.

According to the Innovation Center, the states will design a plan for providing “person-centered” care that “coordinates primary, acute, behavioral and long-term supports and services for dual eligible individuals.”

In addition to containing costs and providing better care, CMS officials hope this initiative will lead to the “elimination of unnecessary and inefficient conflicts in the regulatory, statutory, and policy requirements of the two programs, where feasible.”

For more information, read the CMS Fact Sheet on Dual Eligibles.

North Carolina Addresses Safety Net in Health Reform Workgroup

North Carolina’s Health Reform Advisory Committee has eight workgroups each focused on a specific health reform topic. One is charged with analyzing the new federal requirements for safety net providers, exploring the effects of health reform on the state’s unmet health needs, and identifying opportunities for community-based, collaborative networks of care.

In March 2011, the North Carolina Health Reform Advisory Committee issued an interim report that included a description of the ACA provisions aimed at strengthening access to safety net providers. Some of these provisions include:

• A total of $9.5 billion over five years to expand the number of federally qualified health centers, the array of services they provide and the number of people they serve, and $1.5 billion for construction and renovation.
• New requirements in order for charitable hospitals to maintain their tax-exempt status, including conducting an assessment of the needs of their communities and how they might help meet those needs.
• An appropriation for new competitive grants to help establish regional systems of trauma care and emergency response and expand emergency services for children.
• An expansion of the 340B discount drug program, started on Jan. 1, 2010, which provides deeply discounted prescription drugs for certain types of safety net providers, including children’s hospitals, free-standing cancer hospitals, critical access hospitals and sole community hospitals.
• An appropriation of $50 million for capital expenses to expand school-based health centers between FY 2010 and FY 2013.

Chris Collins, co-chair of the Safety Net Workgroup and Deputy Director of the Office of Rural Health and Community Care in North Carolina says, “The workgroup is currently assessing the infrastructure and community needs related to the health safety net in order to move forward with recommendations for 2014 and beyond.”

The Safety Net Workgroup is scheduled to meet on Monday, May 23 to address prescription drug issues.

New York Releases Report on Coordinating Medicaid and Exchanges

With support from the NYSHealth Foundation, New York’s United Hospital Fund released the second of a five-part report series. “Coordinating Medicaid and the Exchange in New York” identifies five areas o for integration between Medicaid and the exchange: eligibility and enrollment; renewals and transitions; information systems; consumer communications; and challenges associated with aligning the plans, networks and benefits offered.

The first report, “Building the Infrastructure for a Health Benefit Exchange: Key Decisions for Policymakers” was released in January and focused on the governance and organizational options the state has in designing an exchange. For a complete list of state reports related to federal health reform, visit NCSL’s State Reports and Research web page.