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Affordable Care Act: State Action Newsletter

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February 25, 2011

Feds Approve Minnesota’s “Early Expansion” of Medicaid

Minnesota belongs to a small group of states that have health insurance programs for low-income adults that are funded by state money (no federal match). These programs are increasingly at risk given the budget gaps that states are facing. 

Funding for Minnesota’s General Assistance Medical Care program, which provides coverage for low-income childless adults who are not eligible for Medicaid, is in jeopardy. Instead of cutting the program, Gov. Dayton asked for and received approval from CMS to enroll about 95,000 people who are currently either in state health care programs or who have no health insurance into the Medicaid program where the state can draw down a federal match to help with funding. 

The ACA allows states to expand Medicaid to people with incomes up to 133 percent of poverty “early”, beginning on April 1, 2010, through the state plan amendment process. This option allows states to draw down federal funds for coverage that was previously paid for with state-only money. Early expansion is available to all states, although with the budget shortfalls that many states are facing, it may only be attractive to the small number of states that are already providing coverage for this population through state-funded programs. Expanding Medicaid early does not affect a state’s ability to receive the higher matching rate for newly eligible populations beginning in 2014.

To date, Connecticut, Washington and the District of Columbia have also received approval and are enrolling people in early expansion programs. However, not every state with state funded programs are opting for the Medicaid expansion. 


States Return Federal Grants After Florida Judge Ruling

On Feb. 17, the U.S. Department of Justice motioned for Judge Vinson to clarify his order declaring the Affordable Care Act’s individual mandate unconstitutional. The Department of Justice specifically requested clarification on whether government agencies and employees were “relieve[d]...of their rights and obligations under the Affordable Care Act.”

In response to the ruling, a few states have returned, or are discussing returning, some of the federal funding made available through provisions in the law or have chosen not to apply. As of February 23, a total of $3,219,508,190 in federal awards has been distributed to all 50 states through the ACA.

The following are examples of states returning or not applying for federal grants:

• Alaska Governor Sean Parnell elected not to apply for federal funds to establish a health insurance exchange.

• Florida Governor Rick Scott returned $1 million that was awarded to the state to begin implementation planning for health insurance exchanges and another $1 million that would have funded a system to monitor premiums and insurance-rate changes.

• New Hampshire’s House Republican leaders asked the Executive Council to block a $610,000 federal planning contract that would use federal grant funds to create a state health insurance exchange shortly after the Legislative Fiscal Committee voted 9-1 to accept it.

• Wisconsin Governor Scott Walker returned a $637,114 federal “consumer assistance” grant.

Each of these states has accepted and not returned other ACA-related federal grants. For example, Wisconsin was recently awarded an HHS “Early Innovator” grant for $37,757,266, to help design and implement the information technology infrastructure needed to operate health insurance exchanges.
 

Inside This Issue




 


 

“Early Innovator” States Chosen

On February 16, 2011, HHS awarded seven cooperative agreements to a total of 11 states to design and implement the information technology needed for state-based health insurance exchanges to conduct the eligibility and enrollment activities required by the ACA. Approximately $241 million in federal funding will be awarded to Kansas, Maryland, New York, Oklahoma, Oregon, Wisconsin, and a multi-state consortium led by the University of Massachusetts Medical School, which includes Connecticut, Maine, Massachusetts, Rhode Island and Vermont. These “early innovators” plan to develop models that can be adopted by other states, who can tailor them to their individual state’s needs.  

       

CMS Releases Proposed Rules for Health Care-Acquired Conditions

On Feb.17, the Centers for Medicare and Medicaid Services released proposed rules for nonpayment for health care-acquired conditions (HACs) under the Medicaid program. The statute gives great leeway to the secretary of health to develop rules that allow the incorporation of practices determined to be appropriate for application to the Medicaid program in regulation. Under the proposed rules, states will be required to:


• Identify additional “provider preventable conditions,” requiring health acquired conditions to be the minimum. Establish systems for self reporting of PPCs and HACs.

• Submit revised state amendment plans by July 1, 2011.

There are 17 states that have already established Medicaid nonpayment policies.


HHS Responds to Request for Flexibility from the States

On February 24, HHS Secretary Kathleen Sebelius sent a letter to a group of 21 governors in response to their request for flexibility in implementing the ACA. Specifically, they requested state flexibility in 1) operating exchanges, 2) determining essential health benefits that participating plans must offer, 3) waiving ACA provisions that might inhibit the availability of consumer-driven plans and health savings accounts, and 4) enrolling Medicaid beneficiaries into private plans without HHS approval. Sebelius wrote, “The Affordable Care Act is built on the belief that states understand their health insurance markets better than anyone else. As such, it puts the states in the driver's seat to lead the process.” She outlined the improved opportunities for states in each of these four areas compared to the current marketplace allowing states “broad flexibility to capitalize on those opportunities in reshaping state marketplaces for the 21st century.” The letter pointed out the broad discretion given to states in the ACA in operating their exchange including the ability to seek a waiver for state innovation (Section 1332—additional guidance is forthcoming.) Read the letter for more details.


Some States Get Waivers Allowing Insurance Benefit Limits

The Affordable Care Act sets a nationwide minimum annual dollar limit for covered health services. Under HHS regulations, plans offered between September 2010 and September 2011 may not limit annual coverage of essential benefits such as hospital, physician and pharmacy benefits to less than $750,000.

In February, it was announced that Florida, Massachusetts, New Jersey, Ohio and Tennessee, received waivers allowing health insurance companies to continue offering less generous annual limits on benefits. In these cases, existing state law already mandates that policies with lower annual limits on coverage be offered. The Center for Consumer Information and Insurance Oversight (CCIIO), explained that because “limited benefit plans, or mini-med plans, are often the only type of insurance offered to some workers,” the one-year waivers allow continuity.

The February list of Approved Applications for Waivers includes a breakdown of about 90,000 enrollees in three states. HHS waivers are reviewed on a case-by-case basis by department officials based on whether “a premium increase is large or if a significant number of enrollees would lose access to their current plan because the coverage would not be offered in the absence of a waiver.”


Announcements

  • NCSL recently concluded its six-part webinar “States Implementing Health Reform” series. Visit NCSL’s web site to listen to the audio archives and download the powerpoint presentations.  

 

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