|
|
|
|
|
Patient Protection and Affordable Care Act: State Action Newsletter
Nov. 9, 2012
|
Breaking News: Exchange Deadline Extended
States have more time to submit a blueprint for their state-run exchange. The details or blueprint will be due to the federal government on Dec. 14, which gives states an extra 28 days, according to a letter sent to governors by U.S. Health and Human Services Secretary, Kathleen Sebelius, on Nov. 9. The deadline for informing the federal government of the state’s intentions related to a state-run exchange remains Nov. 16. “We have heard from many states that additional time would allow you to submit a more comprehensive, complete blueprint application for your exchange,” said Sebelius. In addition, declaration letters and blueprint applications for State Partnership Exchanges will be accepted on a rolling basis with a final deadline of Feb. 15, 2013.
Election Wrap-up: What the Results Mean for Federal Health Reform Law
After months of campaigning and election spending into the billions, political control of the federal government remains unchanged. At the highest levels, it seems, little about PPACA will change.
What state legislators hope comes from the federal government in abundance—and soon—are details. Florida Representative Matt Hudson, Co-Chair of NCSL’s Standing Committee on Health said, “It is difficult for states to make decisions about how to proceed when the federal government has not yet determined how it will proceed.”
Delegate Don Perdue from West Virginia, the other co-chair, agreed: “[States] need better guidance on the rules that will be applied. And at the same time, [the feds] can’t get so bogged down in political banter that states are insecure about the rules and their application, or how long they may be in effect.”
States have the lion’s share of the work to do and decisions to make about implementation. State politics will make a difference. Post-election shifts in political control were about average for an election year, in contrast to the landslide victories Republicans achieved in state legislatures two years ago, when Republicans gained 24 chambers. On Election Day, Democrats took back 12 of the 24 chambers, while the Republicans gained four others. In 2013, 30 states will have Republican governors. According to preliminary date, Republicans will control 26 state legislatures, Democrats 14 and four states will have split party control between chambers. Nebraska’s unicameral legislature is bipartisan. For comprehensive coverage, see NCSL’s State Vote.
The most immediate PPACA deadline is Nov. 16, when states must declare if they want to operate the exchange(s). More deadlines cascade after that. Several states took a “wait and see” approach toward planning. But even states resisting implementation know they will have to address PPACA soon. Representative Hudson said, “Florida will have to make decisions about an exchange, Medicaid expansion, insurance regulation and the state employee group plan. The Legislature may make affirmative choices, or may take no action – both are decisions.”
It is not likely that states without a process well underway for establishing an exchange will meet the PPACA’s deadlines for state-run exchanges. Also unclear is the federal government’s preparedness to establish and run exchanges in the states that do not wish to partner with them. The U.S. Department of Health and Human Services has released little information on this option. By NCSL’s count, 13 states and the District of Columbia have decided to establish a state exchange and nine have made an official statement that they will not create these entities.
Delegate Perdue and Representative Hudson both said Medicaid will be a major focus of the upcoming session. Health reform’s Medicaid expansion is set to begin in 2014, but so far, the federal government has been silent about its flexibility on a partial expansion.
Some states are instead looking to long-term programmatic reforms to save money. Florida is implementing the largest-ever reform of its $21 billion program, shifting the vast majority of the program’s 3 million recipients into a form of managed care, including HMOs and provider-based care networks. Said Hudson: “The legislation initiating the reforms passed in 2011, but ensuring good implementation and making ongoing improvements is still a legislative priority.”
States have a host of decisions to make and are seeking guidance to do so in the coming legislative sessions. Delegate Perdue summed it up this way: “We have a basic roadmap but don’t have specific information [for] the journey ahead. We still must get there. The ACA is real. Would we like better directions and information? Of course, but it doesn't change the need to start the journey.”
|
Inside This Issue
|
Voters in 5 States say Yes or No on PPACA Roles
Voters in Alabama, Missouri, Montana and Wyoming passed initiatives aimed at banning or limiting state implementation of PPACA. Florida’s initiative--a proposed constitutional amendment banning the state from implementing many of the PPACA’s laws and regulations--failed. It is unclear what affect these measures will actually have on state activity. It is likely that some will have symbolic meaning only, but it is also possible that states may have to revisit the issues in the near future. For example, the governor and other state agencies in Missouri cannot participate in setting up insurance exchanges; they can be subject to lawsuits if they do so without the permission of the legislature or the people.
Alabama Conducts Wholesale Review of Medicaid, Expects to Make New Policy
All states share concerns about Medicaid’s rising costs, consuming ever more of tight state budgets. Recognizing the need to develop an integrated and comprehensive state policy to keep the Medicaid program and the state fiscally solvent, the legislature passed HJR363 in April 2012, which created the Permanent Joint Legislative Committee on Medicaid Policy.
Representative Greg Wren, who chairs the Permanent Joint Legislative Committee and co-chairs NCSL’s Task Force on Federal Health Reform Implementation said, “The Committee has engaged over 250 individuals representing every health care [sector] as we move forward with comprehensive Medicaid reform.” The collaborative effort, and the in-depth knowledge of the stakeholders, will “prove invaluable to our legislative efforts,” said Wren.
The Committee’s work is well underway. Its priority for the upcoming session is to reshape Medicaid’s financing, payment and delivery system. According to Wren, “Medicaid consumes [so much] of our state’s general fund budget that building a sustainable and affordable delivery system is one of our state’s top priorities.”
The Committee expects to work closely with Governor Robert Bentley to analyze the impact of a PPACA Medicaid expansion. The governor recently issued an Executive Order creating the Alabama Medicaid Advisory Commission. These two groups include many of the same members and will work together to conduct a full review of the state’s Medicaid program.
Medicaid Pay Raise for Primary Care Docs
Primary care doctors who treat Medicaid beneficiaries will soon get paid at the Medicare rate, if that rate is higher in their state. According to a final rule released this week by the Department of Health and Human Services, states are not liable for the cost increases in 2013 and 2014, in compliance with provisions of the Patient Protection and Affordable Care Act (PPACA). The federal government will pay 100 percent of the increase between the current state-set Medicaid physician rates and the Medicare rates. Physicians will see their raises beginning in January.
The rule offers information about how the Centers for Medicare and Medicaid Services (CMS) will work with the states to make the change. For more information, click here.
Update on Maine’s Deadlock with Feds Over Medicaid Cuts
In a follow-up to a story we brought you on Oct. 26, here is the latest on an ongoing feud between Maine and the federal government. Governor Paul LePage is counting on cuts to the Medicaid program to balance the state’s budget and is upset with the CMS for not responding to Maine’s request for a waiver to do so. The CMS “waited until the 86th day” of its 90-day timeline to ask questions about Maine’s proposed cuts to their Medicaid program, said the governor in a video on the Portland Press Herald website. These questions reset the timeline and give the federal government an additional 90 days to answer Maine’s request. In the meantime, says Gov. LePage, “every month that these changes are not implemented, we are losing $2.5 million dollars.”
However, the political landscape is shifting, which may affect the state’s dealings with CMS. With Tuesday’s election results, party control will switch in both legislative chambers come January, with Democrats taking over the helm. House Assistant Democratic Leader Terry Hayes told Kaiser Health News that, “A new direction is likely to prevail. We will look to fully implement the Affordable Care Act.” He also said the state will not pursue the lawsuit against the federal government over PPACA’s maintenance of effort requirements.
Washington Reveals Branding for Health Insurance Exchange
On Oct. 18, the Washington Health Benefit Exchange Board formally approved their system’s name, tagline and logo. Washington Healthplanfinder is an online source for consumers to compare health plans and find out if they are eligible for premium subsidies. Their tagline, “click. compare. covered.” was tested in focus groups and online surveys. Click here to see the logo.
According to NCSL tracking data, Maryland [Maryland Health Connection], Oregon [Cover Oregon], and Vermont [Vermont Health Connect] also have released their exchange brands. California’s is expected soon.
State Medicaid Integration Tracker Resource Now Available
The National Association of States United for Aging and Disabilities, which represents the nation’s 56 state and territorial agencies on aging and disabilities, published the State Medicaid Integration Tracker, which will be updated monthly. The website tracks state activities regarding managed care for people with Medicaid-financed Long -Term Services and Supports, state demonstrations to integrate care for people dually eligible for Medicaid and Medicare and other long term care reform activities in the states. The website includes several links to specific state programs, including Medicaid demonstration waivers, and may be helpful for legislators and staff looking to see what other states are doing for these specific populations.
Announcements
|
|
|
|
|
|
|
|
|
|
|
Issues & Resources
Find the NCSLstaff member who handles the issue in which you are interested.
NCSLprovides access to current state and federal legislation and a comprehensive list of state documents, including state statutes, constitutions, legislative audits and research reports.
Members
As legislators and legislative staff, you are part of the nation's largest, most influential and only bipartisan organization of state legislators and staff.Learn about the resources NCSL has for you.
NCSL offers an array of services for legislative staff. Find out what's available.
|
|
|
|
|
|
|
|