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Health Reform and Women, Children and Adolescents

Health Reform and Women, Children and Adolescent
Table of Contents

NCSL Health Reform Resources
Picture of children
Updated April 2011

 

Federal Health Law and the Supreme Court
This page was last updated prior to the U.S. Supreme Court’s federal health reform law decision, announced June 28, 2012.  For NCSL’s updated summary and analysis of the Court’s decision and its effects see: U.S. Supreme Court and Federal Health Law     
[notice added 6/28/2012]

 

The federal Patient Protection and Affordable Care Act (H.R. 3590), enacted on March 23, 2010, and the Reconciliation Act (H.R. 4872), enacted on March 30, 2010, make significant changes to public programs, insurance and other aspects of health policy affecting the states and individuals.  By January 2014, the law will require individual health insurance coverage, an expansion of Medicaid and create health benefit exchanges to help low-income individuals obtain coverage. These broad components of health reform are expected to provide health coverage to 32 million uninsured people, including many women and children. 

Various provisions within the law specifically affect women, children and adolescent populations including insurance provisions, the Children's Health Insurance Program, Medicaid, the Maternal and Child Health Services Block Grant Program (Title V) and many other initiatives. 

This webpage provides a summary of provisions that specifically affect women, children and adolescents.  The section numbers included in each summary below refer to the section number within the integrated language of H.R. 3590 and H.R. 4872, also referred to as the Affordable Care Act. 

State Implementation

Many components of the Affordable Care Act affecting women, children and adolescents require action at the state level and in some cases states took actions on these issues prior to the enactment of the federal law.   The extension of benefits for dependent coverage for adults was addressed in many states across the nation prior to the federal law.  In response to the special rules within the federal law, states have already begun to enact laws regulating insurance coverage for abortion in the state exchanges.  All states receive Maternal and Child Health Services Block Grant (Title V funds), and the federal law modifies certain components of these state block grants.  Title V provisions include a new state home visiting program that has already required action at the state level and funds are to be available to states beginning in fiscal year 2010.  In addition, the federal law makes modifications the Children's Health Insurance Program, which will affect programs in all 50 states. 

Insurance Provisions

Topics Covered: Abortion Coverage  ll  Dependent Coverage  ll  Essential Health Benefits Requirements  ll  Health Status Discrimination Prohibition  ll  Preexisting Condition Exclusions  ll  Preventive Health Services

Coverage of Preventive Health Services  (Section 1001, which amends Section 2713 of the Public Health Services Act) 

Essential Health Benefits Requirements (Section 1302)

  • Among many provisions in this section, the law requires the Department of Health and Human Services (DHHS) secretary to define essential health benefits to be included in state insurance exchanges. Benefits that especially relate to women and children include maternity and newborn care, mental health and substance abuse including behavioral treatment, preventive and wellness services and pediatric services including oral health and vision.  The law also limits deductibles and cost sharing.  A catastrophic plan is to be available in the exchange in the individual market for people under age 30 with a qualifying income specified in the statute. In addition, this section requires that if a qualified health plan is offered through the exchange in any level of coverage, the issuer shall also offer a plan at that level in which the only enrollees are individuals who, under 21 years, a 'Child-Only Plan.'

  • NCSL’s State Actions to Implement the Health Benefit Exchange webpage

  • Institute of Medicine (IOM) Determination of Essential Health Benefits webpage

Extension of Dependent Coverage (Section 1001, which amends Section 2714 of the Public Health Services Act)

Prohibition of Discrimination Against Individual Participants and Beneficiaries Based on Health Status (Section 1201, which amends Section 2705 of the Public Health Services Act)

  • Among other provisions, this section prohibits insurers from establishing rules for eligibility (including continued eligibility) based on specified health status-related factors, including conditions arising out of acts of domestic violence.

Prohibition of Preexisting Condition Exclusions or Other Discrimination Based on Health Status (Section 1201, amending Section 2704 of the Public Health Services Act)

Special Rules (Section 1303) and Executive Order: Related to coverage for abortion within the exchanges.

  • The law maintains current Hyde Amendment restrictions governing abortion policy, which prohibits federal funds from being used for abortion services (except in cases of rape or incest, or when the life of the woman would be endangered), and extends those restrictions to the newly created health insurance exchanges. The new health reform law also maintains federal "conscience" protections for health care providers who object to performing abortion or sterilization procedures that conflict with their beliefs. In addition, the law provides new protections that prohibit discrimination against health care facilities and providers who are unwilling to provide, pay for, provide coverage of, or refer women for abortions. The law allows a state (through legislation) to prohibit abortion coverage in qualified health plans offered through an exchange. In addition, the "Patient Protection and Affordable Care Act's Consistency with Longstanding Restrictions on the Use of Federal Funds for Abortion" executive order establishes an enforcement mechanism to ensure that federal funds are not used for abortion services, consistent with existing federal statute.  

  • NCSL's Abortion State Laws webpage

  • NCSL's Health Reform and Abortion Coverage in the Insurance Exchanges webpage

Maternal and Child Health Services Block Grant (Title V funds) Provisions

Topics Covered: Abstinence Education  ll  Children Aging Out of Foster Care  ll  Home Visiting  ll  Personal Responsibility Education  ll  Postpartum Depression  ll  Teen Pregnancy Prevention: Abstinence Education and Personal Responsibility Education

Inclusion of Information about the Importance of Having a Health Care Power of Attorney in Transitional Planning for Children Aging out of Foster Care and Independent Living Programs (Section 2955)

  • The law amends 42USC675(5)(H) and 42USC422(b)(15)(A), created by the Fostering Connections to Success and Increasing Adoptions Act of 2008, and 42USC677(b)(3) to require the inclusion of specified information in transition planning for children aging out of foster care and independent living programs. The transition planning must include information about the importance of designating another individual to make health care treatment decisions on behalf of a child if the child becomes unable to participate in such decisions and to provide a child with the option to execute a health care power of attorney, health care proxy, or other similar document. The law also amends the Fostering Connections to Success and Increasing Adoptions Act of 2008 to ensure that these requirements are met under the Health Oversight and Coordination Plan. The amendments of this section take effect on October 1, 2010.

Maternal, Infant, and Early Childhood Home Visiting Programs (Section 2951)

Personal Responsibility Education (Section 2953)

  • Through Title V (the Maternal and Child Health Services Block Grant), the law provides $75 million per year from 2010-2014 for grants to states for the purpose of educating adolescents about abstinence and contraception to prevent pregnancy and sexually transmitted infections, including HIV/AIDS. Programs must replicate an evidence-based effective program or incorporate components which are scientifically proven to change behavior (e.g., delay sexual activity, increase condom and/or contraceptive use among sexually active youth), be medically accurate and complete, include activities to educate sexually active youth about responsible sexual behavior, place substantial emphasis on both abstinence and contraception as preventative measures, and be age-appropriate. The program must also incorporate at least three of the following topics: healthy relationships; adolescent development; financial literacy; parent-child communication; educational and career success; and/or healthy life skills. Grants to states should be no less than $250,000 per fiscal year. State applications must include pregnancy and birth rate data from the state, state-established goals for reducing pregnancy and birth rates among youth, description of the planned use of funds, especially among high-risk and vulnerable youth populations such as youth in foster care, homeless youth, youth with HIV/AIDS, pregnant or parenting youth under age 21, and youth residing in areas with high youth birth rates. The law defines “youth” as being between 10 and 20 years old. States that do not submit applications in fiscal years 2010 or 2011 are no longer eligible for these funds. With the unexpended allotment, the DHHS secretary must solicit applications for three-year grants to local organizations and entities in states that did not apply or faith-based organizations to conduct these educational activities. Funding is also available for innovative pregnancy prevention strategies and targeted services to high-risk youth; Indian tribes or tribal organizations; and research, training and technical assistance.

  • HHS Awards Evidence-Based Teen Pregnancy Prevention Grants, U.S. Department of Health and Human Services, Health Resources and Services Administration, Press Release, September 30, 2010

  • Health Care Reform Personal Responsibility Education Program At-A-Glance, Association of Maternal and Child Health Programs, April 2010  

Restoration of Funding for Abstinence Education (Section 2954)

  • The law restores the abstinence education funding from fiscal years 2010 through 2014 within Title V, and appropriates $50 million per fiscal year for grants to states.

Support, Education, and Research for Postpartum Depression (Section 2952)

  • The law expands and intensifies research activities related to postpartum depression by encouraging the DHHS secretary to continue research to expand the understanding of the causes of, and treatments for, postpartum conditions.  The law also enables the director of the National Institute of Mental Health to conduct a nationally representative longitudinal study of the relative mental health consequences for women of resolving a pregnancy in various ways.  In addition, the law authorizes appropriations of $3 million for new grants to states in fiscal year 2010 (and sums as maybe necessary for fiscal years 2011 and 2012) to provide services to individuals with, or at risk, of postpartum depression and their families. Activities include delivering or enhancing home-based and support services, including case management and comprehensive treatments; inpatient care management services ensuring the well being of the mother, family and infant; improving support services and providing counseling; and promoting earlier diagnosis and treatment and providing information to new mothers. 

Medicaid and Children's Health Insurance Program (CHIP) Provisions

Topics Covered: CHIP and Additional Federal Participation  || CHIP Funding ||  CHIP Technical Corrections  ||  Family Planning Services ||  Former Foster Children and Medicaid Coverage ||  Freestanding Birth Center Services || Medicaid and CHIP Coordination with Exchanges  ||  Medicaid and CHIP Payment and Access Commission ||  Medicaid Coverage for the Lowest Income Populations ||  Pediatric Accountable Care Organization Demonstration Project   ||  Pregnant and Parenting Teens  ||  Presumptive Eligibility under Medicaid  ||  Terminally Ill Children ||  Waiver Transparency

 

Medicaid and CHIP Health Reform Resources

NCSL's Children's Health Insurance Program webpage
NCSL's Preliminary Draft Summary of the Medicaid and CHIP Provisions, April 2010
Medicaid and Children’s Health Insurance Program Provisions in the New Health Reform Law, April 2010, Kaiser Family Foundation
Medicaid and CHIP Health Reform Implementation Timeline, April 2010, Kaiser Family Foundation
Summary of Medicaid, CHIP, and Low-Income Provisions in Health Care Reform, March 2010, Center for Children and Families, Georgetown University Health Policy Institute
Medicaid's Role for Women Across the Lifespan: Current Issues and the Impact of the Affordable Care Act, January 2012, Kaiser Family Foundation
 

  

Additional Federal Participation for CHIP (Section 2101)

  • The law extends the current reauthorization period for the Children’s Health Insurance Program (CHIP) by two years, through September 30, 2015.

  • The law provides that from FY 2016 to FY 2019 (October 1, 2015 through September 30, 2019), states will receive a 23 percentage point increase in the enhanced federal match rate for CHIP, subject to a cap of 100 percent.

  • The law includes a maintenance of effort provision, effective through September 30, 2019, that requires states to maintain their eligibility criteria (eligibility standards, methodologies or procedures) under Medicaid or CHIP for children in effect on the date of enactment (March 23, 2010). States must comply with these conditions to receive future Medicaid payments. However, states may impose a limitation on enrollment, such as an enrollment cap or other numerical limitation on enrollment, or establish a waiting list to enroll children in CHIP.

  • The law specifies that CHIP-eligible children who cannot be enrolled in CHIP due to federal allotment caps, must be screened for eligibility for, and if eligible enrolled in, Medicaid. If the child is not Medicaid-eligible, then the child will be deemed ineligible for CHIP and Medicaid and will then be eligible for tax credits in a health exchange.

  • The law requires the secretary of the Department of Health and Human Services to review the benefits offered for children and the cost-sharing imposed on these benefits by qualified health plans offered through an Exchange. The secretary must certify plans that offer benefits for children and cost-sharing that are at least comparable to the benefits offered and cost-sharing provided under the state’s CHIP program.

  • The law ends the CHIP performance bonus payment established by the Children’s Health Insurance Program Reauthorization Act of 2009 (Pub. L. 111-003) on October 1, 2013.

  • The law specifies that beginning January 1, 2014, modified adjusted gross income and household income, as defined in Section 2002 of the Patient Protection and Affordable Care Act, must be used to determine eligibility for CHIP (or under any waiver), including with respect to imposing premiums and cost-sharing.

  • Holding the Line on Medicaid and CHIP: Key Questions and Answers About Health Care Reform's Maintenance-of-Effort Requirements, Center for Children and Families, Georgetown University, March 26, 2010

  • Maintenance of Effort Requirements Under Health Reform, Families USA Fact Sheet, March 2010

  • Maintenance of Effort Guidance Medicaid and CHIP, February 2011, Centers for Medicare and Medicaid Services

Amendments to the Social Security Act and Title II of This Act: Waiver Transparency (Section 10201)

  • One provision in this section of the law relates to applications for or renewal of experimental projects, pilots or demonstration projects by amending Section 1115 of the Social Security Act (42USC1315). The law provides that any application or renewal of these demonstration projects undertaken to promote the objectives of Medicaid or CHIP that would result in an impact on eligibility, enrollment, cost-sharing or financing will be subject to specified requirements established by the Secretary. The Secretary of Health and Human Services, not later than 180 days after enactment of this subsection, must promulgate regulations relating to applications for and renewals of a demonstration project that provide for:

    • A process for public notice and comment at the state level, including public hearings, sufficient to ensure a meaningful level of public input;

    • Requirements relating to: the goals of the program to be implemented or renewed under the project; the expected state and federal costs and coverage projections of the project; and the specific plans of the state to ensure that the project will be in compliance with Medicaid and CHIP;

    • A process for providing public notice and comment after the application is received by the Secretary, that is sufficient to ensure a meaningful level of public input;

    • A process for the submission to the Secretary of periodic reports by the state concerning the implementation of the project; and

    • A process for the periodic evaluation by the Secretary of the project.

      The Secretary must report to Congress annually concerning actions taken by the Secretary related to these provisions. 

Concurrent Care for Children (Section 2302): Related to terminally ill children

  • The law amends 42USC1396d(o)(1) to allow children, as defined by the state, who are eligible for Medicaid or the Children’s Health Insurance Program (CHIP), to receive hospice care without forgoing any other service to which the child is entitled under Medicaid or CHIP.

  • Hospice Care for Children in Medicaid and CHIP, Letter to State Health Officials and State Medicaid Directors, Centers for Medicare and Medicaid Services, September 9, 2010

Coverage for Freestanding Birth Center Services (Section 2301)

Enrollment Simplification and Coordination with State Health Insurance Exchanges (Section 2201)

The law amends 42USC1397aa et seq. by adding a new provision, Section 1943 to require states to meet the following requirements for calendar quarters beginning after January 1, 2014 as a condition of receiving any federal Medicaid funds. The state is required to establish procedures to:

  • Enroll, without any further determination by the state, individuals who are identified by a state exchange as being eligible for Medicaid or CHIP;

  • Ensure that individuals who apply for Medicaid and/or CHIP, but are determined ineligible for either program, are able to apply for and be enrolled in coverage through a state exchange and, if applicable, obtain premium credits for state exchange coverage and receive information regarding any other assistance or subsidies available through the state exchange;

  • Ensure that the state Medicaid agency, the state CHIP agency and the state exchange use a secure electronic interface sufficient to allow for a determination of an individual‘s eligibility for their programs;

  • Ensure that coverage provided to Medicaid-eligible individuals who are also enrolled in a state exchange plan is coordinated; and

  • Conduct outreach to and enroll vulnerable and underserved populations eligible for Medicaid or CHIP, including children, unaccompanied homeless youth, children and youth with special health care needs, pregnant women, racial and ethnic minorities, rural populations, victims of abuse or trauma, individuals with mental health or substance-related disorders and individuals with HIV/AIDS.

The state Medicaid agency and the state CHIP agency are permitted to enter into an agreement with the state exchange under which each agency may determine whether a state resident is eligible for premium credits for state exchange coverage, so long as the agreement meets requirements prescribed by the secretary of the Treasury to reduce administrative costs and the likelihood of eligibility errors and disruptions in coverage.

The state Medicaid agency and the state CHIP agency are required to participate in and comply with the requirements for the system established under section 1413 of the Patient Protection and Affordable Care Act (relating to streamlined procedures for enrollment through a state exchange, Medicaid and CHIP).

The state must establish a website to be function by January 1, 2014 that:

  • Allows Medicaid and CHIP-eligible individuals to enroll or reenroll in Medicaid and CHIP, and consent to enrollment or reenrollment through an electronic signature.

  • Links to all websites established by any state exchange so that individuals who are identified by a state exchange as Medicaid or CHIP eligible are able to enroll in Medicaid or CHIP online without having to submit an additional or separate application. The website must also allow individuals who apply for Medicaid, but are determined ineligible, to apply for and be enrolled in coverage through an exchange. If applicable, these individuals can obtain premium credits for exchange coverage without having to submit an additional or separate application. The website must also provide information regarding any other assistance or subsidies available through the exchange.

  • Allows the state to assess an individual for purposes of providing home- and community-based services under the state plan or under a waiver for individuals who would be Medicaid eligible if they were in a medical institution, and with respect to whom there has been a determination that, but for the provision of home- and community-based services under a waiver, they would require the level of care provided in a hospital, nursing facility, or intermediate care facility for people with mentally retardation.

  • Allows individuals who are eligible for Medicaid and who are also eligible to receive premium credits for exchange coverage to compare the benefits, premiums, and cost-sharing available to the individual under exchange plans. In the case of a child, the website must allow for the comparison of the coverage that would be provided to the child through Medicaid with coverage that would be provided to the child through enrollment in family coverage under exchange coverage including any supplemental coverage provided by the state under Medicaid. 

Extension of Funding for CHIP through Fiscal Year 2015 and Other CHIP-Related Provisions (Section 10203)

  • This section of the law extends and specifies CHIP funding for FY 2013, FY 2014 and FY 2015.

  • The law increases funding for CHIP outreach and enrollment activities for fiscal years 2009 through 2015 to $140 million from $100 million.

  • The law creates an exception to the exclusion of children of employees of a public agency in the state who are eligible for enrollment in CHIP. The amount of agency expenditures for annual premium contributions for family coverage for the most recent state fiscal year must not be less than the amount of such expenditures made by the agency for the 1997 state fiscal year, adjusted for inflation. A child qualifies for a hardship exception if the state determines, on a case-by-case basis, that the annual combined amount of premiums and cost-sharing imposed for coverage of the family of the child would exceed five percent of the family’s income in that year.

  • NCSL's State Employee Health Benefits webpage

  • CHIP Coverage of Children of Public Employees, Letter to State Health Officials, Centers for Medicare and Medicaid Services, April 4, 2011

Medicaid and CHIP Payment and Access Commission (MACPAC) Assessment of Policies Affecting All Medicaid Beneficiaries (Section 2801)

Medicaid Coverage for Former Foster Care Children (Section 2004)

  • The law amends 42USC1396a and establishes a new mandatory eligibility category under Medicaid for former foster children up to age 26 who were in the foster care system when they became 18 years of age (or a higher age set by the state for ending foster care benefits) and were enrolled in Medicaid when they aged-out of the system. Children who qualify for Medicaid through this eligibility pathway will receive all benefits under Medicaid, including Early and Period Screening, Diagnostic and Treatment (EPSDT) benefits. This provision is effective January 1, 2014. 

Medicaid Coverage for the Lowest Income Populations (Section 2001)

  • Beginning in 2014, individuals with an income at or below 133 percent of the federal poverty guidelines will be eligible for Medicaid coverage.  Previously only children ages 0 to 5 years had coverage up to 133 percent and children ages 6 to 18 years were only covered up to 100 percent of the federal poverty guidelines under Medicaid, so as of 2014 Medicaid coverage will be available to all children up to 133 percent of the federal poverty guidelines. Children enrolled in CHIP between 100 and 133 percent of the federal poverty guidelines will be transitioned in to Medicaid coverage.  In addition, the law establishes that states will receive an increased Federal Medical Assistance Percentage (FMAP) match for newly eligible Medicaid participants.

  • New Option for Coverage of Individuals Under Medicaid, Letter to State Health Officials and State Medicaid Directors, Centers for Medicare and Medicaid Services, April 9, 2010

Pediatric Accountable Care Organization Demonstration Project (Section 2706)

  • The DHHS secretary must establish the Pediatric Accountable Care Organization Demonstration Project, which will authorize a participating State to allow pediatric medical providers that meet specified requirements to be recognized as an accountable care organization for purposes of receiving incentive payments in the same manner as an accountable care organization is recognized and provided with incentive payment. A participating State, in consultation with the DHHS secretary is to establish an annual minimal level of savings in expenditures for items and services covered under Medicaid and the CHIP, which must be reached by an accountable care organization to receive an incentive payment. The demonstration project is to begin on January 1, 2012, and end on December 31, 2016. The section does not provide specific appropriations, rather authorizes the appropriation of such sums as may be necessary to carry out this section.

Permitting Hospitals to Make Presumptive Eligibility Determinations for All Medicaid Eligible Populations (Section 2202)

  • The law amends 42USC1396a(a)(47) by providing that any hospital that is a participating provider under Medicaid may make presumptive eligibility determinations, in addition to providers currently eligible to do so. Hospitals and other providers, with state verification of capability, may make these determinations for all Medicaid-eligible populations. This section takes effect on January 1, 2014 and applies to services furnished on or after this date.

State Eligibility Option for Family Planning Services (Section 2303)

  • The law allows states to provide coverage for limited family planning services to certain individuals, including women who are not pregnant up to the highest income eligibility level provided to pregnant women, through a Medicaid state plan amendment.  In addition, the law allows the state the option to provide presumptive eligibility for family planning services, and the law provides guidelines and requirements for this option. 

  • Family Planning Services Option and New Benefit Rules for Benchmark Plans, Letter to State Health Officials, Center for Medicare and Medicaid Services, July 2, 2010.

Support for Pregnant and Parenting Teens and Women (Section 10211-10214)

  • The law appropriates $25 million per fiscal year from 2010 to 2019 to establish the Pregnancy Assistance Fund and requires the secretary of Health and Human Services and the secretary of Education to collaborate and coordinate as appropriate. Funds will be awarded to states on a competitive basis and passed through to eligible state agencies, as well as institutions of higher education, high schools, community service centers, and state attorneys general in order to assist statewide offices. With these funds, institutions of higher education will establish, maintain or operate pregnant and parenting student services. High schools and community service centers are also eligible to receive funding to establish, maintain and operate pregnant and parenting services. Attorneys general will also assist statewide offices in providing a variety of social services for pregnant women who are victims of domestic violence, sexual violence, sexual assault or stalking. Funding is also available to increase public awareness and education about services available to pregnant and parenting teens and women.

  • Secretary Sebelius Announces the Availability of Funding for the Support of Pregnant and Parenting Teens and Women, News Release, U.S. Department of Health and Human Services, July 2, 2010.

Technical Corrections (Section 2102): Related to CHIP

  • This section of the law makes technical corrections, including changes to the Children’s Health Insurance Program Reauthorization Act of 2009 (Pub. L. 111-003). The law makes adjustments to the allotments for FY 2010 to account for changes in projected spending, deletes clauses that have been eliminated, and makes other minor amendments. 


Other Health Reform Provisions Related to Women, Children and Adolescents

Topics Covered: Alternate Dental Providers  ll  Childhood Obesity  ll  Dentistry Training  ll  Emergency Medical Services for Children  ll  Immunizations  ll  Improving Women's Health  ll  Medical Homes  ll  Nurse-Midwife Services  ll  Nursing Mothers  ll  Oral Health Care Prevention  ll  School-Based Health Centers  ll  Tobacco Cessation for Pregnant Women  ll  Young Women's Breast Health

Alternative Dental Providers Demonstration Project (Section 5304)

  • The law authorizes appropriations of $4 million to create a 15-site demonstration program to train and/or employ alternative dental health care providers. Alternative dental providers include community dental health coordinators, advance practice dental hygienists, independent dental hygienists, supervised dental hygienists, primary care physicians, dental therapists, dental health aides, and any other health professional that the DHHS secretary determines appropriate.  The program is intended to begin within two years and conclude within seven years of the enactment of this act.  The law establishes the eligible entities to receive these grants, which include state and tribal public health clinics.  The law also requires each grantee to certify it is in compliance with all applicable state licensing requirements. In addition the law charges the DHHS secretary to contract with the Institute of Medicine to evaluate the program.

  •  NCSL's Children's Oral Health Policy Issues Overview webpage

  • States Implement Health Reform: Oral Health, NCSL Brief, March 2011

Coverage of Comprehensive Tobacco Cessation Services for Pregnant Women in Medicaid (Section 4107)

  • Effective October 1, 2010, the law requires coverage under Medicaid for counseling and pharmacotherapy for cessation of tobacco use by pregnant women, and prohibits cost-sharing for such services for pregnant women. 

  •  NCSL's Tobacco Cessation webpage

Establishing Community Health Teams to Support the Patient-Centered Medical Home (Section 3502)

  • The law requires the DHHS secretary to establish a program to provide grants or enter into contracts with states, state-designated entities, Indian tribes and tribal organizations to establish community-based interdisciplinary, interprofessional health teams to support primary care practices. The law provides guidelines to determine eligibility of a state or tribe for the grants and lists requirements for health teams established under such a grant or contact.  Some health team provisions include: defining what should be included in the patient-centered medical home model of care, requiring collaboration between state and local entities to coordinate resources and to develop and implement care plans and provide support for local primary care providers to coordinate and provide access to a variety of services for patients.  In addition, requirements for health care providers who contract with health teams include providing a care plan to health team for a patient, providing access to health records and meeting regularly with health team to ensure integration of care. 

  •  NCSL's Medical Home Model of Care webpage

Funding for Childhood Obesity Demonstration Project (Section 4306)

  • The law allows the appropriation of $25 million to fund the childhood obesity demonstration project from fiscal year 2010 to fiscal year 2014, out of any funds in the Treasury not otherwise appropriated.

  • NCSL's Childhood Obesity webpage

Immunizations (Section 4204)

  • The law reauthorizes the immunization program, Section 317 of the Public Health Service Act and authorizes states to purchase recommended vaccines for adults under Section 317.  Also under Section 317, the law establishes a demonstration program to improve coverage by awarding grants to states through the Centers for Disease Control and Prevention (CDC) to help states improve the provision of recommended immunizations for children, adolescents, and adults through the use of evidence-based, population-based interventions for high-risk populations.  States should submit state plans describing interventions to be implemented under the grant and how such interventions match with local needs and capabilities as required by the DHHS secretary.  An evaluation of this program is required to be submitted to the secretary within three years of a state's receipt of the grant.  In addition, the law funds and authorizes a Government Accountability Office study and report on access to vaccines for Medicare beneficiaries. 

  •  NCSL's Immunizations Policy Issues Overview webpage

  • Immunizations and the Affordable Care Act, NCSL LegisBrief, April 2011

Improved Access for Certified Nurse-Midwife Services (Section 3114)

Improving Women's Health (Section 3509)

  • The law establishes an Office on Women's Health within the Department of Health and Human Services.  The law charges the DHHS Office on Women's Health with various objectives, including establishing a National Women's Health Information Center and a Coordinating Committee on Women's Health.  The law also transfers functions of the Office on Women's Health of the Public Health Service to the newly established DHHS Office on Women's Health.  In addition, the law creates an Office of Women's Health within the CDC, an Office on Women's Health and Gender-Based Research within the Agency for Healthcare Research and Quality, an Office of Women's Health within the Health Resources and Services Administration and an Office of Women's Health within the Food and Drug Administration.  These offices within the various agencies are all required to report the status of their activities related to women's health, establish women's health-related goals and objectives for their agency, identify women's health projects to be conducted or supported, consult with key partners to develop policies for the agency and serve as a member of the Coordinating Committee on Women's Health.  The section does not provide specific appropriations, rather authorizes the appropriation of such sums as may be necessary for fiscal years 2010 through 2014.

  • NCSL's Women's Health Across the Lifespan Overview webpage

  • NCSL's State Laws and Initiatives on Women's Health webpage

  • Report to Congress on “Improving Women’s Health” HealthCare.gov

Oral Health Care Prevention Activities (Section 4102)

  • Establishes the Oral Health Care Prevention Education Campaign, which requires the DHHS secretary with the CDC to establish a five-year national public education campaign to promote oral health within two years of enactment of the law. The campaign must target specific populations and use science-based strategies to convey oral health prevention messages,  including community water fluoridation and dental sealants. The DHHS secretary, in collaboration with the CDC, must establish a grant program to demonstrate the effectiveness of research-based dental caries disease management.  Eligible grantees include state and tribal departments of health.   The law also authorizes appropriations for school-based dental sealant programs and infrastructure and requires that all states, territories and Indian tribes receive grants for school-based dental sealant programs.  The law requires the CDC to enter into cooperative agreements with all states, territories and tribes to improve oral health infrastructure through leadership and program guidance, data collection and interpretation of risk, delivery system improvements, and science-based population-level programs. In addition the law requires that the secretary update and improve national oral health surveillance by requiring the inclusion of oral health reporting on pregnant women through the Pregnancy Risk Assessment Monitoring System; that the National Health and Nutrition Examination Survey include tooth-level surveillance; the Medical Expenditure Panel Survey include the verification of dental utilization, expenditure and coverage through a look-back analysis by the Agency for Healthcare Research and Quality; and that all states must participate in the CDC's National Oral Health Surveillance System. 

  •  NCSL's Children's Oral Health Policy Issues Overview webpage

  • States Implement Health Reform: Oral Health, NCSL Brief, March 2011

Reasonable Break Time for Nursing Mothers (Section 4207)

Reauthorization of Wakefield Emergency Medical Services for Children Program (Section 5603)

School-Based Health Centers (Section 4101)

  • The law appropriates $50 million each fiscal year from 2010 through 2013 to award grants for school-based health centers. These grants are to be used for capacity-building, rather than provision of services. Eligible expenditures include construction of new buildings, improvements on existing structures, or buying or leasing equipment. Preference will be given to applicants that serve high numbers children and adolescents who are covered by Medicaid and CHIP.  In addition, the law authorizes a federal grant program for the operation of school-based health centers.  The law establishes criteria and requirements for the health centers and a process for awarding grants.  The section does not, however, provide specific appropriations for school-based health center operations, rather authorizes the appropriation of such sums as may be necessary for fiscal years 2010 through 2014.

  • SBHCs in Health Care Reform, National Assembly on School-Based Health Care 

  • School-Based Health Center Capital Program Funding Opportunity Announcement, Information on the School-Based Health Center Capital Program, Health Resources and Services Administration, June 30, 2010.

Training in General, Pediatric, and Public Health Dentistry (Section 5303)

  • The law expands the dental workforce training program by allowing the DHHS secretary to award grants or enter into contracts with schools, hospitals or nonprofits to do the following: train dental students and practicing dentists as well as residents; provide financial assistance to dental trainees, including dental hygienists; develop new training programs; expand faculty capacity through traineeships and fellowships for dentists who teach; award grants for faculty development and faculty loan repayment programs; advance pre-doctoral training in primary care dentistry; and provide technical assistance to pediatric dental training programs in population and public health issues.

  •  NCSL's Children's Oral Health Policy Issues Overview webpage

  • States Implement Health Reform: Oral Health, NCSL Brief, March 2011

Young Women Breast Health Awareness and Support of Young Women Diagnosed with Breast Cancer (Section 10413)

  • The law creates a national, evidence-based public education campaign to be administered through the CDC to increase awareness about young women's knowledge related to breast health.  The law requires the DHHS secretary to establish an advisory committee within 60 days of the enactment of health reform through CDC to help create the education campaigns.  In addition, the law requires the DHHS secretary to conduct an education campaign to increase awareness among physicians and other health care professionals.  The law directs the director of the CDC to conduct prevention research on breast cancer in younger women.  The DHHS secretary must award grants to organizations and institutions to provide health information from credible sources and substantive assistance directed to young women diagnosed with breast cancer.  The DHHS secretary, acting through the director of the CDC must perform measurements related to breast cancer and young women and report these.  The law authorizes appropriations of $9 million for each fiscal year from 2010 through 2014. 

  •  NCSL's Cancer At-a-Glance webpage

Additional Resources  

Association of Maternal and Child Health Programs

Center for Children and Families, Georgetown University

Children's Dental Health Project

HealthReform.gov

Kaiser Family Foundation

National Association of County and City Health Officials

 Sources: National Conference of State Legislatures, Association of Maternal and Child Health Programs, Center for Children and Families and the Kaiser Family Foundation.

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