Affordable Care Act State Action Newsletter 15

Affordable Care Act: State Action Newsletter

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July 29, 2011 (Revised August 2, 2011)

School-Based Health Centers Receive Support from ACA Grants 

On July 14, the Health Resources and Services Administration awarded 278 school-based health center (SBHC) programs in 41 states and the District of Colombia $95 million in competitive grants. These grants were the first round of a total $200 million appropriated for SBHCs by the Affordable Care Act. School-based health centers that received grants currently serve 790,000 students and are expected to expand services to an additional 440,000 students. In total, approximately 1,900 centers serve around 2 million people nationwide.

New York and California had the largest number of grant recipients, with more than 30 SBHCs or sponsoring facilities receiving awards. Colorado was awarded $2,478,119 to seven sponsoring facilities that will distribute funding to local centers. For example, Denver Health and Hospital Authority received $500,000 to build its 15th SBHC at Place Bridge Academy in Denver. Alabama received $863,107 for three sponsoring facilities, including HEALS, which will put the funds toward two new centers and an electronic health record system, among other projects.

SBHCs vary greatly in the services they provide in order to meet community needs. For example, limited primary care services are available in all the centers, mental health services in 75 percent and dental care in 12 percent. They cooperate with the school they are located in to ensure students are healthy and able to focus on learning. SBHCs often have sponsoring facilities that are the primary administrative home. Sponsors include hospitals, public health departments, community health centers and nonprofit health care agencies.

Click here for more information on SBHCs.

Colorado Study Shows Benefit of Community Health Centers for Medicaid Patients

A recent study by the Colorado Department of Health Care Policy and Financing shows Medicaid clients who are seen at CHCs use hospital services 30 percent less than those seen in private practices. CHCs provide primary care and preventive health services to people with limited access to health care. The researchers found Medicaid patients seen at CHCs were less likely to have emergency department visits, inpatient hospitalizations, preventable hospital admissions and hospital readmissions within 90 days.

The study highlights the cost-savings for insurance providers when patients can avoid additional care in expensive hospital settings. The article concludes: “Public funders such as states should work with community health centers to improve the quality and reduce the cost of care even further.” According to the National Association of Community Health Centers, Colorado allocated $33,959,382 to CHCs in FY 2011, a 22 percent decrease from the previous fiscal year. Currently, Colorado is among the 33 states and District of Columbia that provide funding to CHCs, although funding has decreased in recent years due to budget deficits.

Finding enough providers to serve the 22 million Americans who will be newly covered under health reform beginning in 2014 is a major challenge.

The Affordable Care Act appropriates $11 billion to community health centers (CHCs) over the next five years to expand their service capacity and to build new centers. However, a subsequent cut of $604 million in the federal budget in 2011 means that fewer service expansions and new health centers than anticipated will be funded with the new money. Go here to learn more about CHCs.

IOM Releases Recommendations for Preventive Services for Women

An Institute of Medicine (IOM) committee generated a buzz last week when it recommended health insurance plans cover all forms of FDA-approved contraceptive methods, sterilization procedures, and patient counseling and education for all women with reproductive capacity without cost-sharing requirements. This is one of eight recommendations the IOM released after reviewing the list of preventive services for women outlined in the Affordable Care Act (ACA).

The ACA seeks to shift the focus of health care to prevention, and, to accomplish this, is requiring health insurance plans to remove cost-sharing requirements for specified preventive services. The U.S. Department of Health and Human Services tasked the IOM with making additional recommendations to ensure the list of preventive services that affect women’s health and well-being is comprehensive. DHHS is expected to respond to the recommendations next month. If approved, the IOM’s recommendations will be added to services already identified in the ACA by other independent expert bodies. Other IOM recommendations include:

  • At least one well-woman preventive care visit for adults to obtain recommended preventive services.
  • Annual counseling on sexually transmitted infections for all sexually active women.
  • Annual counseling on and screening for HIV for all sexually active women.
  • Additional screening for high-risk human papillomavirus (HPV) DNA, no more than every three years, beginning at age 30.
  • Comprehensive lactation support, counseling, and costs of renting breastfeeding equipment.
  • Screening for gestational diabetes.
  • Screening and counseling for interpersonal and domestic violence for all women and adolescents.

Many states already require insurance coverage for some of these services, but allow various cost-sharing provisions. For example, at least 25 states require coverage for FDA-approved contraception. At least 10 states currently mandate coverage for HIV screening and 31 states require coverage of HPV screening. It is estimated that any particular mandate may add between 1 percent and 3 percent to the overall cost of a premium, based on patient usage.

Check out NCSL’s resources on preventive coverage for women, children and adolescents, and state laws regarding contraceptive coverage for more information.

Inside This Issue


North Dakota Denied Request for Medical Loss Ratio Variation

The medical loss ratio (MLR) provision of the Affordable Care Act (ACA) requires insurance companies that issue individual and small employer policies to spend at least 80 percent of the premium dollars they collect on medical care and quality improvement activities beginning in 2011. Companies that fail to meet this standard will be required to provide a rebate to their customers starting in 2012. The ACA allows states to apply for a temporary adjustment if they can demonstrate that the new 80 percent standard could destabilize the insurance market, resulting in fewer choices for consumers. To date, 12 states and Guam have submitted applications to have their MLR standards adjusted to a lower rate for up to three years.

On July 22, North Dakota became the first state to have its application completely denied by HHS. According to HHS’s Center for Consumer Information & Insurance Oversight (CCIIO), most insurers operating in North Dakota already are operating at, or have plans to operate at, an 80 percent or greater MLR in the near future. Therefore, CCIIO has determined that no companies are likely to withdraw from the individual market as a result of the new standard.

HHS handed down different determinations for Iowa and Kentucky, agreeing in part with state analyses that an 80 percent MLR standard could destabilize the individual market in the short term. However, in each case HHS declined to lower the standard to the state’s requested rate. Iowa’s MLR rates were lowered to 67 percent in 2011 and 75 percent in 2012; they must meet the national standard by 2013. Kentucky will be allowed a 75 percent MLR in 2011 and must comply with the 80 percent standard in 2012. 

This spring, HHS issued similar in-part determinations for New Hampshire and Nevada, and granted Maine the full adjustment the state requested.

To learn more, visit NCSL’s Health Insurance Medical Loss Ratios Web page.


Governors Move Forward with Implementation, Despite Opposition

Republican governors of two states have taken steps in recent weeks to implement portions of the Affordable Care Act (ACA) despite vocal opposition to the law.

Idaho Governor Butch Otter, whose state is one of 26 suing the federal government over the ACA and who signed an executive order last April barring state agencies from implementing provisions of the law, has signed 10 waivers to that order.

The waivers will allow Idaho to draw down as much as $19 million from the federal government under the ACA for activities such as workforce training, tobacco cessation programs, and prevention and wellness efforts in the state.

Ohio Governor John Kasich also has been a vocal opponent of the ACA. In February, he signed a letter to Health and Human Services Secretary Kathleen Sebelius that stated: “[The law] in its current form threatens to destroy our budgets and perpetuate and magnify the most costly aspects of our health care system.”

Despite this opposition, Governor Kasich recently supported the creation of a state-based insurance exchange. Quoted in the Columbus Dispatch, Kasich said, “We have to get in position for this because we don’t want the federal government coming in here and dictating an exchange.”

The moves by these governors are not unique. A number of other governors who have expressed disagreement with the law have also taken steps to move forward with implementation, including: Mitch Daniels of Indiana, Nathan Deal of Georgia and Robert Bentley of Alabama.

Ohio Ballot Measure Update

On July 26, Ohio Secretary of State Jon Husted certified a July 26 citizen initiated constitutional amendment to block the federal health care law in the state, which will appear on the Nov. 8 ballot. Petitioners, comprised of Tea Party and Constitutional rights groups, were able to get 426,998 signatures certified, well more than the 385,245 needed.

Opponents to the measure have promised to challenge the certification.

So far in 2011, three other states—Alabama, Florida and Wyoming—have sent constitutional amendments regarding the Affordable Care Act to the ballot. Visit NCSL’s State Legislation and Actions Challenging Certain Health Reforms page to learn more.

NCSL’s 2011 Annual Legislative Summit in San Antonio   

NCSL’s annual Legislative Summit is August 8 – 11 in San Antonio, Texas. Online registration is closed but on-site registration is still available. Web streaming is also available for 12 policy sessions.

Highlights from the Health Program include speaker Joel Ario, Director of the Office of Health Insurance Exchanges, as well as sessions on the Affordable Care Act, Medicaid and many more issues.


 Due to the upcoming Legislative Summit, the next issue of the Affordable Care Act: State Action Newsletter will be August 26.



NCSL’s annual Legislative Summit is August 8 – 11 in San Antonio, Texas. Online registration is closed but on-site registration is still available. Web streaming is also available for 12 policy sessions.

Highlights from the Health Program include speaker Joel Ario, Director of the Office of Health Insurance Exchanges, as well as sessions on the Affordable Care Act, Medicaid and many more issues.

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