Affordable Care Act State Action Newsletter 4

Affordable Care Act: State Action Newsletter

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March 4, 2011

$100 Million in Medicaid Grants to States to Prevent Disease  

On Feb. 25, 2011 the Department of Health and Human Services announced $100 million in grants through 2015 for states to provide financial incentives to Medicaid enrollees to adopt healthy behaviors. In the last few years, states have increasingly shown interest in such programs.

Before enactment of the ACA, some states were experimenting with incentives to encourage people covered by public health insurance to make healthy choices. For example, Florida’s Enhanced Benefits Accounts pilot program, which began in September 2006, financially rewards Medicaid recipients for adopting specific healthy behaviors. Idaho’s Preventive Health Assistance program, launched statewide in 2007, promotes a healthy lifestyle for Medicaid enrollees with incentives for tobacco cessation, weight management, child immunizations and well-baby visits. At least six state Medicaid programs provide comprehensive tobacco cessation coverage for beneficiaries.

To be eligible for the new Medicaid grants, states must use evidence-based research to address at least one prevention strategy, such as weight loss, smoking cessation, blood pressure and cholesterol control, or diabetes prevention or management. Interested states should submit their notice of intent to the Centers for Medicare and Medicaid Services by April 4, 2011 and the complete grant application by May 2, 2011. 

Support Growing for State Innovation Waivers

On February 28, President Obama told the nation’s governors that he would support Congressional Senate Bill 3958 to move the effective date for State Innovation Waivers from 2017 to 2014. These waivers will allow states to craft alternatives to certain provisions of the ACA such as the individual mandate. However, the state must cover as many people, provide the same level of benefits and operate with the same federal financial contribution as in the ACA.


Inside This Issue



States Awarded Federal Grants Through the ACA

The Affordable Care Act made numerous grants available to states to assist with health reform implementation. Below is a list of the awards each state has received since March 2010. Grants were awarded to state agencies, tribal organizations, health centers, research centers and other entities in the state. Not all grants were available to every state. Please see NCSL’s Affordable Care Act Grants Awarded to States for more detailed information about the specific grants.

This table was last updated March 1, 2011.









































































































*Total amounts reflected in the table include the portions of ACA awards that were not accepted or returned to the federal government.

State Health Insurance Mandates and the ACA

State health insurance mandates will come under increased scrutiny due to a provision in the Affordable Care Act. For many lawmakers, this topic has been relatively dormant for some time. The reason for the scrutiny is that states will be responsible for paying for any mandated coverage over and above the “essential health benefits” required in the new health insurance exchange.

Under the ACA, the secretary of the Department of Health and Human Services is responsible for defining the “essential health benefits” to be included with any policies in the health insurance exchange as of January 1, 2014. The Secretary has been directed to base additional regulations on current employer plans.

All 50 states have laws that require health insurers to cover or offer to cover certain services, benefits and patients. No two states have the same requirements. Idaho currently has at least 13, while Maryland has 67. The national average hovers around 40. For example, a state can require that insurers cover the cost of services provided by chiropractors, podiatrists, or massage therapists; benefits such as mammograms, acupuncture or drug abuse treatment; or certain populations such as adopted children.

Until additional regulations are announced, the current “floor” of benefits include: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. Most of these are already covered by insurance or through existing state mandates.

Once the definition of “essential health benefits” is determined, states may need to either amend state law to limit or remove mandates or appropriate funds to pay for the benefits not included in the essential health benefit definition.

CMS Releases MOE Provisions to States


On Feb. 25, HHS Secretary Kathleen Sebelius clarified aspects of the Affordable Care Act’s maintenance of effort (MOE) rules for Medicaid and CHIP. The ACA’s MOE provision requires that states’ eligibility rules under Medicaid remain in place until 2014 for adults and until 2019 for children.
Sebelius’s letter and supporting Q & A document address three elements of the MOE provisions: the MOE exemption for higher income adults in states experiencing budget deficits; the implication of the MOE on 1115 demonstration programs; and the treatment of premiums under the MOE. The letter clarifies that the MOE provision does not require states to seek a new or renewed 1115 waiver after their current waivers expires, and addresses other issues.



Student Health Plans to Comply with Consumer Protections in Affordable Care Act

HHS proposed a new rule in February that would define student health plans as a type of individual health insurance coverage, ensuring that students in these plans will benefit from the consumer protections guaranteed under the ACA. The plans included in the proposed rule are: those provided by a college or university through a health insurance company; those available only to students and their dependents enrolled in the sponsoring college or university; and those available to students regardless of their health. Estimates show some 3 million students have this type of health insurance, often because family coverage is unavailable or too expensive. New protections would include: no lifetime dollar limits on coverage; no arbitrary rescissions of insurance coverage due to an unintentional mistake on an application; no pre-existing condition exclusions for students under age 19. The public has until April 12 to comment on the proposed rule. For more information:

Pennsylvania Cuts Insurance Program Due to Budget Woes

On Feb. 28, Pennsylvania’s adultBasic, a health insurance program for low-income uninsured residents since 2002, closed its doors. The program was funded by tobacco settlement money and contributions from Blue Cross and Blue Shield. The 41,467 people who lost coverage will most likely be eligible for Medicaid or subsidies in 2014 when the ACA coverage expansion provisions kick in.


  • Did you miss our webinar series “States Implementing Health Reform?” If so, you can download the PowerPoint presentations and listen to the audio from the archives

  • Check out this tool for implementation of ACA: State Legislator’s Checklist for Health Reform Implementation 2011. 

  • Coming Soon on NCSL’s Health Reform Web Pages!  The Health Reform Legislative Tracking Database will be a 50-State Database designed to capture 2011 legislation filed in response to the Affordable Care Act.

  • Are you interested in research and reports related to implementation of the ACA from other states?   Visit NCSL’s State Reports and Research Web Page.

  • Health Reform Information on the NCSL Web Page:

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