December 14, 2012

December 14 Washington Update

Greetings from Washington.  Although Congress has been fairly quiet this week, the administration has been quite busy.  Among other things, it announced conditional approval of state-based Exchanges in nine states, and issued FAQs which clarify that states will not be allowed to get federal matching for partial adoption of ACA's Medicaid expansion. 

F2F Funding.  There is no news on the F2F funding front.  As discussed earlier, we are hoping to get the F2F funding extension incorporated into a piece of legislation that is likely to become law.  Candidates for such a legislative "vehicle" include the "doc fix," to prevent a reduction in Medicare reimbursement to physicians, and legislation to implement any sort of budget deal that is reached in the coming weeks or months. 

At this point, we are suggesting that constituents contact only targeted Members of Congress to ask them to support the funding legislation.  We will let you know if you are represented by one of the key lawmakers who still need to be approached.  Also, please thank those who have already cosponsored the bill (listed at the end of this update).

ACA implementation.  This week, the Centers for Medicare and Medicaid Services (CMS) released a set of Q's and A's to address states' questions about implementation of the ACA's provisions on Exchanges, Medicaid expansion and insurance market reform. 

Medicaid expansion.  As you may recall, the ACA expanded Medicaid eligibility to cover all individuals with incomes under 133% of the Federal Poverty Level (FPL).  The federal government would pay all of the cost of this expansion for the first three years.  Thereafter, federal match rates would decline until 2020, when the matching rate would be fixed at 90% for the expansion population.  

The Supreme Court ruled that states are not obligated to implement this Medicaid expansion, however, leading some states to ask whether they could expand Medicaid eligibility up to a lower income threshold and still get the enhanced matching rate.  The CMS document issued this week answers that question in the negative. 

The FAQ document also clarifies that there is no deadline by which states must decide whether to adopt the ACA's Medicaid expansion.  The document points out, however, that the enhanced federal matching rates for newly eligible individuals are tied to specific calendar years in the statute.  Thus, states will receive 100 percent support for the newly eligible adults in 2014, 2015, and 2016; 95 percent in 2017, 94 percent in 2018, 93 percent in 2019; and 90 percent in 2020 and thereafter.

Exchanges.  This week, HHS provided conditional approval of state Exchanges in nine states -- Colorado, Connecticut, the District of Columbia, Kentucky, Massachusetts, Maryland, New York, Oregon, and Washington.  To see the status of Exchange implementation in the states, see the Kaiser Family Foundation website at

Essential Health Benefits.  On Thursday, Family Voices held a webinar on the proposed rule to govern implementation of the "Essential Health Benefits" (EHB) provision of the ACA.  The webinar slides, recording and related materials are available through the NCFPP website at

The proposed rule would require each state to determine its own package of EHB, and raises some serious concerns about benefits and cost-sharing, so individuals and organizations are urged to submit comments, due on December 26.  Family Voices will provide more information next week to help people craft their comments. 

For additional information, see a summary of the proposed rule, information on the proposed EHB-benchmark plans for each of the 50 states and the District of Columbia, and a Guide to Reviewing the State Benchmarks.

12/19 conference call on navigators.  The ACA requires that state Exchanges fund "navigators" and in-person "assisters" to help consumers select health plans, which might provide a source of funding for F2Fs in the future.  Families USA is holding a conference call on this topic on Wednesday, December 19, 2:30 ET.  Click here for background information and a tool-kit for advocates from the Families USA website. To RSVP for the call, click here.


As always, please feel free to contact us with any questions. 

Brooke Lehmann, MSW, Esq.

Janis Guerney, Esq.

NOTE:  Past issues of the Washington update can be found on the Family Voices home page by scrolling down in the "News Feed" section.


Cosponsors of Representative Pallone's bill (H.R. 4083), as of 12/6/12:

Rep Carson, Andre [IN-7] - 4/26/2012
Rep Cicilline, David N. [RI-1] - 2/17/2012
Rep Engel, Eliot L. [NY-17] - 2/17/2012
Rep Green, Gene [TX-29] - 3/5/2012
Rep Hanabusa, Colleen W. [HI-1] - 7/18/2012
Rep Langevin, James R. [RI-2] - 2/17/2012
Rep Michaud, Michael H. [ME-2] - 2/17/2012
Rep Norton, Eleanor Holmes [DC] - 2/17/2012
Rep Pingree, Chellie [ME-1] - 2/17/2012
Rep Rangel, Charles B. [NY-15] - 3/8/2012
Rep Roybal-Allard, Lucille [CA-34] - 3/20/2012
Rep Waxman, Henry A. [CA-30] - 7/9/2012
Rep Welch, Peter [VT] - 11/16/2012

Cosponsors of Senator Menendez's bill (S. 2123), as of 12/6/12:

Sen Akaka, Daniel K. [HI] - 6/4/2012 
Sen Bingaman, Jeff [NM] - 2/17/2012 
Sen Conrad, Kent [ND] - 2/17/2012 
Sen Franken, Al [MN] - 6/5/2012 
Sen Inouye, Daniel K. [HI] - 8/2/2012 
Sen Kerry, John F. [MA] - 3/13/2012 
Sen Klobuchar, Amy [MN] - 5/8/2012 
Sen Lautenberg, Frank R. [NJ] - 2/17/2012 
Sen Schumer, Charles E. [NY] - 9/21/2012 
Sen Snowe, Olympia J. [ME] - 2/17/2012 
Sen Whitehouse, Sheldon [RI] - 2/17/2012 
Sen Wyden, Ron [OR] - 9/19/2012