April 19, 2013

April 19 Washington Update

Greetings from Washington.  This week's update will focus again on the proposed regulations and Funding Opportunity Announcement about federal Navigator grants for states not running their own exchanges. Optional letters of intent are due on May 1.  Applications are due on June 7.  Registration to be a federal grantee is required and takes some time, so it is important to act now if your organization might want to apply for a Navigator grant.  First, though...

F2F funding legislation.  There are no updates on this legislation.  The House bill (H.R. 564), sponsored by Representative Frank Pallone (D-NJ), and the identical Senate bill (S. 423, corrected number), sponsored by Senator Robert Menendez (D-NJ), each have one cosponsor.  The bills would extend funding for Family-to-Family Health Information Centers (F2Fs) through FY 2016 at the current funding level of $5 million per year.  If you would like to urge your Representative and/or Senators to cosponsor these bills, you can find their contact information at http://www.congressmerge.com/onlinedb/index.htm

Navigator grants. Under the ACA, Exchanges (a.k.a., "Marketplaces") are required to provide grants to "Navigator" entities that will help people figure out how to select insurance in a post-reform world.  The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule to amend and clarify standards for Navigators that were established in an earlier rulemaking.  Last week, CMS issued the Funding Opportunity Announcement (FOA) for Navigator grants in states where the federal government will operate the Exchange, either alone or in partnership with the state. (In states running their own Exchanges, the state will be issuing navigator grants.)  For links to the proposed rule and FOA, see webpages listed below.

As explained in the FOA, optional (but encouraged) Letters of Intent to apply for a Navigator grant are due on May 1.  Applications are due June 7, and awards will be made August 15.  Note that the proposed rule (especially section III. - Collection of Information Requirements on page 20591 of the Federal Register notice) also provides background information that should be helpful to grant applicants as they develop a budget. 

If your organization might apply for a Navigator grant, and does not have a current registration to be a federal grant applicant, it is important to act now.  To register, go to http://grants.gov/applicants/get_registered.jsp, a process that can from a few days to a few weeks.  Registering does not obligate one to apply and there is no cost.

CMS is encouraging groups within a state to apply as a consortium so that sub-grantees can specialize in serving certain populations or geographic areas.  Entities from multiple states can also apply together.  Each Navigator grantee will be expected to be able to help all types of consumers and small businesses, after undergoing online training to be provided by the Department of Health and Human Services (HHS).  Therefore, it might make sense for F2Fs and SAOs to apply for a grant with another organization(s) that cover(s) a different or broader population and could use the expertise of the F2F/SAO to assist families whose children have special health care needs.

Helpful resources.  Below are some resources available to help explain the federal Navigator standards and FOA, and to provide resources to help consumers (whether you are a federally funded Navigator or not).  

CMS conference call for grant applicants.  CMS is holding pre-application conference calls for potential applicants.  The conference calls will provide an overview of the project, budget guidance, a review of the instructions provided by the FOA, and other available materials, and will include an opportunity for potential applicants to ask questions.  The next and final call will be held on Wednesday, April 24, 2013, from 3:30-5:00p.m. ET.  Toll-free teleconference phone number: 877-267-1577; ID: 8100Based on past experience, it may be difficult to get on the call, so call in as far ahead as possible. 

The Office of Minority Health Resource Center will be holding a webinar, Technical Assistance: Foundations of Grant Writing, which will provide the essentials of putting together a successful federal grant proposal.  Potential applicants for the Navigator grant or another funding opportunity may find this workshop helpful.  

Date: Thursday, April 25, 2013
Time: 4:00 PM - 5:30 PM EDT

Register at https://www2.gotomeeting.com/register/896642522.

Family Voices resources.  (1) There is a webpage devoted to the Navigator grant application, proposed rule, and related materials at http://www2.familyvoices.org/blog/navigator.html.  The user name is cms; the password is navigator. The webpage has links to relevant CMS and other materials.  (2) There is also a Family Voices BigTent page, which will have the same information as the webpage, but will also allow users to post information and "discuss" issues related to the grant application.  To get access to this, please contact Peggy Curran at pcurran@familyvoices.org

Families USA Resource Center.  To provide organizations with the latest news and resources needed to plan and establish effective navigator programs, including information on the FOA, Families USA has developed a Navigator and In-Person Assisters Resource Center.  It will also establish a navigator and assister interest group, for those interested in updates and communication (like emails or webinars) related to these programs. To join or learn more, click here.

Georgetown Center on Children and Families.  See this blog series.

Kaiser Family Foundation

  • How Will Consumers Navigate New Health Care Options? (Webcast)
  • Consumer Assistance in Health Reform (Issue Brief)
  • Navigator and In-Person Assistance Programs: A Snapshot of State Programs (Issue Brief)

Enroll America.  For a video replay of a webinar held this week, slides, and related materials go to Enroll America's webinar archives.  See also:  "Where are the uninsured?" tool (gives detailed information about the uninsured in regions of each state, which might be helpful in preparing a navigator grant application) and Messaging research.  This material is fairly general, rather than being focused on the Navigator FOA.

Other ACA implementation information.  The Center for Medicare and Medicaid Services will be holding state-by-state calls to discuss implementation of Exchanges/Marketplaces.  The Open Door Forum page provides the tentative schedule, updates, and best point of state contacts in CMS Regional Offices.  States not listed on that page have decided to run their own State Based Marketplace.  Your State Marketplace provides links to websites that describe each state's Marketplace efforts.

Other websites where one can get information and sign up for updates are:

1.     HealthCare.gov: This site is geared towards consumers and provides general information about the Marketplace and health insurance. Consumers can sign up for email and/or text message updates.

2.     Marketplace.cms.gov: This page has a wide variety of tools and resources to help you help people prepare to apply, enroll and get coverage in 2014. You can also sign up for updates by clicking on "Get updates." After entering your email address, check the box that says "Health Insurance Marketplace (Exchange)" under the "Outreach and Education" section near the middle of the page. This is the main avenue that CMS will use to communicate with interested stakeholders on Marketplace updates.

To submit comments or make inquiries, contact partnership@cms.hhs.gov.

MAGI.  Under the ACA, a new way of determining income for Medicaid applicants will be instituted.  "Modified Adjusted Gross Income" (MAGI) will be used as a national standard for income calculation, replacing current state-by-state standards.  The National Health Law Program (NHeLP) has an article explaining MAGI in this month's Health Advocate.  See also http://www.shadac.org/blog/what-magi-and-why-does-it-matter.

Senate amendment on mental health.  A bipartisan, fairly modest mental health amendment to gun policy legislation was adopted by the Senate this week.  That bill has been pulled from the Floor, however, and it is unclear when it will be considered again.   The budget neutral amendment would reauthorize various mental health programs run by the Health and Human Services and Education departments, including grants for college mental health services. See the CQ Roll Call story at http://www.cq.com/alertmatch/184039856.  

Medicaid Premium Assistance Programs.  CMS released a set of Frequently Asked Questions regarding states' authority to use Medicaid funds to subsidize private insurance, as has been proposed by Arkansas.  The National Health Law Program has summarized the FAQs.  The summary, available through StateReforum at http://www.statereforum.org/discussions/premium-assistance, includes a link to the full HHS document.  According to news reports, governors and legislators in several states, including Arkansas, Florida, Louisiana, Ohio, Pennsylvania, and Tennessee, are developing premium assistance proposals.  See also this blog from the Georgetown Center on Children and Families.


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

Best, Janis & Brooke

Janis Guerney, Esq.

Brooke Lehmann, MSW, Esq.