May 03, 2013

May 3 Washington Update

Greetings from Washington!  Congress has been on recess this week, but the administration has been somewhat busy.  It issued a revised model application for health care insurance in the Exchanges, which was shortened and simplified from the application released earlier.  In addition, HHS has issued some new FAQs regarding ACA implementation issues.  Comments on the proposed regulation regarding Navigator standards are due on Monday, and we urge you to submit comments. (See below.)

Proposed Rule on Navigator Standards.  As reported in previous weeks, the Centers for Medicare and Medicaid Services (CMS) issued, on April 5, a Notice of Proposed Rule Making (NPRM) on standards for Navigators in states that are not running their own exchanges.  Comments on the proposed regulation are due on Monday, April 6 (by 11:59 p.m.) and we urge you to submit comments. A template for these comments was emailed earlier today to F2Fs and SAOs.  You need only customize the introductory paragraphs to describe your F2F, SAO or other organization.  (If you did not receive this email, please contact Janis or Brooke; contact info below.)

A summary and the NPRM can be found here, as can a link to the pdf version.  Click SUBMIT from that page to send comments. Note that you can upload your comments at Step 3 rather than typing comments at Step 2.

The proposed regulation sets forth various standards that Navigators must meet, including standards related to conflicts of interest, training and certification, and accessibility.  Navigator grantees will be held to these standards once they are finalized.

Family Voices will be submitting comments along with several other child health organizations, and will submit individual comments as well.  The Family Voices comments (on which the template is based) emphasize that it is important to ensure that Navigators are trained about the specific coverage needs of and options for children and, more specifically, are trained to assist families of children and youth with special health care needs.  The Family Voices comments also urge CMS to give priority to grant applications submitted by F2Fs or consortia that include F2Fs, and point out that, while F2Fs already fulfill many navigator functions, they will need more funding to meet greater demand.

Navigator GrantsOn April 9, CMS issued a 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.)  More information about the grants is listed at the end of this update.

Single Streamlined Applications for Health InsuranceOn April 30, CMS released the model single, streamlined application that people will be able to use to apply for health insurance (private or public) through Exchanges and for premium tax credits and cost-sharing subsidies.  States may choose to use the model application or may develop an "alternative" application that is approved by CMS.  For states in which there is a Federally-Facilitated Exchange, the state's Medicaid/CHIP agency will accept the model form and may, in addition, develop an alternative application to be approved by CMS.

The model application released this week has been simplified and significantly shortened from the proposed application released earlier for public comment.  The application for individuals without health insurance has been reduced from twenty-one to three pages, and the application for families is reduced by two-thirds.  According to CMS, the forms are much shorter than industry standards for health insurance applications. The applications can be viewed here, and more information can be found in this CMCS Informational Bulletin.  Click here to see a blog post about the new application from the Georgetown Center on Children and Families.

Family Voices comments on IRS proposed rule on "Shared Responsibilty Payments."  On February 1, the Internal Revenue Service (IRS) issued proposed regulations regarding the "shared responsibility payments" (penalties) that individuals will have to pay if they fail to obtain health insurance after the ACA goes into effect.  The proposed regulations define "minimum essential coverage" for purposes of satisfying the health insurance requirement and describe the individuals who are exempt from the penalty.  Medicaid is considered "minimum essential coverage."

Under the ACA and previously issued regulations, a person who has "minimum essential coverage" is not eligible to receive tax credits to subsidize the cost of premiums for private insurance purchased through an Exchange.  Therefore, individuals receiving Medicaid "wrap-around" benefits to supplement private insurance may not be able to get a premium tax credit for which they would otherwise be eligible based on family income.

On May 2, Family Voices submitted comments on the proposed IRS regulations, both individually and in concert with several other child health organizations.  The Family Voices comments and joint comments recommend, among other things, that the IRS exclude such "wrap-around" Medicaid benefits from the definition of "minimum essential coverage," so that children with special health care needs who get Medicaid to supplement to their private coverage remain eligible for any premium tax credit to which they would otherwise be entitled.

ACA implementation - new FAQs

On May 1, The Center for Consumer Information and Insurance Oversight (CCIIO) issued Frequently Asked Questions (FAQs) on the role of agents, brokers, and web-brokers in Health Insurance Marketplaces.  View the FAQs here.

April 25, 2013, CMS issued FAQs addressing the availability of the 75 percent federal match for maintenance and operations, systems issues regarding communication between the Federally-Facilitated Marketplace and Medicaid, and further policy guidance regarding the use of section 1115 demonstrations.  View these FAQs here.

Other ACA implementation information: 

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

1. 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. 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

F2F funding legislation:  There are no updates on these bills, although the Family Voices policy team is communicating with Hill staff to identify potential vehicles through which the legislation might be enacted.  The House bill (H.R. 564), sponsored by Representative Frank Pallone (D-NJ), and the identical Senate bill (S. 423), 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


Information on the navigator grants is below.  As always, please feel free to contact us with any questions. 

Best, Janis & Brooke

Janis Guerney, Esq.

Brooke Lehmann, MSW, Esq.


Information on Navigator grants [repeat of last week's info with outdated items removed]

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.

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, 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.

Below are some resources available to help explain the federal Navigator standards and FOA and Navigators and assisters in general, and to provide resources useful in helping consumers (whether you are a federally funded Navigator or not).  

For more information about navigators, see the HHS In-Person Assistance page, which includes fact sheets, FAQs, etc. Email individual questions to

The Office of Minority Health Resource Center held a webinar, Technical Assistance: Foundations of Grant Writing.  You can access a recording at (You need to "register" as if attending the webinar, but then you will get access to the recording.)

The Kaiser Family Foundation and the Robert Wood Johnson Foundation hosted a forum to examine what consumers are already asking about their new health coverage options; what progress states are making and challenges they are facing to develop consumer assistance plans; and what role the federal government and other private sector entities might play in order to help consumers navigate the new health care landscape. 

Transcript (.pdf) | Podcast (mp3) | Speaker Biographies | Agenda | Slides (.pdf)

Other resources from the 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)

Family Voices resources.  (1) There is a webpage devoted to the Navigator grant application, proposed rule, and related materials at  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 Soon we hope to provide F2Fs with language about how F2Fs are qualified to be Navigators, and therefore should be awarded Navigator grants. 

CMS infoThe CMS Open Door Forum page provides information about Federally Facilitated and State Partnership Exchanges and contact information for 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.

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.

Enroll America.  For a video replay of a webinar held last 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.