June 14, 2013

June 14 Washington Update

Greetings from Washington, DC!  This week, it was officially announced that F2Fs will be funded through May 2014, and Congressman Frank Pallone sent a letter to his House colleagues asking that they cosponsor his bill to extend F2F funding beyond that.  In addition to information on these developments, this update provides information on upcoming webinars regarding ACA implementation.

F2F grant funding announcement.  On June 12, the Health Resources and Services Administration (HRSA) published a Federal Register Notice to officially announce that funding for Family-to-Family Health Information Centers (F2Fs) has been extended until May 31, 2014, and there will be no competition for these grants during this year.  Note that this funding is the FY 2013 funding made available through the American Taxpayer Relief Act passed on New Year's Eve.  The Menendez-Pallone legislation must still be enacted to extend funding beyond May 2014.  Speaking of that legislation...

F2F funding legislation.   A new development: House-bill sponsor Congressman Frank Pallone (D-NJ) has sent a letter to his House colleagues asking them to cosponsor the bill (H.R. 564).  Therefore, this would be a good time to contact your Representative to ask him/her to cosponsor the legislation.  You can find his or her contact information at www.house.gov.  You can find the contact information for your Representative and Senators at http://www.congressmerge.com/onlinedb/index.htm.  So far, the only House cosponsor is Rep. David Cicilline (D-RI).  The cosponsors of the Senate bill (S. 423) are Senators Sheldon Whitehouse (D-RI), Al Franken (D-MN), and Amy Klobuchar (D-MN).  Senator Menendez will likely send a letter to his colleagues seeking additional cosponsors in the near future.  We will let you know when he does so.

{Remember:  no federal resources can be used to contact your elected officials about cosponsoring the legislation.}

Family Voices Executive Director in DC.  This week, Lynn Pedraza, the Executive Director of Family Voices, was in DC for a meeting and made a brief presentation about Family Voices and F2Fs to the Children's Health Group, a coalition led by the American Academy of Pediatrics of 30+ organizations concerned with children's health issues.  Groups represented at this meeting included the Children's Hospital Association, the March of Dimes, the American College of Obstetricians and Gynecologists, Autism Speaks, the Children's Defense Fund, and others.  The Family Voices Policy Team regularly participates in the Children's Health Group, as well as a sub-group of child health advocates with which we visit with congressional staff and develop materials for Capitol Hill and comments on proposed regulations.  In fact, we are working now to prepare an information sheet to help navigators and other consumer assistance personnel working with families of children with special health care needs.


ACA cost-reduction provisions.  The second installment of the Center on Budget and Policy Priorities' Beyond the Basics of Health Reform webinar series will take place next Wednesday, June 19, at 2:00-3:30 pm Eastern (11 am Pacific).

This webinar will provide an in-depth look at cost-sharing reductions, which, together with premium tax credits, will make coverage affordable for large numbers of Americans in 2014.  The webinar will go beyond the basics of who will qualify for cost-sharing reductions to illustrate how these subsidies reduce the cost of medical care for those enrolled in plans in the new health insurance marketplaces.  Specific areas of focus will include:

* The cost-sharing standards that apply in all Marketplace plans;
* What you need to know about "actuarial value;"
* How plans in the marketplaces will provide cost-sharing reductions;
* Choices available to people who are eligible for cost-sharing reductions.

The webinar will feature real-life scenarios to illustrate how the cost-sharing reductions work, and there will be ample time for questions. Space is limited.  Register now at: https://www4.gotomeeting.com/register/571509055

Innovation grants.  The CMS Innovation Center will host a webinar on June 18, 2013, from 1:30-3:00pm EDT, titled Health Care Innovation Awards Round Two - Overview of Categories Three and Four.  This webinar is primarily intended for potential applicants interested in submitting proposals for innovative service and delivery payment models in the specified categories.  HHS subject matter experts will present on the remaining two of the four innovation categories:  transforming the financial and clinical models of specific types of providers and suppliers; and improving the health of populations through better prevention efforts.  Staff will also provide technical assistance on submitting a Letter of Intent during this webinar.  Registration is still available

On Thursday, June 20, 2013, from 1:00-2:00pm EDT, the CMS Innovation Center will conduct a webinar intended for financial officers at organizations interested in submitting proposals for innovative service and delivery payment models.  Register here.

Health Insurance Marketplaces (Exchanges).  CMS has announced series of training webinars about Exchanges. There will be two levels, basic and advanced.  Space is limited, but the webinars are offered on multiple dates.  See the end of this update to register.


TRICARE.  Family Voices Public Policy Co-Director Brooke Lehmann will be attending a meeting on Tuesday, June 18, about children's coverage under the military's TRICARE program.  Please let her know if you have encountered problems with TRICARE that would inform her discussion.  Her contact information is at the end of this update.

State preparations for ACA implementation.  An interesting article from the Pew Charitable Trust's Stateline publication discusses some of the issues states are dealing with in implementing the ACA.  http://www.pewstates.org/projects/stateline/headlines/states-prepare-to-launch-new-health-law-85899482172

Brokers as navigators.  This week's blog of Community Catalyst has a post on ACA consumer assistance that discusses the role of insurance brokers at http://blog.communitycatalyst.org/index.php/2013/06/14/the-latest-scoop-on-enrollment-broker-regulations/.

Supreme Court decision on special education.  As reported in Disability Scoop, the U.S. Supreme Court declined this week to review a lower appeals court decision about whether or not parents should have a say in deciding which school their children with disabilities attend. The court said it would not hear an appeal in a case brought by the parents of a boy with autism against the New York City school system.  Accordingly, the federal appeals court ruling still applies and the school district "may select the specific school without the advice of the parents so long as it conforms to the program offered in the IEP."  The Supreme Court did not comment on its decision.

CMS Program Integrity guidelines for Marketplaces.  Today, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule outlining program integrity guidelines for the Health Insurance Marketplace (Marketplace) and premium stabilization programs.   According to the announcement, "With open enrollment only a few months away, consumers can look forward to receiving more information in the coming weeks and months about how to enroll in the Marketplace.  This summer, CMS will re-launch HealthCare.gov, where consumers will have access to real-time information and help to sign up for coverage during open enrollment in October. The Marketplace call center will begin taking calls from consumers, beginning with educational information and then assisting with enrollment and plan selection on October 1.  CMS will also begin consumer assistance training this summer so that consumers will have the help they need in applying for and choosing the coverage that is right for them."  To access the proposed rule released today, visit: http://www.ofr.gov/inspection.aspx.   To view a fact sheet on the proposed rule, visit: http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/pi-nprm-6-14-2013.html.  For more information about Health Insurance Marketplaces, visit: www.healthcare.gov/marketplace.

AAP seeking family stories on home care benefits.  Julie Beckett, FV Board of Directors, has forwarded the following request from the American Academy of Pediatrics (AAP) regarding home care benefits in the ACA.  The AAP is seeking family stories about home care for children, specifically:

"Family Stories" for a story bank....illustrating cases where children who are in need of home care services, do not obtain them. Please illustrate the reason they qualify, the struggle in obtaining services and or the struggle after denied services. Pictures, names (obviously with specific permission of parent) are appreciated.

They are looking for these stories to be sent in by June 26th.  Please send the stories to Julie Beckett, at waivermom@earthlink.net and Melanie Rubin, mrubin@familyvoices.org who will ensure that they are forwarded on to AAP.


NEW:  Community Catalyst and Georgetown University's Health Policy Institute created a Health Insurance 101 online guide on private health insurance.  The guide is intended to help consumer advocates answer critical questions about private insurance:  What is health insurance and how does it work?  How do people get health insurance today?  How will health insurance change under health care reform?  Answers to questions about fully insured employer health plans, self-insured employer health plans, medical underwriting, and more are provided.

Premium Tax Credits.  The Center on Budget and Policy Priorities held a webinar on June 5 about premium tax credits under the ACA.  A recording of the session (with synched slides) is available on YouTube, and the slides alone can be found here.  The Center has also prepared a fact sheet on Frequently Asked Questions about premium tax credits.    

Navigators and In-Person Assisters: 

Families USA has created a Navigator and In-Person Assister Resource Center and people can sign up to receive updates on this topic.  Also available:

This week's blog of the Georgetown Center on Children and Families includes a post about training and other elements needed for an effective consumer assistance system.  This outline could be helpful to advocates attempting to shape a state's policy with respect to consumer assistance training and support.

From CMS: Helping Consumers Apply and Enroll Through the Marketplace (explains the different types of "navigators," "assisters" and "application counselors")

 StateRefor(u)m, a project of the National Academy for State Health Policy (NASHP) and the Robert Wood Johnson Foundation, has a wealth of information on state ACA implementation, including draft/final regulations on consumer assistance plans in California and Minnesota.

Eligibility and Enrollment:

An issue brief from the Kaiser Family Foundation's Commission on Medicaid and the Uninsured identifies five key lessons based on a review of existing research on previous outreach and enrollment experience in Medicaid and the Children's Health Insurance Program. 

Available here is a webcast of a session held by Families USA and Enroll America that discusses: (1) tactics for successfully engaging uninsured people, particularly communities of color, to get them enrolled in health insurance, and (2) best practices for raising public awareness about the health insurance options available under the ACA.

Information on "Churning": The Continuity of Medicaid Coverage is a report from George Washington University explaining the benefits of minimizing disruptions for Medicaid enrollees.  It includes an updated analysis of rates of continuity of coverage in each state and recommendations for states to address churn by such methods as easing the yearly renewal process and using electronic income verification.  Eligibility, Enrollment and Churn Recommendations, are recommendations adopted by the District of Columbia exchange board for easing eligibility processes and reducing churn through such tactics as not requiring reporting of income changes of less than $150 per month; requiring QHPs to have transition plans for enrollees moving on or off the plans; and granting "good faith" extensions of deadlines to resolve inconsistencies in an application.

MAGI rules for Medicaid Eligibility, provides three versions of a flow chart designed to map the steps for determining a person's eligibility for Medicaid under the new MAGI rules. Find the charts and post your comments here.

Exchanges and Qualified Health Plans (from StateRefor(u)m):

State Approaches to Qualified Health Plan Certification Chart, which shows how much authority each exchange or partnership state has in the various domains related to certifying health plans to be sold in an exchange. Includes links to source documents.  The recording and slides from a webinar on three states' certification methods, including Q & A, are also available.

State and Partnership Exchange Policy Decisions Chart, which identifies various decisions states must make with respect to Exchange implementation, such as with the eligibility system will include Medicaid, how to approach consumer assistance; how to finance the exchange; and how much authority over insurance plans they will have.  Includes links to source documents.

Exchange Blueprint Chart/Where States Stand on Exchanges Map, two documents providing information  about which type of exchange will be in each state, some of the background on how each state came to that decision, and any future plans to change status.

Medicaid Expansion Update and Resources

As state legislative sessions come to a close, you may find this new infographic from Families USA useful. A 50-State Look at the Medicaid Expansion explains the basic facts about the status of Medicaid expansion along with a brief analysis of three states to watch--Arizona, Florida and Pennsylvania.

Another great resource to track the Medicaid Expansion is CBPP's (Center on Budget and Policy Priorities) Medicaid Expansion Toolkit. They just added a new fact sheet to their toolkit on how the expansion will impact rural America. If all states expanded Medicaid, 2.6 million people in rural American could gain coverage.

Also, NHeLP has updated their Medicaid Expansion Toolbox and they continue to add additional resources and factsheets to this toolbox.

ACA information and subscription to updates can also be found at:

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.


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

Best, Janis & Brooke

Janis Guerney, Esq.

Brooke Lehmann, MSW, Esq.




[NOTE:  There are two lists of webinars below.  The second provides additional dates/times for the "Level 1" webinars plus a "Q & A" webinar in Spanish.]


  • Level 1: Health Insurance Marketplace 101 (basic) - A one-hour high-level webinar overview of the accomplishments of the Affordable Care Act and a basic introduction to the Marketplace (Exchanges) highlighting who is eligible and how the Marketplace will work.


  • Level 2: Understanding the Health Insurance Marketplace (advanced) - A two-hour detailed review of the Marketplace (Exchanges), including eligibility, enrollment, plan structure, Medicaid expansion, and the streamlined application.


Select the webinar that best suits your needs and then select the Registration Link that corresponds with the date to register for the webinar.  Please note that there is a limit of 200 people for each of the webinars and will be filled on a first come first serve basis.


NOTE:  In the fields asking for agency and division/group, enter ‘NA'.  Although I understand that some people are able to register without a problem, I have had technical difficulty registering, using the links in the first list below, but not the list of "new" webinars.  I have been trying to get information to resolve the technical difficulties, but have not yet been successful.  Please let me know if you are having trouble registering too.



Level 1: Health Insurance Marketplace 101



1:00 - 2:00 pm ET




1:00 - 2:00 pm ET




1:00 - 2:00 pm ET




1:00 - 2:00 pm ET




1:00 - 2:00 pm ET




1:00 - 2:00 pm ET




Level 2: Understanding the Health Insurance Marketplace


1:00 - 3:00 pm ET




1:00 - 3:00 pm ET




1:00 - 3:00 pm ET




For more information on these and other events hosted by the Centers for Medicare & Medicaid Services, email the CMS National Training Program at training@cms.hhs.gov.  Marketplace information and training materials for partners is available at Marketplace.cms.gov.


Click on the title of the webinar you prefer and fill out the registration form. After registering you will receive an e-mail confirmation containing information about joining the webinar. Please contact us at ACA101@hhs.gov  if you have problems registering or if you have any questions about the health care law. All webinars are one hour.

Please note that the first 1,000 people who join each webinar at the start time are able to attend. If there is significant interest in a webinar, we will do our best to schedule another session for the following month. If possible, please use your computer speakers to listen to the audio portion of the webinar.


NEW - The Health Care Law - Health Insurance Marketplace 101

June 19 at 12:30 pm ET

A presentation on the main provisions in the health care law (the Affordable Care Act) and how to access care in your community. Topics include the Health Insurance Marketplace, how to enroll in health insurance, and how to receive updates on implementation of the law. A brief question and answer session will provide answers to commonly asked questions.


NEW - The Health Care Law - Health Insurance Marketplace 101

July 11 at 2:00 pm ET


NEW - The Health Care Law - Health Insurance Marketplace 101

August 7 at 3:00 pm ET