June 22, 2013

June 22 Washington Update

Greetings from Washington, DC!  As of Saturday, 6/22, there are 100 days until enrollment for health insurance begins in the nation's exchanges!  Yesterday, the Department of Health and Human Services launched the newly designed www.healthcare.gov health care reform website, along with a 24/7 toll-free number. This week's update will focus on implementation of health care reform, a.k.a. the ACA (Affordable Care Act), particularly issues related to consumer assistance.  We would also like to report a new cosponsor for the F2F funding extension bill.


On Friday, June 28, at 12:00 -1:00 pm ET, the anniversary of the Supreme Court decision upholding the ACA, the National Health Law Program (NHeLP), will host a "Twitter Townhall" to answer all questions related to the ACA and Medicaid.  Track the tweets (@NHeLP_org) and join the conversation by using the hashtag #NHeLPanswers.

If your organization has key facts or nonpartisan links (ie, polling data, infographics, blogs, etc) that you would like us to use during our Townhall, please email them to barredondo@rabengroup.com.  NHeLP will try to tweet them and "mention" your group.  Spread the word using one of these sample tweets or one of your own:

  • Join our friends @NHeLP_org for a Twitter townhall marking 1 yr #SCOTUS #ACA decision 6/28 12-1 PMEST! Follow discussion w/ #NHeLPanswers.
  • Have questions about the #ACA #Medicaid and more? Join our friends @NHeLP_org for #NHeLPanswers Twitter townhall, June 28, 12-1 PM EST!
  • 1 yr after #ACA #SCOTUS decision, but ?s remain. Join [insert name of org] & @NHeLP_org for #NHeLPanswers & ask your ?s 6/28, 12-1PM EST!

On Wednesday, July 10 at 2:00 (to 3:30) pm Eastern (11 am Pacific) the Center on Budget and Policy Priorities (CBPP) will present the next webinar in its ACA ‘Beyond the Basics' series, which will focus on employer responsibility and coordination with the exchange.  See below for archives of the previous webinars in this series, on premium assistance and cost-sharing subsidies. 

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.

New HRSA Video Series on Grant Applications [always available].  A HRSA video series is intended to debunk the myths surrounding the grant application process and provide tips for how to submit a successful application.  In short animated segments, the series explains grant eligibility, planning for and preparing your submission and the approval process.  See:  Video Series; How to Apply for a Grant.


New cosponsor on F2F funding bill.  Senator Elizabeth Warren (D-MA) joins Senators Sheldon Whitehouse (D-RI), Al Franken (D-MN), and Amy Klobuchar (D-MN) as cosponsors of the F2F funding extension bill (S. 243) sponsored by Senator Robert Menendez (D-NJ).  As reported last week, House-bill sponsor Congressman Frank Pallone (D-NJ) sent a letter to his House colleagues asking them to cosponsor the bill (H.R. 564), so if you have not yet contacted your Representative to alert them to this letter and ask them to cosponsor the bill, this would be a good time to do so.  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). 

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


Toll-free number now operational!  I discovered Friday night that HHS quietly relaunched its www.healthcare.gov website.  It has a chat feature (not operating at the moment I tried it) and a 24/7 hotline (1-800-318-2596).  The website solicits feedback on each page, so check it out and suggest improvements.  I called the hotline, and after a brief chat with a computerized operator, actually spoke to someone after midnight EST!  Try it and see what you think. 

The telephone line is being run by a contractor, Vangent, a subsidiary of General Dynamics Information Technology, which already runs the call center for Medicare.  To handle all of these calls, Vangent is expected to triple its staff to more than 13,000, according to this interesting article in the Washington Post, which also reports that employment ads for the call centers' "temporary customer service representatives" seek applicants who have a high school diploma or equivalent and six months of telemarketing or secretarial experience.  The article also notes that there have been problems with the Medicare call center run by Vangent.

Promotion of the ACA.  The "Get Covered America!" campaign launches today (June 22) - 100 days until the beginning of the enrollment period for people to sign up for health insurance through Health Insurance Marketplaces (Exchanges).  The campaign is a project of Enroll America (which offers email updates), an organization led by several former Obama campaign staffers.  Plans are to reach out to the uninsured in multiple ways: knocking on doors, handing out brochures in public places, advertising on television and radio, and partnering with churches, civic groups, hospitals and, possibly sports leagues and celebrities.  Read more at http://www.politico.com/story/2013/06/selling-of-obamacare-officially-begins-93008.html#ixzz2WuFv2blc and http://news.yahoo.com/nonprofit-launches-campaign-reach-uninsured-183729406.html;_ylt=A2KJ2Ui3sMFR3GsAdy_QtDMD.

Meanwhile, Organizing for America, a political advocacy group created from the Obama reelection campaign, aired its first pro-ACA television ad this week.

GAO Report on ACA implementation progress.  This week, the Government Accountability Office (GAO), an arm of Congress, released a report on the status of implementing Federally Facilitated Exchanges, and another report on federal and state efforts to establish health insurance exchanges for small businesses ("SHOP" exchanges).  While much progress still must be made, the Centers for Medicare and Medicaid Services (CMS) has stated that it believes all exchanges will be up and running by October 1.  In a Health Affairs blog post on June 20, health law professor Timothy Jost, of the Washington and Lee University School of Law, outlined some of the implementation challenges faced by the administration.  He notes that much remains to be done with respect to consumer assistance:

"The exchange function that seems to be most behind schedule is consumer assistance.... Although CMS says that it expects to have navigator programs operational in each of the 34 states with a federal exchange by October 1, navigators will have to undergo training and certification and pass an exam before they can begin serving consumers.  A number of states have adopted navigator licensure laws that impose additional requirements, some quite onerous.  It is hard to see how the program will be up and running by October 1, although it is quite possible to have it in place soon thereafter in most states.

Six of the partnership states will be operating consumer assistance programs that will supplement the navigator program.  These states are, according to CMS, making progress but several are behind schedule.  The CMS call center and the Healthcare.gov website relaunch are scheduled for June 2013.  A contract has been let by CMS for English-language media outreach and a contract for Spanish-language outreach is scheduled for June, with translation of educational materials into 25 languages to follow."

Consumer Assistance, continued...

This Kaiser Health News article also discusses the challenges of implementing consumer assistance programs.  It notes that such programs are operating in 21 states but that, according Mark Schlesinger, a professor of health policy at Yale, the quality of the programs varies considerably.  And this Kaiser Health News article, Preparing For Flood Of Consumer Questions On Insurance Exchanges, highlights consumer assistance efforts in Minnesota and Florida.

Meanwhile, some Republican Members of Congress raised concerns about navigators and other consumer assisters.  On June 7, over 30 House Republicans wrote a letter to Secretary of Health and Human Services Kathleen Sebelius asking her to explain how the administration will ensure that the public knows that navigators are not licensed or insured against accidental mistakes like agents or brokers, who carry errors and omissions insurance.  And this week nine Senators wrote a letter to Secretary Sebelius raising similar concerns and asking how the administration plans to protect consumers' privacy as they are provided with assistance in applying for insurance.  They suggested that the administration has not proposed adequate safeguards and sufficiently stringent training of consumer assistance providers to protect consumers from identity theft or other crimes, since assisters and navigators could have access to information such as Social Security numbers and tax returns.  In addition, they asked how HHS planned to prevent potential fraud by people who present themselves as navigators or assisters "to unsuspecting consumers for nefarious purposes."  For more information, see this CQ Roll Call article: http://www.cq.com/alertmatch/190098373.


"Suggested Model for Written Notification of Parental Rights Regarding Use of Public Benefits or Insurance" for payment of IDEA services.  On February 14, 2013, the Office of Special Education and Rehabilitative Services (OSERS) published the final regulations under the Individuals with Disabilities Education Act to amend regulations governing the use of public benefits of insurance.  The amendment included a new requirement for public agencies to provide written notification to a child's parents before accessing a child's or parent's public benefits or insurance for the first time and annually thereafter.  On June 11, OSERS issued an explanation of the final regulations and a suggested model for written notification of parental rights regarding use of public benefits or insurance.  The explanation and model notification form can be found at Suggested Model for Written Notification of Parental Rights regarding Use of Public Benefits or Insurance.pdf.

CMS Guidance on Alternative Streamlined Applications.  On June 18, CMS released guidance regarding the process for submission of requests for use of an alternative single, streamlined application for all insurance affordability programs.  This guidance builds off of the release of the model application on April 30, 2013, which -- in both its paper and online versions -- will be the sole application used by the Federally-facilitated Marketplace to facilitate eligibility determinations and enrollment in health coverage. Medicaid agencies, CHIP agencies, and State-based Marketplaces may choose to use the model single, streamlined application, or may develop an alternative single, streamlined application approved by CMS. The guidance is available online at http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/state-alt-app-guidance-6-18-2013.pdf.

In addition, CMS has posted materials for states considering an integrated human services application, which were developed by the CMS Medicaid and CHIP Expanding Coverage Learning Collaborative. 

CMS has also reformatted its display of ACA-related FAQs in the State Resource Center on Medicaid.gov. They are now sortable and searchable, rather than being stored in .pdf documents.  See http://www.medicaid.gov/State-Resource-Center/FAQ-Medicaid-and-CHIP-Affordable-Care-Act-ACA-Implementation/FAQ-Medicaid-and-CHIP-Affordable-Care-Act-ACA-Implementation.html.


Health Insurance 101.  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 (CBPP) 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.    

Cost-sharing reductions.  Slides from this CBPP webinar can be found here.  [Note: There was an error on the original slides (slide 7) regarding the federal requirement for the maximum out-of-pocket limit for marketplace plans in 2014.  The correct amount - reflected in the slide deck posted- is $6,350 for a plan that covers an individual and $12,700 for a plan that covers a family. These amounts, which cap what people must pay in cost-sharing charges in their health plan each year, will be reduced for individuals and families receiving cost-sharing reductions.]  More resources on this topic will be posted later. 

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:

A new 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.

State-Specific Information (from StateRefor(u)m, which also has other resources):

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, from different sources within HHS.  The second provides additional dates/times for the "Level 1" webinars.]

  • 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 had technical difficulty registering last week.  Today I was successful, so if you've had problems, you might want to try again also.

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.


 The Health Care Law - Health Insurance Marketplace 101

July 11 at 2:00 pm ET


The Health Care Law - Health Insurance Marketplace 101

August 7 at 3:00 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.