July 13, 2013

July 12 Washington Update

During the past two weeks... The administration announced a one-year delay in enforcement of the Affordable Care Act requirement that large employers offer health insurance to their employees.  The administration also finalized two important ACA-related rules, including one to govern the "navigators" who will help consumers select and enroll in insurance plans.  In the Senate, the Appropriations Committee approved a bill to fund the Department of Health and Human Services, providing level funding for the Maternal and Child Health Services Block Grant.  Read about these topics and more below.



Administration conference call about final Navigator ruleOn Monday, July 15th at 11:00am ET (English) and 11:30am ET (Spanish), senior leaders from the U.S. Department of Health and Human Services will discuss the final outlining the standards for Navigators.  (More detail about the rule is below.) 

ENGLISH (11:00 ET): 888-989-4719 ;  PASSCODE:  HEALTHCARE


Medicaid, CHIP, Exchanges Final RuleOn Tuesday, July 16th at 3:30pm ET, the Georgetown Center for Children and Families (CCF), Center on Budget and Policy Priorities (CBPP) and National Health Law Program (NHeLP), joined by CMS officials, are holding a special state partner call to discuss this important rule. Call-in Number is (866)793-1308.  (More information about the rule is below.)

Webinars on Innovation Grants - Round Two.  On Thursday, July 18, 2013 from 1:00 - 2:00pm EDT the Centers for Medicare and Medicaid Services (CMS) will provide an overview and answer questions about the application package, project narrative and Executive Summary for the second round of Innovation Grants (see more below).  Advance registration is required. 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.

 Eligibility for premium tax credits and MedicaidThe Center for Budget and Policy Priorities (CBPP) will continue its "Beyond the Basics" series, holding webinars on determining eligibility for premium tax credits and Medicaid.  More details to be provided later.  

  • On Wednesday, July 24 at 2 pm Eastern (11 am Pacific) -- how household size will be determined, and
  • On Wednesday, August 7 at 2 pm Eastern (11 am Pacific) -- what counts as income.

Federally Facilitated and State Partnership Marketplaces.  The next round of CMS quarterly calls about the operation of Marketplaces (Exchanges) will begin the week of July 29, 2013 in each state with a Federally-facilitated (FFM) or State Partnership Marketplace (SPM).  Individuals and organizations that will interact with and utilize the Marketplace are encouraged to join these calls.  CMS will provide an update on the implementation of the Marketplace and listen to feedback. View dates and sign-up information here.

Video Series on Grant Applications from the Health Resources and Services Administration (HRSA) [always available].  This 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 grant submissions, and the approval process.  See:  Video Series; How to Apply for a Grant.


Delay in employer mandate.  On July 2, the Administration announced that it would delay for one year (until January 1, 2015) enforcement of the requirement in the Affordable Care Act (ACA) that large employers (those with an average of 50 or more employees) offer health insurance to their workers.  See this Washington Post article and this article from the National Journal.  In part, this was a response to employers' concerns about difficulty implementing the law's reporting requirements.  See this blog post from the Department of the Treasury, Assistant Secretary for Tax Policy. 

Some Members of Congress, including House Speaker John Boehner (R-OH), are now pushing for a delay in the requirement that individuals be covered by health insurance, which goes into effect on January 1, 2014.  At the same time, many Republicans are still pushing for a complete repeal of the ACA.

The delay in the employer mandate is not expected to have a significant impact on workers, since the vast majority of large employers already offer health insurance to their employees.  Kaiser Health News provides answers to frequently asked questions about this decision, and provides viewpoints on the news here.  The decision could, however, increase federal expenditures, since presumably there will be more people without employer-sponsored insurance who will qualify for subsidized insurance in the Exchanges.  See this Health Affairs blog post by law professor Timothy Jost.

Self-attestation.  On July 5, the administration announced that it would significantly scale back the health law's requirements that new insurance marketplaces verify consumers' income and health insurance status.  Instead, the federal government will allow state-run Exchanges to rely more heavily on consumers' self-reported information until 2015, when it plans to have stronger verification systems in place.  See these articles from the Washington Post and Reuters.



Senate Appropriations for the Maternal and Child Health Block Program, Special Education, and Community Health Centers

This week, the U.S. Senate Labor, Health and Human Services and Education Appropriations Subcommittee and the full Appropriations Committee approved the fiscal year (FY) 2014 Labor, Health and Human Services (HHS) and Education Appropriation bill.  There is good news:  the bill includes level funding for the Title V Maternal and Child Health (MCH) Services Block Grant -- $643.8 million.  This is a $5.2 million increase over the President's budget request of $638.6 million and an estimated $39 million increase from the final post-sequester FY 2013 level of $604.9 million.   Funding at the FY 2013 level is considered a "win" in this budget-cutting era.  According to the Association of Maternal and Child Health Programs (AMCHP),  "While there is a long way to go to finalize FY 2014 program levels, this is an important statement of priorities and represents a small victory in our ongoing advocacy to sustain funding for the Title V MCH Block Grant." 

It is unclear when, or if, the bill will move to the floor of the U.S. Senate for consideration.  If approved by the full Senate, the bill will have to be reconciled with the corresponding bill passed by the House.  Unfortunately, the total House allocation for the programs in this bill is 25.9 percent below the amount provided in the Senate.  Moreover, sequestration will reduce the amount available for the program unless there is a "grand bargain" to replace the sequester, which does not look likely.  In the end, it is likely that appropriations for FY 2014 will be made through another "continuing resolution" to fund the government at current sequestered levels (lower than the level in the appropriations bill).

The Senate FY 2014 Labor-HHS-Education appropriations bill also provides some increases in funding for special education:  $11.7 billion, an increase of $125 million, under section 611 of Part B Grants to States for educating students with disabilities; $463 million, an increase of $21 million, to support statewide systems of coordinated and early intervention services for children with disabilities 2 years old and younger and their families; and nearly $70 million, an increase of $20 million, to support research on how people with disabilities learn and how best to meet their educational needs.  In addition, the bill includes nearly $1.6 billion for Community Health Centers (CHCs).  Combined with mandatory funding provided in the ACA, the FY 2014 program level for CHCs is almost $3.8 billion, an increase of $700 million.

A summary of the bill can be found here.

Bills to Extend Funding for Family-to-Family Health Information Centers (F2Fs)

Current cosponsors of the Senate bill F2F funding bill (S. 423), sponsored by Senator Robert Menendez (D-NJ), are Senators Sheldon Whitehouse (D-RI), Al Franken (D-MN), Amy Klobuchar (D-MN), and Elizabeth Warren (D-MA).  The House bill (H.R. 564), sponsored by Congressman Frank Pallone (D-NJ), is cosponsored by Representative David Cicilline (D-RI).  If you would like to contact your Representative and/or Senators to urge them to cosponsor one of these bills, you can find their contact information at http://www.congressmerge.com/onlinedb/index.htm



Final Rule on Medicaid, CHIP and Health Insurance Marketplaces

On July 5, CMS issued a final rule implementing provisions of the Affordable Care Act (ACA) related to eligibility, enrollment, and benefits in Medicaid, the Children's Health Insurance Program (CHIP) and the Health Insurance Marketplaces.  The rule addresses aspects of eligibility notices and appeals processes; benefits and cost sharing for state Medicaid programs; design of Alternative Benefit Plans; employer coverage and income verification for premium tax credits; and requirements for premium assistance programs.  It also provides operational guidance to help states implement their Health Insurance Marketplaces.

This final rule does not address all of the proposed regulatory changes included in the proposed rule released on January 22, 2013.  The remaining issues will be addressed in future rulemaking. 

This week's Georgetown Center on Children and Families (CCF) blog (Say Ahhh!) is devoted to analyzing this long and complex rule, which will be published in the Federal Register on Monday, July 15: 

  • Tricia Brooks takes an overall look at the rule.
  • Joan Alker blogs about what the rule has to say about state Medicaid premium assistance plans such as the Arkansas proposal.
  • Elisabeth Wright Burak takes a look at what the rule has to say about CHIP waiting periods and argues that now it is up to states to do the right thing and end the wait for kids.
  • CBPP's Judy Solomon explains the income verification changes

Final Rule on Navigators and Certified Application Counselors

On July 15, the Centers for Medicare & Medicaid Services (CMS) issued the final rule outlining the standards for Navigators in Federally-facilitated and State Partnership Marketplaces.  State-based Marketplaces have the option of using this guidance or developing their own. The rule identifies training, conflict of interest standards, and standards for serving people with limited English proficiency and people with disabilities.  The final rule also outlines the standards for certified application counselors, including training, qualifications, and requirements.

Grant awards for Navigators in states with Federally-facilitated and State Partnership Marketplaces will be awarded on August 15, 2013.  Open enrollment in the Marketplace begins October 1, 2013, with coverage to begin January 1, 2014.

To learn more about helping consumers apply and enroll in health coverage through the Marketplace, visit: http://www.cms.gov/CCIIO/Resources/Files/Downloads/marketplace-ways-to-help.pdf

Guidance on Child and Family Trauma

On July 11, HHS issued new guidance related to children and families who have experienced trauma.  The guidance letter is intended to encourage states and tribes to use integrated, trauma-focused screening, functional assessments and evidence-based practices in child-serving settings for the purpose of improving child well-being.  It was developed as part of an ongoing partnership among the Administration for Children and Families (ACF), Centers for Medicare & Medicaid Services (CMS), and Substance Abuse and Mental Health Services Administration (SAMHSA) to address complex, interpersonal trauma and improve social-emotional health among children known to child welfare systems. The letter is available online at http://www.medicaid.gov/Federal-Policy-Guidance/Federal-Policy-Guidance.html.  (Click on 7/11 document "Tri-Agency Letter on Trauma Informed Treatment.") 



Enrollment Grants for Community Health Centers

On July 10, HHS Secretary Kathleen Sebelius announced $150 million in grant awards to 1,159 Community Health Centers (CHCs) across the nation to enroll uninsured Americans in new health coverage options made available under the ACA.  Health centers in every state, even those that have governors opposing the health law, will be getting some of the funding.  Each center will get from $59,000 to $500,000. Nationwide, the money will allow health centers to hire an additional 2,900 outreach and eligibility assistance workers, which are expected to help the centers enroll 3.7 million people into the health plans through Exchanges, as well as Medicaid and the Children's Health Insurance Program.  See the Kaiser Health News story at http://capsules.kaiserhealthnews.org/index.php/2013/07/?referrer=search (scroll down).  For a list of health centers receiving this funding, see http://www.hrsa.gov/about/news/2013tables/outreachandenrollment/.

Grants for Connecting Kids to Coverage

On July 2, HHS announced $32 million in grants for efforts to identify and enroll children eligible for Medicaid and the Children's Health Insurance Program (CHIP).  The Connecting Kids to Coverage Outreach and Enrollment Grants were awarded to 41 state agencies, community health centers, school-based organizations and non-profit groups in 22 states; two grantees are multistate organizations. 

Grants were made in five focus areas: 

  1. Engaging schools in outreach, enrollment and retention activities (9 awards);
  2. Reducing health coverage disparities by reaching out to subgroups of children that are less likely to have health coverage (8 awards);
  3. Streamlining enrollment for individuals participating in other public benefit programs such as nutritional or other assistance programs (3 awards);
  4. Improving application assistance resources to provide high quality, reliable Medicaid and CHIP enrollment and renewal services in local communities (13 awards); and
  5. Training communities to help families understand the new application and enrollment system and to deliver effective assistance to families with children eligible for Medicaid or CHIP (8 awards).

Grant amounts range from $190,000 to $1 million.  For a list of grantees, see http://www.insurekidsnow.gov/.



ACA resources and the webinar schedule are below.  As always, please feel free to contact us with any questions. 

Best, Janis & Brooke

Janis Guerney, Esq.

Brooke Lehmann, MSW, Esq.




http://www.hhs.gov/healthcare/rights/index.html - summary of ACA

www.healthcare.gov - information for consumers about how to select and enroll in an insurance plan through the applicable Marketplace/Exchange, and additional information .  Over the summer, the site will continue to add new functions to help consumers to shop for affordable qualified health plans.  The website is built with a responsive design so that consumers may access it from their desktops, smart-phones, and other mobile devices. In addition, the website is available via an application interface at www.healthcare.gov/developers (whatever that means).

CuidadoDeSalud.gov - Spanish version of healthcare.gov.


Toll-free number (1-800-318-2596) - consumer call center that will be open 24 hours a day, seven days a week to answer questions and, starting in October, to provide personalized assistance for callers filling out their application or selecting a plan.  The hotline will provide services in 150 languages.

FAQs about the ACA -- https://questions.cms.gov/faq.php?id=5005&rtopic=1993

Social Media sites -- Facebook.com/HealthCare.gov or Facebook.com/CuidadoDeSalud.gov and

Twitter @HealthCareGov or @CuidadoDeSalud.


Infographics - posters about preventive health care and the ACA.


PSA videos that can be run on short-circuit TV networks in waiting rooms and on agency YouTube channels. 


NEW Marketplace widget and badges in English and Spanish that can be put on websites and sent out through social media. 


http://marketplace.cms.gov/ -- Source for the latest resources for consumers and those assisting them, including brochures, fact sheets, posters, postcards, and checklists.


Other promotion of the ACA.  Last week, the organization Enroll America launched the"Get Covered America!" campaign, which will 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. 

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

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





{Newly added} Employer Responsibility.   The Center for Budget and Policy Priorities has archived materials from last week's webinar on employer responsibilities under the ACA.    The slides can be found here.  A recording of the webinar in YouTube can be found here.

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.    

Health Insurance 101.  Community Catalyst and Georgetown University's Health Policy Institute created a Health Insurance 101 online guide on private health insurance and how it will be obtained after health care reform is implemented. 


Cost-sharing reductions

{Newly added} Kaiser Health News did an article about cost-sharing subsidies on July 9.

Slides from a CBPP webinar on this topic can be found here

Navigators and In-Person Assisters: 


Families USA Navigator and In-Person Assister Resource CenterSign up to receive updates.

Georgetown Center on Children and Families blog 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:

{Newly added} The National Academy for State Health Policy (NASHP) has developed a Toolbox for Advancing Children's Coverage through Health Reform Implementation, to provide a centralized source of information and tools relevant to the impact of the ACA on children's coverage.  While the Toolbox is meant primarily for states, it might also be useful to advocates trying to influence state policy decisions.  The Toolbox complements NASHP's June 2013 report, Making Health Care Reform Work for Kids: Planning and Design Considerations for Policymakers. The report and toolbox highlight ideas learned through NASHP's Children in the Vanguard initiative.

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.

Medicaid Expansion Update and Resources:

50-State Look at the Medicaid Expansion explains the basic facts about the status of Medicaid expansion.

CBPP's (Center on Budget and Policy Priorities) Medicaid Expansion Toolkit

NHeLP Medicaid Expansion Toolbox, to be updated continually.

ACA information and subscriptions 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 is the main avenue that CMS will use to communicate with interested stakeholders on Marketplace updates. It provides a wide variety of tools and resources to 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.

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



  • 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'. 


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



The Health Care Law - Health Insurance Marketplace 101

August 7 at 3:00 pm ET


Level 2: Understanding the Health Insurance Marketplace


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.