October 07, 2013

October 7 Washington DC Update

[Don’t forget to check out the Family Voices/NCFPP ACA webpage!]

ACA OPEN ENROLLMENT ….No doubt you have heard about, or even experienced, various glitches and long waiting times on www.healthcare.gov and state Exchange websites. Still, it must be gratifying to the supporters of Affordable Care Act (ACA) to know that there is so much interest in using the Exchanges to purchase health insurance.  Apparently one of the first to make such a purchase was a woman from Rhode Island, who has been uninsured for more than five years and said she was “chompin’ at the bit” to get coverage for medical care she often could not afford. See http://capsules.kaiserhealthnews.org/index.php/2013/10/ri-woman-among-first-to-enroll-in-obamacare-exchange/.  According to the Department of Health and Human Services, the federal Marketplace website had 2.8 visitors on the first day and there were 81,000 calls placed to the health law’s consumer hotline, alongside 60,000 requests for assistance via live chat.  It was later reported that there were 4.7 million visitors to the website in its first 24 hours, and more than 8.5 million visitors during the first week.  See http://www.latimes.com/nation/la-na-obamacare-debut-20131006,0,7460906,print.story.

So…The federal Marketplace may be working, more or less, but what about the rest of the executive branch and the legislative branch of the U.S. government?  See below for more on the big shut-down. 


Using Health Information Technology to Support Child Health QualityOn Tuesday, October 15, 2:00-3:30 PM ET, the Center for Medicaid and CHIP Services at CMS will conduct the last in a series of five webinars designed to share findings and lessons learned from the CHIPRA Quality Demonstration Grants.  Participants will learn how grantees from Florida and Illinois have developed health information technology applications to improve the quality of care delivered through medical homes and for prenatal care. The webinar will also feature presentations from the Agency for Healthcare Research and Quality (AHRQ) and grantees from North Carolina and Pennsylvania about the development and testing of the CMS-AHRQ children’s electronic health record format.  Register here.

Ready, Set, Go: ACA Basics and Outreach & Education Opportunities Webcast.  On Wednesday, October 16, 2013, at 3:00 - 4:30 pm ET, the Maternal and Child Health Bureau, will host a webcast about the ACA’s coverage expansions beginning in January 2014 – specifically, the two major pathways to health care coverage for maternal and child populations and strategies and resources for MCHB grantees to help educate families and others about the new insurance options. Information on the different types of consumer assistance available will be shared. There will be time for questions.  Click here to join the webcast on Oct. 16.  [NOTE:  At this point, the link leads to the actual webinar page, which had no content as of this writing.]

Health Care Marketplace 101.  On Thursday, October 17, from 2:30-4:00 PM ET, the CMS Division of Training will conduct a webinar providing a high-level overview of how the Marketplace works, what it means for consumers and individuals, who is eligible to enroll, and how programs for people with limited incomes work. The presenters will answer questions via webinar chat.  The webinar is aimed at information and referral specialists in various settings.

To join the webinar on October 17, follow this link: https://webinar.cms.hhs.gov/aging1017/, and call the WebEx conference line: 1-877-267-1577; follow the instructions you hear on the phone.  

WebEx Meeting Number: 990 501 705 (you will be asked to enter this number to join).

Beyond the Basics – the Individual Mandate.  Pencil in Wednesday, October 23 at 2 pm ET for this Center for Budget and Policy Priorities webinar. Confirmation of date/time and a registration link will be distributed soon.                                                                  


F2F Funding.  The Family Voices policy team is working with key Members of Congress to secure an extension of F2F funding for at least another year via incorporation of the F2F-funding legislation into a larger bill that is certain to be enacted.  It is possible that such a legislative “vehicle” will be arising soon, so it would be very helpful to get more cosponsors of these bills, particularly Senate Republicans.  Contact information for Members of Congress can be found at http://www.congressmerge.com/onlinedb/index.htm

Background. Senator Robert Menendez (D-NJ) and Representative Frank Pallone (D-NJ) have introduced bills (S. 423 and H.R. 564) to extend funding for Family-to-Family Health Information Centers (F2Fs) at the current level of $5 million per year through FY 2016.  The Senate bill currently is cosponsored by Senators Sheldon Whitehouse (D-RI), Al Franken (D-MN), Amy Klobuchar (D-MN), Elizabeth Warren (D-MA), and Christopher Coons (D-DE).  The House bill is cosponsored by Representative David Cicilline (D-RI). 

Government Shut-Down and Funding Negotiations. 

Most of the executive branch has been shut down since the beginning of the 2014 federal fiscal year on October 1.  (See below for the impact on various programs of relevance to CYSHCN.) The two houses of Congress are still at an impasse regarding the funding needed to keep the government running via a “continuing resolution” (CR).  The Republican-controlled House refuses to pass a short-term CR without some sort of rider to de-fund, delay, or repeal parts of “Obamacare,” while the Democratic-controlled Senate refuses to accept changes to the ACA, or anything but a “clean” CR.  Bear in mind that any of the current CR proposals would appropriate funding only for a matter of weeks, while Congress addresses funding for the remainder of the fiscal year -- whether/how the cuts required by the “sequester” will be modified, and what the specific funding levels for each agency will be.  The Senate and the President do not want to open negotiations on these longer-term issues until the whole government is operating again and the “debt limit” is increased.  Accordingly, Senate Democrats have rejected House-passed legislation to fund specific government functions, such as cancer research, Head Start, and the WIC program.  

The debt-limit issue is actually much more important than the government shut-down.  It is estimated that the debt limit will be reached on or soon after October 17, at which point the Treasury Department can no longer borrow (issue bonds) to cover its costs and pay back current bond-holders.  Such a default has never happened before, and the President said, “We don’t fully understand what might happen.… But we know it would have a profound destabilizing effect on the entire economy -- on the world economy, because America is the bedrock of world investment.”

It is unclear what will happen now, although House Speaker John Boehner has said he will not allow a default to occur.  See http://www.nytimes.com/2013/10/04/us/politics/debt-limit-impasse.html?_r=0.  This story from Politico provides a good picture of what’s going on.  http://politi.co/1a0jmYV.

IN THE ADMINISTRATION -- Impact of Government Shut-Down.

October 1 brought the expiration of laws funding the federal government's “discretionary” programs -- those dependent on annual appropriations – leading to the furlough of certain “non-essential” personnel and the curtailment of agency activities and services.  Spending for programs funded by other laws – entitlements such as Social Security, and other mandatory spending, including much of the ACA – may be affected if program execution relies on activities that receive appropriated funding. 

Some of the activities and programs that have been stopped or curtailed include the flu vaccine program, and the surveillance of flu, foodborne illness, and other diseases by the Centers for Disease Control and Prevention (CDC), and the Protection and Advocacy program for persons with developmental disabilities.  The Vaccines for Children program will continue. The Indian Health Service will continue to provide direct services at its facilities, as well as referrals for contracted services that cannot be provided through its clinics, but will not be able to provide funding to Tribes and Urban Indian health programs.  For more details on HHS programs affected, see http://www.hhs.gov/budget/fy2014/fy2014contingency_staffing_plan-rev2.pdf.

Social Security and Supplemental Security Income (SSI) payments will continue without interruption or changes in payment dates, and Social Security Administration hearing offices will continue to conduct hearings.  See http://www.socialsecurity.gov/shutdown/index.html.


[Please see above for information about webinars and teleconferences related to the ACA.]

Federal ACA website.  As noted above, the federal ACA website, www.healthcare.gov, proved to be very popular.  As a result of the high level of traffic, as well as technical problems, wait times were very long, and many people who visited the site were unable to create an account to allow them to compare health insurance plans and/or enroll.  (Residents of the 36 states not running their own Exchange websites must use the federal website to sign up for insurance.) 

On Thursday, the Department of Health and Human Services (HHS), announced that it had made progress in addressing these problems, thus reducing online wait times by one-third and phone wait times by one half. See


Communication with state Medicaid agencies.  Nonetheless, HHS has announced that its website will not be able to communicate with state Medicaid agencies until at least November 1.  If someone goes to the federal website and is found to be eligible for Medicaid, they will then be directed to their local Medicaid office, where they will have to repeat the process of providing detailed information about their income, residency status and other data.  See http://capsules.kaiserhealthnews.org/index.php/2013/10/federal-insurance-marketplace-cant-yet-talk-to-state-medicaid-agencies/.

Reporting problems to HHS.  The Centers for Medicare & Medicaid Services (CMS) Office of Communications has asked stakeholders engaged with enrollment activities to help the department by sharing Marketplace consumer experience issues.  In order to make sure this information gets tracked and prioritized by the appropriate officials, these comments should be directed to marketplacecomment@cms.hhs.gov.  CMS will monitor all communications to this inbox and work internally to relay the comments and issues to its operations team.

[NOTEPlease also send your comments to jguerney@familyvoices.org so that Family Voices can keep track of the issues and weigh in as an organization as well.]

Another interesting article: Marketplace Plans Vary Widely in Costs, Within Counties and across the Country

On the lighter side:

Amusing security questions on Exchange websites.  According to an article in Politico, there are some amusing security questions used by both state and the federal Exchange websites, including questions about first kisses, favorite professors and the colleges one applied to but did not attend.   The NY website asks, “What band poster did you have on your wall when you were in high school?”  Read more at http://www.politico.com/story/2013/10/obamacares-funny-bone-97744.html#ixzz2gyxccyDJ.

Obamacare” versus the Affordable Care Act.  Speaking of humor, late-night talk-show host Jimmy Kimmel did a “person-on-the-street” piece in which people were asked which they thought was better – Obamacare or the Affordable Care Act.  Many people (all those included in the clip) did not realize that the two were the same.  Not really so funny, but at least they all had favorable opinions of the ACA.  See http://www.youtube.com/user/JimmyKimmelLive?feature=watch (4 minutes).


Family Voices/NCFPP Webpage on the ACA.  Family Voices and the National Center for Family/Professional Partnerships (NCFPP) have a frequently updated and searchable ACA resource page which can be found at http://www.fv-ncfpp.org/tools-and-resources/aca/.  This page offers a place for families, family leaders, and others to get information they need to understand the ACA's impact on children with special health care needs and their families, and to help others to understand it as well.  We welcome suggestions for resources to post on the webpage.  Please send your ideas to mailto:pcurran@familyvoices.org.

Navigating the Health Insurance Exchanges:  An Interactive Tool: The Commonwealth Fund developed this animated tool to explore how the state health insurance Exchanges, will work for individuals, families, and small businesses. The tool provides a very basic explanation, but might be helpful for consumers who need an introduction to the application process. http://www.commonwealthfund.org/interactive/navigator.html.

Three Things to Know Before Buying a Health Plan -- And Where to Find Them.  Kaiser Health News discusses three key questions to ask when shopping for an insurance plan. http://www.kaiserhealthnews.org/Stories/2013/October/02/Three-Things-To-Know-Before-Deciding-On-A-Health-Plan.aspx

Kaiser Family Foundation expanded FAQs.


Essential Benefits: Where are we now?  Community Catalyst has written a brief on the status of the states’ Essential Health Benefits (EHB), which notes that, once certified, these plans cannot be amended until 2015.  The brief urges advocates to monitor their states’ plans to identify both gaps in coverage and ways the ACA and EHBs are improving coverage, particularly in the areas of habilitative services, pediatric dental services, maternal and women’s health services, and nondiscrimination for LGBTQ people.

Health Insurance Marketplaces: Preparing to Assist People with Disabilities --

What do you know? What do you need to know? This is an archived webinar that was held on September 26, 2013, by the Friends of the National Center on Birth Defects and Developmental Disabilities. http://friendsofncbddd.org/2013/09/26/friends-webinar-health-insurance-marketplaces/

ACA Implementation: What Happens Next?  This is an archived webinar held by the Association of University Centers on Disabilities on September 24, 2013, which covers, among other things, parameters for Essential Health Benefits and Medicaid “alternative benefit plans,” which will be applicable to most newly eligible for Medicaid beneficiaries in states that choose to expand Medicaid pursuant to the ACA.  https://aucd.adobeconnect.com/_a1005431686/aca_update/.

“Beyond the Basics…” This webinar series presented by the Center on Budget and Policy Priorities (CBPP) goes into detail about a variety of ACA topics.  So far, topics covered have been:  premium tax credits; cost-sharing reductions; employer responsibility; determination of household size and income determinations of eligibility for Medicaid and premium tax credits; and plan selection and enrollment.  Slides and other materials for all the webinars are posted at www.healthreformbeyondthebasics.org.  

State Medicaid Integration Tracker September 2013 Edition.  The National Association of States United for Aging and Disability (NASUAD) has published the September 2013 Edition of the State Medicaid Integration Tracker.  The report is updated each month with information on:

·         Managed care for people who receive Medicaid-funded long-term services and supports (LTSS)

·         State Demonstrations to Integrate Care for Medicare-Medicaid enrollees and other Medicare-Medicaid Coordination Initiatives

·         Other LTSS Reform Activities, including the Balancing Incentive Program, Medicaid State Plan amendments under §1915(i), the Community First Choice option under §1915(k), and Medicaid Health Homes.


If you have any suggestions about how to make the Update more useful to you please let us know!  What parts are helpful and not so helpful?  And, as always, please feel free to contact us with any questions. 


Yours truly,




Janis Guerney, Esq.




Brooke Lehmann, MSW, Esq.




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