October 15, 2013

October 15 Washington DC Update

Washington DC Update 10/15/13

{Don’t forget to check out the Family Voices/NCFPP ACA webpage!} 

Greetings from Washington.  We hope you had a fine Columbus Day! 

We are now in Week 3 of the ACA open enrollment period.  Apparently, some of the long wait-times and other problems of the www.healthcare.gov website have been reduced, and it is now possible to get some basic information about health plans without the difficulties associated with creating a personal account.  It seems, though, that consumers remain confused and continue to encounter problems.  The Department of Health and Human Services (HHS) has been reticent about the number of people who have actually enrolled in health plans. (More below.)

And…some significant information 

For purposes of avoiding a penalty, the deadline for uninsured people to enroll in a Qualified Health Plan is February 15, 2014 – not March 31.  According to an Associated Press article published on Wednesday in the Washington Post, this deadline was confirmed by an administration official who “was not authorized to speak publicly and insisted on anonymity.” Individuals must have insurance by March 31, 2014, in order to avoid paying a penalty, according to this article.  See more on this subject below.


Resources for Advocacy Through the Transition Years and Beyond - Tuesday, October 15, 2013, at 2:00­3:00 PM ET.  This webinar will walk through the online Advocacy ATLAS, focusing specifically on resources for education services and supports, transition to adulthood, youth leadership, and steps to employment success.  Presenters will share their own first-and experiences of how these resources can be helpful in laying the groundwork for services supports, and success throughout the transition years and beyond.  Family Voices’ Bev Baker, Co-Director of the National Center for Family and Professional Partnerships, is one of the presenters. Register at: https://attendee.gotowebinar.com/register/504635508489795842.

Using Health Information Technology to Support Child Health QualityOn Tuesday, October 15, at 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.

ACA Update.  On Tuesday, October 15, at 4:00 PM ET (later than usual time), the Georgetown Center on Children and Families will hold a State Partner Call.  Presenters will (1) compare the ACA roll-out “glitches” to those of the initial weeks and months of Medicare Part D implementation, and (2) discuss the impact of budget negotiations on ACA implementation and Medicaid.  Call-In: (866) 804-3547.  Resources: How Does ACA’s First Week Compare to Medicare Part D’s?; Measuring ACA Enrollment: Lessons from Medicare Part D.

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 and 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.  Accordingly, we are seeking more cosponsors of these bills, particularly Senate Republicans, since we would like the bill to be bipartisan and the Senate is most likely to be the place for action on this legislation.  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

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 Shutdown and Funding Negotiations 

For two weeks, the two houses and parties of Congress have been at an impasse regarding:  (1) the funding needed to keep the government running temporarily via a “continuing resolution” (CR); and (2) the extension of the “debt limit” in order to keep the country from defaulting on its financial obligations for the first time in history.  Originally, the House Republicans said they would not pass the CR without delaying, de-funding, or repealing some of the Affordable Care Act (ACA, or “Obamacare”).  At this point, however, they are backing away from their ACA-related demands, since the President and Senate Democrats repeatedly said they would not alter the law.

At this point, it looks like the logjam might be shifting a little.  As of this writing, Senate Majority Leader Harry Reid (D-NV) and Minority Leader Mitch McConnell (R-KY), seem to have reached a tentative agreement on both a CR and the debt limit.  Good sources of up-to-date information about what’s happening in Congress are the websites of these “inside-the-beltway” publications:  The Hill, the Hill’s Healthwatch blog; Roll Call, Politico, and Politico “Pulse” (health issues).


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

Enrollment must take place on or before February 15, 2014, to avoid a penalty for lack of insurance

For purposes of avoiding a penalty, the deadline for uninsured people to enroll in a Qualified Health Plan is February 15, 2014 – not March 31, the last day for open enrollment in general.  According to an article published on Wednesday in the Washington Post, the February 15 cut-off date was confirmed by an administration official who “was not authorized to speak publicly and insisted on anonymity.”

Individuals must have insurance by March 31, 2014, in order to avoid paying a penalty, according to this article. This makes sense, since, in general, coverage commences on the first day of the month following enrollment if a person enrolls on or before the 15th of any given month.  If enrollment takes place after the 15th of the month, then coverage begins on  the first day of the second following month.  Thus, if someone enrolled on March 31, he/she would not have coverage until May 1, and so would not be able to document coverage by March 31, or even by the time tax returns are filed on April 15. 

Note, however, that penalties are prorated by the number of months a person is without insurance.  Thus, if a person without any insurance failed to enroll by February 15, but enrolled by March 15, they would only have to pay one-fourth of that year’s penalty (for the 3-month period they were uninsured, from January 1 through March 31.)  If they enrolled during the last two weeks of March, they would have to pay the penalty for the one-third of the year they lacked insurance of the year (January 1 through April 30).  The penalty for in individual who does not have insurance for the entire year of 2014 is the higher of $95 or one percent of the person’s income.  The most a family would have to pay in 2014 is $285. Penalties are higher in subsequent years.  See the HHS website for more details about the amounts of and exemptions from penalties.

It is important for consumers to be aware that, after March 31, insurance is not available through the Marketplace (Exchanges) for coverage in 2014, unless the person has a qualifying life event.

ACA websites 

Apparently, some of the long wait-times and other problems of the www.healthcare.gov website have been reduced, and it is now possible to get some basic information about health plans without the frustration of trying to create a personal account. 

Still, it seems that consumers remain confused and are encountering problems when trying to get information or enroll, and the Department of Health and Human Services (HHS) has been reticent about the number of people who have actually enrolled in health plans.  White House spokesman Jay Carney said that enrollment data will be released monthly.

Some reports indicate, however, that some of the state Exchange websites are performing well and enrolling people in health plans. 

Reporting problems to HHS.   And speaking or problems, 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.

Former Foster Youth – Web badge available to spread the word that they are eligible for Medicaid 

Under the ACA, youth who have recently aged out of foster care who have not yet reached age 26 will be eligible for Medicaid starting on January 1, 2014.   However, it is unclear how this population will be notified that they qualify for coverage, since they are no longer connected with the child welfare system. To help spread the word, the American Academy of Pediatrics (AAP) has created a website to help former foster children learn about their potential Medicaid eligibility.  Interested Organizations and agencies can post a “web badge” (also found at the AAP website, at the bottom of the page) so that former foster youth visiting their site are alerted to the opportunity to obtain Medicaid coverage. 

Four “Quirks” in Obamacare subsidies

The Capitol Hill newspaper/website Roll Call ran an informative article, “4 Quirks in Obamacare Coverage You Need to Know.”  The “quirks” relate to the federal subsidies available to purchase insurance on the Exchanges. 

One of these quirks – under the heading ‘Affordable’ Family Coverage in the article -- is actually a problem that Family Voices and other child health advocates have been concerned about for quite a while, and have tried unsuccessfully to get the IRS to remedy.  Under the ACA, a person who is offered employer-sponsored insurance coverage is eligible for a federal premium credit only if the employer plan is inadequate or “unaffordable,” which is defined by statute to be 9.5% or more of the employee’s family income.  Under a final IRS regulation, this test is met if the cost of an individual insurance plan exceeds the 9.5% threshold, even though a family plan would be much more expensive.  According to the article, the Kaiser Family Foundation found that about 3.9 million children and spouses would be blocked from discounted rates in the exchanges under this rule.  Advocates have referred to this policy as the “family glitch.”

Another of the quirks described in the article -- Already Covered? Subsidies Depend on the Kind of Coverage – is also an issue that Family Voices and other advocates have tried to get the IRS to remedy.  The problem relates to the definition of “minimum essential coverage” (MEC).  If a person already has or has access to MEC through Medicaid, Medicare, CHIP or an (adequate and affordable) employer-sponsored plan, he/she is not entitled to a federal premium subsidy. 

Advocates were concerned that the receipt of “wrap-around” Medicaid services to supplement private insurance coverage would preclude a child from getting a premium subsidy to defray the cost of the private plan, even though the family income would otherwise warrant a premium subsidy. 

In September, the IRS issued a final rule declaring that a child receiving Medicaid through the Family Opportunity Act, a TEFRA (Katie Beckett) state option, or certain premium assistance programs, does have MEC, thus precluding receipt of a premium subsidy for that child.  (The rest of the family can still get premium subsidies.)  The IRS announced that it will make a decision later about whether coverage under section 1115 waivers, ‘Katie Beckett’ waivers, and Medicaid spend-down (“medically needy”) programs will count as MEC.  In the preamble to the rule, the IRS states that it expects to treat all of these types of Medicaid coverage as not constituting MEC, unless the Secretary of HHS determines otherwise.  If individuals receiving Medicaid through those eligibility pathways are not considered to have MEC, they will still be eligible for premium tax credits.  They would also be responsible for obtaining MEC, but the IRS stated that it would not assess penalties for these enrollees for 2014 if they fail to have other insurance.  See this blog post from the Georgetown Center on Children and Families for a simple explanation of the IRS rule and this article from George Washington University’s “HealthReform GPS” for a more detailed explanation and a discussion of the rule’s ramifications for the future.


You may have read in an earlier Update about ways in which Republicans in the U.S. House of Representatives, as well as Republican governors and state legislatures, have been erecting barriers to make it harder for Exchange “Navigators” to do their work. 

Last week, a federal judge temporarily blocked Tennessee from enforcing some of its emergency rules restricting the activity of ACA outreach workers.  In a separate case, the state agreed to narrow the scope of the emergency rules, ensuring that they apply only to workers officially classified as "navigators" or certified application counselors under the healthcare law.  Plaintiffs had argued that the rules violate the First Amendment, and the judge agreed. 

Several weeks ago, the House Energy and Commerce Committee sent a letter to many of the Navigator grantees in federally facilitated Exchanges asking them to supply so much information that it would create a great burden on grantees.  More recently, the committee issued press releases, posted on the committee website, which accused some Navigators of improper conduct -- going door-to-door to solicit Obamacare signups.  Apparently, though, the organizations that had been cited were actually not official navigators.  In response, the top Democrat on the committee, Henry Waxman (D-CA), wrote a letter criticizing the committee leadership and urging that the material be taken down from the website.  It seems that the offending press releases have, in fact, been removed from the website.


Impact of government shutdown.  Now that the government shutdown has been in effect for two weeks, you may be hearing more and more about its effects.  As reported last week, 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), as well as the Protection and Advocacy program for persons with developmental disabilities.  More details on HHS programs affected can be found in the Department’s contingency plan.

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.  Click here for more details. 

States, and thus Medicaid providers, in most of the country will continue to receive their reimbursements during the shutdown, since Medicaid funding is “mandatory” and therefore does not need to be appropriated.   Interestingly, the story is different in the District of Columbia.  Its budget and spending authority are subject to congressional approval as part of the federal budget and appropriations process.  As a result, the city cannot spend any of the $2.7 billion it budgeted for Medicaid, even though those funds come from its own tax revenues.  As in other jurisdictions, the city pays healthcare providers in the Medicaid program and then receives federal reimbursement.

[Personal note:  Actually, all government functions in DC are in jeopardy, since Congress must approve DC spending of DC’s own local tax revenues.  The city is now spending its contingency funds to keep the government and schools operating, but these monies will be depleted soon.  By the way, do you know that “taxation without representation” – the “tag line” on DC license plates, which are now borne on the President’s limo -- is still occurring in our nation’s capital?!  We have one non-voting delegate in the House and no one to represent us in the Senate.  JEG]

Social Security programs for people with disabilities.   On Sunday, October 6, the CBS news program 60 Minutes ran a story about fraud in Social Security Disability programs.  The disability community was distressed about this piece because it gave the impression that fraud is much more widespread that it actually is.  The broadcast – called “Disability USA” -- preceded a hearing the next day of the Senate Homeland Security and Government Affairs Committee which focused on a very serious situation of alleged collusion by an attorney, doctors, an Administrative Law Judge and others in Social Security’s Huntington, WV, office. 

The story suggested that the situation in Huntington is indicative of widespread problems in the system, but 60 Minutes did not interview any person with a disability, disability policy expert or advocate, or anyone from the Social Security Administration, and reportedly repeated many harmful factual inaccuracies.  For more information, see the website “Our Family Security,” a project of Health and Disability Advocates. 

On the lighter side???

It is good to know that the Members of Congress have felt the effects of the government shut-down in a very personal way – now they have to re-use their towels in the House and Senate gyms (for which they have to pay a membership fee) because laundry service has ceased.  This is clearly trivial compared to losing one’s WIC coupons, child care through Head Start, or a chance to participate in a clinical trial that might save one’s life!  But at least the Members have to suffer a little bit.  Earlier this week, Senator Lindsey Graham (R-SC) noted that the Senate’s gym was becoming “rank.”  


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 information for both families and family leaders to help them understand the ACA's impact on CYSHCN 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.

Emails from CMS. You can sign up to receive emails from CMS about what’s happening with ACA implementation (bottom right corner of page).  These emails are aimed at consumers. 

IRS info on the ACA. http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-Home.

IRS list of ACA-related government websitesHealthcare Online Resource electronic flyer (IRS Publication 5093) .

Basic information about the ACAWhat ObamaCare Means for You, from Kaiser Health News

ACA/Insurance Q & A.  Extensive questions and answers about securing insurance can be found on the website of Kaiser Health News.

FAQ on Pediatric Dental And Vision Care under the ACA.   From Kaiser Health News.

Buying outside the Exchanges.  Kaiser Health News published a helpful article about how the sale of insurance will take place outside the Exchanges.  The article, Consumers Shopping For Health Policies Outside The Marketplaces May Be Confused By Mix Of Plans Offered, points out that insurance agents and brokers will be selling plans approved for sale within Exchanges – and therefore eligible for premium subsidies -- and other plans that are not eligible for subsidies. 

Consumer Reports HealthLawHelperThe visitor to this website is asked questions about family size, income, and insurance status, and then given coverage options.  It seems somewhat duplicative of the federal site, but may be helpful in some states that have weaker websites.  From a brief test, it looks like it might be a useful tool, particularly for people just seeking information and not trying to enroll.


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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