October 29, 2013

October 28 Washington DC Update

Washington DC Update 10/28/13

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

Greetings from Washington!  This week the administration announced an extra six weeks – through March 31 -- for people to obtain insurance coverage in time to avoid a penalty.  Meanwhile, in congressional hearings, various contractors that constructed the www.healthcare.gov website pointed fingers at one another for aspects of the website’s problems, but united in blaming the Department of Health and Human Services (HHS).  Administration officials now say that these problems will be rectified by the end of November. Meanwhile, the President defended the health care law and pitched the toll-free number that people can call as an alternative to applying for insurance online.  (“…1-800-318-2596. I want to repeat that -- 1-800-318-2596.”)  Shortly after that, someone standing behind the President fainted.

Special note:  Diana Denboba, the project director for Family-to-Family Health Information Center grantees and the National Center for Family/Professional Partnerships, will be retiring from her 35 years of government service on October 31.  Best wishes and expressions of gratitude for her leadership have been sent by many family leaders in the Family Voices network.  She has been described as a committed and  champion, advocate and teacher, who has provided vision, wisdom and encouragement while simultaneously leading and partnering with family leaders to achieve family-centered and culturally competent care for children with special health care needs.  Thank you, Diana, and all the best for a happy retirement!


Keeping Pace with the Affordable Care Act.  The National Council on Aging (NCOA) and IlluminAge are hosting a webinar on October 29, 2013, at 1:30-2:30 pm ET, that will serve as a refresher on what is happening with the Affordable Care Act, and how it is impacting the aging and disability networks. Discover the latest on the Medicaid expansion, care coordination for individuals dually eligible for Medicare and Medicaid, and how the Health Insurance Marketplace works.  Click here to register.

Impact of the Affordable Care Act, Medicaid Expansion & Insurance Exchanges on HIV/AIDS and Viral Hepatitis Services.  The AIDS Drug Assistance Program (ADAP) Advocacy Association, in partnership with the Community Access National Network (CANN) Great Lakes ADA Center, and HealthHIV is hosting an educational webinar on Wednesday, November 6th, 2013, at 2:00-3:00 pm ET.  The webinar is open to all HIV/AIDS and Viral Hepatitis stakeholders nationwide. The webinar is being held online in the Great Lakes ADA Center's virtual conference room.  Click here to register.

Beyond the Basics.   Hold the date for the next in this series of webinars about the ACA presented by the Center for Budget and Policy Priorities (CBPP) -- Wednesday, November 20th at 2 pm Eastern (11 am Pacific).   Topic and registration details to be announced later.


Federal BudgetAs explained in last week’s update, a bicameral, bipartisan conference committee will be attempting to negotiate a budget resolution acceptable to both the House (majority Republican) and Senate (majority Democratic).  It is supposed to make a report to Congress by Friday, December 13. 

It is not expected that the committee members will reach a “grand bargain” to make significant changes to the tax code or entitlement programs (e.g., Social Security, Medicare and Medicaid).  Rather, it is hoped, more modestly, that the committee will find a way to mitigate the 2014 sequester cuts in spending.

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 arise 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

Family Voices has circulated a letter of support for the legislation, to which 16 national disability and child health organizations have signed on so far.

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). 


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

Extension of deadline to obtain insurance.  In order to avoid a penalty for failure to have insurance coverage, consumers will now have until March 31, 2014, to enroll in a plan.  Although this was always the date through which there would be an “open enrollment” period for insurance purchased through the Marketplace (Exchanges), the date by which someone would have to purchase insurance to avoid a fine was previously February 15. 

Some Members of Congress – generally Republicans who oppose the ACA altogether -- have proposed that the “individual mandate” to purchase insurance be delayed for a year.  In light of the enrollment problems, even some Democrats who support the law – particularly Senators up for reelection in 2014 – have proposed extending the deadline beyond March 31.

ACA website problems.   The Administration has appointed a former Obama budget officials and entrepreneur, Jeffrey Zients, to serve as the point person for fixing the federal online Marketplace, www.healthcare.gov, which serves all of the states (36) that chose not to establish their own health care Exchanges.   Zients stated, “We are confident that each week, the site will get better, and by the end of November, healthcare.gov will operate smoothly for vast majority of users.”  He admitted that only about one third of users trying to complete an application on the website have been able to do so, but the Administration has noted that about 350,000 people have been able to complete the process of determining if they are eligible for federal subsidies or Medicaid.  A spokeswoman for the Centers for Medicare and Medicaid Services (CMS) said that the agency will be communicating directly with users who have not been able to complete their applications on the website.  They should expect to receive emails explaining how to move forward.

More on ACA implementation.  From Politico Pulse on 10/24:  On November 1, the ACA enrollment system is scheduled to transmit a huge amount of Medicaid data hub to the states.  Apparently, CMS Director Marilyn Tavenner told state officials that the process is not yet ready. The transmission has already been delayed once and, according to some experts, any further delay could disrupt health coverage for many new Medicaid enrollees hoping to gain coverage on January 1.  According to an article in an email from Politico Pulse, consumers who have signed up for Medicaid on HealthCare.gov have been unable to confirm their enrollment when they talk to their state Medicaid offices, leading to applicant confusion.

On the brighter side, an article in The Hill reports that the Internal Revenue Service (IRS) has conducted more than 330,000 eligibility calculations for premium tax credits under the ACA since October 1.  This figure provides the clearest sense so far of how many people have tried to enroll in the new health insurance marketplaces and to seek premium subsidies. 

According to the article:

  • Federal health officials will not release official enrollment data until November, but have said that nearly 700,000 applications have been filed around the country, with more than half coming from HealthCare.gov.
  • An internal memo from the Department of Health and Human Services (HHS) suggested that the administration once projected 500,000 signups by Oct. 31.
  • The IRS said that it has completed more than 1.3 million verification requests for personal data required on the exchange applications, and is receiving about 80,000 data requests every day.


ACA Resources

NEW BLOG from Family Voices!  The first installment of the Family Voices ACA monthly blog, written by  Lauren Agoratus, --  the mother of a child with multiple disabilities and the NJ Coordinator for Family Voices and the southern coordinator in her state's Family-to-Family Health Information Center -- is about How People with Disabilities can Access the Marketplace under Healthcare Reform.   This blog posting discusses lifetime caps, essential health benefits, tiered plans, accessibility standards, health plan options for special needs, and more. 

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.

Indiana Family Voices ACA guide. Indiana’s Family Voices has created this resource guide to answer basic questions about purchasing insurance under the ACA and to help families choose the most suitable insurance plan for them and their children with special health care needs.

Resources on the ACA and immigrants.   On Friday, the Department of Homeland Security’s Immigration and Customs Enforcement Administration released a memo that addresses some questions that have been raised recently regarding treatment of information about immigration status, among other issues.  There is also a set of Qs and As about immigrant families and the ACA available on the HHS website.

Stairstep kids.  This week’s blog of the Georgetown Center on Children and Families includes a post regarding “stairstep kids” – children who will be transitioned on January 1 from stand-alone CHIP programs to Medicaid due to the ACA’s Medicaid eligibility expansions.  CMS recently released guidance on this topic to help states implement a smooth transition for families and minimize the states’ administrative burden.

Enrollment assistance resources.  Families USA has updated its resource center for those helping consumers to enroll in health care plans.  Also, you can sign up here for updates from the resource center.

ACA story bank.  Families USA has also recently launched "My Coverage Story," a national project designed to collect and share stories from individuals who have enrolled in health coverage under the Affordable Care Act.  People can share their stories at www.mycoveragestory.org.

Everything You Ever Wanted to Know About MAGI, But Were Afraid to Ask.  Under the ACA, income determinations for purposes of establishing eligibility for Medicaid, CHIP and ACA subsidies will be made using a formula known as “MAGI” (Modified Adjusted Gross Income). 

A new MAGI resource from The National Health Law Program (NHeLP) explains in detail how these new income determination rules work, including who is and who is not subject to MAGI, the types of income counted and excluded, and how to figure out who is in an applicant's "household" for determining eligibility. The 85-page guide contains a number of helpful charts and hypothetical examples to demonstrate how the new rules work.

In addition, NHeLP’s resource library has dozens of documents on MAGI, and a MAGI discussion page.

CBPP Question of the Day.  Speaking of MAGI, the CBPP has launched a new “Question of the Day” feature at www.healthreformbeyondthebasics.org, and this week, questions have dealt with MAGI and how income is counted.  Judy Solomon also tweets the questions out each morning from her Twitter handle, @JudyCBPP.

Follow HHS.  ACA information is available from HHS via Facebook, Google + and Twitter:  https://www.healthcare.gov/connect/?utm_medium=email&utm_source=recon&utm_campaign=Improving_healhtcaregov_blog&utm_content=10_24_13#state=georgia

Other Resources

New Fact Sheet on SNAP Benefit ReductionThe 2009 Recovery Act's temporary boost to benefits under the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, is scheduled to end on November 1, 2013.  The National Center for Benefits Outreach and Enrollment (NCOA) has developed this fact sheet to explain what the resulting reductions may look like for different households and how to offset the reductions with various income deductions.  Another resource is the NCOA SNAP guide, which provides basic information about eligibility for the SNAP program.

Managed Care TerminologyThe Patient Advocate Foundation has published a Glossary of Managed Care Definitions which provides a valuable resource for understanding managed care terminology. 

Worth repeating:  This month’s newsletter of the National Health Law Program (NHeLP) is a brief about “EPSDT” -- the federal requirement that all children under age 21 who are enrolled in Medicaid receive Early and Periodic Screening, Diagnosis and Treatment services.  The newsletter also links to another valuable resource for advocates – 30 Questions to Ask about Managed Care and EPSDT.  You can sign up for NHeLP’s free monthly e-newsletter here.


On the lighter side?  Check out this cartoon about how people perceive ObamaCare. http://www.kaiserhealthnews.org/Cartoons/2013/October/Bad-News-Bears.aspx

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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