February 11, 2014

February 11 Washington DC Update

Washington DC Update 2/11/14

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

Greetings from Washington!  The big news this week is the administration’s decision to further delay implementation of the health-insurance employer mandate created by the Affordable Care Act (ACA). The administration will also give consumers limited flexibility to change health plans purchased on the Exchange through March 31. In addition, improvements have been made to the HealthCare.gov website.


“Champions for Coverage” Call  On Wednesday, February 19, 2014, at 2:00 ET, the Centers for Medicare and Medicaid Services (CMS) will hold another call for those involved in helping people to enroll in health plans under the Affordable Care Act (ACA). Please submit any questions in advance regarding Marketplace outreach and education via email at Champion@cms.hhs.gov and include “Champion call question” in the subject line. 

Dial-In Number: (855) 258-3677 / Conference ID: 47040109

Webinar Series:  “A Practical Guide to Healthcare Reform: The ABCs of Eligibility under the ACA”  A series of free seminars is being offered every Wednesday, beginning March 5, from 2:00-3:30 ET, by Manatt Health Solutions. Intended for community-based organizations, in-person assisters, Navigators, and others seeking to help individuals understand their health insurance options, the presenters in this five-part series will address rules that govern individual eligibility for Medicaid, premium tax credits and cost sharing reductions, and suggest strategies to inform consumers’ decisions when exploring their health coverage options. Manatt is also available to offer free trainings to groups of 50 or more on any of the five topics in the series. For more information or to schedule a training session, contact Arielle Traub at 212-790-4551 or atraub@manatt.com. Click here (scroll down to end of page) for information on the topic of each session and to register.


F2F Funding   [Updated short explanation.]  As detailed in last week’s Washington Update, a provision to extend and increase F2F funding is included in a bill reported out of the Senate Finance Committee that addresses Medicare physician reimbursement (“SGR” bill). The F2F provision is part of a package of health and human services “extenders” in that bill to extend expiring provisions of law.

Two House committees have also developed SGR bills – which do not include any extenders – and last week, the three committees announced that they had reached a consensus position on how to permanently address Medicare physician payments. This is a significant achievement because it solves a long-standing problem with physician reimbursement policy. At this time, however, the committees have not identified any “offsets” to pay for the cost of the new policy.

It is not clear whether any final SGR legislation will also include the F2F extension and the other extenders that were in the Senate Finance Committee bill. Whether the extenders will be in the final package is likely to be a function of the cost of the legislation and the corresponding offsets to pay for it.

F2F Funding Bills   At this point, the F2F provision in the Senate Finance Committee’s Medicare physician-payment bill – providing five years of additional funding at $6 million per year – is preferable to the three-year extension of $5 million in the Menendez and Pallone bills. Nevertheless, cosponsorship of one of these bills is a means of expressing support for the F2F program. The House bill (H.R. 423) now has six cosponsors in addition to Rep. Pallone. The Senate bill (S. 423) has five cosponsors in addition Senator Menendez.

Children’s Health Insurance Program (CHIP)  February 4 was the fifth anniversary of the enactment of the Children’s Health Insurance Program (CHIP) Reauthorization Act (CHIPRA), which reauthorized the CHIP program through FY 2015. The ACA then extended authorization for the program through FY 2019, although it did not provide funding beyond FY 2015. Children’s health advocates have begun efforts to get Congress to extend funding for the program before the end of FY 2015, and to make some improvements in the program. Family Voices and a large number of other local, state, and national organizations have signed onto a letter, being circulated by the children’s advocacy group First Focus, calling on Congress to extend funding for CHIP.

ACA NEWS and INFORMATION  [See below for ACA resources.] 

Consumers May Make Some Changes in Insurance Coverage before March 31  On Friday, the Washington Post reported  that, on Thursday night, the administration distributed a memo to insurers spelling out some changes to the process of signing up for insurance in the federal Exchange at HealthCare.gov. According to the Washington Post article, the memo says that people may pick a different health plan before the end of March if they are dissatisfied with the one they chose – but only if they stay with the same insurer and tier of coverage – and that people will be given more freedom and a longer opportunity to get a new health plan if they can prove that HealthCare.gov displayed inaccurate information about the benefits that a health plan offers. According to the Post, which obtained a copy of the memo, the memo indicates that consumers may make changes before March 31 if they want to “move to a plan with a more inclusive provider network” or if they fit within “other isolated circumstances,” but the memo does not define what the other circumstances might be.

Improvements to HealthCare.gov, Including Ability to Add a Child Denied or Awaiting Medicaid Coverage  This week, CMS implemented changes to the HealthCare.gov website to allow consumers to make changes to submitted applications. For example, applicants can report increases or decreases in income; add or remove household members; or report a change in address, a new pregnancy, or a gain or loss in health coverage.

The website improvements also address a problem confronted by some families whose children were not originally covered in their Exchange-purchased plans because they were assumed to be Medicaid-eligible. See this ABC News story. The website asks applicants a new question – whether they have recently been denied eligibility for Medicaid and CHIP by the state agency. This question serves as a short-term solution for a problem known as “looping” – applicants getting referred back and forth between HealthCare.gov and their state’s Medicaid agency website. Now, applicants who indicate that they have recently been denied Medicaid eligibility by the state will be blocked from being determined or assessed as Medicaid- or CHIP-eligible by the federal Exchange. Instead, they will be assessed only for eligibility for Advanced Premium Tax credits, Cost-Sharing Reductions, and coverage in a Qualified Health Plan. More information about this Medicaid question and how consumers should answer it is available at https://www.healthcare.gov/help/found-not-eligible-for-medicaid/.

Another Delay of Employer Mandate  On February 10, the administration announced a final rule on employer responsibility under the ACA. The rule delays implementation of the employer health insurance mandate until 2016 for employers with 50-99 employees. Employers with fewer than 50 employees were never subject to the mandate. All other employers were supposed to offer insurance coverage to full-time employees in 2014, but the administration had earlier delayed this mandate for a year. The administration will also let employers with 100 more employees phase in coverage of their workforce over two years. The administration’s policy is expected to counter the incentive for employers to reduce employees’ hours in order to avoid the insurance mandate. For more details, see this Washington Post story and this fact sheet from the Treasury Department.

Third-Party Funds May Be Used to Supplement Purchase of ObamaCare  According to this report from Reuters, CMS may strengthen its position on health plans accepting third-party payments to help consumers purchase insurance, such as payments provided under the 1990 Ryan White Act. An issue arose when Blue Cross and Blue Shield of Louisiana, the state's largest health insurer, began rejecting checks from that federal program, which is designed to help patients pay for AIDS drugs and insurance premiums, and notifying customers that their enrollment in its Obamacare plans will be discontinued. The insurer claims it is attempting to prevent fraud. In response, CMS clarified that "Federal rules do not prevent the use of Ryan White funds to pay for health care plans," and added that it had issued guidance “encouraging issuers and Marketplaces to accept such payments.”

According to the Reuters article, hundreds of HIV/AIDS patients in Louisiana are dependent on Ryan White payments to help pay for their Obamacare insurance because they fall into a coverage gap:  they are not eligible for Medicaid because the state did not take up the program expansion under the ACA, and federal subsidies under the ACA are not available to people with incomes under 100 percent of the federal poverty level.


CFPB Requests Comments on Information for Upcoming Rules on Debt Collection  The Consumer Financial Protection Bureau (CFPB) has issued a request for comments as it considers whether to issue rules to regulate debt collectors. The Bureau will be collecting information on a wide array of debt-collection topics through February 28, 2014. The CFPB is particularly interested in the experiences of people with disabilities, family members contacted by debt collectors, and potential rules for when debt-collection contact should be allowed. For more information and to submit comments, see http://www.regulations.gov/#!documentDetail;D=CFPB-2013-0033-0001 or http://www.consumerfinance.gov/newsroom/cfpb-considers-debt-collection-rules/. Note that these two sites each provide a different way of submitting comments.

More Information about Federal Funds for Tracking Devices for Children with Autism  As reported in last week’s Washington Update, Attorney General Eric Holder recently announced that local police departments could use federal funds to purchase and distribute tracking devices for children prone to wandering due to autism or another developmental disability. This article in Disability Scoop, summarizes recently released information from the Department of Justice on exactly how those funds can be accessed.


Here is a list of several fact sheets and resources recently posted to http://marketplace.cms.gov/getofficialresources/publications-and-articles/publications-and-articles.html .

  • Contacting your health plan’s customer service number (under Open Enrollment Resources)
  • What to know about getting your prescription medications
  • What you should know about provider networks
  • Appealing your insurer’s decision not to pay
  • What you should know about seeing your doctor
  • Getting emergency care
  • I signed up, but don’t have health coverage
  • What you should know about early renewal of health coverage


  • Helping consumers with the application process
  • Helping consumers with eligibility and plan selection
  • Helping consumers with casework
  • Helping consumers with eligibility and the application process
  • Helping consumers with payment and eligibility issues

Here are helpful links on HealthCare.gov regarding immigration:

  1. Information on Eligible Immigration Status Types
  2. More Information on Eligible Immigration Status Types
  3. Information for Naturalized or Derived Citizens
  4. Information on Immigration Documentation and How to Correctly Put It into the Application

Worth repeating:

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/. We welcome suggestions for resources to post on the webpage. Please send your ideas to arichey@familyvoices.org .

FV/NCFPP ACA Blog The most recent blog posting from NJ family leader Lauren Agoratus can be found on this page.

Follow HHS ACA information is available from HHS via Facebook, Google + and Twitter. You can sign up here for Marketplace email and text message updates, or visit the Marketplace page for CMS partners to sign up for Marketplace email updates geared towards partners and to download CMS resources, training materials, or learn about partnership opportunities.

“Comparing Health Plans’ Benefits and Coverage Summaries” The National Disability Navigator Resource Collaborative (NDNRC) has released its first fact sheet – “Comparing Health Plans’ Benefits and Coverage Summaries” – which is designed to inform navigators and other enrollment specialists about what people with disabilities need to look for in the Summary of Benefits and Coverage sections on HealthCare.gov. A list of upcoming fact sheets is available here. The NDNRC website (http://www.nationaldisabilitynavigator.org/) also has news and resources designed to support groups providing enrollment assistance to consumers with disabilities, including the “Guide to Disability for Healthcare Insurance Marketplace Navigators.” 



Collection of ACA Stories Family Voices is collecting anecdotes about people’s experiences with the ACA – both positive stories and information about problems – so that we can inform policy makers. Please share your story, and encourage others to share theirs, at http://www.familyvoices.org/action/share. Please indicate in the first line that it is a story about the ACA.


Please help us make the Update more useful to you. Does it provide the right amount of information?  What parts are helpful and not so helpful?  Please let us know!

And, as always, please feel free to contact us with any questions.

Yours truly,


Janis Guerney, Esq.



Brooke Lehmann, MSW, Esq.



Lynda Honberg


NOTEPast issues of the Update appears can be found on the home page of the Family Voices website  by scrolling down the "News Feed" items.