March 05, 2014

March 4 Washington DC Update

Washington DC Update 3/4/14

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

Greetings from (snowy) Washington!  Only 27 days left in the ACA open-enrollment period (it ends March 31)!  The President has said that about 4 million people have signed up for health insurance so far through federal and state Exchanges. They are hoping that two to three million more will sign up by the end of the month.


Making MLTSS More Consumer-Focused  On Tuesday, March 4, at 3:00-4:00 ET, the Administration for Community Living (ACL) will hold a webinar on Managed Long Term Services and Supports (MLTSS) and the impact on older adults and people with disabilities. The webinar will showcase a new interactive web-based tool that combines a checklist for assessing and shaping MLTSS with examples of practices, policies or contract language that implement the criteria. Click here to register for the webinar.

Direct Enrollment by Web Brokers and Insurers: What You Need to Know to Protect Consumers  Under the ACA, people can use insurance agents and brokers to purchase Qualified Health Plans (QHPs) rather than going through a state or the federal Exchange.  Families USA will be conducting a webinar on Wednesday, March 5, at 1:00-2:00 ET, at which the speaker will discuss:  what direct enrollment through web brokers and insurers entails and how it works; what the federal requirements are for these entities if they wish to perform direct enrollment; and how marketplaces can protect consumers in the direct enrollment process. Click here to RSVP.  For additional information see the Families USA issue brief, Consumer Protections for Web Brokers that Participate in the Health Insurance Marketplace.

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 Click here (scroll down to end of page) for information on the topic of each session and to register.

National Disability Navigator Resource Collaborative  On Thursday, March 6, at

12:00-1:00 PM ET, the Friends of the National Center on Birth Defects and Developmental Disabilities (NCBDDD) will host a webinar to familiarize participants with the resources available from the National Disability Resource Collaborative, which provides disability information and support to navigators and other enrollment specialists as they assist consumers with enrollment through the Affordable Care Act insurance marketplaces. The webinar is designed for anyone involved in enrolling individuals in the healthcare marketplaces and for anyone concerned with making sure people with disabilities are properly enrolled in the most appropriate health insurance plan. Space is limited. Reserve a place now at:


President’s Budget  On March 4, the administration will deliver the President’s budget proposal to Congress. This year the President’s budget is less significant than usual, since the December 2013 budget agreement already set the amount that Congress can spend on “discretionary” (appropriated) programs. Moreover, since it is an election year, there is little chance that any changes will be made in taxes or entitlement programs. This article from The Hill gives a few suggestions about what to look for in the President’s budget.

F2F Funding Outlook  As reported in previous Updates, $2.5 million for Family-to-Family Health Information Centers (F2Fs) for the current (2014) fiscal year was included in the December 2013 budget agreement. These funds will be made available through the Health Resources and Services Administration in the coming months. It remains to be seen whether or how the additional $2.5 million for the program (at the current level of $5 million per year) will be provided. As detailed in an earlier 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 future of that legislation is unclear, but Congress must somehow address the SGR issue by March 31, when a temporary measure to maintain physician payments expires. It is possible that a provision to provide additional F2F funding will be included in that legislation.

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.

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

Retroactive Tax Credits and Cost-Sharing Reductions to be Available in “Exceptional Circumstances”  On February 27, the Centers for Medicare and Medicaid Services (CMS) issued a bulletin to state Marketplaces (Exchanges) announcing that an Exchange “may” provide retroactive payment of Advanced Premium Tax Credits (APTCs) for the purchase of Qualified Health Plans (QHPs), and retroactive application of cost-sharing reductions (CSR) to individuals who tried but were unable to enroll in a QHP through an Exchange due to technical difficulties with that Exchange. (Maryland, Oregon, and some other states, as well as the federal government, have had serious problems with their Exchange websites.)

To receive retroactive APTCs or CSR, an individual must enroll in a QHP through an Exchange and must be determined to have been eligible for these benefits at the time they had originally tried to enroll. The consumer also must pay his/her share of the premiums and any cost-sharing for the applicable time period. These retroactive benefits can be provided both to people who never purchased a QHP and to those who purchased a QHP outside of an Exchange. A “special enrollment period” will be available to qualified individuals. For an explanation of this new policy, see the CMS bulletin and/or this post from Tim Jost on the blog of Health Affairs.

CMS Clarification of Third Party Payments of Premiums  As reported in an earlier update, some health plans were refusing to accept third-party payments to help certain people pay their insurance premiums for ACA Qualified Health Plans (QHPs). Such payments include aid available through the Ryan White Act (for people with AIDS) or charities intended to help people with certain conditions. On February 7, CMS issued a further explanation of its policy on this point.

Healthcare.Gov and HHS Prepared for an Enrollment Surge  A spokesperson for the Department of Health and Human Services (HHS) has announced that has been made simpler to use and is ready to serve "millions more" in the few weeks left of open enrollment for health coverage. In addition, the administration has enhanced its capacity to help consumers. It is transitioning 1500 service representatives from web chat to direct telephone assistance (available 24/7), added an additional 800 Spanish-speaking representatives to the call center, and provided additional training to call-center staff and in-person assisters. In total, there are approximately 14,000 call-center personnel and more than 25,000 trained in-person assisters across the country. For more information see this announcement from HHS.


HIPAA Guidance on Sharing Mental Health Information  On February 21, the Department of Health and Human Services Office for Civil Rights issued guidance reviewing the circumstances under which health care providers treating patients for mental health conditions may share protected health information under the Health Insurance Portability and Accountability Act’s (HIPAA) privacy rule. Among other topics, the guidance reviews when HIPAA permits health care providers to communicate with family members, friends or others involved in the patient's care; and how providers may communicate with family members, law enforcement or others when the patient presents a serious and imminent threat of harm to themselves or others.

Grants Available to Increase Stakeholder Involvement in Patient-Centered Outcomes Research  The Patient-Centered Outcomes Research Institute (PCORI) recently launched the Eugene Washington PCORI Engagement Awards program, a $15.5 million initiative to forge opportunities for patients and other stakeholder communities to become more involved in patient-centered outcomes research. For more information, see


If there are families who still need to enroll by March 31, but are reluctant or confused, here are some potentially helpful resources:

Enroll America has issued a basic guide about the ACA and insurance terms which can be found at

How to Get Financial Help to Pay for Insurance:  A recent study by the Robert Wood Johnson Foundation (RWJF) found that more than 8 and 10 of the uninsured would be likely to enroll if they received financial help to pay for health insurance. In response, RWJF has launched – a new website that raises awareness of financial help and sends consumers to the marketplace in their state to get them enrolled. The site features testimonial videos of real people who have received financial help, a tool that explains the tax credit and how to use it, and snapshots of real people who are saving on health insurance plans because of financial help. 

Especially for immigrant and Spanish-speaking families:

Reassurance from the Secretary of the Department of Homeland Security. Secretary  

Jeh Johnson posted an op-ed aimed at Spanish-speaking immigrant families titled “Setting the Record Straight on Immigrant Families and the Affordable Care Act” in the Spanish-language publication La Opinion. It can be found at

The American Cancer Society has developed a Spanish-language ACA consumer guide: Ley de Atención Médica: Cómo esta ley puede ayudar a las personas con cáncer y a sus familias.

Enroll America has issued a basic guide about the ACA and insurance terms which can be found in Spanish at

Materials for enrollment assisters:

The National Immigration Law Center recently presented a webinar on the ACA and Immigrant Families. The slides are available at 

NOTE:  The upcoming March Family Voices blog from Lauren Agoratus will also discuss the ACA and immigrant families.

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 We welcome suggestions for resources to post on the webpage. Please send your ideas to .

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

“In the Loop” is a free, private online community and feedback mechanism to connect enrollment specialists, and share synthesized data with policymakers to support implementation of the ACA. Participants can post ACA enrollment and eligibility questions, which will be answered by fellow enrollment assistants and national experts. The In the Loop website also provides links to various ACA resources which are searchable by topic or by group (e.g. Navigators, healthcare providers, non-profit organizations). Registration is required and be done at Moderators sometimes seek information from the In the Loop community, such as one of this week’s questions:  “How are former foster youth getting enrolled in Medicaid coverage in your state?”  In the Loop is coordinated by two national not-for-profits, Community Catalyst and the National Health Law Program (NHeLP) with support from the Ford Foundation.

National Disability Navigator Resource Collaborative  Several fact sheets are available from The National Disability Navigator Resource Collaborative (NDNRC), a consortium of seven disability advocacy organizations working to support those helping to enroll people with disabilities in ACA-related health plans. The NDNRC also has published the “Guide to Disability for Healthcare Insurance Marketplace Navigators,” which provides information on special considerations people with disabilities face as they shop for healthcare coverage.

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.


Identification and Assessment of Children and Youth with Special Health Care Needs in Medicaid Managed Care: Approaches from Three States  A new report from the National Academy for State Health Policy (NASHP) profiles how state Medicaid programs and Medicaid health plans in California, Massachusetts and Michigan identify and assess children and youth with special health care needs. The report outlines some promising practices states may consider in implementing Medicaid managed care for this population.


Key letters that Family Voices signed on to this week:

  • Appropriations for health and education programs:  A letter from numerous national health, welfare, education and labor organizations to the House and Senate Appropriations Committees’ chairmen and ranking members urging that they allocate $163.6 billion to the Labor, Health and Human Services and Education Appropriations (Labor-HHS) Subcommittee for FY 2015. Through its “302(b)” allocations, the full appropriations committee in each house decides how much each of its subcommittees will get to fund the agencies within its jurisdiction. The requested amount would be an increase from recent years, but would only restore spending to the FY 2010 level. Many programs of importance to CYSHCN and their families are funded by the Labor-HHS Subcommittee, including the Maternal and Child Health Block Grant, medical research, and special education.
  • EMSC reauthorization. A letter from a number of national organizations to the House and Senate sponsors of bipartisan legislation (to be introduced soon) to reauthorize the Emergency Medical Services (EMS) for Children grant program for an additional five years. This program provides grants to states to ensure that their EMS systems are equipped to provide optimal care to critically ill or injured children, and also funds research into pediatric emergency care.
  • Combating Autism Act. Letter from several national organizations (members of the Consortium of Citizens with Disabilities Task Force on Autism, Developmental Disabilities and Family Support) to all Members of Congress urging reauthorization of the Combating Autism Act.


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 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.