March 26, 2014

March 25 Washington DC Update

Washington DC Update 3/25/14

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

Greetings from Washington!  Only 6 more days until the end of the open season to buy health insurance (March 31). Last week the administration announced that over 5 million people had enrolled in health insurance plans under the ACA since October 1, in both the federal and state Marketplaces (Exchanges), and officials are making a final push this week to get more to enroll. This update includes some last-minute enrollment resources, as well as information on a comprehensive proposed rule on the future implementation of the ACA.


Webinar Series:  A Practical Guide to Healthcare Reform: The ABCs of Eligibility under the ACA  This is a free webinar series offered by health care consulting firm Manatt Health Solutions. For more information and to register, click on the name of the webinar below. Remaining sessions:

According to the website, if you sign up now, and you will receive an On-Demand link that enables you to access all the programs, at your convenience, any time after the original air date.

Disability-Competent Care Webinar Roundtable Series  The CMS Medicare-Medicaid Coordination Office is conducting three more webinars in the Disability-Competent Care Webinar Roundtable Series:

  • Providing Home Modifications: The webinar on March 25, 2:00-3:00 ET, will help participants understand the scope of home modifications commonly funded by home and community-based waivers, the value of in-home functional assessments and components of the home modification assessment process.
  • Establishing Linkages between Medical (Health Care) and Community Providers and Resources: The webinar on April 1, 2:00-3:00 ET, will highlight strategies to facilitate timely communication between care coordinators and medical and long-term services and supports providers.
  • Integrating Behavioral Health Competency within Disability-Competent Care Teams and Individualized Plans of Care: The webinar on Tuesday, April 8, 2014, 2:00-3:00 ET, will help participants understand the prevalence and importance of addressing participant behavioral health needs; and discuss strategies to facilitate timely communication and collaboration between behavioral health providers and disability-competent care teams. Though open to all, the target audience of this webinar is individuals who work with persons with disabilities, particularly behavioral health providers.

Registration is required to participate. Click here to register.

Exemptions and Special Enrollment Periods  On Wednesday, March 26, 2:00-3:30ET, the Center on Budget and Policy Priorities will present its next “Beyond the Basics of Health Reform” webinar, which will focus on how the penalties for not having coverage are calculated, how people can qualify for exemptions from the penalty, and triggers and timing for special enrollment periods. Register here. NOTE:  The webinar site can only accommodate the first 1,000 people who sign in, so make sure to sign in early on Wednesday to secure a spot. If you cannot join, you can get the recording at Health Reform: Beyond the Basics later this week. 

ACA Basics (good for consumers)  From the HHS Center for Faith-based and Neighborhood Partnerships: Wednesday, March 26, 7:00-8:00 ET, Health Care Law 101 – Health Insurance Marketplace. For Phone Only, Dial 646-307-1705, Access Code: 603-316-464 (Pin Number is the # key).

Supporting People with Disabilities Who Experience Sexual Violence  On March 27, at 1:30 ET, The Arc’s National Center on Criminal Justice and Disability’s Join will present a webinar “Can You Hear Me? Connecting the Dots and Building Collaboration to Support People with Disabilities Who Experience Sexual Violence.”  Participants will learn how “word choice” can impact the type of sexual assault services victims receive, the importance of “touch” as a proactive strategy for reducing risk of sexual victimization and understand how survivors with complex communication needs can testify in court. Registration for this webinar and archived copies of past webinars are available on the Justice Center website. Direct any questions to

Webinar Series:  Fostering Partnership and Teamwork in the Pediatric Medical Home Hosted by the National Center for Medical Home Implementation and the American Academy of Pediatrics. To register for each session, click on its name below.

White House Office of Public Engagement Disability Community Call: Thursday, March 27, 3:00 ET (please dial in 5 minutes early). The next White House Office of Public Engagement disability community conference call will feature Catherine E. Lhamon, Assistant Secretary for Civil Rights at the U.S. Department of Education. RSVP here. (Once you register, a confirmation page will display dial-in numbers and a unique PIN. You will also receive an email confirmation of this information.) This call is accessible to deaf and hard of hearing participants via live captioning. For live captioning feature, at the start time of the call, please login by clicking on the following link:  (This call is off the record and not for press purposes.)

Realizing Rural Care Coordination: Considerations and Action Steps for State Policy Makers  Wednesday, April 2, 2:00-3:15 ET. The National Academy for State Health Policy/State Refor(u)m, is sponsoring this webinar featuring state officials from Colorado, Montana, and New Mexico, who will share their distinct approaches to coordinating care for rural residents. The speakers will participate in a moderated panel-style discussion to explore the development, financing, daily operations, challenges, and lessons learned of their state models. Discussion will focus on key policy decisions and action steps that states can take to implement care coordination strategies for rural populations. Register here.

Enrolling Eligible Children & Teens in Medicaid and CHIP Year Round On Thursday, April 3, 2014, 2:00-3:15 ET, the Connecting Kids to Coverage National Campaign is hosting this webinar to raise awareness that individuals who are eligible for Medicaid and CHIP can enroll at any time. This webinar is also an opportunity to learn about the Connecting Kids to Coverage spring outreach campaign, and new enrollment messages. Register for the Enrolling Eligible Children & Teens in Medicaid and CHIP Year Round webinar.


F2F Funding Outlook  As reported last week, the legislation to provide future funding for F2Fs has made it through another necessary, but not sufficient, step:  the new chairman of the Senate Finance Committee, Sen. Ron Wyden (D-OR), introduced legislation to fix the Medicare physician payment problem, and that bill includes the (very good) F2F provision from an earlier iteration of that bill – an extension of funding through FY 2018 at $6 million per year. While this is very good news, the ultimate outcome is still unclear.

Memory refresher: The Bipartisan Budget Act enacted in December 2013 provided $2.5 million for F2Fs for the part of federal fiscal year 2014 ending March 31 (six months). The F2F provision, and various other “extenders” of current Medicare and other health law provisions, were packaged with the so-called “doc fix” (“SGR”) section of the law, which delayed a cut in Medicare physician payments through March 31.

In December, the Senate Finance Committee, under the leadership of then-Chairman Max Baucus, approved an SGR bill that included an F2F extension for 5 years at $6 million per year. That bill was not voted on by the full Senate. The House version of the SGR bill did not include the F2F provision or any other “extenders.” 

Outlook: There less than one week until the current “doc fix” expires. Chairman Wyden’s SGR bill is expected to be voted on in the Senate this week. A Republican SGR bill may also get a vote. It is quite possible that neither bill will pass, so the House and Senate would then negotiate another temporary “patch” to keep Medicare physician payments from getting cut by 24 percent. We hope that such a patch will also be applied to the extenders (including the F2F provision).

It is not clear how long such a patch would be in effect. It could be a matter of weeks or as long as nine months. If, indeed, the F2F provision were included in such legislation, it would almost certainly provide the current level of funding ($5 million annually), rather than $6 million. It is also unlikely that it would provide funding beyond either the end of FY 2014 (September 30, 2014), or the end of the temporary SGR patch.

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. As noted above, however, the future of the SGR legislation is quite unclear at this point in time, and cosponsorship of the F2F legislation is a means of expressing support for the program. The House bill (H.R. 564) recently now has seven 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.]

March 31 Deadline Also Applies to Non-Exchange Plans  It is important to note that the open-enrollment period applies to private, individual insurance plans sold outside the federal and state Exchanges, as well as those sold through the Exchanges, as explained in these excerpts from posts on the In the Loop* website:

You cannot sign up for private coverage outside open enrollment unless you have a special enrollment opportunity event (e.g. loss of ESI, divorce, birth) that qualifies you to do so.

There may be plans that are sold outside the open enrollment period, but they will be short-term (not a full year) or without full Essential Health benefits. Therefore they will not qualify as Minimum Essential Coverage, so a person would still be subject to the individual mandate penalty. 

…Under federal rules, the open enrollment period for coverage both inside and outside the Marketplace is the same. Insurers in most states are not required to issue policies to anyone after March 31, 2014. Thus, in most states if someone doesn't enroll during the open enrollment period, they will have to wait until next November to enroll and it would be January 1, 2015 before their coverage could begin (unless they have a change of circumstance that would trigger a special enrollment opportunity). States do have the option to enact different open enrollment standards outside the marketplace in order to give consumers greater access to coverage. However, to date only two have done so.

* NOTE:  In the Loop is an online community for enrollment assisters to share information. Family-to-Family Health Information Centers (F2Fs) and others helping consumers enroll in health care plans can join at

Important to Pay First Month’s Premium  Families USA provides this reminder:  It is important to remind consumers that after they’ve selected health plans they must pay their first month’s premium by the date listed on the information they receive from their health plan. If consumers do not receive this information within seven days, they should call the health plan to ask about their enrollment and how to pay their premium. If consumers have not paid their first month’s premium, and it is past the date when their coverage should have started (the effective date for their plan), they should call their health plan to see if they can still pay their premium. If their health plan has terminated their enrollment, they should 1) go into their online account, 2) cancel their health plan, 3) create a new account, and 4) submit a new application. Premium-payment grace periods apply only after the initial payment.

Possible Grace Period for Some Consumers Having Trouble with Enrollment?  Although the administration has stated clearly that the March 31 open-enrollment deadline will not be extended, articles in The Hill and Reuters indicate that some people may be allowed able to enroll thereafter if they started the process before the deadline but could not successfully complete it due to technical difficulties.

In addition, states may let some individuals who enrolled in plans outside the Exchanges, because of technical difficulties with an Exchange, enroll in an Exchange plan and receive retroactive coverage. See this NPR story.

Proposed ACA Regulations  As reported last week, on March 14, the administration issued a slew of regulations, proposed regulations and sub-regulatory guidance regarding various provisions of the ACA. A comprehensive proposed regulation on future ACA implementation issues was among these. It is now available in the March 21 Federal Register, and summarized in this fact sheet from HHS and this article from The Advisory Board Company, as well as this Health Affairs blog post cited in last week’s Update.

Navigator restrictions  One of the provisions of the proposed rule would limit states’ ability to restrict consumer assistance through burdensome regulations on navigators and other assisters. See this blog post from the Georgetown Center on Children and Families, and this article from the George Washington University HealthReformGPS.


ABLE Act.  Senators Bob Casey (D-PA) and Richard Burr (R-NC) announced Monday that Senate Majority Leader Harry Reid (D-NV) and Senate Minority Leader Mitch McConnell (R-KY) have cosponsored their bill, the Achieving a Better Life Experience (ABLE) Act (S. 313).  The bill in the House (H.R. 647) was introduced by Rep. Ander Crenshaw (R-FL).  The measure would allow individuals with disabilities or their families to open a tax-sheltered savings account to pay for certain long-term expenses, without affecting their eligibility for government benefits.  The accounts would be similar to the current 529 program that allows families to save for college education.  The legislation now has the support of 68 Senators and 345 members of the House, making it one of the most widely supported bills in Congress.  Now that leaders Reid and McConnell have cosponsored this bill, it has a greater likelihood of getting enacted during this session of Congress.  See this article from the Washington Post for an explanation of the bill. 

Senate Bill Would Increase SSI Asset Limits. As explained in this article from Disability Scoop, Senators Elizabeth Warren (D-MA) and Sherrod Brown (D-OH), introduced legislation last week that would, for the first time since 1989, increase the amount that a person could save without losing access to SSI benefits. The bill would raise the asset limit from $2,000 to $10,000. It would also increase the amount of income beneficiaries could earn without losing benefits, and eliminate restrictions that currently disallow friends and family from providing financial, food and housing support to SSI beneficiaries. A similar measure was introduced last year in the House of Representatives by Rep. Raul Grijalva (D-AZ). In the current political climate, it does not seem likely that the bill will advance through the legislative process, but it helps to promote discussion about the adequacy of SSI benefits.

FEATURED RESOURCES ON THE ACA – for consumers and advocates

Given the last-minute enrollment push, here a number of resources, some of which are repeated from earlier updates:

For consumers

Navigator Tools for Consumers   The Answer My Questions page, from the National Health Council, is a collection of patient-focused materials and guides provided by trusted national organizations. These tools are designed to inform patients and family caregivers about health care reform and help them make good decisions about health insurance coverage. One of the resources is a worksheet to help people calculate the expected costs of their health care. Some of the resources are tailored to patients with specific chronic diseases and disabilities.

Premium Tax Credit Information – in Spanish  The IRS translated into Spanish the Premium Tax Credit flyer (Pub 5120) and trifold (Pub 5121), entitled “Facts about the Premium Tax Credit”: - Publication 5120(SP) - Premium Tax Credit flyer - Publication 5121(SP) - Premium Tax Credit trifold

Guide Hispanic Youth and Families Through Choosing a Health Insurance Plan With Spanish-Language Videos – From HHS, which also offers immigrant families updated guidelines regarding their status and eligibility for health care coverage. – A site for consumers to learn about the financial assistance that is available to them to purchase insurance and find an in-person enrollment assister near them.

At Cost Estimate Calculator consumers can figure out how much insurance should cost them, based on where they live and other circumstances. You can also go to this website to install the cost-calculator widget on your own website.

How Do I Qualify for an Exemption from the Fee for Not Having Health Coverage?

Consumer Guide from Kaiser Health News:

From the Family Voices National Center for Family/Professional Partnerships: 

For Advocates

Family Voices National Center for Family/ Professional Partnerships (NCFPP) ACA resources, including the latest entry in our Family Voices Blog - How Immigrant Status Affects Eligibility for Health Plans in the Marketplace at

Individual Mandate Requirements  For a review of the rules regarding the ACA’s individual responsibility requirement (individual mandate), see this blog post from the Georgetown Center on Children and Families. 

Explanation of Exemptions from the Fee for Not Having Insurance

Families USA  Enrollment Assister Resource Center.

National Health Law Program (NHeLP) website, including the Advocate’s Guide to MAGI, designed to help advocates understand and apply the ACA’s new income- counting rules for certain applicants, including youth with special health needs who are NOT on SSI and/or a waiver, and are living at home. An NHeLP webinar on the MAGI rules is available here. 

National Disability Navigator Resource Collaborative  (NDNRC). NEW FACT SHEET:  “Rehabilitation and Habilitation Services and Devices”—This fact sheet is intended to help navigators and other enrollment specialists answer specific questions that people with disabilities might ask about health plans’ coverage of rehabilitation and habilitation services and supports, as well as devices such as wheelchairs, prosthetics, low vision aids and augmentative communication devices. The fact sheet and a 2-page executive summary can be found at. A list of all available and upcoming fact sheets can be found at The NDNRC “Guide to Disability for Healthcare Insurance Marketplace Navigators” can be found at

The State Health Reform Assistance Network, a program of the Robert Wood Johnson Foundation, has developed a series of consumer assistance resource guides on:

Miscellaneous Enrollment Problems Community Catalyst and the National Health Law Program (NHeLP) recently compiled this document from guidance the administration provided to assisters. Among other topics, it gives specific instructions on how to deal with these enrollment situations that have been causing problems in

  • Heads of households
  • Married and expecting a divorce
  • Twins, triplets, and other multiples 
  • Spend-down/medically needy 
  • Medicaid denial checkbox 
  • Immigrants under 100% FPL needing premium tax credits and/or cost-sharing reductions.

“In the Loop” is a free, private online community and feedback mechanism to connect enrollment specialists and provide feedback to policy makers. The In the Loop website also provides links to various ACA resources which are searchable by topic or by type of enrollment assister. Register (no cost) at

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.

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


Yours truly,




Janis Guerney, Esq.


Brooke Lehmann, MSW, Esq.


Lynda Honberg


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