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 Legislative & Policy Corner

Health Reform Implementation
Now that the polls are closed and the results are in, implementation of the Affordable Care Act (ACA) is expected to march forward, although not completely without opposition at some levels. Congress will continue to provide oversight of implementation of the law and a series of legislation designed to defund provisions of the law is expected; however, these proposals will not gain traction with the Senate. There are opponents of the law that are still bent on challenging certain aspects of the ACA in court, too. The outcomes of these challenges remain to be seen. The final debt deal in Congress may include provisions that will propose changes to Medicaid, premium subsidies and Medicare eligibility.

The administration is expected to release many anticipated regulations related to the implementation of the ACA that were most likely put on hold until after the election. Federal agencies will be moving quickly to meet the scheduled opening of the health insurance exchanges on Oct. 1, 2013, 11 months from now. Anticipated regulations that are pertinent to maternal and child health (MCH) populations include:

    • Proposed rules setting standards for essential health benefits and identifying states benchmark selections
    • Proposed rules or guidance on evaluation of state readiness to establish a state-based health insurance exchange
    • Proposed rules or guidance on prohibitions on preexisting condition exclusions
    • Further guidance or proposed rule on the operation of federally facilitated exchanges and state-federal partnership exchanges
    • Rules or guidance on the standards for navigator programs and “in-person assistors”

Health Insurance Exchange Deadline for States
Many governors were awaiting the results of the election to make an important decision on the implementation of the states’ health insurance exchange. Nov. 16 was the deadline set by the U.S. Department of Health and Human Services (HHS) for states to submit their plan to run a state-based insurance exchange, enter a partnership with the federal government, or have the federal government run the exchange entirely. Health insurance exchanges are scheduled to open for business on Oct. 1, 2013 for enrollment. However, on Thursday, Nov. 15, Secretary Sebelius  extended the deadline for states to Dec. 14, 2012:

  • The deadline for a declaration letter for a state-based Exchange is now Dec. 14, 2012
  • In order to continue to provide states with appropriate technical support if they are pursuing a state-based exchange, HHS extended the deadline for state-based exchange blueprint application submissions to Friday, Dec. 14, 2012
  • HHS will approve or conditionally approve the state-based exchanges for 2014 by the statutory deadline of Jan. 1,2013

Additionally, for states that are pursuing a state partnership exchange, HHS will accept declaration letters and blueprint applications and make approval determinations for state partnership exchanges on a rolling basis. The final deadline for both the declaration letter and blueprint application for state partnership exchanges that would be effective for 2014 has been extended to Friday, February 15,2013. States will be able to apply to run exchanges in subsequent years.

To follow the progress on this issue, State Reforum has an ongoing map and grid on states’ decisions that can be found here

Medicaid Expansion Remains in Question for Some States
The Supreme Court decision earlier this year that upheld the ACA entirely, left the Medicaid expansion decision up to states. While there is no official deadline for states to increase eligibility, having the systems in place to accept the newly eligible populations through the health insurance exchanges is something states will need to consider. Again, now that election is decided, many governors might reconsider expansion, however, budget woes loom for many states, which are an ongoing concern for many governors and weigh heavily on their decision to expand Medicaid.

There are key opportunities for MCH professionals to weigh in on these important decisions that will be occurring at a rapid pace and there are implications for MCH populations depending on state Medicaid expansion decisions. AMCHP stands ready to provide analysis for members based on internal expertise and also collaborating with other partner organizations and you, the members. Please keep us informed on occurrences in your state that might be worth sharing with other states.