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 Legislative & Policy Corner

Update on Proposed Medicaid/CHIP Managed Care Regulation
A few weeks ago, the Centers for Medicare and Medicaid Services (CMS) released a proposed regulation entitled Medicaid and Children's Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability available here. Since its release, the AMCHP policy team has been reviewing the regulation and connecting with key partners including the National Association of Medicaid Directors to get a sense of how people are responding to the proposal.

On Friday Jun. 24, you should have received this message from AMCHP staff containing highlights of the proposed rule and seeking your input. Please share your questions, comments and concerns with us directed to Brent Ewig at We will continue to use the AMCHP Legislative and Health Care Finance Committee to guide our response on this and appreciate your feedback to inform those efforts.

Appropriations Committees Propose MCH Cuts
On Thursday Jun. 25, the Senate Appropriations Committee voted 16-14 to approve the Labor, Health and Human Services, Education, and Related Agencies bill, which would cut overall spending from the FY 2015 enacted level by nearly $4 billion to $153 billion. The bill proposes a $21.7 million reduction to the Title V Maternal and Child Health Services Block Grant, with report language directing a $5,369,000 increase to the state grant portion of the grant and the balance of reductions from the Special Programs of Regional and National Significance (SPRANS) line. While AMCHP welcomes the recognition of pressing state needs, we are concerned that the proposed increase comes at the expense of the Title V program component that supports states by funding innovation, workforce, technical assistance, quality improvement and other mission critical efforts. Details on this proposal are here starting on page 47. We are working to compile information on other proposed MCH-related cuts in this bill.

Last week, the House Appropriations Committee passed a bill recommending a $1.2 million increase for the Title V MCH Services Block Grant. That bill, however, proposes the complete elimination of Title X Family Planning grants, the entire Agency for Healthcare Research and Quality (AHRQ) and the evidence-based Teen Pregnancy Prevention Program, among other cuts.

AMCHP is working with key partners to develop messaging and potential action alerts to oppose these proposed cuts and will share additional details as available. 

Health Reform Implementation

In Case You Missed It: King vs. Burwell
AMCHP CEO Lori Freeman issued a statement regarding the ruling in the King v. Burwell case:

"AMCHP welcomes today's Supreme Court ruling that preserves coverage for millions of low and moderate-income women and families who receive subsidized coverage through the federal health insurance Marketplace…"

To view the full statement, click here.

Special Enrollment Period – Pregnancy
New York State Senate & Assembly passed a bill to amend current insurance law to allow pregnancy to be added as a qualifying life event. Qualifying life events, such as birth of a child, change job status, change in marital status, etc., can prompt a special enrollment period (SEP). An SEP allows an individual to sign up for Affordable Care Act marketplace plans outside of the traditional open enrollment period. The bill is awaiting signature from the New York Governor. This bill strengthens access to adequate care during the critical prenatal period.

The issue of SEP for pregnancy has surfaced time and again in the past several months. Back in February, we shared a report by Young Invincibles, Without Maternity Coverage: The Need for Special Enrollment in the Health Insurance Marketplaces during Pregnancy. This report recommends that pregnancy be included as a qualifying life event eligible for a special enrollment period in the marketplace. The report stresses the importance of maternity care throughout pregnancy, identifies health insurance plans that may not include maternity coverage, and discusses policy implications and recommendations for a special enrollment period. And in March, several members of Congress wrote a letter to U.S Department of Health and Human Services (HHS) Sec. Burwell expressing the need for a special enrollment period for pregnant women. The members of Congress noted that pregnancy should be considered a qualifying life event that triggers special enrollment, similar to the birth or adoption of a child. The letter in its entirety is available here.

Essential Health Benefits – Benchmark Selection
On Feb. 20, 2015, CMS issued a final notice for benefit and payment parameters. The rule seeks to ensure coverage options in the Health Insurance Marketplace are affordable, accessible, and of high quality. In addition, the rule further strengthens transparency and accountability. Within the final rule, there are several changes to essential health benefits (EHBs) that may have implications for MCH populations MCH including children and youth with special health care needs (CYSHCN). The selection of benchmark plans is underway in several states. Title V programs have an opportunity to engage in the transformation of the health care delivery system because of the Affordable Care Act and state-level health reforms. AMCHP developed a fact sheet, Opportunities for Title V Programs and the Essential Health Benefits, to provide an overview of opportunities.