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 Legislative & Policy Corner

President Releases FY2017 Budget
In case you missed it, the President unveiled his FY2017 budget proposal on February 9.  The proposal included important investments in several maternal and child health priorities including level funding for Title V, a proposal to expand the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV) over 10 years, increased funding to address prescription drug abuse and heroin use, and emergency funding to address the Zika virus.  The release of the President's budget signals the start of the appropriations process, though given recent history and the fact that is an election year with a divided government the process is unlikely to follow regular order. Nonetheless, AMCHP will be meeting with key Appropriations Committee members in the coming weeks to advocate for an increase of Title V funding to $650 million to ensure our voice is heard and we will be following up with you on how to urge your elected officials to support this request! Click here to read AMCHP's full statement on the President's budget.

 Health Reform Implementation

50-State Survey on Medicaid & CHIP Released by Kaiser Family Foundation
The Kaiser Family Foundation, along with the Georgetown Center for Children and Families, recently released the annual 50-State Survey on Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost-Sharing Policies. The report found that more than two-thirds of states (37) report they can make real-time Medicaid eligibility determinations (defined as less than 24 hours) for children, pregnant women, and nondisabled adults. Implementing these sorts of policies is crucial for maternal and child health populations. Real-time eligibility determinations allow eligible individuals to access the care they need in a timely manner without facing unnecessary red tape.

Tax Rules May Stop Children from Falling Through the Cracks
In a recent blog for the Georgetown Center for Children and Families, Tricia Books explains how discrepancies in tax rules versus Modified Adjusted Gross Income (MAGI) calculations for Medicaid could leave some children without coverage. One of the five exceptions to MAGI rules for Medicaid is that when a child lives in a household with both parents, regardless of their marital or tax filing status, non-tax rules apply. To prevent children from falling through the cracks, the IRS code dictates that a taxpayer's family is defined as the individuals for whom a taxpayer properly claims a deduction for a personal exemption under section 151 for the taxable year, and family size is defined as the number of individuals in the family. This clarification should help children in unique family situations access the coverage they are entitled to.

CMS Issues Clarification on Special Enrollment Periods
On January 19th, the Centers for Medicare and Medicaid Services issued a statement on clarifying, eliminating and enforcing special enrollment periods in the health insurance marketplace. Special enrollment periods allow individuals who experience a qualifying life event to enroll in coverage outside of the normal open enrollment period. In an effort to improve the Marketplace experience for consumers and insurers and to ensure the sustainability of the Marketplace, CMS has eliminated a number of outdated special enrollment periods related to tax filing. Additionally, it has clarified eligibility for certain qualifying life events such as a permanent move, and it has developed an action plan to enforce these new and existing rules. 

Basic Health Program a Good Option for States
Section 1331 of the Affordable Care Act gives states the option of creating a Basic Health Program (BHP), a health benefits coverage program for low-income residents who would otherwise be eligible to purchase coverage through the Marketplace. The BHP gives states the ability to provide more affordable coverage for low-income residents and improve continuity of care for people whose income fluctuates above and below Medicaid and Children's Health Insurance Program (CHIP) levels. This is particularly relevant for pregnant women and families who might otherwise churn between Medicaid and the Marketplace. The BHP could offer stability and help a pregnant woman maintain continuity of coverage. So why haven't more states adopted a BHP? Experts suggest that people with incomes under 200 % of the federal poverty level (FPL) make up as much as two-thirds of Marketplace enrollment in some states. A smaller Marketplace might be less attractive to insurers and result in fewer, more expensive offerings, if those earning under 200% FPL were to switch to a BHP.

High Costs Pushing Some States to Enroll in Limited Coverage Health Plans
Under the ACA, most people are required to have insurance that meets minimum standards, or pay a fine. In 2016, the penalty is $695 per adult and $347.50 per child, or 2.5 percent of household income, whichever is greater. Faced with high premiums and deductibles in many Marketplace plans, some consumers are looking at other options, such as limited coverage health plans, which include short-term, critical illness, and accident policies.  These plans, which don't qualify as minimal essential coverage under the ACA, have significant drawbacks.  They typically do not provide access to preventive care and may deny treatment for pre-existing conditions.  In addition, these plans frequently impose dollar limits on coverage, and often refuse to renew policies if enrollees become sick and need expensive treatment. Families may view these plans as more cost effective than qualified health plans.  But in purchasing them, they incur the federal penalty for not having adequate insurance, and lose the opportunity for the more comprehensive coverage that QHPs provide.

12.7 Million Individual Enrollees during the Past Open Enrollment Period
On February 4th, the Department of Health and Human Services announced that nearly 12.7 million people signed up for health coverage by the January 31st deadline. This number includes 4 million new healthcare.gov consumers. About 7 in 10 consumers with 2015 coverage came back to healthcare.gov and actively selected a plan for 2016. In a press statement, HHS Secretary Sylvia Matthews Burwell noted "The Marketplace is growing and getting stronger and the ACA has become a crucial part of healthcare in America."