Implementation, Regulations, and Guidance

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HHS Announces Navigator Grantees

HHS has announced $60 million in grants to Health Insurance Navigator programs in federally-facilitated and state-partnership marketplaces. Grantees include AUCD network members in Arkansas and North Dakota.



UPDATED: Status of State Action on the Medicaid Expansion Decision

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A central goal of the Affordable Care Act (ACA) is to significantly reduce the number of uninsured by providing a continuum of affordable coverage options through Medicaid and the Health Insurance Marketplaces. The ACA expands Medicaid coverage for most low-income adults to 138% of the federal poverty level (FPL). Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. This table shows the status of those decisions.



CCIIO issues FAQ on Essential Community Providers

A new FAQ released by the Center for Consumer Information and Insurance Oversight (CCIIO) addresses questions insurance issuers may have concerning Essential Community Providers (ECPs). The Affordable Care Act (ACA) requires issuers to contract with a sufficient number of ECPs, or providers that generally treat low-income and medically underserved patients. The FAQ describes specifics of the ECP requirements, how issuers can access the non-exhaustive ECP list, and how ECPs can actively pursue inclusion in insurance planes. The exclusion of Children's Hospitals as ECPs has been of concern to the disability community.



State-by-State ACA Fact Sheets

Updated to include FY13 data

HHS has updated its state-by-state Affordable Care Act fact sheets with data through FY13. The fact sheets provide data on the marketplace, Medicaid expansion, mental health coverage, health care workforce, and more.



HHS Releases Final Marketplace Rule

HHS has released a final rule regarding key marketplace standards for 2015 and standards and protections for navigators and other consumer assistance personnel.



Exemptions and Special Enrollment Periods

This chart from Health Reform GPS explains the current exemptions from the shared responsibility payment and triggers for special enrollment periods in the health insurance marketplaces and how one applies for each.



Individuals with Pre-Existing Conditions May be Eligible for Special Enrollment Period

Individuals who had pre-existing conditions and were enrolled in the Pre-Existing Condition Insurance Plan (PCIP) are now eligible for a special enrollment period (SEP). Although open enrollment ended March 31, coverage under PCIP ended on April 30, 2014. CMS issued guidance at the end of last month indicating that individuals previously covered by PCIP would have a SEP for 60 days (until June 30) to obtain coverage through the marketplace.



Archived Webinar on Special Enrollment Periods and Exemptions

CBPP Health Reform Beyond the Basics

Updated to include new information, this webinar focuses on the triggers and timing for special enrollment periods, including new guidelines for limited circumstances special enrollment periods for complex cases, and on how people can qualify for exemptions from the penalty for not having health coverage.



Health Care Toolkit for State Budget Officers: Resources for Implementing the Affordable Care Act and other Health Care Reforms

State budget officers provide a unique perspective on how the crucial delivery of a key service such as health care fits into the framework of state budgets. This report from the National Association of State Budget Officers looks at five core areas pertinent to state budgets as a means to analyze the implementation of the Affordable Care Act and other health reforms.



Proposed Rule: Exchange and Insurance Market Standards for 2015 and Beyond

Proposed Navigator and Marketplace Standards

This proposed rule from the Centers for Medicare and Medicaid Services (CMS) includes standards for Health Insurance Marketplaces as well as protections and standards for Navigators and other consumer assistance personnel.



Proposed Standards for Navigators and Consumer Assistance Counselors: Preemption of Certain State Navigator Regulatory Laws

A brief from Health Reform GPS

Many states have created policies regulating the activities of navigators created by the Affordable Care Act. On March 17, 2014, HHS released a proposed rule in public view form that addresses a variety of issues including Exchanges, Navigators and Non-Navigator consumer assistance personnel. This brief explains and provides context for the proposed rule.



Basic Health Program Final Regulations

A brief from Health Reform GPS

On March 7, 2014, the Centers for Medicare and Medicaid Services (CMS) published final regulations implementing the Affordable Care Act's Basic Health Program (BHP) market option. The BHP is an optional program for states to provide protections for people who may "churn" between Medicaid and the Marketplaces. This brief explains the final regulations from CMS.



CMS Bulletin on Premium Subsidies and Cost-Sharing Reductions in 2014 Due to Exceptional Circumstances

A brief from Health Reform GPS

The Affordable Care Act (ACA) provides premium tax credits (PTCs) and cost sharing reduction assistance (CSRs) to help individuals defray the cost of enrolling in qualified health plans (QHPs) provided by insurance issuers and purchased through the Health Insurance Marketplace. Technical problems, however, have plagued many state Marketplaces as well as the Federally-facilitated marketplace during the initial 2014 open enrollment period, resulting in a potential for lost enrollment opportunities. This brief from Health Reform GPS explains the allowances CMS will make in eligibility determinations for those who faced technical difficulties applying for coverage.



CMS 2015 Draft Letter to Issuers in the Federally Facilitated Marketplace: Network Adequacy and Inclusion of Essential Community Providers

Summary and Analysis from Health Reform GPS

On February 4, 2014, the Centers for Medicare and Medicaid Services (CMS) issued a Draft Letter to Issuers in the Federally-facilitated Marketplace (FFM). Comments were due by February 25, to be followed by a revised letter. This update from Health Reform GPS reviews key provisions of the Letter and identifies key issues to watch in the final revised letter.



Implementing Health Reform: Medicaid Asset Rules and the Affordable Care Act

On February 23, 2014, the Centers on Medicare and Medicaid Services released a State Medicaid Directors Letter analyzing the application of Medicaid liens, estate recoveries, transfer-of-asset rules, and post-eligibility income rules to individuals who become eligible for Medicaid because of their modified-adjusted gross income (MAGI). This Health Affairs blog post explains the context and content of the letter.

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