The Affordable Care Act: A State Implementation Update

1. The Affordable Care Act: A State Implementation Update Rachel B. Morgan RN, BSN, Health Committee Director National Conference of State Legislatures 10th National Forum For Heart Disease & Stroke Prevention October 17, 2012

2. Affordable Care Act Basics • Signed into law March 23, 2010 • ACA coverage expansion • American Health Benefit Exchange • Medicaid expansion • Eligibility and enrollment simplification • Insurance market reforms • Requirements for prevention and wellness coverage in Medicare, Medicaid, and in the private insurance market • Supports improvements for delivery of health care services

3. ACA Coverage Expansions

4. American Health Benefit Exchanges • Requires that a health insurance exchange be established in every state by Jan. 1, 2014. • Health Insurance Exchange Options • State-Based Exchange (SBE)-state performs all exchange functions • Federally-Facilitated Exchange (FFE) • Federal government performs all exchange functions • State Partnership Exchange-states share administration of the exchange and can be the primary entity plan administration or consumer assistance or both

5. Key Implementation Deadlines • Essential Benefits Package (EHB) Benchmark Plan Selection-Sept. 30, 2012 (soft deadline) • Health Insurance Exchange Blueprint-Nov. 16, 2012 • Secretary certifies State readiness for State-Based Exchanges, or Federal Partnership Exchanges-Jan. 1. 2013 • Open enrollment period begins-Oct. 2013 through March 2014 • Exchanges become fully operational Jan. 1, 2014 • Exchanges must be self sustaining by Jan. 1, 2015

6. EHB Benchmark Plans-Status States that have taken no action States that have submitted a plan (includes preliminary plans) AL, FL, IA, IN, LA, MA, ME, MN, MS, NC, NJ, OH, OK, PA, SC, TN, TX, WI, and WV AR, AZ, CA, CO, CT, DC, DE, DE, HI, IL, KS, KY, MA, MD, MI, ND, NE, NM, NV, NY, OR, RI, UT, VA, VT, and WA

7. State Exchange Update Jurisdictions with laws States with Executive Orders CA, CO, CT, DC, HI, MD, OR, VT KY, NY, RI

8. State Exchange Update States that have submitted letters regarding the “blueprint” for a SBE States that have indicated they will not participate in any form of an exchange CA, CO, CT, DC, HI, MA, MD, MN, OR, RI, NY, VT, WA AK, FL, LA, ME, SC, SD, TX

9. Medicaid Expansion

10. The Medicaid Provisions in the ACA • Expands eligibility levels for nonelderly with incomes at or below 133% of the federal poverty level (FPL). • Streamlines the enrollment and eligibility process. • Consolidated eligibility categories into four groups-adults, children, parents, and pregnant women • Provides an enhanced federal match, 100%, for the newly eligible starting in fiscal year (FY) 2014-2016. • Requires state Medicaid systems to interface with a Federal Data Services Hub.

11. NFIB v. Sebelius

12. Effects of the U.S. Supreme Court Ruling on the Medicaid Expansion • Limited the ability of the federal government to withhold all federal Medicaid funding unless states accept and comply with the ACA Medicaid expansion requirements. • Only the funding for the Medicaid expansion may be withheld if as state declines to participate.

13. State Decisions on the Medicaid Expansion States that Plan to Expand their Medicaid Program States that are Opting Out of the Expansion CA, CT, IN, MA, MD, MN, MO, RI, VT, WA FL, GA, LA, MS, SC, TX

14. The ACA & Preventive Care?

15. Key Prevention Provisions in the ACA • Required coverage of clinical preventive services in Medicare, Medicaid, and private insurance plans. • Establishes a framework for federal community-based prevention activities. • Establishes the “Prevention and Public Health Fund.”

16. Unfunded Provisions • CHIPRA Childhood Obesity Demonstration Project • Better Diabetes Care • Public Access Defibrillation Programs • National Diabetes Prevention Program

17. November 6th!!!! If there is an Obama Administration the ACA proceeds as planned. If there is a Romney Administration ….????

18. Contact Information Rachel B. Morgan RN, BSN Health Committee Director, NCSL Rachel.morgan@ncsl.org