R a c h e l B . M o r g a n R N , B S N , H e a l t h C o m m i t t e e D i r e c t o r

N a t i o n a l C o n f e r e n c e o f S t a t e L e g i s l a t u r e s

1 0 t h N a t i o n a l F o r u m F o r H e a r t D i s e a s e & S t ro k e P re v e n t i o n

O c t o b e r 1 7 , 2 0 1 2

The Affordable Care Act: A State Implementation Update

Affordable Care Act Basics

Signed into law March 23, 2010

ACA coverage expansion

1. American Health Benefit Exchange

2. Medicaid expansion

3. Eligibility and enrollment simplification

4. 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

ACA Coverage Expansions

American Health Benefit Exchanges

Requires that a health insurance exchange be established in every state by Jan. 1, 2014.

Health Insurance Exchange Options1. State-Based Exchange (SBE)-state performs all exchange

functions

2. 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

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

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

EHB Benchmark Plans-Status

Jurisdictions with lawsStates with Executive

Orders

CA, CO, CT, DC, HI, MD, OR, VT

KY, NY, RI

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

State Exchange Update

Medicaid Expansion

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.

NFIB v.

Sebelius

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.

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

State Decisions on the Medicaid Expansion

The ACA & Preventive Care?

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.”

Unfunded Provisions

CHIPRA Childhood Obesity Demonstration Project

Better Diabetes Care

Public Access Defibrillation Programs

National Diabetes Prevention Program

• November 6th!!!!

• If there is an Obama Administration the ACA proceeds as planned.

• If there is a Romney Administration ….????

RACHEL B. MORGAN RN, BSNHEALTH COMMITTEE DIRECTOR, NCSL

RACHEL.MORGAN@NCSL.ORG

Contact Information