A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Community Health Centers restriced in ability to enroll uninsured under ACA

Posted on January 14, 2014 | Comments Off

Irrespective of their increased efforts, a new study released today indicates that community health centers operating in states less receptive to the Affordable Care Act (ACA) are having difficulty performing outreach and enrolling uninsured individuals. The study, performed by the Geiger Gibson Program within The George Washington University School of Public Health and Health Services and RCHN Community Health Foundation, is the first to assess how state restrictions are impacting enrollment and coverage under the ACA. A press release describing key findings about the study may be accessed here.

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HHS releases enrollment figures

Posted on January 13, 2014 | Comments Off

The US Department of Health and Human Services (HHS) recently released enrollment figures from October 1st, 2013 to December 28th, 2013 for the Affordable Care Act’s (ACA) health insurance marketplace. Below are several of the key findings:

  • Nearly 2.2 million Americans have enrolled in health insurance;
  • About 24% of these individuals are between the ages of 18 and 34;
  • 60% of enrollees selected a silver plan; and
  • 79% of individuals selected a plan with financial assistance.

The most recent Assistant Secretary for Planning and Evaluation (ASPE) Issue Brief provides a detailed breakdown and explanation of the enrollment figures.

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Update: Medicaid Expansion Map

Posted on January 13, 2014 | Comments Off

This updated map reflects the recent acceptance of Wisconsin’s 1115 demonstration waiver to permit childless adults earning up to 100% of the federal poverty level (FPL) to receive health coverage from Wisconsin’s Medicaid program, BadgerCare.

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CMS approves WI Medicaid waiver

Posted on January 13, 2014 | Comments Off

Last week. the Centers for Medicare and Medicaid Services (CMS) approved a 1115 demonstration waiver for Wisconsin to expand the state’s Medicaid program, BadgerCare.  The waiver expands Medicaid to childless adults earning up to 100% of the federal poverty level (FPL).  Individuals previously enrolled in Wisconsin’s BadgerCare Plus program and those deemed newly eligible for Medicaid under the Affordable Care Act’s (ACA) criteria will be placed on the federal health insurance Marketplace operating in Wisconsin.  The waiver went into effect on January 1st, 2014.

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Implementation Brief Update: Proposed IRS Procedures for Tax-Exempt Hospitals to Correct and Disclose Failures to Meet Their Community Benefit Obligations Under the Internal Revenue Code

Posted on January 13, 2014 | Comments Off

In order to be exempt from federal income taxes, nonprofit hospitals seeking such a designation under the Internal Revenue Code must provide a community benefit, a policy that has been in place since 1969 but that has gone essentially unenforced since its creation by the Nixon Administration. Government estimates of the value of nonprofit hospital tax-exemption placed the total national value at more than $12 billion in 2002, a figure that undoubtedly has grown over the past decade and that reflects both federal tax losses and losses resulting from the fact that most states and localities use federal law to determine exemption from state and local property, sales, and income taxes…

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Insurance plans must cover breast cancer preventive medications

Posted on January 9, 2014 | Public Comment (1)

According to a set of FAQ’s issued by the Center for Consumer Information and Insurance Oversight (CCIIO), insurers are now required to fully cover medications that help reduce the incidence of breast cancer among women at high risk. Examples of these medications include tamoxifen and raloxifene. The policy change, arising from recommendations by the US Preventive Services Task Force (USPSTF), was decided in September 2013 and goes into effect for plan years beginning on or after September 24th, 2014.

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Implementation Brief Rating the Quality of Qualified Health Plans Sold in the Marketplace

Posted on January 7, 2014 | Comments Off

On November 19, 2013, the Obama Administration published a Notice with comment that describes the overall Quality Rating System (QRS) framework for rating the quality of health plans (QHPs) sold in the health insurance Marketplace (another term for Exchanges). The purpose of the Notice is to solicit comments on the framework. Comments must be received by January 21, 2014. Comments are sought on both the proposed quality measures that QHP issuers would be expected to report, as well as on ways to preserve the integrity of QHP ratings and on areas for future measurement…

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Implementation Brief Update: Contraception Coverage Lawsuits Reach U.S. Supreme Court

Posted on January 6, 2014 | Comments Off

As discussed in earlier Briefs, the ACA requires all individual and non-grandfathered group health plans to cover certain preventive services, including comprehensive contraceptive services. On August 3, 2011, the Departments of Treasury, Labor, and Health and Human Services (HHS) published an Amended Interim Final Rule incorporating HRSA’s guidelines to require mandatory coverage by non-grandfathered group and individual insurance plans of all preventive services (including contraception) without cost sharing beginning on August 1, 2012. Religious employers and other interested parties argued that requiring employers to sponsor insurance that included contraception violated religious liberty…

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HHS submits marketplace verification report to Congress

Posted on January 2, 2014 | Comments Off

On the last day of the year, US Department of Health and Human Services (HHS) Secretary Kathleen Sebelius submitted a report to Congress certifying that Marketplaces are verifying applicants receiving premium support and cost-sharing reductions for their insurance under the Affordable Care Act (ACA) are in fact eligible for that assistance. The report, Verification of Household Income and Other Qualifications for the Provision of Affordable Care Act Premium Tax Credits and Cost-Sharing Reductions, contains information on “statutory, regulatory, and policy requirements that both State-based Marketplaces and Federally-facilitated Marketplaces must follow” in regards to verification requirements and the associated procedures.

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New GAO report finds similarities among state CHIP plans

Posted on January 2, 2014 | Comments Off

A new report from the Government Accountability Office (GAO) examined Children’s Health Insurance Program (CHIP) plans from five states and compared these plans to each state’s respective benchmark Qualified Health Plan (QHP) offered through the Affordable Care Act (ACA). Overall, GAO found the CHIP plans were comparable to the benchmark plans in terms of the services covered and the limitations placed upon those services. The cost of these services to the consumers, however, was generally less for the CHIP plans than for the benchmark plans. Plan usage for certain services was one difference detected between the two plans. For instance, CHIP beneficiaries reported more usage of emergency room services compared to individuals with private insurance.

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