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February 26, 2013

Florida Governor Rick Scott Announces Florida Medicaid Expansion

Florida Republican Governor Rick Scott,  one of the most prominent critics of the Affordable Care Act (ACA),  declared that Florida will expand Medicaid, which means individuals under 138% of the federal poverty level (FPL) are eligible for Medicaid. He supports a three year expansion, where the federal government will pay 100% of Medicaid costs for newly eliglibles before some of the costs shift to the states.

However, the Florida Republican dominated legislature still has to approve the Medicaid expansion, which it has been against since the passage of the ACA. Still, it is highly likely that Florida will finally decide to participate in Medicaid Expansion, an important accomplishment for American Indians and Alaska Natives (AI/AN), whom 11,542 will benefit (projected estimate of AI/AN in Florida below 138% FPL).

February 28, 2013

The Final Verdict for States and D.C. on Health Insurance Marketplaces (Exchanges)

February 15th was the final deadline for states to announce whether they want to be a state partnership on the health insurance marketplaces (exchanges).

Exchanges are marketplaces where individuals can shop for insurance plans for the most affordable option among competing insurance companies. If states choose not to establish a state exchange, they can choose to partner with the federal government in a partnership exchange to share operation functions. States who choose neither will be defaulted to a federally facilitated exchange (FFE), in which the U.S. Department of Health and Human Services (HHS) will run the exchange.

Below is a breakdown of what each state decided.  *Please note that the states in bold have federally recognized Tribes.

State Partnership Exchanges: The following states have expressed they want to establish a state partnership:

  • Iowa, Michigan, New Hampshire, and West Virginia.

They are joining the following conditionally approved states for state partnership. HHS Secretary Kathleen Sebelius, after reviewing state applications for a state or partnership exchange, grants conditional approval and provides the information states need to guide their continued work.

  • Arkansas, Delaware, and Idaho.

State Exchanges: The following states have been conditionally approved by HHS Secretary Kathleen Sebelius for establishing a state exchange:

  • California, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, Oregon , Rhode Island, Utah, Vermont, Washington

Federally Facilitated Exchanges (FFE): The states that are defaulting to a federally facilitated exchange include:

  • Alabama, Alaska, Arizona, Florida, Georgia,Indiana, Kansas,Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, North Dakota, New Jersey, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Virginia, Wisconsin, Wyoming



February 25, 2013

TTAG Face to Face Meeting in Washington, D.C. & Tribal Consultation with CMS and IRS

The Tribal Technical Advisory Group (TTAG), an advisory committee to the Centers for Medicare & Medicaid Services (CMS) on important health care matters associated with the Affordable Care Act (ACA) and public health services, held its tri-annual face to face meeting in Washington, D.C. last week. The members of  the TTAG and other Tribal Leaders engaged in Tribal Consultation with CMS and the Internal Revenue Service (IRS) on theProposed Rules for Minimum Essential Coverage and Individual Shared Responsibility for Health Insurance. Here are some brief updates:

Director of the Center for Information and Insurance Oversight (CCIIO) Gary Cohen stated that aggregated payment (Tribal sponsorship) will not be available on the federally facilitated exchanges (FFE) for the first year of implementation.

The Indian Addendum to be used with qualified health plans (QHPs) on the health insurance marketplaces (also being referred as the QHP Addendum) will be finalized by CCIIO in the next few months.

Sonciray Bonnell, Tribal Program Analyst for Cover Oregon (Oregon’s Health Insurance Marketplace) provided an update about Oregon’s Tribal Premium Sponsorship Program, which offers a one door policy for applying for health coverage on the exchange, verifying AI/AN status, training staff on AI/AN cultural perspectives and benefits, and encouraging the use of the Indian Addendum with QHPs. For questions or comments about Oregon’s successful program to encourage AI/AN to participate on the exchanges, contact Ms. Bonnell at [email protected]

Starting in 2014, the individual shared responsibility provision calls for each individual to have basic health insurance coverage, known as “minimum essential coverage”, qualify for an exemption, or make a shared responsibility payment when filing a federal income tax return.  American Indians and Alaska Natives (AI/AN) are exempt from the shared responsibility payment. Both CMS and IRS issues rules that proposes eligibility standards related to the categories of exemption.  A fact sheet about these rules can be found here. The CMS comment is due March 18, 2013 and the IRS comment is due May 2, 2013.

The NIHB and TTAG submitted comments to CMS’s proposed rule 2334-P Medicaid, CHIP, Health Insurance Marketplaces Eligibility and Enrollment. To read the TTAG comment, click here. To read the NIHB comment, click here.

February 22, 2013

HHS Announces 25 State Innovation Model Awards

The Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today announced the first recipients of the State Innovation Models initiative awards. Twenty-five states will be working to design and implement improvements to their health care systems that will bolster health care quality and decrease costs.

Made possible by the Affordable Care Act, nearly $300 million in awards will support the development of models of care that will transform health care delivery throughout the states. Over $250 million in Model Testing awards will fund 6 states – Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont – in implementing their plans for health care delivery transformation. These states will use these funds to test multi-payer payment and service delivery models on a broader scale within their state. An additional 19 states will receive nearly $35 million to develop their State Health Care Innovation Plans that will guide for comprehensive health care transformation.

To learn more about the State Innovation Models initiative and view the 25 awardees, please visit

February 22, 2013

HHS Issued Final Rule–Five Key Consumer Protections from the ACA

Key health insurance protections for all Americans moves forward

The U.S. Department of Health and Human Services (HHS) today issued a final rule that implements five key consumer protections from the Affordable Care Act, and makes the health insurance market work better for individuals, families, and small businesses.

“Because of the Affordable Care Act, being denied affordable health coverage due to medical conditions will be a thing of the past for every American,” said HHS Secretary Kathleen Sebelius. “Being sick will no longer keep you, your family, or your employees from being able to get affordable health coverage.”

Under these reforms, all individuals and employers have the right to purchase health insurance coverage regardless of health status.  In addition, insurers are prevented from charging discriminatory rates to individuals and small employers based on factors such as health status or gender, and young adults have additional affordable coverage options under catastrophic plans.

The final rule implements five key provisions of the Affordable Care Act that are applicable to non-grandfathered health plans:

  • Guaranteed Availability
    Nearly all health insurance companies offering coverage to individuals and employers will be required to sell health insurance policies to all consumers. No one can be denied health insurance because they have or had an illness.
  • Fair Health Insurance Premiums
    Health insurance companies offering coverage to individuals and small employers will only be allowed to vary premiums based on age, tobacco use, family size, and geography.  Basing premiums on other factors will be illegal.  The factors that are no longer permitted in 2014 include health status, past insurance claims, gender, occupation, how long an individual has held a policy, or size of the small employer.
  • Guaranteed Renewability
    Health insurance companies will no longer refuse to renew coverage because an individual or an employee has become sick.  You may renew your coverage at your option.
  • Single Risk Pool
    Health insurance companies will no longer be able to charge higher premiums to higher cost enrollees by moving them into separate risk pools.  Insurers are required to maintain a single state-wide risk pool for the individual market and single state-wide risk pool for the small group market.
  • Catastrophic Plans
    Young adults and people for whom coverage would otherwise be unaffordable will have access to a catastrophic plan in the individual market.  Catastrophic plans generally will have lower premiums, protect against high out-of-pocket costs, and cover recommended preventive services without cost sharing.

In preparation for the market changes in 2014 and to streamline data collection for insurers and states, the final rule amends certain provisions of the rate review program. HHS has increased the transparency by directing insurance companies in every state to report on all rate increase requests.   A new report has found that the law’s transparency provisions have already resulted in a decline in double-digit premium increases filed: from 75 percent in 2010 to, according to preliminary data, 14 percent in 2013.

In addition, the U.S. Department of Labor announced an interim final rule in the Federal Register that provides protection to employees against retaliation by an employer for reporting alleged violations of Title I of the Act or for receiving a tax credit or cost-sharing reduction as a result of participating in a Health Insurance Exchange, or Marketplace.  Additional information is available at or

For more information on how this final rule helps create a better health insurance market for consumers, please visit:

For information on the rights and protections guaranteed by the health care law, please visit:

For the full text of the proposed rule, please visit: