2012 Finish Line Flash Editions

By Tara Mancini

December 12, 2012

In this edition of the Finish Line Flash, we introduce you to a new website that aims to protect against Medicaid cuts, a toolkit for developing navigator programs, and news of an upcoming webinar on exchange blueprints. We also include three resources related to health reform implementation: newly released FAQs from HHS, a brief on certifying plan management and consumer assistance in state partnership exchanges, and an update on states’ selection of essential health benefits benchmark plans.  As this is the last edition of the Finish Line Flash for 2012, we wish you a safe and happy holiday season!


NAPH Launches ProtectMedicaid.org –– This new website from the National Association of Public Hospitals and Health Systems (NAPH) is a great resource to assist Medicaid advocates in opposing cuts.  ProtectMedicaid.org provides the facts to argue why Medicaid is good for patients, and how the ACA expansion will benefit the health care system, businesses, and the economy. The website also addresses NAPH’s related advocacy efforts, such as their opposition to Medicaid provider tax changes and their support for continued funding of disproportionate share hospitals.

Health Reform Resources

HHS Releases FAQ on Exchanges, Market Reforms, and Medicaid –– On December 10, 2012, HHS released a set of frequently asked questions in response to the inquiries that Secretary Sebelius has received from a number of state governors.  The 17-page document clarifies that states cannot receive the ACA’s enhanced Medicaid match for partial expansions, discusses allowable “bridge plans” that could offer coverage both in Medicaid and through exchanges, identifies some ways states may offer premium assistance in Medicaid and CHIP, and addresses other topics related to exchanges, market reforms, consumers, and Medicaid.

State Tasks in Partnership Exchanges –– In this issue brief, Manatt Health Solutions draws on HHS’ “Blueprint for Approval of Affordable State-based or State Partnership Insurance Exchanges” to summarize the tasks that must be completed by a state participating in a state partnership exchange, in order to be certified in plan management and/or consumer assistance. Also included are some related tasks that, while not included in the Blueprint, will assist in the development of state partnership exchanges.  The brief also addresses tasks required of state Medicaid and CHIP agencies to coordinate Medicaid, CHIP, and tax credit and cost-sharing reduction eligibility determinations with the Federally Facilitated Exchange.

Update on States’ EHB Benchmark Plan Decisions  –– This Kaiser Quick Take provides a summary chart that indicates each state’s EHB benchmark plan name and type, which, if any, coverage supplements were added, and whether the plan includes habilitative services. As of the time of the analysis, it was determined that 26 states and D.C. had recommended a benchmark plan to HHS, while 24 states had not, and therefore defaulted to the largest small group plan.  The brief also includes a concise overview of the federal requirements for states’ essential health benefits benchmark packages.

Consumer Assistance

Navigator Program Toolkit –– This toolkit from FamiliesUSA provides background information on navigator program requirements, differences in the program’s operation under different exchange models, and in-person assistance programs.  The bulk of the toolkit addresses seven key questions to consider when establishing a navigator program.  Also, the list of steps in the enrollment process where consumers will need assistance is another helpful resource.

Upcoming Events

State Exchange Blueprint Webinar –– On Thursday, December 13, 2012, at 4:30pm Eastern, State Refor(u)m will hold a webinar to address questions and concerns related to state exchange model decisions. Three state leaders will join the webinar: Peter Lee of the California Health Benefit Exchange, Colleen Burns of the Illinois Department of Insurance, and Norm Thurston of the Utah Department of Health Care Finance.  Peter and Colleen will each discuss their own state’s blueprint, as well as the vision and policy processes behind their development.  Norm will speak to the factors that Utah is evaluating as it considers what exchange model it will choose.

November 29, 2012

In this edition of the Finish Line Flash, we bring you two new Medicaid resources, a fact sheet on health reform implementation, and new data from the American Community Survey. The first Medicaid resource is a toolkit from advocates in Arkansas, and the other is an updated state-by-state analysis on the costs of expanding Medicaid from the Kaiser Commission on Medicaid and the Uninsured. We also feature a fact sheet from Enroll America that concisely distinguishes navigator and in-person assistance programs. Finally, new multi-year estimates from the American Community Survey provide data for communities with smaller populations.


Arkansas Finish Liners Release Medicaid Expansion Toolkit –  Arkansas Advocates for Children and Families has developed fun and informative resources to increase the public’s awareness of the critical role played by Medicaid in insuring Arkansans and how the state can take advantage of the opportunity provided by the ACA to strengthen Medicaid. The toolkit includes county-specific fact sheets, appealing graphics for proponents to use on Facebook, a blog post, and a Youtube video.

New Estimates of State Medicaid Expansion Costs – An analysis released earlier this week by the Kaiser Commission on Medicaid and the Uninsured reveals that incremental state costs for the expansion will be modest, adding less than three percent to total state Medicaid spending from 2013 – 2022. The budgetary impacts of the expansion will vary; states with more generous Medicaid programs may see savings, while states with high numbers of uninsured will likely experience higher costs. Projected increases in state spending are small relative to gains in states’ receipt of federal funding and decreases in the uninsured population.

Consumer Assistance 

A Role for In-person Assisters – This Families USA brief clarifies how assister programs are different from navigator programs, and how in-person assisters can help fill the initial gap in resources for some navigator programs. In addition, the brief discusses the different requirements and functions of in-person assisters in state-based, partnership, and federally facilitated exchanges.

Health Insurance Data 

New Multi-year Estimates from the ACS Now Available – The U.S. Census Bureau has released a new set of data from the American Community Survey.  Three-year estimates are available for cities, counties, and geographic areas with populations of 20,000 or more. The data can be accessed via the American Fact Finder portal. Once there, you can use the tools on the left-hand side to narrow your selection. In addition, the Census Bureau will release five-year estimates from the ACS on December 6, 2012–the data collected from 2007-2011 will be available for communities down to the census tract. The Census Bureau will host a webinar on Monday, December 3, at 1:00 pm Eastern to discuss how to access and use the estimates.

November 14, 2012

This edition of the Finish Line Flash connects you to a brief from Families USA on in-person assisters, a State Refor(um) table that outlines states’ exchange policy decisions, and a helpful summary from the Center for Health Care Strategies, Inc. on CMS’ final rule for the Medicaid primary care rate increase. We also include a brief from NASHP focused on how medical homes can coordinate care for children. We feature two webinars in our upcoming events. The fiscal cliff is the focus of today’s webinar that is co-hosted by the Children’s Leadership Council, the Coalition for Human Needs, and Voices for America’s Children. Tomorrow, CMS will host a webinar on how to use education and outreach to connect children and families to coverage.

Outreach and Enrollment

A Role for In-person Assisters – This Families USA brief clarifies how assister programs are different from navigator programs, and how in-person assisters can help fill the initial gap in resources for some navigator programs. In addition, the brief discusses the different requirements and functions of in-person assisters in state-based, partnership, and federally facilitated exchanges.

Health Reform Resources

States’ Exchange Policy Decisions and Documents – Some states have been making exchange policy decisions for some time, while others have delayed making choices.  With renewed attention to exchange planning since the election, advocates and other stakeholders may want to use other states’ decisions and documents to aid their own.  This helpful table from NASHP’s State Refor(u)m organizes exchange policy decisions into categories including financing, type of eligibility system, and plans for consumer assistance, among others.  It also links to available documents with more information.

Summary of the Final Rule on Medicaid Primary Care Rate Increase – On November 1, 2012, CMS released the final rule on Medicaid’s primary care rate increase for 2013 and 2014. This overview of the rule from the Center for Health Care Strategies, Inc., discusses some of the key provisions, including which providers and services are eligible, the applicable Medicare fee schedule, the methodology for Medicaid managed care, requirements for state plan amendments, claiming federal financial participation, and state data collection and reporting to CMS.


Using Medical Homes to Improve Care Coordination – This brief from the National Academy for State Health Policy considers models to improve care and aid healthy development for children with or at risk for developmental delays.  Using experiences from states that are participating in the Assuring Better Child Health and Development (ABCD III) learning collaborative (Arkansas, Illinois, Minnesota, Oklahoma, and Oregon), this brief identifies four promising policies that any state could adopt to help to ensure medical homes meet the needs of developing children.

Upcoming Events

Understanding What Is at Stake for Children in the Impending Fiscal Cliff – This afternoon at 4:00 PM Eastern, join a panel of experts from the Center on Budget and Policy Priorities, the Coalition on Human Needs, the Children’s Leadership Council, and Voices for America’s Children who will explain what is at risk for children and families if Congress fails to find an amenable solution before automatic budget cuts go into effect in January 2013. Learn what to expect and what advocates can do.

Connecting Children and Families to Coverage  The Centers for Medicare and Medicaid Services will hold a webinar tomorrow, Thursday November 15th, to discuss their plans to support advocates’ education and outreach activities in 2013.  Presenters will include Cindy Mann, Director of the Center for Medicaid and CHIP Services, the Connecting Kids to Coverage Communications Team, as well as some state Medicaid and CHIP leaders.

November 1, 2012

In this week’s edition of the Finish Line Flash, we highlight an opinion piece from the Huffington Post advocating for more federal investments in children, two Medicaid resources, and one on eligibility and enrollment. Both Medicaid resources are from Kaiser and provide valuable information on the program’s financing at both the state and national level.  NASHP and Mathematica, Inc. collaborated on the brief for Maximizing Enrollment that discusses the complexity of state systems for coding eligibility denials and disenrollment and proposes a new streamlined solution.

Media Materials

Pediatrics Professor Argues for Investing in Children’s Health–In his Huffington Post piece, T. Berry Brazelton, MD, Professor of Pediatrics Emeritus at Harvard University persuasively made the case that in the wake of looming budget cuts, our dedication to investing in children cannot be abandoned.  Touting the success of children’s public programs like Medicaid and CHIP among others, Dr. Brazelton argues that regardless of who leads the next Administration, our nation must continue to support and build upon the progress we have made.  Reminding readers that “How our nation treats its children reflects our societal values,” he urges the rest of us “. . . to do right by them, stand up for them, and advocate for what they need to grow and prosper.”


50-State Medicaid Budget Survey Shows Slow but Steady Recovery – This 12th annual survey, produced by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates, looks at actual FY 2012 and projected FY 2013 Medicaid and revenue data.  The findings indicate that growth in total (state and federal) Medicaid spending slowed in FY 2012.  State spending, though, increased, reflecting the cost of covering higher, recession-fueled enrollments coupled with the expiration of ARRA-enhanced FMAP rates.  With a slowly recovering economy and slower-growth in Medicaid enrollment, states on average have projected a marked decrease in spending growth for FY 2013.  The majority of states continue to implement cost containment measures, but some have also been able to make enhancements to their programs, the state details of which are provided in the report. You can also read Tara Mancini’s Say Ahhh! blog post on the report.

Chartbook Illustrates What Drives Medicaid Spending In Your State – Medicaid spending can vary considerably by state.  This chartbook from the Kaiser Commission on Medicaid and the Uninsured presents detailed information on spending by state, including per enrollee costs for different populations.  The chartbook also works to explain the differences in spending.  It identifies five key components in which states may experience variation: revenue capacity, demand for public services, the private health care market, existing state Medicaid policy, and the state’s own budget and policy process. These state-by-state data can be useful to advocates for understanding what is happening with their Medicaid programs and comparing them to other states.

Eligibility and Enrollment

Streamlining Codes to Better Understand Eligibility and Churn – Good management requires good measurement, particularly in Medicaid and CHIP enrollment.  Inconsistency between the systems of coding used by states to track individuals who are denied or who are disenrolled from public health insurance make it difficult to evaluate the performance of states against one another and also to coordinate across state lines. This brief, written by NASHP staff and Mathematica Policy Research, Inc., suggests a new standardized system of fourteen codes that could replace the current complex codesets.  The streamlined codes can make data on eligibility denials and disenrollment more meaningful and allow states to better measure the outcomes of these practices against policy goals.  A great document to share with policymakers who have responsibility over enrollment systems.

October 18, 2012

This week, the Finish Line Flash connects you to a helpful blog post on in-person assisters from Arkansas, a new Georgetown report on the steps states have taken to keep child-only plans available in the private market, and two useful resources on the Medicaid expansion—a short video explaining states’ choices and a brief that paints a picture of the kinds of people who will benefit.

Enrollment Assistance

Finish Liner Blogs on In-Person Assistance—Arkansas Advocates for Children and Families’ Anna Strong wrote a blog post for Enroll America that looks at ways to aid families in enrolling.  It considers both navigators as described in law and regulations and the emerging category of in-person assisters.  It seems likely that states will employ both types of personnel come 2014, so the post is a great way to come up to speed on how they’re similar and different.


Video Explains State Medicaid Choice—We’ve all read too many issue briefs and know that some audiences prefer other means of learning new information.  The Alliance for Health Reform has posted a short video of an interview with the Robert Wood Johnson Foundation’s John Lumpkin in which he explains how states will assess the choice of whether to expand Medicaid.  He mentions some of the fiscal, political, and human considerations.  The video could be a good way to introduce time-strapped state legislators or others to the topic.

CPFC Illustrates Potential Medicaid Beneficiaries—Nonetheless, issue briefs are here to stay.  This one from the Child and Family Policy Center in Iowa provides short hypothetical sketches of the types of individuals who stand to benefit from Medicaid expansion.  It emphasizes how Medicaid can help improve access, consistency, and cost-effectiveness in health care for them and can also offset state and local costs for much of the care people like them already receive.

Child-Only Plans

Georgetown CHIR Report Examines State Strategies for Supporting Private Coverage—An important benefit of the ACA is to prevent discrimination based on pre-existing health conditions, a protection that is already in effect for children.  The Georgetown Center for Health Insurance Reforms has produced a report that shows many states have taken action to assure that this consumer protection works within their existing individual health insurance markets.  States have established open enrollment periods, required the offering of certain plans, and established reinsurance plans.  The report assesses the availability of child-only plans in states that have acted and can be helpful in suggesting avenues your state may want to consider.

October 3, 2012

This edition of the Finish Line Flash includes several health reform resources, three that deal with Medicaid and two that focus on health insurance exchanges. Among the Medicaid materials are two worksheets from the State Health Reform Assistance Network—one that helps estimate the state fiscal impact of expansion and another that outlines required and optional Medicaid state plan amendments related to the ACA.  Also included are two fact sheets on the expansion for state advocates by NHeLP.  Families USA has two new briefs on partnership exchanges, included under our resources for Exchange implementation.  Finally, we link to a new data hub for health statistics created by the Robert Wood Johnson Foundation.

Medicaid Resources

Estimating the State Fiscal Impact of the Medicaid Expansion  –– For many states, the question of cost is the key factor in debates around the expansion. Therefore, it is vital that stakeholders know what to include and exclude in a reasonable fiscal impact analysis. This template worksheet from the State Health Reform Assistance Network defines six areas that all states should consider, as well as other fiscal impacts that states may want to evaluate, even if their impact on state budgets is not easily measurable.  The worksheet and its guidance materials can help identify specific state savings and revenue effects or help in assessing existing cost estimates even if advocates don’t plan on performing the entire analysis themselves.

Anticipating Medicaid State Plan Amendments –– The Affordable Care Act requires or authorizes states to make several changes to Medicaid and CHIP, some of which require amendments to state plans.  For the State Health Reform Assistance Network, the Center for Health Care Strategies has prepared a list of potential plan amendments. This comprehensive resource includes links to relevant sections of the ACA, any supporting guidance or regulations, and required or suggested dates for completing the amendments.  The list can be a helpful guide for advocates both in anticipating amendments their states may be working on and for identifying where advocacy may be needed to get states moving.

Medicaid Expansion Resources for State Advocates – The National Health Law Program has assembled a toolkit to assist state advocates in supporting a Medicaid expansion in their states.  Two items that may be particularly useful are “Fact Sheet: 10 Advocacy Steps to Support a Medicaid Expansion in Your State,” and “NHeLP’s 50 Reasons Medicaid Expansion is Good for Your State.” The resource center also includes state-specific advocacy materials for many states.

Exchange Implementation Resources

Exchange Options for States that are Not Implementing State-Based Exchanges –– States that are not likely to be ready to implement a state-based exchange in 2013 may be considering whether to enter into a partnership exchange with the federal government or have the federal government establish a federally facilitated exchange.  This Families USA brief outlines some essential questions for states in this situation to consider. Of foremost concern is whether a state is willing to perform the functions required of states in a partnership and if it will carry out those function in a manner that is beneficial to consumers and small businesses.

Guidance for States Implementing a Partnership Exchange –– States implementing a partnership exchange have the option to conduct plan management, consumer assistance, or both. Using information provided by HHS’ Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges, this Families USA policy brief addresses the specific responsibilities entailed by each function, while also outlining some of the activities that will be carried out by the federal government under a partnership exchange.

State Data 

Find Your State Story in the Numbers –– Finding state-level data to raise awareness about a health issue or support a legislative initiative may now be easier for state advocates.  Using the Robert Wood Johnson Foundation’s Data Hub for “Health Statistics You Can Visualize, Customize, and Share,” advocates may access needed data on covering the uninsured; health care costs; quality, value and equality; and other topics.

September 19, 2012

In this edition of the Finish Line Flash, we bring you three health reform resources, and news of a three upcoming events. Our picks for health reform resources are CBPP’s Medicaid expansion toolkit for state advocates, a new Georgetown CCF paper on the duties and competencies required of navigators, and an Enroll America brief on the importance of providing in-person assistance to consumers.  Upcoming events include a webinar hosted by SHADAC on assessing newly released health insurance coverage estimates and a webinar from NASHP’s State Refor(u)m on  state selection of essential health benefits benchmark plans.  Also featured are two regional conferences on exchanges that will be hosted by U.S. PIRG in October.

Health Reform Resources  

Medicaid Expansion Resources for State Advocates – In case you missed it, the Center on Budget and Policy Priorities has compiled a toolkit to assist state advocates in supporting the Medicaid expansion. The toolkit includes policy briefs, related blog posts, and messaging resources created by the Center and other organizations.  The resource center also features a map of the United States indicating the position of state leaders on the expansion, and which links to state specific fact sheets that outline the estimated fiscal impact of the expansion.  The toolkit additionally includes state specific analyses prepared by advocates and materials related to the Supreme Court decision.

Strengthening Duties and Competencies in the Navigator Program – Georgetown CCF’s Tricia Brooks and Enroll America’s Jessica Kendall discuss the federal regulations that set the threshold for navigator programs as well as the flexibility given to states to strengthen their program. Designing Navigator Programs to Meet the Needs of Consumers: Duties and Competenciesexplains that exchanges that identify the needs of consumers early on will best be able to define the range of work that is expected of their navigators. The brief poses a number of strategic questions to help guide states in creating a vision for their navigator program and think through many key operational decisions.

The Vital Role of In-Person Assistance in Educating and Enrolling Consumers – This brief, authored by Deepak Madala of Enroll America, focuses on the importance that in-person assistance will play in ensuring that the millions of people who are newly eligible for health insurance under the ACA will be able to access coverage.  It details how local stakeholder groups that have become trusted resources in a community can play an especially important role in conducting outreach and education and assisting in enrollment.

Upcoming Events

SHADAC Webinar on 2011 Health Insurance Data – On Tuesday, September 25, 2012, at 1:00 pm Eastern, the State Health Access Data Assistance Center will host a webinar to discuss the recent health insurance coverage estimates from the U.S. Census Bureau’s American Community Survey (ACS) and Community Population Survey (CPS), both of which release their latest data this month. SHADAC staff will be joined by Census Bureau experts to guide attendees on how to access data. They will also discuss proposed changes in data collection that are being developed to evaluate the impact that exchanges will have on health insurance coverage in the states.  

As a reminder, the 2011 ACS estimates will be released this Thursday, September 20, 2012.  Don’t forget to visit the Say Ahhh! Blog on Thursday, as we will provide our initial thoughts on the 2011 ACS health insurance coverage estimates.

NASHP Webinar on Selecting a State Benchmark Plan for Essential Health Benefits – Next Tuesday, September 24, at 3:00 pm Eastern, NASHP’s State Refor(u)m will host a webinar featuring a panel of state officials who will discuss efforts in their states to define the Essential Health Benefits.  Officials from Nevada and Oregon will discuss how they chose private market EHB benchmarks and how the decision will influence the process of selecting an EHB benchmark for Medicaid.

Consumer-Oriented Exchange Conferences to be Held in the West and Midwest – During October, the U.S. Public Interest Research Group (PIRG) will hold two one-day conferences to convene a diverse group of stakeholders who are interested in ensuring that states develop consumer-oriented exchanges. Breakout and plenary sessions will focus on issues such as successful marketing, outreach and enrollment, engaging the public in exchange design, and how to ensure that exchanges work for small businesses. For more information, or to register, use the links below. If you have questions or comments, contact Laura Etherton at ethertobn@pirg.org

October 3rd event for states across the West: Information and registration
October 12th event for states across the Midwest: Information and registration

September 5, 2012

In this edition of the Finish Line Flash, we link you to new Census estimates that allow you to see how the uninsured rate for children varies by county in your state. We also include a useful discussion from researchers at the Urban Institute on the low per-enrollee spending in Medicaid and its implications for the future of the federal budget. We also share two health reform resources—a legal analysis of states’ authority to provide comprehensive pediatric benefit design under the ACA’s essential health benefits provision and a NASHP brief that uses lessons from children’s coverage to guide states as they develop plans to conduct outreach and enrollment under the Affordable Care Act.

Coverage Estimates 

County-level Uninsurance Data – Last week, the Census Bureau released its 2010 Small Area Health Insurance Estimates (SAHIIE). An accompanying brief highlights with a map estimates for uninsured children who are under 19 years old and are living in families with income below 138 percent and 400 percent of the federal poverty level.  Advocates will also find the interactive map and data tool useful.  To access estimates for a county in your state, use the drop-down menu on the left-hand side of the page to select your state and be sure to check “Include Counties.”  Modifiers for age, sex, and income are also available.


Medicaid Spending in the Context of Deficit Reduction –Spending growth in Medicare and Medicaid usually prompts proposals from legislators to cut or modify these programs, but rarely are such program reforms warranted, according to two Urban Institute researchers. John Holahan and Stacey McMorrow remind readers in the New England Journal of Medicine that existing data illustrate that spending increases over the past decade have mostly been due to increased enrollment.  Over the next decade, enrollment is expected to continue to be the main cost driver, as spending per-enrollee in both Medicare and Medicaid has slowed and is already close to the growth in GDP per capita. Holahan and McMorrow suggest using cost-saving measures that work within the current structure of each program rather than creating new proposals that shift costs to enrollees.

Health Reform Resources

State Options for Pediatric Benefits under the Essential Health Benefits – In this memo, George Washington University Health Law and Policy Professor Sara Rosenbaum provides legal analysis on the question of whether states may modify their essential health benefit benchmark plan to allow for enriched pediatric benefits.  Highlighting language within the ACA and in guidance from CCIIO, Rosenbaum finds that states do have this flexibility, “particularly where the coverage concerns pediatric care.”  This is due to the ACA’s identification of pediatric services as a benefit class and the statute’s requirement for additional consideration of the needs of children. The memo concludes that states do not risk triggering the ACA requirement to defray the cost of state mandated benefits if they act “under the EHB “pediatric services” category.”

Strategies to Educate and Enroll Families under the ACA – This NASHP State Health Policy Briefing examines states’ experiences in creating awareness and increasing enrollment in Medicaid and CHIP and identifies lessons for health reform implementation.  As states gear up to enroll more eligible children and families in expanded coverage options available under the ACA, the lessons presented in the brief are meant to inform the development of states’ marketing, outreach, and enrollment efforts.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

August 22, 2012

In this edition of the Finish Line Flash, we showcase an op-ed from a Finish Liner in Utah who explains why it is smart for the state to invest in the Medicaid expansion, while refuting frequently heard opposition arguments. We also include a number of health reform resources. Two briefs from Urban Institute researchers examine the state fiscal effects of the Medicaid expansion and state-specific demographics of those who would enroll. A report by consumer representatives to the National Association of Insurance Commissioners has recommendations for states on implementing  11 of the insurance reforms created by the ACA. Finally, we bring you news of CMS’ recently announced teleconferences for stakeholders to discuss exchange implementation.

Media Materials

Utah Finish Liner Takes on Arguments Against the Medicaid Expansion—In a Salt Lake Tribune op-ed, Voices for Utah Children’s Lincoln Nehring addresses some of the main arguments against expanding Medicaid under the Affordable Care Act.  He notes that savings to the state will likely offset the relatively small costs of expanding coverage to newly eligible beneficiaries.  He then addresses the objection that the welcome mat effect will lead to unsustainable costs, observing that, despite some costs, it will solve real problems for real Utahns.  He concludes that “Not investing in the health of our kids and families is the cost we cannot afford to pay.”

Health Reform Resources

Urban Institute Guide for Estimating the Fiscal Impact of Medicaid Expansion –– This Urban Institute brief serves as a starting point for creating estimates of the fiscal effects of implementing the Medicaid expansion established under the Affordable Care Act. Author Stan Dorn suggests that analysts take into consideration federal funding changes, the cost of coverage, savings to the state, administrative costs, and revenue effects when assessing the fiscal impact. Additionally, he puts forward the factors that may be associated with greater or lesser impacts for each consideration.

Who Would be Covered by the Medicaid Expansion? –– Another brief from the Urban Institute provides state-specific estimates of the number of adults below 138% of the federal poverty level who would be eligible for Medicaid under the Affordable Care Act as well as the number below 100%. The authors provide national and state estimates on the sex, age, and race and ethnicity for the almost 15 million adults who would be newly eligible for Medicaid if all states implement the expansion. The results show that a greater share of men than women under 45 years of age would be eligible, while among older nonelderly adults the trend is reversed.  The racial and ethnic composition of newly eligible adults varies considerably by state.

Consumer Representatives’ Recommendations for Private Insurance Reforms–– Consumer representatives to the National Association of Insurance Commissioners (NAIC) collaborated on this paper that addresses 11 of the health insurance reforms required by the Affordable Care Act. It provides specific policy asks advocates can make of state insurance regulators to improve the implementation of the ACA.  Also included are summaries of related federal guidance, possible issues that could arise for consumers under certain implementation scenarios, and recommendations to federal lawmakers and regulators. The Appendix contains a convenient chart of the provisions, their legal citations, effective dates, and the insurance markets to which they apply.

CMS Stakeholder Teleconferences on Exchange Implementation –– Beginning Tuesday, September 11th, the Centers for Medicare and Medicaid Services will hold 10 regional teleconferences to engage stakeholders in discussions on the implementation of exchanges. The sessions will also address how to reach out and educate the uninsured, under-insured, and small businesses about expanded insurance coverage options available under the Affordable Care Act.

August 8, 2012

In this edition of the Finish Line Flash, we bring you news of a media-friendly CHIP celebration in Utah and a video from Texas that shows Medicaid’s value.  There are two Medicaid resources: The first is a piece from the Urban Institute that looks at access and use of care among non-elderly adults in Medicaid. The second study examined the percentage of physicians who said they were accepting new Medicaid patients in each state in 2011.  Health reform resources we’re sharing include a new report on enhancing consumer assistance through the use of technology and the latest from the Kaiser Health Tracking Poll on attitudes toward Medicaid.

Media Materials

Utah Finish Liners Celebrate CHIP and Medicaid — Voices for Utah Children held an event to mark the 15th anniversary of CHIP and won coverage in the Salt Lake Tribune as well as on TV and radio.  The newspaper story highlights the family that advocates put front-and-center at the event, showing how making families available as spokespeople can drive media attention.

Video Advocacy

Texans Produce Medicaid Video — Advocates who are part of Texas Well and Healthy put together a short video to introduce viewers to the basics of Medicaid with an emphasis on its role for children.  The two-minute video mentions those who Medicaid supports, not only kids but expectant mothers, people with disabilities, seniors, and community hospitals.  It tells a story of success and shows how Medicaid supports not only those in need of coverage but all children in the state.


Urban Institute Assesses the Evidence on Adults’ Access to Care in Medicaid — Urban Institute researchers prepared this report as a supplement to the June 2012 MACPAC report.  The report presents national findings on access to care and care utilization by non-elderly adult Medicaid beneficiaries.  It contrasts their access with adults who have employer-sponsored coverage and those who are uninsured.  See page 2 for a summary of results.  The report finds adults with Medicaid are more likely than those who are uninsured to have a usual source of care, to report more health care visits, and to have received more timely care. In addition, they are less likely to delay obtaining needed care or to forgo needed care due to costs. Adults with Medicaid were also more likely than adults with ESI to have a usual source of care, any outpatient or office visits, and to report having a routine check-up.  However, due to the higher health care needs and typically lower socio-economic standing of adult Medicaid beneficiaries, they were more likely to have unmet health care needs due to cost than were privately insured adults. These data provide great evidence to refute opposition messages that downplay the value of Medicaid coverage for adults.

State-by-State Results on Physicians’ Reported Acceptance of New Patients by Payer — In a Health Affairs study, Sandra Becker estimates that nationally, just under 70 percent of physicians accepted new Medicaid patients in 2011.  In contrast, doctors reported accepting new patients with self pay, private insurance, or Medicare at higher rates.  The estimates for Medicaid patients varied by state, ranging from a low of 40 percent in New Jersey to a high of 99 percent in Wyoming.  Exhibit 2 provides estimates for all 50 states.  It is notable that the study also found the acceptance of new Medicaid patients to be higher in states with higher Medicaid-to-Medicare reimbursement ratios, so the author suggests that the temporary increase in Medicaid primary care physician rates could mean that more primary care physicians will be willing to accept new Medicaid patients in 2013 and 2014.  You can also read a Washington Post blog post on the research.

Health Reform Resources

New IT Tools to Help Enroll Consumers in Coverage — This new issue brief co-authored by CCF’s Tricia Brooks and Enroll America’s Jessica Kendall highlights the experiences of states that have pioneered the use of information technology in the enrollment process.  It raises important considerations for states to examine as they retool their business processes and continue to integrate technology in supporting enrollment.  Also discussed are key components for creating a successful state strategy to transition to a coordinated and integrated enrollment process.  In case you missed it, Tricia Brooks also recently released a paper on designing navigator programs.

Two-Thirds of Americans Support the ACA’s Medicaid Expansion — In July, the Kaiser Family Foundation monthly health tracking poll found strong support for the expansion of Medicaid, with 67% of respondents supporting it in general.  However, approval is divided along party lines, with 87 percent of Democrats favoring it and 57 percent of Republicans opposed. Moreover, when asking respondents specifically about whether their state should participate in the expansion, the poll finds that a plurality of 49 percent of people support expanding Medicaid in their own state while 43 percent say they prefer to keep their state’s status quo.  When asked about the value of Medicaid to themselves and their family, 52 percent of respondents indicated that it was either very or somewhat important.  Among that 52 percent, the promise of a safety net was cited as the most popular reason for valuing Medicaid.

As a reminder, you can now access the CCF research library that was introduced at the CCF Conference through the Zotero database.

July 26, 2012

In this edition of the Finish Line Flash, we bring you three health reform resources and news of an upcoming webinar on connecting kids to coverage. The first health reform resource is an advocate’s guide created by FamiliesUSA that highlights how advocates can engage in their states’  processes of designing an essential health benefits packages. The next two resources are related to the impact of the Supreme Court’s decision on the ACA for Medicaid. First, a Congressional Research Service memorandum examines the impact of the Supreme Court Ruling on Medicaid Law. Next is the CBO cost estimate, which reflects the possible coverage and cost outcomes in light of the Court’s decision. Also, we highlight a webinar to be hosted next week by CMS and text4baby on connecting the two enrollment outreach efforts.

As a reminder, our Say Ahhh! blog has moved.  If you previously subscribed to its RSS feed, you will need to renew your subscription.

Health Reform Resources

Advocates’ Guides for Designing Essential Health Benefits – Families USA has produced a guide that gives an overview of the requirements for crafting an essential health benefit package and details how advocates can engage in their state’s process to champion a robust set of benefits. As a reminder, CCF is also drafting an EHB guide for child health advocates.  The draft version of our guide, which focuses on considerations for children, can be accessed here.  You can expect to see the final version suitable for sharing with the public in the next few weeks.

CRS Addresses Medicaid Questions – A recent memorandum from the Congressional Research Service discusses the implications for Medicaid of the Supreme Court decision and reinforces the fact that only the enforcement mechanism is affected. It finds that a “careful reading” of the decision reveals the maintenance-of-effort (MOE) and modified adjusted gross income (MAGI) provisions are not affected. However, matters related to states’ ability to opt in or out of the “new program” are still unclear, as is the Secretary’s ability to modify the Medicaid expansion.  While others have provided similar analyses, this memo from an official, non-partisan Congressional source may be helpful in adding credibility for some.

New CBO Estimate of ACA Effects – Following the Supreme Court’s decision on the Affordable Care Act, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) have updated their estimates of the impact of the health insurance coverage provisions contained in the law.  They estimate a net decrease of $84 billion in federal spending over the next eleven years due to the possibility that some states will not take up the Medicaid expansion.  Without the mechanism to enforce the Medicaid expansion, CBO and JCT now estimate that six million fewer people will be covered by Medicaid in 2022. This will result in approximately three million more people taking up coverage through exchanges and 3 million more people remaining uninsured.  The cost estimate was released in conjunction with a estimate of the effects of repeal of the ACA, requested by Speaker Boehner. The analysis finds that repeal would cause a net increase in the federal deficit of $109 billion between 2013 and 2022.  You can also read the CBO blog post that summarizes the estimates here, or check out Martha Heberlein’s post on Say Ahhh!.

Upcoming Events

Connecting Kids to Coverage Webinar –  You are likely familiar with the CMS initiative to enroll more children in Medicaid and CHIP called Connecting Kids to Coverage.  CMS has partnered with text4baby to help inform new mothers of eligibility and enrollment opportunities. On Tuesday, July 31 at 12:00 pm Eastern, CMS and text4baby will host a follow-up webinar to discuss how advocates can connect text4baby and Medicaid/CHIP outreach. Register at the link.

July 11, 2012

In this edition of the Finish Line Flash, the first following the historic Supreme Court ruling, we highlight some resources to help in analyzing the decision and its implications, as well as some briefs to address state implementation issues around Medicaid and exchanges.  First, we share with you an op-ed from Finish Liners in Texas that celebrates the outcome of the ruling and calls on the state to get to work in implementation.  Next is a brief from HealthReformGPS that sorts out the Court’s decision on the Medicaid expansion and an Urban Institute brief that estimates the number of adults in each state that would be covered by the ACA’s Medicaid expansion. In addition, a SHADAC brief looks at issues that remain around state implementation of new Medicaid and CHIP eligibility rules and an NHeLP brief explains the difference between the separate benchmarks states may select for Medicaid benefits and for the essential health benefits.

Media Materials

Texas Finish Liners Push for Progress—In a Houston Chronicle op-ed, Finish Liners from Texas celebrated the Supreme Court’s decision upholding most of the ACA and urged their state leaders to move forward in implementing the law.  The op-ed concisely reviews the current and coming benefits of the ACA using state-specific numbers and shows how the law supports some widely-held values.  It ends with a brief but specific ask for state leaders to take the first steps to expand Medicaid and build an exchange.

Health Reform Resources

Medicaid Questions Raised by the SCOTUS Ruling – This HealthReformGPS brief summarizes the Supreme Court’s ruling on the Affordable Care Act, focusing on the impacts on Medicaid.  It identifies a number of immediate questions about the reach of the decision as well as key implementation issues that it raises.

How Many Adults Would be Covered by the Medicaid Expansion in Each State? – This Urban Institute brief provides state level data on the number of adults newly eligible for Medicaid under the Affordable Care Act, noting both the number of adults with income below 100% of the federal poverty level and below 138% FPL. Expanding Medicaid to all eligible adults below 138% FPL would reduce the number of uninsured adults by 15 million nationwide, but many of them are at stake of remaining uninsured if some states opt out of the Medicaid expansion.  Additionally, in states that do not expand Medicaid, the poorest adults will face the biggest burden, as the 3.6 million uninsured adults that are below 100% FPL, but above current Medicaid eligibility levels, also do not qualify for Premium Tax Credits.

Two Separate But Interrelated Benchmarks – Medicaid and Essential Health Benefits –This NHeLP brief helps advocates understand the difference between the two systems of benchmark benefits by providing an overview of each that includes: what populations the benchmarks will be provided to, states’ options for selecting each set of benchmark benefits, and the specific services that must be covered. While noting that further guidance is needed on how the two systems may interact, the authors point to some specific implementation issues that state advocates should monitor in the meantime.

Eligibility and Enrollment

Implementation Issues Facing Sate Medicaid and CHIP Programs – This analysis, prepared by Mathematica and funded by SHARE, is the first in a three part series on implementing eligibility changes using modified adjusted gross income, as required by the Affordable Care Act. The brief teases out for states the ten most significant provisions of the final/interim final Medicaid eligibility rule issued by CMS in March 2012, based on feedback that was provided during a 2011 SHARE workshop of state Medicaid and CHIP eligibility directors and policy experts. The analysis notes which of the states’ concerns have been addressed thus far through CMS regulations, guidance, and technical assistance, as well as those issues that CMS has yet to resolve and could slow down implementation at the state level.

Upcoming Events

ACA Webinars for Faith and Community Partners – The HHS Center for Faith-based and Neighborhood Partnerships plans to host a series of webinars on the ACA and how it impacts communities.  Two national webinars will be held, one in English and one in Spanish, and at least four regional webinars are planned, ranging from July 12 through August 8.  A good resource to pass along to faith and community-based partners.

June 27, 2012

In this week’s Finish Line Flash, you will find a cluster of resources on health reform implementation, eligibility and enrollment, and some great materials on oral health in the United States. In the health reform section, a brief from the Urban Institute contemplates four possible scenarios for tomorrow’s Supreme Court decision on the Affordable Care Act. A wealth of other resources for implementation follow: exchange guidance prepared and submitted to state officials by Finish Line partners in two states, Arkansas and California; a set of flow charts commissioned by the state of Indiana that illustrate how to determine MAGI eligibility in Medicaid and the exchanges; a State Reforum chart and linked documents on the status of Essential Health Benefit planning in the states; and the release of the Enroll UX 2014 project design, a model user experience for public and private health insurance portals. We also bring your attention to the recording of a recent Enroll America webinar that discussed how to conduct outreach and enrollment efforts in communities of color using a racial equity framework. To conclude, we bring you the latest resources on the status of oral health and access to oral health coverage from the Kaiser Family Foundation.

Health Reform Resources

Possible Scenarios for the Supreme Court Decision – The countdown is on.  In less than 24 hours, we will know the Supreme Court’s ruling on the Affordable Care Act. The Urban Institute released this brief that summarizes the likely key effects on the uninsured, spending, and implementation under alternative Supreme Court decisions.  The brief contemplates scenarios including a complete uphold, the elimination of the individual mandate, invalidation of the mandate plus the insurance market reforms, and the overturning of the whole law.

Finish Liners’ Recommendations on Making Exchanges Work for Children – Finish Liners in both Arkansas and California recently developed principles and recommendations for exchange planners and submitted them to state officials.  They outline the steps a state exchange or state partner in a federally facilitated exchange should take in order to ensure there are strong consumer protections that will encourage consumer participation and protect children and their families.

The Steps in Determining MAGI Eligibility for Medicaid and Exchanges – For those who want to think further through the details of eligibility determinations, the state of Indiana commissioned a series of flow charts that illustrate the flow of decisions and verifications based on the final rules published in March 2012.  The flowcharts start with a summary overview and progress to some very detailed processes, but they are separated into modules so you can focus only on those of interest.  The document also contains an enumeration of the decisions that states need to make for implementation.

State Actions and Documents on Essential Health Benefits—This chart from NASHP’s State Reforum outlines the progress states have made as of June 2012 in establishing an Essential Health Benefits package. It notes which states have: formed a working group, conducted an analysis of existing state benefit mandates, assessed benchmark plan options, held public comment periods, and decided on a benchmark plan.And the table links to related documents from each state.Enroll UX 2014 Design Released—Many of you have been aware of the ongoing Enroll UX 2014 project, which engaged state and federal officials as well as consumer groups and other stakeholders to develop a model user interface for public and private health insurance enrollment systems.The design template has now been released and is available for download by registered users.It includes a prototype and a design manual that allows for customization by states.

Enroll UX 2014 Design Released—Many of you have been aware of the ongoing Enroll UX 2014 project, which engaged state and federal officials as well as consumer groups and other stakeholders to develop a model user experience for public and private health insurance enrollment systems.  The design template has now been released and is available for download by registered users.  It includes a prototype and a design manual that allows for customization by states.

Eligibility and Enrollment

An Equitable Approach to Enrolling Communities of Color – Ethnic and racial minorities have disproportionately higher rates of uninsured  non-elderly adults. This recording of a webinar hosted earlier this month by Enroll America featured panelists from the Greenlining Institute, The National Council of La Raza, and Maryland Healthcare for All! Coalition, to guide outreach and enrollment efforts in diverse communities.  The Greenlining Institute explained how a racial equity framework, a values-based thinking tool, can be used by all in the policy-making process, so that comparably favorable outcomes may be achieved across and within groups. The National Council of La Raza discussed how enrolling lower- and moderate-income Latinos will be dependent on the efforts of advocates, policy-makers and stakeholders to ensure privacy, security, and confidentiality of consumer information; consumer access to culturally and linguistically appropriate services; SHOP design, and federal oversight and enforcement of safeguards in the Medicaid and state exchange application process. Maryland Healthcare for All! shared the organization’s “Got healthcare?” outreach and enrollment campaign to reach Medicaid-eligible Marylanders in African American communities.

Oral Health Resources

Gaps in Oral Health Access for Kids – The Kaiser Family Foundation recently released this brief on the prevalence of oral disease caused by gaps in access to dental care among children and the level of disparities by income and race/ethnicity.  The brief discusses the role of Medicaid and CHIP in providing access to dental care, barriers to access such as out-of-pocket costs and an unevenly distributed workforce of dentists, and the potential for the ACA to address these barriers.  The brief is part of a larger effort to highlight the general lack of access to oral health care experienced by children and adults in the United States and its impact on overall health. These issues were highlighted at a recent forum held at the Kaiser Family Foundation where a new Frontline documentary on dental care was screened.

June 13, 2012

In this week’s Finish Line Flash, you will find an op-ed from doctors in Ohio describing the benefits of the ACA and two helpful reports on Medicaid.  The first report, from the California Healthcare Foundation, looks at how Medicaid beneficiaries rate their coverage.  The second report, from the journal Pediatrics, examines dental visits by children in Medicaid and how rates have changed over a five-year period.  Last but not least, we call your attention to two new briefs on federal health reform, as well as a new report on how health reform in Massachusetts has impacted children.  The first brief is from the Urban Institute and it reviews the experiences of five states that got an early start on health reform through the State Health Access Program.  The second shares recommendations from California’s experience in designing a Navigator program.  The last resource analyzes the extent to which Massachusetts health reform has helped children in the state, finding that among its benefits are improved coverage, changes in the way kids utilize care, and fewer children who forgo care due to costs.

Media Materials

Ohio Doctors Share the Benefits of the ACA – A recent op-ed that appeared in the Cleveland Plain Dealer highlights how the landscape of health care has been transforming under the auspices of health reform.  Using a case study of Audrey, an insured woman who was diagnosed with MS before the passage of the Affordable Care Act, the doctors note how the law benefits Audrey and thousands of individuals like her that have walked through their clinic’s doors.  The op-ed is a great example of the way those with on-the-ground experience can bring to life the policy changes in the ACA.


Medicaid Beneficiaries View Their Coverage Positively – This report from the California Healthcare Foundation gives voice to perhaps the most important stakeholders in the Medicaid program, its beneficiaries.  Among the adult Medicaid beneficiaries surveyed in California, some key findings include:  90% of Medi-Cal beneficiaries view the program positively, 78% believe it covers the care that is needed, and 69% believe that it provides access to full quality care. The report is a good resource for highlighting the real value Medicaid delivers to those enrolled and calls attention to areas for improvement identified by those who depend the most on Medicaid.

Dental Care Rates for Children in Medicaid and CHIP – This study, which appears in the journal Pediatrics, uses claims data from 2002-2007 to investigate the prevalence of dental visits in all 50 states and the District of Columbia, for children enrolled in Medicaid or CHIP for at least one month.  Figure 1 (Page 4) illustrates for each state the percent change in the number of children who had at least one dental visit in 2007, compared to 2002.  Most states experienced a positive increase over that time, with a median percent change of +16 percent.  Also, Table 1 (Page 3) features data by state on the prevalence of dental care for children in 2007, by five age groups: under 3 years old, 3-5 years old, 6-9 years old, 10-14 years old and 15-18 years old.  A news article that appeared inHealth Day also provides an overview of the report.

Health Reform Resources

Best Practices in Outreach, Eligibility, and Enrollment Activities – This brief, prepared by Urban Institute for the State Health Access Data Assistance Center, follows the experiences of five states – Colorado, Kansas, Minnesota, New York, and Oregon – that received federal grants to expand health coverage through the State Health Access Program. Having put these states on an early track to health reform, the brief shares states’ best practices in the areas of community-based outreach, enrollment simplification, and modernizing eligibility determination systems as well as implications for continuing this progress under the ACA.

Recommendations for Designing a Successful Navigator Program – Community Health Councils, Inc prepared this report in response to questions posed by the California Health Benefits Exchange Board about the nature of the California Navigator program. This report’s list of recommendations for a successful Navigator program will be of interest to advocates in any state that is planning a program.  Recommendations focus on key features, such as the programmatic and financial structure, Navigator qualifications and responsibilities, standards for linguistic and cultural competency, and the role of brokers and agents.

Massachusetts Health Reform Is Good for Children – A study published in the American Economic Review delves deeper into the impact of health reform on children, analyzing more than just the increase in the state’s already high coverage rate among children. The researcher finds that health reform changed the composition of children’s coverage, health care utilization, and health outcomes. As a result, more children now have comprehensive coverage and there have been declining rates of ER use, and an uptick in the use of primary care. In addition, fewer children have had to forgo care due to costs, and more children are described as being in excellent health.  Read more about the study in Tara Mancini’s post on Say Ahhh!

May 30, 2012

In this week’s Finish Line Flash, you will find two new briefs on health reform, links to new FAQs from CMS, and news of a webinar that addresses how to maintain the gains in children’s coverage.  The first brief, from the Urban Institute, examines the number of children in families with complex coverage scenarios nationwide and in selected states.   The other discusses how states are taking advantage of options provided by the ACA to improve Medicaid.  In addition, CMS released several new FAQs on a variety of Medicaid and CHIP issues that are relevant to ACA implementation.  Finally, don’t miss the NASHP webinar that is taking place today, and its accompanying brief, on how states can continue to keep children’s health coverage strong in the future.

Health Reform Resources

Complex Coverage Will be the New Norm for Families–A new brief from the Urban Institute provides estimates of the different pathways by which families will receive coverage beginning in 2014.  It finds that over half of all children will be in some type of complex coverage circumstance–those where children but not their parents are eligible for Medicaid or CHIP or where at least one parent is absent.  A large majority–76 percent–of Medicaid and CHIP eligible children will be in such circumstances.  The numbers reinforce the importance of developing coverage systems that are integrated and seamless for families. The brief provides estimates for the nation as well as for California, Texas, and New York.  Check out Gene Lewit’s blog post on the brief on Say Ahhh!

State Adoption of New Medicaid Options–A new brief from the Kaiser Family Foundation summarizes how states are taking advantage of early options available under the ACA to improve coverage, delivery of care, and financing mechanisms in Medicaid. The five provisions covered by the brief include: early expansion of Medicaid coverage for adults up to 133% of the FPL, the availability of federal funding for upgrading Medicaid eligibility systems and implementing disease prevention programs, delivery system reform and enhanced federal matching rates for beneficiaries with chronic conditions, and the ability to integrate care and financing for dual eligibles. A fifty-state table allows states to compare their progress to one another in these areas.

FAQs on Medicaid and CHIP Implementation under the ACA–Last week, CMS released a set of new frequently asked questions to address a number of concerns state officials have raised on ACA implementation.  The covered topics include: eligibility and enrollment systems, eligibility policy, coordination across insurance affordability programs, Section 1115 waiver transitions, CHIP, benefits/delivery system, and FMAPs.  Each set of FAQs is four pages or less.

Upcoming Event

NASHP Webinar TODAY on Children in Health Reform–This is the second of a two-part webinar series sponsored by NASHP.  Today’s webinar will highlight key considerations for children’s coverage under health care reform and why we should continue to focus on children.  Presentations will include a discussion of complex coverage scenarios for children, opportunities and challenges in the final federal rules on eligibility, and a highlight of one state’s efforts to address children’s coverage needs.  Presenters include NASHP’s Catherine Hess, Genevieve Kenney and Stacy McMorrow of the Urban Institute, CCF’s Jocelyn Guyer, and Robin Callahan of MassHealth.  NASHP has also released a brief on the same topic.  The webinar will take place today, Wednesday, May 30, from 1:30-3:00 pm Eastern. Click the link above to register.

May 16, 2012

This week, the Finish Line Flash brings you a notable op-ed from a Finish Liner in Wisconsin about getting kids and adults in the state to the finish line.  In addition, there are four health reform resources: an overview of the Medicaid primary care rate increase, a discussion of plan management in exchanges, a fact sheet on the number of small businesses that will benefit from ACA tax credits, and a brief on the most pertinent final eligibility rules. Also included are a few articles from the current issue of Health Affairs, covering such topics as Medicaid participation rates among adults, how the ACA can reduce racial disparities in health insurance coverage, and one on declining rates of health care access for adults.

Media Materials

Wisconsin Finish Liners Mark Cover the Uninsured Week–In a letter-to-the-editor that appeared in multiple publications, the Wisconsin Council on Children and Families’ Sara Eskrich and a co-author work to restore focus on the real value that health coverage provides to individuals and communities.  They show success and that the problem of uninsurance is solvable, reminding readers that their state is a national leader in covering kids and families.  But they note that more work remains since thousands continue to be uninsured.

Health Reform Resources
Medicaid Primary Care Rate Increase—The ACA provides federal funding for states to increase their Medicaid payments for primary care to Medicare rates in 2013 and 2014.  HHS recently released regulations outlining how this will work and the Center for Health Care Strategies has produced a 3-page fact sheet on the regulation.  It summarizes the rule and suggests some next steps for states to begin implementation of the payment increase.  Also be sure to check out the blog post on this topic from Tricia Brooks on Say Ahhh!

Exchange Plan Management Choices—The Georgetown Center on Health Insurance Reforms and the National Academy of Social Insurance have published a report discussing the choices exchanges—state-run, partnership, and federally-facilitated—will have to make in managing the health plans that participate in them.  The report compares current state insurance regulation practices with the tasks that exchanges will have to undertake.  It focuses on licensing, network adequacy, benefit and rate review, marketing, quality improvement, and ongoing oversight.

Families USA Highlights Small Business Credits–Under the ACA, small businesses–those with fewer than 25 full-time employees with average wages of less than $50,000–are eligible for a federal tax credit for purchasing health insurance.  Families USA and Small Business Majority partnered to create a fact sheet that provides national and state-by-state estimates of the number of small businesses that will be eligible for the credit.  Three 50-state tables detail the number of small businesses in each state that will be eligible for a credit when filing their 2011 taxes, the number of people employed by these eligible small businesses, and the average credit per worker.  Nationwide, it is estimated that more than 3.2 million small businesses, employing 19.3 million workers, will be eligible for this credit, totaling more than $15.4 billion – an average of $800 per employee.

10 Things to Note in the Final Eligibility Rules–Through NASHP, the Maximizing Enrollment project produced a fact sheet that reviews the most pertinent eligibility provisions of the final Medicaid and Exchange rules.  Rather than being a summary of the rules, it highlights 10 major changes from prior rules and current policy that state officials and stakeholders should know as eligibility and enrollment systems, policies, and procedures are developed for 2014.  The interim provisions for which CMS is currently soliciting feedback, as well as a number of areas where further federal guidance is still expected are at the top of the list, followed by determinations of eligibility, verification, MAGI screening, eligibility and affordability in CHIP, alignment between programs, timeliness of eligibility determinations, eligibility and benefits for pregnant women, accessibility for populations with disabilities and limited English proficiency, and waivers.


Participation Among Adults–A new article from Health Affairs examines the Medicaid participation rate for adults and draws out implications for the 2014 expansion.  It finds that for the Medicaid expansion to meaningfully reduce uninsurance rates, adult Medicaid participation rates need to improve.  The researchers find that the national take-up rate among eligible adults without private coverage is 62.6 percent, although rates varied widely among the states.  A map of the U.S. groups states according to their adult participation rates.  Low participation rates are most closely correlated with asset tests, while high participation rates are closely correlated with lower cost-sharing, more generous benefits and more managed care.  The new Health Affairs also includes useful articles on health reform’s effects on racial and ethnic disparities in coverage and declining rates of access to care.

May 2, 2012

This week, the Finish Line Flash is spilling over with materials for advocates.  We bring you a great op-ed from a Finish Liner in Pennsylvania and three health reform briefs, including an overview of navigator program requirements in three states and DC, a Kaiser brief with state-level estimates of health insurance premium rebates due to consumers, and a Health Affairs brief on Essential Health Benefits.  Also included is a bevy of resources related to the newly effective rule on Medicaid waiver transparency and information on an upcoming NASHP webinar focused on CHIP and children’s coverage.

Media Materials

Pennsylvania Finish Liner Calls Attention to Crisis in Kids Coverage —This op-ed from Finish Liner George Hoover at Pennsylvania Partnerships for Children is a good example of pressing for immediate improvements to Medicaid while also highlighting the existing and future benefits of the ACA.  Hoover reminds readers and state leaders that 89,000 Pennsylvania children have been dropped from Medicaid since August, many with special health care needs. He succinctly ties the current Medicaid challenges to the benefits many Pennsylvanians are already receiving due to the ACA and the need for the state legislature to create an Exchange so that fewer children have to experience gaps in coverage.

Health Reform Resources

Navigator Program Decisions—State Coverage Initiatives assembled these quick bullet point overviews that describe how Maryland, Minnesota, Washington, and Washington. D.C. are proceeding on decisions around navigators for their states. Included are links to relevant state task force recommendations and legislation.

Insurer Rebates Coming to Consumers in Your State —This report released last week by the Kaiser Family Foundation reports estimated average amounts that consumers will receive this year as rebates under the medical loss ratio provision of the ACA. The report details the average amount for each state for each of the individual, small group, and large group markets.  In all, the provision will afford consumers and businesses an estimated $1.3 billion when rebates are issued this August for the 2011 policy year.  A series of tables details the number of plans paying rebates in each state, as well as the estimated total and average rebates, and the number of eligible plan enrollees.

Essential Health Benefits Brief—The editors of Health Affairs have produced a policy brief that explains HHS’ approach allowing states to craft EHB packages.  The brief also raises a number of key issues around EHBs, including state mandated benefits, insurer flexibility, and the definition of medical necessity.


Waiver Transparency Rule—On April 27, 2012, a final rule became effective that sets new transparency requirements for state applications for Section 1115 waivers in Medicaid.  A number of resources are available to help advocates understand the new protections in the rule.  Families USA released a guide for advocates on the rule.  CCF’s Joan Alker wrote a blog post for Say Ahhh!  And CMS will hold a call for stakeholders to explain the new rule and the website it has launched to collect public comment on waiver applications:
Time: Thursday, May 3, 3:30 – 4:30 PM Eastern
Call-in-number: (800) 603-1774
Confirmation Number: 76839817

Upcoming Events

NASHP Webinar on CHIP and Children’s Coverage—The first of a two-part series on children’s coverage hosted by NASHP, this first webinar will include presentations from Catherine Hess, Managing Director at NASHP and Stan Dorn, Senior Fellow at the Urban Institute Health Policy Center.  The speakers will outline key concerns and insight from CHIP Directors and discuss research findings that have implications for future health coverage options available to children in low-income families.  The panel will be moderated by Alan Weil, Executive Director of NASHP. The webinar will be held on Monday, May 14th from 2:00 – 3:00 pm EDT.  Follow the link above to register.

April 18, 2012

The Finish Line Flash this week shares a handy document listing the ACA implementation milestones states should accomplish this year, highlights an interactive tool for tracking the ACA funds flowing to your state, alerts you to a webinar for state advocates on essential health benefits, sends along a useful brief on coverage transitions, and, finally, links you to the this year’s CHIP allotments.

Health Reform Resources

Milestones for 2012—State implementation of the ACA involves both much activity and much uncertainty.  Advocates often want to know:  What should my state be doing right now?  Manatt Health Solutions has produced a list of key milestones for states to accomplish in 2012.  Importantly, it includes milestones in support of 2014’s Medicaid expansion in addition to objectives around exchange and private market reforms.  This is a great checklist for those who are concerned their state may be missing a key implementation activity.

ACA Federal Funds Tracker – This online tool developed by the Kaiser Family Foundation tracks funds received by the states, local governments, employers, community organizations, and other entities through the Affordable Care Act.  Click on a state for a profile of its health reform-related funding streams, which you can break down to eight categories, ranging from prevention and public health, to Medicaid special projects, and private insurance exchanges. (Note that Medicaid and Medicare funding are not included.)  Advocates can use this tool to show how the ACA is already in effect and bringing funds into their state.

Managing Coverage Transitions—One of the major challenges for 2014 and beyond will be the frequent movement of individuals between different sources of coverage.  For the State Health Reform Assistance Network, the Center for Health Care Strategies examined ways to encourage seamless transitions among coverage sources.  The brief looks at existing practices in Medicaid managed care and Medicare Part D and provides some potential contractual and technology solutions for managing transitions.

Upcoming Events

CBPP Webinar on Essential Health Benefits – Intended for state advocates, this webinar will address concerns and confusions about HHS’s decision to allow states to choose their own EHBs.  Larry Levitt of the Kaiser Family Foundation and Sarah Lueck of CBPP will cover how a state’s EHB benchmark would likely be constructed, common gaps in potential benchmark plans, and principles that advocates should consider as they evaluate the potential benchmark plan options in their states. The webinar will take place on Wednesday, April 25, from 1 – 2:30 pm Eastern.  Register through the link above.


2012 CHIP Allotments—The federal fiscal year 2012 CHIP allotment amounts are now available on the CCF website.  Our table includes the allotment amounts for 2009-2012.  All states saw an increase in their allotment from 2011-2012.

April 4, 2012

This week, the Finish Line Flash is chock full of health reform resources.  We include a list of essential health benefits-related documents, a set of short videos explaining the ACA, a toolkit that shares Massachusetts’ efforts around outreach and enrollment, a paper that looks at state implementation of the ACA’s health insurance reforms, and news of an exchange webinar.

Health Reform Resources

EHB Resource List—The process for determining which benefits will make up the essential health benefits has become a complex one, with each state selecting from multiple benchmark choices and potentially supplementing them with other benefits to meet statutory requirements.  CCF has compiled a list of relevant documents to aid state advocates as the selection process continues in their states.  The list includes federal guidance, state analyses, issue briefs, blog posts, and more.  We’re also working on a more in-depth guide to EHBs that will be released soon.

Alliance for Health Reform Videos—Even with all the issue briefs, fact sheets, and summaries that are available on the ACA, sometimes a spoken explanation can convey the information in a new way.  The Alliance for Health Reform has produced a series of videos explaining parts of the ACA, including effects on young adultsthose with pre-existing conditionsthose who will gain Medicaidsmall employers, and others.

State Action on Insurance Market Reforms—CCF’s sister center, the Georgetown Center on Health Insurance Reforms, has completed an analysis of state responses to the ACA market reforms that went into effect in September 2010.  It finds that 49 states took action to support the implementation of these reforms.  In addition to the brief, the link also includes an interactive map.

Outreach and Enrollment Toolkit–The Blue Cross Blue Shield of Massachusetts Foundation has put together a guide and extensive collection of primary source documents to share the Bay State’s efforts to enroll newly eligible individuals into coverage.  It provides examples of organizational structures, job descriptions, requests for proposals and quotations, and other work products from Massachusetts’ health reform implementation experience.

Upcoming Event

NASHP Exchange Webinar—The National Academy for State Health Policy will host a webinar to discuss the issues around building a state exchange.  It will feature exchange executive directors from Alabama, California, and Colorado.  The webinar will be held Thursday, April 12, from 2:30-4:00 pm Eastern.

March 21, 2012

The Finish Line Flash this week alerts you to tomorrow’s White House Twitter chat on the ACA, CMS’s webinar series on the new Medicaid rules, a paper from the Center on Budget and Policy Priorities on one state’s experience with a Medicaid block grant, and a new paper on the effects of state exchange policy choices.

Upcoming Events

ACA Twitter Chat—MomsRising and the National Women’s Law Center will host a chat with White House officials on the ACA tomorrow, Thursday March 22 from 2:00-2:30 Eastern.  The officials will answer questions on the benefits of the ACA for children and families.  Use the hashtag #ACAwhchat.  For more info and to RSVP, email Anita Jackson, anita@momsrising.org.

Strengthening Medicaid

Rhode Island’s Waiver Experience—The Center on Budget and Policy Priorities has released an analysis of Rhode Island’s Medicaid waiver, which caps the federal funding available for the state’s Medicaid program.  CBPP cites a new, independent report that finds Rhode Island’s waiver savings to be modest and unrelated to the federal cap.  The report provides important lessons as the idea of capped block grants for Medicaid receives renewed attention in federal budget proposals and state waiver planning.

Health Reform Resources

Cost and Coverage Effects of State Exchange Choices—A new Urban Institute paper looks at the cost and coverage implications of several exchange design options.  It examines how many more or fewer people would be covered and how premiums would change depending on whether states choose to merge the small group and individual markets, increase the small business threshold to 100 employees, or make other choices.  It finds that the overall cost and coverage effects from these choices would be modest, so states can make choices that are in the best interests of consumers.

March 7, 2012

This week, the Finish Line Flash brings you a great example from Texas of messaging around the benefits of the ACA, a new paper on the success of express lane eligibility in Louisiana, and another batch of papers on important health reform topics—state choices in eligibility requirements, issues in building a consumer-friendly exchange, and a look at state mandated benefits.

Media Materials

Texans Tell Legislators the Benefits of the ACA—A story published by a local ABC affiliate shows how messages prepared for legislative testimony can be spread to a wider audience.  With a committee hearing as a hook, the story allows Finish Liners and their coalition members to have their message about the ACA’s benefits placed directly into a news story.  The advocates do a great job citing both the benefits that are already in effect and those to come in 2014.

Eligibility and Enrollment

Analysis and Lessons from ELE in Louisiana—The Urban Institute recently released an analysis of Louisiana’s use of express lane eligibility.  It found that ELE allowed the state to enroll more than 10,000 eligible but previously unenrolled children and that the new procedure disproportionately reached age groups and geographic regions with relatively high concentrations of uninsured children.  The study also found significant administrative savings from ELE.

Health Reform Resources

Eligibility Requirements and State Flexibility—The State Health Reform Assistance Network produced an issue brief that details both the federal requirements for verifying eligibility for Medicaid and exchange subsidies and the flexibilities that states have within the requirements.  The brief is based on the regulations proposed by HHS last year.  Some requirements and flexibility may be subject to change in the final rule expected in the coming weeks.

Supporting Consumers in Exchanges—The National Academy for State Health Policy looks the key issues in making exchanges consumer-oriented in a number of ways:  involving them in the governance, gathering their input in policy choices, and planning the consumer-serving functions like navigators and web portals.

State Mandates and Health Reform—The National Institute for Health Care Reform, a non-profit established by automakers and autoworkers, commissioned a study by the Center for Studying Health System Change on the interaction of state mandated health insurance benefits and the ACA.  The analysis examines the potential costs that states would need to pay under the ACA for state mandated benefits that go beyond the state’s essential health benefits.  It finds that the costs would vary depending on the benchmark a state chooses for its EHBs and on the structure of the state’s mandates.  Contrary to what many have assumed, it finds that for one state at least—Maryland—the state would face the highest costs if it chooses a small group market plan as its EHB benchmark.

February 23, 2012

The Finish Line Flash this week links you to several new resources on ACA implementation as well as notice of an upcoming webinar on state exchanges.  We include a brief from the Kaiser Commission on Medicaid and the Uninsured on outreach and enrollment efforts, a report from the Center for Health Care Strategies on creating a seamless system for low-income populations, a study from HHS with state-by-state data on the number of children and adults who have benefited from expanded preventive services under the ACA, and a toolkit from the Young Invincibles that aids young adults in securing coverage.

Health Reform Resources

Key Issues for Outreach and Enrollment—The Kaiser Commission has released a six-page brief that identifies the top issues that state stakeholders should consider in developing strategies to enroll eligible individuals under both the Medicaid expansion and exchanges starting in 2014.  The brief mentions the availability of enhanced Medicaid matching funds, the need for a cultural shift among eligibility workers, the opportunity to adopt existing successful Medicaid and CHIP strategies, and the need for navigators and other enrollment assistance.

Strategies for Seamless Systems—The Center for Health Care Strategies has another brief that looks past initial eligibility and enrollment to ways to ensure that those who transition between different sources of subsidized coverage don’t experience breaks in coverage or care.  The brief suggests strategies like continuous enrollment, auto-enrollment, and making the same providers available across plans that can provide some stability for those who move between coverage sources.

Expanded Preventive Services Helping Many—HHS’s Assistant Secretary for Planning and Evaluation assembled estimates for each state of the number of people who have received expanded access to preventive services due to Affordable Care Act.  The numbers are broken down between children, men, and women for each state and show that nationally, an estimated 14.1 million children gained access to some preventive services through the provision.

Toolkit for Young Adults—The Young Invincibles has updated its toolkit that helps young adults find health coverage.  The toolkit has information customized by state and provides advice for young adults in getting coverage while in school, after they graduate, by joining their parents’ plans, and in a variety of other situations. (Click the X if you want to skip entering an e-mail address.)

Upcoming Webinar

CBPP on State Exchange Policy and Strategy—The Center on Budget and Policy Priorities will host a webinar for state advocates to discuss possible policy options for key state exchange questions, including governance, plan management/active purchasing, financing models, and others.  It will also discuss legislative strategy around exchanges more generally, such as when alternative policy choices may become preferable to move exchange development forward.  The webinar will take place on Thursday, March 1 from 1:00 to 2:30 Eastern.  Register at https://www3.gotomeeting.com/register/365549182.

February 9, 2012

This week, the Finish Line Flash passes along a great op-ed from Finish Liners in Arkansas that references CHIPRA’s anniversary.  We also share news of a new initiative from HHS on maternal and newborn health as well as a chance to nominate your colleagues for an award in recognition of efforts to educate the public on the ACA.

Media Materials

Arkansas Finish Liners Cheer CHIPRA—Arkansas Advocates for Children & Families took advantage of the third anniversary of CHIPRA to place an op-ed in newspapers in Northwest Arkansas that thanked lawmakers for their progress in covering kids and encouraged them to reach the finish line. “We don’t hear often enough about what our elected officials have done right, so it’s a good time to point one out: children’s health insurance coverage in Arkansas,” the op-ed states.  In addition to praise, AACF also gave lawmakers some advice on how to reach the finish line:  the op-ed urges officials to take advantage of the provision in CHIPRA that allows Arkansas to cover lawfully residing immigrant kids.  Using numbers specific readers’ home county, the op-ed points out the impact this choice could have on local families.

Strengthening Medicaid

Strong Start Aims to Improve Newborn Health—HHS this week announced the Strong Start initiative to reduce preterm births.  A main component of the effort is a grant opportunity to support reductions in premature delivery among pregnant Medicaid beneficiaries. Grants will be available to obstetric care providers, state Medicaid agencies, Medicaid managed care organizations, or conveners of other participating organizations.  The grants are intended to test maternity care options that improve quality and reduce preterm-related poor birth outcomes.  Over $40 million will be awarded in a competitive process.

Award Opportunity

White House Seeks Champions for Change—The White House is asking for nominees for recognition under its Champions for Change program.  In the Affordable Care Act category, it is looking for “an individual or organization who is educating their community about the new health care law and helping people take advantage of the benefits from the law.”  Nominations are due by February 16 and can be submitted at the link.

January 25, 2012

The Finish Line Flash this week shares a new report on building a modernized enrollment system from California and one on strategies for covering more kids from the Finish Line team in Colorado.  We also alert you to new info from HHS on state’s essential health benefits benchmark choices and an upcoming webinar on eligibility and enrollment from NASHP.

New Publications

The Children’s Partnership Draws a Roadmap to Effective Enrollment—In a new report, The Children’s Partnership provides a detailed framework to guide states in developing eligibility, enrollment, and renewal systems that work for families in 2014.  They outline the connections between systems, eligibility criteria, enrollment processes, and navigation aides that will be needed to move people into the right coverage quickly and efficiently.  While focused on California, the report is valuable for all states as they prepare for 2014.

Colorado Finish Liners Celebrate Progress, Plan for Further Gains—In a new report, Colorado’s All Kids Covered coalition reviews the state of kids’ coverage, highlighting recent advances.  Their report also identifies strategies for making further gains—it looks to successful efforts in Colorado and in other states that can point the way for continued improvements in coverage and access for the state’s children.

Health Reform Resources

Some Potential EHB Benchmarks Identified—HHS today released a list of the three largest small group health insurance products in each state, based on data provided to healthcare.gov, as well as the three largest federal employee health plans.  Under the approach to setting the essential health benefits outlined in its December Bulletin, these plans represent 6 of the 10 choices that each state would have for setting an EHB benchmark.  While it is an important step to know which plans are among the choices, evaluating them will also require an analysis of their benefits and exclusions, information on which was not included in today’s release.  CCF has also provided template comments on the EHB approach described in the HHS Bulletin.

Eligibility and Enrollment

NASHP Webinar—The National Academy for State Health Policy will host a webinar on the challenge for states of developing simplified eligibility and enrollment systems.  It will profile the approaches of three states and identify how states can start to address key decisions.  The webinar will take place Thursday, February 9, at 2:30 pm Eastern.  Register at:  https://cc.readytalk.com/cc/s/showReg?udc=j4315dukh641

January 11, 2012

The first Finish Line Flash of the new year links you to a discussion of the recent Essential Health Benefits bulletin on the Diane Rehm show, a new study on the crowd-out effects of recent CHIP expansions, a brief on ways to approach delivery system reform, and two new exchange reports from the National Academy of Social Insurance.

Media Materials

EHB on NPR—Last week, Diane Rehm devoted one of her shows to a discussion on last month’s Essential Health Benefits bulletin from HHS.  Click the link for a recording of the show which features comments from Judy Feder of the Urban Institute, Julie Appleby of Kaiser Health News, Joseph Antos of the American Enterprise Institute, and Joy Johnson Wilson of the National Conference of State Legislatures.


New Study on CHIP Expansions—A new study from researchers with RAND, Columbia University, and UCLA estimated the rates of crowd-out from CHIP expansions that occurred between 2002-2009.  These expansions were largely to moderate-income families.  Their estimates depended on the definition of crowd-out used.  Under a narrow definition that considers those who drop private coverage compared to those who enroll in public coverage, they found no statistically significant crowd-out.  Under a broader definition that compares the number of children who gain insurance to the number who enroll in public coverage, they estimate a rate of 46%.

Reforming Health Delivery

Best Practices for Delivery System Reform—An important focus of Medicaid reforms underway in many states has been improving the efficiency of the health delivery system.  State Coverage Initiatives has produced a brief that outlines lessons from its State Quality Improvement Institute.  It highlights the elements that can make reform efforts successful at the state level, as well as the types of barriers that can prevent progress, using the experience of the eight states that participated in the Institute.

Health Reform Resources

Exchange Options and Alignment with Medicaid—The National Academy for Social Insurance has released two reports to aid states in exchange planning.  One examines the options for state-run, partnership, and federally-facilitated exchanges as specified in the latest CMS Q&A.  The other reports on how to build the important connections between Medicaid, exchanges, and outside individual insurance markets for 2014.