News from NHeLP (National Health Law Program)
State Option for EarlyMedicaid Expansion
On April 9, CMS issued a letter to state health officials and Medicaiddirectors that implements the provision of the health reform law addressingMedicaid coverage for populations with the lowest incomes. The guidanceexplains that the law expands Medicaid eligibility of individuals with lowincomes (up to 133 percent FPL) who have traditionally not been eligible forMedicaid. States have an option to phase-in coverage for this populationbeginning April 1, 2010. In January 2014, states participating inMedicaid must cover the expanded eligibility population.
To be eligible, an individual must have income of less than 133 percent of thefederal poverty level and not be: included in a state plan or waiverbefore December 1, 2009; an adult under the age of 65; not pregnant; noteligible for Medicare Part A or B; or not already eligible under the Medicaidstatute. The letter also provides further details on increased federalmatching rates for the newly eligible group of individuals in calendar year2014, as well as benefit packages, and income and asset rules. For moreinformation, click here.
State Flexibility for Medicaid Benefit Packages — Final Rule
On April 30, CMS published a final rule, revising an earlier rule, on howstates can design Medicaid “benchmark” benefit packages. Thesebenchmark and benchmark-equivalent benefit packages, authorized in the DeficitReduction Act for certain eligibility groups, offer more limited benefits thangenerally available to Medicaid enrollees. The final rule includesguidance on populations that are exempt from the benchmark option, voluntaryand mandatory enrollment in the benchmark plans, as well as otherinformation. The final rule becomes effective as of July 1, 2010. Click here for the FederalRegister notice.
New CMS Administrator and Chief of Staff
On April 19, the President officially nominated Donald Berwick, M.D., to be thenew CMS Administrator. He is currently the President and Chief ExecutiveOfficer of the Institute for Healthcare Improvement, and a professor at HarvardMedical School and the School of Public Health. CMS also announced thatCaya Lewis, M.P.H., will be Berwick’s Chief of Staff. She is currentlyDirector of Outreach and Public Health Policy for the HHS Office of HealthReform.
CMS Transparency
On April 7, HHS announced its Open Government Plan in response to thePresident’s Open Government Directive for executive departments andagencies. The goal of the directive is to implement principles oftransparency, participation and collaboration. CMS has developed”CMS Dashboard (BETA),” an electronic tool to determine trends in thecost of certain services under fee-for-service Medicare (by using inpatienthospital payment and volume information). Click here for moredetails on CMS Dashboard (BETA).
CMS has also announced that Medicaid State Plan documents will be available tothe public without charge. Each state’s Medicaid state plan documentswill be accessible online, as they were during earlier administrations. State Plans reflect details of each state’s Medicaid program including coverageof optional eligibility groups and services. For a link to Medicaid StatePlans, click here.
Health Care Grants to Enroll Eligible American Indian/Alaska Native Children
On April 16, HHS and CMS announced the availability of $10 million in grantfunding to 41 health programs operated by the Indian Health Service, tribes andtribal organizations, and urban Indian groups to improve outreach to AmericanIndian and Alaska Native (AI/AN) communities to increase the enrollment ofeligible, yet uninsured children in Medicaid or CHIP. The grants arespecifically for increasing the enrollment and retention of AI/AN children inthese health programs from funding in the Children’s Health Insurance ProgramReauthorization Act of 2009. For more details and a list of grantees, click here.
New HHS Office of Consumer Information and Insurance Oversight
On April 19, HHS created the Office of Consumer Information and InsuranceOversight, whose mission is to provide guidance on implementing private healthinsurance provisions of the new health reform law. Divisions with theOffice include an Office of Oversight, which will be responsible for ratereviews and implementing and monitoring compliance with new rules governing theinsurance market and medical loss ratios; and an Office of Consumer Support,which will provide assistance to consumers to aid them in benefiting from thenew health insurance system. For additional information, click here for the FederalRegister notice.