Open Enrollment letter to HSD

From the Center on Law and Poverty:

Morning All,

 

With all of the misinformation that’s been floating around surrounding the Oct. 1st date and what will happen to applications, the Center wrote a letter to HSD outlining their responsibilities under federal regulations and asking for some specific actions to be taken. I’ve attached it to this email. Hopefully it will help shed some light on how this process is supposed to roll out (now whether or not HSD will comply is another question). Feel free to disseminate and let me know if you have any questions about it!

 

Thanks,

 

Dorianne

 

 

 

 

 

 

 

 

 

 

Washington Post: "The White House says Obamacare begins on October 1. Not really"

 

by Sarah Kliff

Updated August 26, 2013

Days until marketplaces launch: 36.

Oct. 1 has become a pivotal date in the media coverage of the Affordable Care Act. It’s  the day, as any regular reader of this column knows, that the health insurance marketplaces open for business. It’s the day that I’m counting down to at the top of this column, and one that the White House says marks the start of Obamacare.

 

That’s one way to think about it. Here’s another: Oct. 1 is a completely arbitrary date, one that never shows up in the text of the Affordable Care Act and that has little bearing on the health law’s success or failure.

As I spent time reporting my most recent article – checking in with state marketplaces — it became increasingly clear that their big day isn’t necessarily Oct. 1. Instead, it’s Jan. 1,  the day that the individual mandate takes effect and any plans purchased on the marketplace actually kick in.

The space between October and December is viewed, by many standing up the health care law, as a soft launch: the time to make their new Web sites live, sort out the kinks and get the site in prime condition for the beginning of 2014.

The Affordable Care Act never set an open enrollment period. It directed the secretary of Health and Human Services to set “an initial open enrollment.” HHS Secretary Kathleen Sebelius’s agency set Oct. 1 through March 31 as the initial period when Americans purchase coverage.

Open enrollment begins in October, but any health insurance coverage sold on the marketplaces cannot take effect until Jan. 1, 2014. So, on the exchanges, there’s no difference in when you begin to receive coverage whether you buy it this Thanksgiving, Christmas or New Year’s Eve.

This is why states seem relatively okay with using the first few months of open enrollment as a test period: Even if there are kinks in October, they don’t expect it to hamper residents’ ability to purchase a plan by Dec. 31.

Oregon recently decided to open its marketplace only to registered brokers and community assisters on Oct. 1, waiting a few weeks until letting the general public in. Just how many weeks is still undecided.

“Even if we don’t go live in the third week or fourth week, that will still give people plenty of time to go on and find a plan,” says Amy Fauver, a spokeswoman for the exchange Cover Oregon.

Fauver says that the decision to delay public access to Cover Oregon wasn’t about capacity; the site could handle heavy traffic. Instead, the agency wanted to have a beta launch, giving a small group of users access first.

“When Google launched Gmail you had to be invited” Fauver says. “That was their beta launch. That was their way to identify bugs. Our benefit is that our initial users will be community partners who will be trained on the system.”

One big unknown for states is how many people will head to the marketplace during this soft launch phase. Numerous consumer marketing campaigns are underway, and there will no doubt be copious media coverage when the switch gets flipped on the first of October.

At the same time, there’s little financial incentive to buy coverage in October that won’t take effect in January. Some experts I’ve interviewed expect that there won’t be heavy take-up until January, or even March of next year, when the individual mandate is in effect and open enrollment nears its end. It’s hard to know because the country has never done something like this before.

Any kinks during the October soft launch will matter: These will the be first reports of how easy – or difficult – it is for consumers to purchase coverage under the new health care law. Will difficulties derail the entire law and its launch? In Oregon, among the states that have been most aggressive in setting up the health care law, they don’t think so.

I think about Oct. 1 as our first glimpse at Obamacare in action, which is why I’m keeping the countdown at the top of this column. But we won’t see Obamacare’s programs kick in or the version of the exchanges that most of the Americans gaining coverage will ultimately interact with until the beginning of the new year.

From the Medicaid Coalition

Medicaid Coalitionistas,

The LFC will hear the Medicaid budget on September 27th at 10 am.

http://www.nmlegis.gov/lcs/agendas/ALFCageSep25.13.pdf 

Also, the Albuquerque Journal ran this story today on Centennial Care and Medicaid expansion:

http://www.abqjournal.com/254535/abqnewsseeker/nm-retools-medicaid-with-eye-on-cost-wellness.html 

See you all at our next meeting on September 11, 10 am, at the SWLC.

Thanks,

Bill

How American Indians Benefit from the Affordable Care Act Takes Center Stage

TRAVERSE CITY, MICHIGAN – Some 400 American Indian tribal leaders and health care professionals are meeting at the Grand Traverse Resort and Spa, owned by the Grand Traverse Band of Ottawa and Chippewa Indians, at the National Indian Health Board's 30th Annual Conference.

"We are delighted to have nearly 400 tribal leaders, elders and health care colleagues engaged in the current health care reform issues that impact every single person in our families and communities. From the American Indian and Alaska Native benefits through the Affordable Care Act to the renewal of the Special Diabetes Program for Indians. It is important to be involved and informed on the policies that are improving health care services and accessibility to our tribal members,"
said NIHB Chairperson Cathy Abramson.
"We are pleased to have a number of federal agency representatives here today to provide this information, to answer our questions and to listen to our comments and concerns."
On Tuesday, conference attendees heard from federal agencies that seek to improve health conditions in Indian country.
Indian Health Service
Dr. Yvette Roubideaux, acting director of the Indian Health Service, who provided an overview of the Affordable Care Act, leading up to the to the October 1st enrollment of the Insurance Marketplace of the Act.
"Meeting with tribes and tribal organizations, such as the NIHB, is a very important part of our agency consultation efforts and IHS's priority to renew and strengthen our partnership with Tribes. We value our partnership with NIHB as we work together to change and improve the IHS and to eliminate health disparities in Indian country,"
Dr. Roubideaux said.
Department of Veterans Affairs
The Department of Veterans Affairs partnered with NIHB to host the second Native veterans' health workshop track at this year's conference.
"We are committed to nurturing an environment that fosters trust and provides culturally competent care for Native American veterans, including creating culturally sensitive outreach materials, incorporating traditional practices and rituals into treatment and ensuring the best possible experience when Native American veterans receive care from the VA,"
said John Garcia, Deputy Assistant Secretary in the Office of Intergovernmental Affairs at the US Department of Veterans Affairs.
"We at the VA are further committed to working with and for tribal leaders on a nation-to-nation basis to address the many issues being experienced by veterans and their families across Indian country."
Health Resources and Services Administration, US Department of Health and Human Services
Mary Wakefield, Administrator for the Health Resources and Services Administration said that under the leadership of the Health and Human Services (HHS) Secretary Kathleen Sebelius, one of the top goals is to improve health equity with Indian tribes.
Levi Rickert, editor-in-chief in Native Health


"We want to eliminate health disparities among American Indians and Alaska Natives. And, we believe we can do that by working toward two other goals - to strengthen the health workforce by expanding the supply of culturally competent primary health care providers in Indian country and Alaska and to improve access to quality health care and services by increasing the number of health care access points,"
Wakefield said.
Substance Abuse and Mental Health Services Administration, US Health and Human Services
Mirtha Beadle, Deputy Administrator for Operations with the Substance Abuse and Mental Health Services Administration in HHS focused her speech on behavioral health issues stating that American Indian and Alaska Natives have the highest level of substance abuse and dependence and unmet need.
"The emphasis is growing on screening and early intervention services. Evidence based practices are an important shift for behavioral health. There is an increased need to focus on bilingual populations in the US. American Indians and Alaska Natives stand to benefit substantially from the implementation of the Affordable Care Act,"
Beadle added.
Office of Personnel Management
Susan McNally, Senior Advisor in the Office of Intergovernmental Affairs with the Office of Personnel Management (OPM) provided n brief overview of the health plans that OPM directs under the Affordable Care Act. OPM will work with private insurance to offer two state health plans – the Multi-State Plan and the Federal Employee Health Benefits program, which OPM has managed for nearly 40 years.
The 30th Annual Consumer Conference continues today with a keynote address from Gold Olympic Medalist Billy Mills, updates from the Tribal Leaders Diabetes Committees and the Tribal Technical Advisory Committee to the Centers for Medicare and Medicaid Services and a panel discussion on the definition of Indian in the Affordable Care Act.

“BREAKING BONDS” The Shutdown of New Mexico’s Behavioral Health Providers

“BREAKING BONDS”

The Shutdown of New Mexico’s

    Behavioral Health Providers

 

The program can be viewed on YouTube.  Simply paste this address  into your browser window and hit “send”. 

http://youtu.be/wUSSR_mJYdU

Following the results of a yet-to-be released audit, the State Human Services Division (NMHSD) has mandated cutting off Medicaid Behavioral Health funding to several agencies, alleging fraud and mismanagement. These agencies represent nearly 90% of the State's entire behavioral health services system.

 

The shutdown will potentially affect 30,000 clients and their families throughout New Mexico, thus further crippling an already fragile behavioral health network. The State has chosen to turn over much of the management of these providers to Arizona companies.

 

New Mexico has one of the highest rates of alcoholism and drug abuse, and is consistently a national leader in the number of suicides.

“BREAKING BONDS” focuses on the impact of terminating long-standing relationships between caregivers and vulnerable clients.  It is a centerpiece of the Coalition’s public awareness campaign that also features press releases, radio/TV and print interviews, a “call-in” allowing providers and families to state their concerns to government officials, a mass rally at the State Capitol on August 30, and TV spots.

KAISER Family Foundation "An Early look at Premiums and Insurer Participation in Heallth Insurance Marketplace, 2014

For more information or full report leave a comment or email this blog.

Advocate Comments on "No Wrong Door Policy" in NMHIX and Medicaid Expansion

Comments from Health Action NM:

  In a meeting today, Roxanne raised that Matt K has said that people applying for Medicaid Expansion before Jan 1 will get denial letters.  This is not what we've heard before and we all need to be stressing the seamless process for people.  If they get a denial letter, they will not be back!!  The suggestion is that we got to congressional delegation, tribes go to CMS and we get a written policy from HSD so we are all clear on this before outreach starts.  Of course, having health care guides inform and enroll on both should be the norm.  So everyone keep their ears up on this one and hammer away in public comment.  

Barbara

 

Comments from Disability rights NM:

Matt's statement is contrary to federal law, so it's disappointing that he's still saying it.   42 CFR 432.1205 says that during the open enrollment period from October 1, 2013 to March 31, 2013, the Medicaid agency has to accept applications (whether submitted directly or through the Exchange) and determine eligibility based on MAGI.  The preamble to the rule (issued July 15, 2013 in the Federal Register) noted concerns about people who become eligible for coverage effective January 2014 through the expansion being turned away and said that "individuals may not be required to return in January to reapply" (78 Fed. Reg. at 42178).

Closer to home, HSD's presentation to the LFC last week (PowerPoint attached) gives conflicting information.  It DOES say that people who apply before January 1 will be assessed for expansion eligibility and if found eligible, will be sent a letter notifying them they'll be covered as of January 1.  BUT it also says that people can apply starting January 1.  (See slides 16-17.)  I take this to mean that HSD will make no effort to inform people of the expansion option or encourage them to apply, but will comply with federal law as far as people who find their way in through no fault of HSD's.

        Ellen