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Return to Advocacy - American College of Nurse-Midwives > State Resource Center
Affordable Care Act Implementation Resources
Below are resources on the implementation of the Patient Protection and Affordable Care Act (ACA). Note that additional resources on health care reform are available at ACNM's Health Care Reform page.
Particular attention is given to the development and implementation of the state health insurance exchanges, which will be designed to allow consumers to compare plans from a variety of health insurance providers and select the plan that meets their individual health care needs. Low and moderate income individuals will receive federal subsidies to help ensure affordable coverage is available to all.
The Centers for Medicare and Medicaid Services (CMS) hosts a monthly "ACA Implementation Update for Providers" conference call on the second Thursday of each month at 2 PM EST. Interested parties may dial in to the call by dialing (888) 455-2963 and entering passcode 2954962. A recorded replay of the call is available for thirty days by dialing (800) 570-8799.
The Commonwealth Fund: "Implementing the Affordable Care Act: Choosing an Essential Health Benefits Benchmark Plan"This March 2013 report from the Commonwealth Fund examines states' progress in selecting benchmark plans. "To improve the adequacy of private health insurance, the Affordable Care Act requires insurers to cover a minimum set of medical benefits, known as "essential health benefits." In implementing this requirement, states were asked to select a "benchmark plan" to serve as a reference point. This issue brief examines state action to select an essential health benefits benchmark plan and finds that 24 states and the District of Columbia selected a plan. All but five states will have a small-group plan as their benchmark. Each state, whether or not it made a benchmark selection, will have a set of essential health benefits that reflects local, employer-based health insurance coverage currently sold in the state. States adopted a variety of approaches to selecting a benchmark, including intergovernmental collaboration, stakeholder engagement, and research on benchmark options." Centers for Medicare and Medicaid Services (CMS): "Frequently Asked Questions about the Affordable Care Act"
A series of informative responses to common questions aimed at state policymakers about how Affordable Care Act implementation will affect Medicaid and CHIP programs.
Subject areas include: Exchanges, Market Reforms, and Medicaid; Dual Eligibles and Medicare Cost Sharing; Eligibility and Enrollment Systems; Eligibility Policy; Coordination Across Insurance Affordability Programs; CHIP; and others.
National Conference of State Legislatures: "State Actions to Address Health Insurance Exchanges"
Frequently
updated map that details state actions toward the creation of state
health exchanges. The interactive portion of the page allows users to
link to state health exchange websites, view health exchange
legislation, and link to health exchange board or commission websites.
Other resources available on the NCSL website
include links to state-specific research reports on the status of
health care reform, a state health reform legislative tracking database,
a newsletter, and an overview of implementation efforts at the federal
level.
Centers for Medicare and Medicaid Services: "Essential Health Benefits: Illustrative List of the Largest Three Small Group Products by State"
This January 2012 guidance provides a list of the products with the three largest enrollments in the small group market in each state and provides a list of the top three nationally available Federal Employee Health Benefits Program (FEHBP) plans based on enrollment. Kaiser Family Foundation: "The Role of the Basic Health Program in the Coverage Continuum"
This March 2012 report, subtitled "Opportunities, Risks, and Considerations for States," explores and assesses "the potential impact of a Basic Health Program on the effectiveness of state exchanges." National Committee for Quality Assurance (NCQA): "Building State Exchanges to Get Better Value"
A March 2012 report that explains how states can construct health exchanges that simultaneously expand coverage and promote better value health care. U.S. Department of Health and Human Services: "45 C.F.R. Parts 155, 156, and 157"
On March 12, 2012, the Department issued a final rule implementing Affordable Insurance Exchanges, consistent with the Patient Protection and Affordable Care Act of 2010. The rule describes standards for exchange establishment, health insurance issuer standards, and employer interactions with the exchanges. A summary of the new rule is available here. An analysis of the regulatory impact of the rules by the Centers for Medicare and Medicaid Services is available here. Centers for Medicare and Medicaid Services: "42 C.F.R. Parts 431, 435, and 457"
These March 2012 rules codify "policy and procedural changes to the Medicaid and CHIP Programs related to eligibility, enrollment, renewals, public availability of program information and coordination across insurance affordability programs" as part of the implementation of the Affordable Care Act (ACA). Kaiser Family Foundation: State Health Exchange Map
Link to an interactive map that displays the status of state action toward creating health exchanges. National Academy for State Health Policy: State Health Insurance Exchange Resources
A selection of issue papers and webinars concerning the establishment and structure of state health exchanges. Center on Budget and Policy Priorities: "Status of State Health Exchange Implementation"
A November 2012 summary report of progress in state health insurance exchange implementation, including the establishment of authority to create an exchange and the obtainment of federal grant funding to support planning activities. Kaiser Family Foundation: "Patient Cost-Sharing Under the Affordable Care Act"
An April 2012 report detailing the deductibles and coinsurance requirements for a "Bronze" plan, the minimum coverage plan that will be offered in the health exchanges and the individual and small group markets beginning in 2014. Centers for Medicare and Medicaid Services: Draft Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges
This May 2012 document outlines the elements states need to include in their health exchange proposals and sets a November 16, 2012 deadline for states to submit a letter of their intent to independently establish operational exchanges by 2014. Centers for Medicare and Medicaid Services: "General Guidance on Federally-Facilitated Exchanges"
A May 2012 report that outlines what a federally-facilitated exchange (FFE) would look like in states that do not choose to operate their own exchange. Specifically, the report discusses how states can partner with the Dept. of Health and Human Services' (HHS) to implement certain aspects of FFEs, key policies, and how HHS will collaborate with a variety of interested parties and stakeholders to implement FFEs. Kaiser Family Foundation: "How is the Affordable Care Act Leading to Changes in Medicaid Today?"
A brief May 2012 report that provides an overview of five key Medicaid options provided by the Affordable Care Act and state take up of these to date. Kaiser Family Foundation: "States Moving Ahead on Defining 'Essential' Health Insurance Benefits Under Federal Law"
Brief September 2012 update on the progress of states' decisions regarding essential health benefits that includes many useful links. Center on Budget and Policy Priorities: "State Policy Decisions in Exchange Implementation"
Brief policy paper that outlines the areas of state exchange development where states have flexibility to create an exchange capable of reflecting the unique health care needs of their populations. Areas considered in the paper include exchange implementation policy and operations (subtopics include exchange establishment, consumer assistance, eligibility and enrollment, Small Business Health Options Program, and plan management) and other programs that affect exchange operation, such as essential health benefits, the selection of the basic health plan, and risk adjustment and reinsurance. Kaiser Family Foundation: "Medicaid Eligibility, Enrollment Simplification, and Coordination under the Affordable Care Act: A Summary of CMS's March 23, 2012 Final Rule"
A December 2012 brief that, according to the Kaiser Foundation, "provides a summary of the Centers for Medicare and Medicaid Services' (CMS)
March 23, 2012 final rule to implement the ACA provisions relating to Medicaid
eligibility, enrollment simplification and coordination. The rule, which is
effective Jan. 1, 2014, lays out procedures for states to implement the Medicaid
expansion and the streamlined and integrated eligibility and enrollment system
created under the ACA. Achieving this goal will require substantial process and
system changes among state Medicaid agencies and close coordination between
Medicaid, the new health insurance Exchanges and other insurance affordability
programs."
State-Specific Resources of Note
California: Insure the Uninsured Project (ITUP) Monthly Updates
The ITUP publishes monthly updates on ACA implementation efforts in California, including updates on health exchange board meetings, health reform legislation, information on MediCal, and other general health care developments in the state.
Massachusetts: Massachusetts Affordable Care Act Implementation Updates
An archive of the Executive Office of Health and Human Services' (EOHHS) weekly update of ACA implementation efforts in the state.
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