On Monday, the US Department of Health and Human Services (HHS) released a “Frequently Asked Questions” (FAQ) document about provisions in the Affordable Care Act (ACA) related to Exchanges, market reforms, and Medicaid. It is a fairly lengthy document (with 40 questions and responses), but it’s considerably easier reading than the recent ACA regulations, totaling hundreds of pages.
Along with Monday’s answers, HHS granted conditional approval to state-based exchanges in six states: Colorado, Connecticut, Massachusetts, Maryland, Oregon, and Washington. Congrats to our friends in those states!
The FAQ clarified many things, but here are the takeaways that we think are especially important for Wisconsin:
Medicaid Expansion Group: HHS made clear that the enhanced reimbursement rate of 100 percent federal funds to expand Medicaid coverage is only available for states doing the full expansion for adults up to 133 percent of the federal poverty level (approximately $15,000 per year for an individual). This answer is consistent with the legal interpretation of the National Health Law Program. However, the guidance suggests that in 2017, when the federal enhanced funding starts to slowly reduce to 90 percent, HHS will allow the possibility for waivers on this issue. (See question 26)
Federal Match Rate for Wisconsin: The guidance indicates that if Wisconsin decides to close the current gap in BadgerCare coverage (for low-income, non-caretaker adults) our state will initially receive 100 percent federal funding for all of the “newly eligible” adults. It appears that the 100% percent funding (from 2014 through 2016) will also apply to the population already enrolled in BadgerCare Core, because the Core Plan isn’t a full Medicaid benefit. However, we await a definitive federal determination that the Core Plan benefit falls short of Medicaid or Benchmark-equivalent coverage. If it were determined to be equivalent (which I think is unlikely), Wisconsin would start at 80% federal reimbursement for the Core Plan population, while getting 100% for the much larger group of “newly eligible” non-caretaker adults. The current federal reimbursement rate is 59% in Wisconsin. (Question 32)
Blended FMAP: In earlier deficit-reduction discussions, the federal administration suggested the possibility of a “blended” federal matching rate for Medicaid, which could have increased the states’ share of total costs. This guidance takes that option off the table. See more from The Hill’s Healthwatch. The Center on Budget and Policy Priorities explains why taking this off the table is a good thing. (Question 27)
Bridge Plans: The guidance offers a way for states to maintain family-based coverage when children and parents may be split between Medicaid (BadgerCare) and Exchange plans. These bridge plans would allow managed care organizations to contract both with BadgerCare and be a qualified health plan in Exchanges, and enable families to have the same coverage and provider networks, to ease their access to care. (Question 14)
State High Risk Pools: The notice of proposed rulemaking from the end of November notes that HHS is exploring ways for states to continue to run their existing high risk pools, such as HIRSP in Wisconsin, beyond 2014. (Question 15)
Consumer Outreach in Federally Facilitated Exchanges: The guidance notes the importance of collaboration between state-based stakeholders and the federal government in consumer assistance functions for the federally facilitated exchanges. It reiterates prior guidance that says one of the navigators in each state must be a community and consumer-focused non-profit group. It also notes that the number of navigators in each FFE state will vary based on funding and the number of applications per state. (Questions 17 and 18)
There will continue to be lots of regulations and guidance on ACA implementation in coming weeks and months. We’ll do our best to keep you informed!
Sara Eskrich
