Latest Information on Insurance Exchanges & Medicaid Expansion

Latest Information on Insurance Exchanges & Medicaid Expansion

Proposed Rules on Essential Health Benefits Requirements from the ACA
On November 20th, HHS issued proposed rules on the essential health benefits requirements in Exchanges.  The rule also proposes a timeline for qualified health plans to be accredited in Federally-facilitated Exchanges.  Further, the rule includes an amendment that provides an application process for the recognition of additional accrediting entities which would certify qualified health plans. Proposed rules can be found here.  The public comment period on the proposed rules closes December 26th.

In coordination, a State Medicaid Director letter regarding essential health benefits in the Medicaid Program was also released to provide guidance to States on the use of “benchmark” or Alternative Benefit Plans for the new eligibility group of low-income adults and the relationship between Alternative Benefit Plans and essential health benefits. The letter also highlights areas where additional rulemaking regarding the application of essential health benefits to Medicaid is expected to be published shortly. 

CMS Issues Letter, FAQs on Exchanges, Market Reforms and Medicaid
On December 10th, CMS released a letter to governors and a Frequently Asked Questions (FAQs) document about the Exchanges, Market Reforms and Medicaid.  These FAQs cover questions about the State-based, Partnership and Federally-facilitated Exchanges, consumer issues and the Medicaid eligibility expansion.  You can read the FAQs here.  Among many important responses, HHS provided the following:

  • HHS will hold firm the deadline extended to December 14 for States to announce a decision and blueprint for a State-Based Exchange in 2014.
  • HHS will not consider partial Medicaid eligibility expansions to be eligible for 100 percent matching rate in 2014 through 2016.

Exchange Requirements on Contracting & Payment to FQHCs
NACHC has posted a Q&A on their Policy Shop blog regarding the Exchanges and the contracting and payment requirements for Qualified Health Plans and FQHCs.  OKPCA and NACHC will continue to provide answers to questions as they are received.