State of Uncertainty

WASHINGTON, DC – The Energy and Commerce Subcommittee on Health today will convene a hearing with federal and state officials to discuss the implementation and regulation of the health exchanges and Medicaid expansion established in the Patient Protection and Affordable Care Act. Governors, members of Congress, and state officials have sent numerous letters requesting this basic information. While informal guidance and some proposed or final rules have been issued, unanswered questions or incomplete answers leave states wondering:

·       What benefits must be included in qualified health plans under rules dictating “essential” health benefits?

·       When will HHS reveal the operational details of the federal exchange?

·       Has HHS accounted for the subsidy cliff included in PPACA that dramatically increases an individual and  family’s exposure to the law’s premium increases?

·       Has HHS considered how the government-run plan administered by the Office of Personnel Management could disrupt markets?

·       Will states have the ability to opt in and out of an exchange management on an ongoing basis given the lack of information related to their operation and cost?  How will this process work?

·       Will the administration again change deadlines related to implementation of state exchanges given the lack of information it has so far provided?

·       Will states that expand Medicaid coverage up to a level below 133 percent of the federal poverty limit (FPL), for example up to 100 percent FPL, after 2017 receive an enhanced federal medical assistance percentage (FMAP) available for “newly covered” populations?

·       Why does Section 1115 Waiver Authority allow CMS to provide states, “significant flexibility” after 2017, but not during 2014-2016?

·       Will states be allowed to phase-in Medicaid coverage up to 133 percent of FPL in years after 2014 and still receive an enhanced FMAP?

·       If a state opts not to pursue the Medicaid expansion as written in PPACA, what other Medicaid provisions of PPACA would apply to their program? Specifically, do financial penalties associated with the PPACA Maintenance of Effort provisions still stand?

·       What options and federal assistance are available for states that decide not to pursue Medicaid expansion as written in PPACA?

·       What additional flexibilities are available to states that may be considering an expansion but believe the financial sustainability of such a policy requires greater state autonomy in managing their Medicaid programs?

·       Regarding the two-year increase in Medicaid reimbursement for primary care codes, are states expected to maintain the additional billions in spending after 2014?

On July 2, 2012, the National Governors Association sent a letter to HHS raising concerns and questions from a bipartisan group of governors in light of the Supreme Court’s ruling striking down the law’s mandated Medicaid expansion.

On July 3, 2012, the National Association of Medicaid Directors sent a similar letter to the Centers for Medicare and Medicaid Services (CMS).

On July 10, 2012, the Republican Governors Association (RGA) sent a letter to President Obama outlining basic operational and implementation questions.

On July 23, 2012, RGA sent a follow up letter to HHS Secretary after CMS failed to provide a substantive response to RGA’s 30 specific questions.

On August 20, 2012, Energy and Commerce Committee Republicans sent a letter to CMS on the administration’s failure to respond to specific questions from states.

On October 4, 2012, Energy and Commerce Committee Republicans sent a follow up letter to Secretary Sebelius.

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