News Briefs

Actions needed in most states to implement ACA’s 2014 market reforms: The Affordable Care Act (ACA) includes numerous consumer protections designed to improve the accessibility, adequacy, and affordability of private health insurance. These reforms will phase in over time, with the most dramatic changes scheduled to take effect in 2014. These changes—known as the “2014 market reforms”—include such provisions as guaranteed access to coverage, a ban on preexisting condition exclusions, restrictions on the use of health status and other factors when setting premium rates, and coverage of a minimum set of essential health benefits. Under the ACA, states are the primary regulators of health insurance and will be key players in enforcing these protections. To understand states’ progress in implementing the ACA, the Commonwealth Fund conducted an analysis of new actions taken by states from January 2010 to October 2012 to implement or enforce seven of the most critical 2014 market reforms. The analysis found that only one state (Connecticut) passed new legislation on all seven protections. An additional ten states and the District of Columbia passed new legislation or issued a new regulation on at least one of the seven protections. Thirty-nine states have yet to take new actions to implement the 2014 market reforms. These findings suggest an acute need for states to take steps in 2013 to help ensure that consumers are fully protected by and benefit from the ACA’s most significant reforms. The 14-page issue brief, Implementing the Affordable Care Act: State Action on the 2014 Market Reforms, is available at www.commonwealthfund.org.

SAMHSA’s Information Resource Center invites ACA-related questions: The Center for Financing Reform and Innovations of the Substance Abuse and Mental Health Services Administration (SAMHSA) has created a new Information Resource Center to link users with information about how the ACA can improve access to behavioral health services. The center can answer specific questions about how the ACA will affect various aspects of the behavioral health care community. Questions e-mailed to [email protected] will receive a response within 48 business hours. Center staff members are trained to quickly link users to the appropriate federal Web sites, documents, and guidance materials. The center is also developing a Frequently Asked Questions feature that will cover topics of most interest to users. In addition, a monthly newsletter, Financing Focus, provides current news on nationwide ACA implementation related to behavioral health. Sign up for the newsletter at public.govdelivery.com/accounts/USSAMHSA/subscriber/new.

KFF poll finds many Americans not comfortable around people with mental illness: A new poll by the Kaiser Family Foundation (KFF) has found that Americans have somewhat contradictory views of mental illness. Whereas most of those polled (76%) stated that people with mental illnesses experience at least some prejudice and discrimination—higher than the share who say the same for persons from racial-ethnic minority groups, women, and people with disabilities—a substantial portion also reported that they would be somewhat or very uncomfortable working in the same place as someone with a serious mental illness (41%) or having their children attend a school where someone with a serious mental illness is employed (66%). Forty-seven percent said they would be uncomfortable living next door to someone with a serious mental illness. These concerns were less severe among people under 30 and people who reported experiences with their own or family members’ mental health problems. The poll, which was conducted in mid-February with more than 1,200 adults, also found that although a majority of the public (75%) is in favor of parity between mental health and general medical coverage, less than half (38%) knew that such parity is already law. Other findings of the KFF poll, which also asked about gun violence and gun control, are available at www.kff.org/kaiserpolls/8418.cfm.

Four KCMU reports on MFP Medicaid demonstration program: The “Money Follows the Person” Rebalancing Demonstration Program (MFP), enacted into law in 2006 as part of the Deficit Reduction Act, provides states with enhanced federal matching funds for 12 months for each Medicaid enrollee transitioned from an institutional setting back to their home or to a community-based residential setting. Four new papers from the Kaiser Commission on Medicaid and the Uninsured (KCMU) examine the MFP program, which the ACA extended through 2016. Forty-six states, including the District of Columbia, have received federal grant money under the program, and as of August 2012, a total of 25,000 individuals nationally had been transitioned since the program’s inception, an increase of 17,000 individuals over 2011. These findings are available in a 19-page report on the KCMU’s survey of state MFP programs conducted in August 2012 (www.kff.org/medicaid/upload/8142-03.pdf). The report describes trends in enrollment, services, and per-capita spending in state MFP efforts. Two related papers provide case studies of MFP demonstrations in Michigan and Washington. Washington State has been a leader in efforts to rebalance Medicaid long-term services and supports. In the early 1990s, 82% of Medicaid funding from long-term care went toward institutional services; by 2010 the proportion had dropped to 37%. Another report offers short profiles of four MFP participants in those states. These reports are available at www.kff.org/medicaid/8142.cfm.

Checklist on coverage of women’s health care needs by state health exchanges: A major feature of the ACA is the creation of state health insurance exchanges—regulated marketplaces where individuals can purchase insurance eligible for federal subsidies. To inform states’ development of exchanges, experts in women’s health have prepared a checklist that identifies key coverage, affordability, and access issues that are important for women. The eight-page checklist, Ensuring the Health Care Needs of Women: A Checklist for Health Exchanges, draws on national policy research and lessons learned from Massachusetts. It was prepared jointly by policy experts at KFF, the Connors Center for Women’s Health and Gender Biology at the Brigham and Women’s Hospital, and the Jacobs Institute of Women’s Health at George Washington University. The checklist compiles questions in critical areas that should be considered in evaluating the quality of the plan’s coverage and the scope of its design. Areas addressed are essential health benefits, including maternity care and coverage of chronic general medical and mental health conditions; implementation of no-cost preventive services, including contraception; provider networks; affordability, outreach, and enrollment efforts; and data collection and reporting standards. Included in each checklist category are links to informative policy documents and reports by an array of public- and private-sector agencies with a focus on health care and reform. The checklist is available at www.kff.org/womenshealth/upload/8410.pdf.

KFF fact sheet on portability of health insurance under the ACA: Portability of health insurance is the ability of an employee to maintain access to coverage and comprehensive benefits after leaving a job and the ability of individuals purchasing insurance on their own to drop one policy and buy another. A four-page fact sheet explains how portability is regulated under current law and how the ACA will affect portability in 2014. Because many ACA provisions do not take effect until 2014, the 1996 federal Health Insurance Portability and Accountability Act provides the only current federal protections for employees leaving job-based coverage, after they have exhausted their COBRA benefits. Implementation of ACA provisions in 2014, such as on guaranteed access and preexisting conditions, will bring significant changes to portability rules in the individual market. Those seeking coverage on their own will shift from a system in which the federal government did very little to ensure portability to one in which portability is guaranteed. Insurers will also no longer be able to restrict benefits because of a pre-existing condition for individuals who change plans. However, individuals may be required to enroll in coverage during an annual open-enrollment period, although special enrollment periods will be available in the wake of certain life circumstances, such as leaving a job or having a baby. In the insurance market for smaller employers, 2014 will bring smaller but still significant changes. For both individual and small-group markets, state regulators will be the enforcers of these standards, and many states may wish to amend their laws to provide their regulators with clear authority to enforce the ACA’s new standards. The fact sheet, which was prepared for KFF by the Center on Health Insurance Reforms of the Georgetown University Health Policy Institute, is available at www.kff.org/healthreform/upload/8421.pdf.