The Department of Health and Human Services (HHS) in December issued an information bulletin outlining how it intends to approach its task of creating an Essential Health Benefits (EHB) package under the health reform. When finalized, this policy will have a significant impact on the services available through both public and private health insurance plans because it establishes the minimum benefits that health plans must cover beginning in 2014. 

 

Rather than define one package at the federal level, the HHS bulletin proposes to leave considerable discretion to the states in crafting their own EHB packages. This week, the National Council submitted its comments on the HHS proposed approach. Our comments express our concern that the December bulletin does not include sufficient protections to ensure adequate access to mental health and substance use disorder treatment services. We offer recommendations to HHS on strengthening its EHB guidance by: developing and enforce safeguards to ensure that affording state flexibility for development of EHB plans does not undermine access to care; establishing stronger oversight for Parity implementation and adherence; ensuring adequate health insurance coverage for children by requiring states to mirror Medicaid’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefits when they establish the EHB plans; defining rehabilitation and habilitation benefits so as to explicitly include services to maintain, as well as improve, daily functioning; and more.

 

HHS has said it intends to engage in formal rulemaking to further clarify its guidance on EHBs but has not announced a timeframe when advocates can expect to see a regulation issued. For additional information on the December bulletin and its impact on behavioral health, see our Essential Health Benefits FAQ. 

 

 

 

A federal judge in California has temporarily blocked a 10% cut in the state’s Medicaid payment rates that were due to go into effect in June. The cut was part of legislation enacted by California’s legislature last March to close its budget shortfall.

 

U.S. District Court Judge Christina Snyder stated in her tentative order that the cut violates federal Medicaid law by putting beneficiaries’ access to care at risk. Federal law states that Medicaid payments must be sufficient to enlist at least enough providers so that beneficiaries have access equal to private insurance enrollees by region.

 

A similar case, Douglas v. Independent Living Center of Southern California,  has gone before the Supreme Court. At issue in the Douglas case is whether states’ cuts to provider payment under Medicaid violate the laws requiring states to ensure beneficiaries’ access to care – and whether providers have legal standing to bring lawsuits against states over this issue. The National Council has joined nine other national organizations in submitting an friend-of-the-court brief to the Supreme Court in the Douglas case. Our groups’ brief argues that reductions in state Medicaid payment rates affect beneficiaries’ access to care and that providers should have standing to bring action against states when such access is threatened. To read the full brief, click here. 

 

The Supreme Court heard oral arguments in the Douglas case last October. No ruling has yet been issued.

 

 

 

The National Council has joined 22 national groups in urging the Centers for Medicare and Medicaid Services to deny a waiver request by the state of Wisconsin that could erode access to Medicaid for thousands of beneficiaries.

 

Wisconsin has requested a section 1115 waiver that would allow it to disregard the provisions of the Affordable Care Act that require states to maintain their 2010 levels of Medicaid eligibility through 2014 when the nationwide Medicaid expansion takes effect (known as Maintenance of Effort, or MOE). The MOE waiver that Wisconsin is proposing would raise premiums to five percent of family income on families with incomes above 150 percent of the poverty line. According to Wisconsin’s Legislative Fiscal Bureau, this change would cause more than 19,000 individuals from BadgerCare to lose coverage, about 12,100 of whom are children.

 

Our groups’ letter explains that “approving this request would set a precedent that we believe would be harmful for children, families and people with disabilities… We believe that Section 1115 demonstration projects should test and evaluate new and innovative approaches to providing health care to Medicaid beneficiaries and other low-income persons. We do not believe that eliminating coverage for thousands of persons is consistent with Section 1115 authority.” 

 

 

 

Are you ready for the major changes of the Affordable Care Act that will go into effect in 2012? At the National Council’s annual conference, to be held this year April 15-17 in Chicago, we have a full line-up of sessions to help you make the most of the changes ahead – and to learn from presenters that have already hit “health reform home runs” in their states. Our sessions include:

Visit our website to view the preliminary program, check out our roster of influential and exciting keynote speakers, and register to get our lowest rates.