ADEA State Update

July 2013 Reports of Interest

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The Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) released its June 2013 Report to the Congress on Medicaid and CHIP. The report examines Medicaid and CHIP eligibility and coverage for maternity services, the newly implemented increase in Medicaid physician payment for primary care services, access to care for persons with disabilities, the availability of data on Medicaid and CHIP that can be used for oversight and program monitoring, and ways to improve the effectiveness of program integrity efforts. According to the report in 2010, Medicaid and CHIP paid for almost half of all births in the United States (about 1.8 million hospital births). Further, many states offer benefits to pregnant women that are not offered to other Medicaid adult enrollees, including dental services.

The Congressional Research Service issued a report which outlines the required minimum functions of exchanges, explains how exchanges are expected to be established and administered under the Affordable Care Act, and the coverage offered through the exchanges. The report comments on stand-alone dental plans, specifically mentioning that the final exchange regulation clarifies that stand-alone dental benefits may be offered in a plan separate from, or in conjunction with, a qualified health plan (QHP), as specified in the law. Exchanges may not limit the offer of stand-alone dental benefits to only one of these two options. In other words, issuers have sole discretion regarding (1) whether they will offer stand-alone dental benefits, and (2) the form in which those benefits will be provided (i.e. separate from, or in conjunction with, a QHP).

The U.S. Government Accountability Office (GAO) released a report finding that certain activities needed to fully implement the Affordable Care Act in states with a federally facilitated exchange–such as the final testing of data hubs that will provide electronic access to the state and federal data that is necessary to verify consumer-eligibility information, and the training of consumer assistance guides–are behind schedule. According to the GAO, the Centers for Medicare & Medicaid Services (CMS) will operate a health insurance exchange in the 34 states that will not operate a state-based exchange for 2014. Of these 34 federally facilitated exchanges (FFE), 15 are in states expected to assist CMS in carrying out certain FFE functions. However, the activities that CMS plans to carry out in these 15 exchanges, as well as in the state-based exchanges, have evolved and may continue to change. For example, CMS approved the states’ exchange arrangements on the condition that they ultimately complete the activities that are necessary for exchange implementation. CMS indicated that it would carry out more exchange functions if any state did not adequately progress towards the implementation of all required activities. Although CMS completed many of the activities that are necessary to establish FFEs by October 1, 2013, many remain to be completed.

The Robert Wood Johnson Foundation and the Urban Institute issued a report as part of its project to monitor and track state implementation of the Affordable Care Act (ACA). Specifically, the project monitors ACA and health reform activity in the following states: Alabama, Colorado, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island, and Virginia. According to the report: 1) considerable variation in preparedness and effort exists across the federally facilitated exchange states; 2) state departments of insurance seem to see many of the roles delineated under exchange plan management as a continuation or modification of their traditional regulatory roles; and 3) consumer assistance functions under the ACA require the development of new programs and may present more of a challenge than plan management.

The Agency for Healthcare Research and Quality (AHRQ) issued its 2012 National Healthcare Disparities Report, finding that emergency departments (EDs) often cannot provide definitive dental treatment and can only provide medication for pain and infection. Hence, use of EDs for dental conditions may reflect system inefficiency in the delivery of dental care (see PDF page 7-7).

Duggan Dental