State Medicaid Snapshot: Affordable Care Act Implementation As of July 31, 2013
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1 State Medicaid Snapshot: Affordable Care Act Implementation As of July 31, 2013 NAMD offers several resources to assist Medicaid directors in their ongoing work to come into compliance with the Affordable Care Act s (ACA) Medicaid-related requirements. This work also reflects options the ACA newly made available to states, specifically the new eligibility expansion option. The periodic State Medicaid Snapshot is one tool which allows Medicaid directors to monitor their state s progress in relation to other states. The enclosed snapshot of progress is based on NAMD s outreach to a representative sample of states at a point during the period from late June through the end of July. NAMD s communication with the states focused on several critical operational areas, including systems connectivity and submission of and approval for state plan amendments. The snapshot also seeks to gauge the time horizon for the portfolio of ongoing tasks states are working to complete. The Association plans to continue this initiative with states and will issue periodic reports accordingly. 444 North Capitol Street, Suite 524 Washington, DC Phone:
2 Progress Summary PCP Rate Bump A majority of states have reported that they have implemented and are currently paying the enhanced rate. E & E System Most state have designed and issued an RFP, and are currently working through system requirements with vendors and testing this month or next. States did not report eligibility and enrollment systems that are operational and in use. Hub Testing Most states have established a connection with the Federal hub and are moving on to testing functionality and interoperability. Identity Proofing This month, states are in the process of designing their identity proofing concepts and a few states are in testing phases of their identity proofing concepts. States plan to meet goals of testing and implementing systems next month or later. 7 Conditions for Enhanced FMAP States were split on whether they had met the conditions for the enhanced FMAP for eligibility-related systems and activities. States are either currently meeting the FMAP requirements or plan to meet the requirement in out months. Few states anticipated that they would meet the requirements next month. Income Conversion Income conversion is an area of implementation where most states are close to completion, reporting that they have submitted SPAs to CMS and are waiting for approval. Page 2 of 5
3 Targeted Enrollment States that have submitted plans to implement a targeted enrollment strategy mostly reported submitting early adoption of MAGI-conversion rules and a plan for extending the Medicaid renewal period this month. Streamlined App Most states working on their streamlined application have made modifications, and plan to submit to CMS for approval this month. PE Approval All states reported being in the designing phase for Presumptive Eligibility Approval.* *note some states surveyed already have presumptive eligibility programs in their state hospitals and community health centers. These survey answers were not included in the progress assessment of states currently implementing a new program. For Expansion States FMAP Claiming States reported being in a variety of stages with their FMAP claiming methodology. For the most part, states are submitting their plans over the next month and waiting for CMS approval. ABP Status Expansion states are still in the early phases of alternative benefit package development. States are currently designing benefit packages and submitting SPAs to CMS, others are planning to submit a SPA within the next month. Communications Most states reported launching an application assister initiative this month or are planning an August launch. Though they are working on outreach initiatives, states are still in the designing phase of communications strategies and call center development. Page 3 of 5
4 Big Questions and Challenges Issues External to the Medicaid Agency Federal Agency Coordination Many states are working on ways to crosswalk the guidance released from CCIIO and CMS. Consistency and maximum flexibility between the two agencies guidance documents would assist states as in their ongoing implementation activities. CMS Guidance The volume and frequency of guidance releases from CMS guidance is challenging state capacity to adapt quickly to new options and requirements. CMS continues to issue many levels of guidance that states are working to implement at the fastest rate possible. Hub Testing States reported a variety of levels where they are testing their systems including: basic functionality, regression, and end to end testing. On the docket for next month, more states expect to be in the end to end testing and a few anticipate being in the production readiness phase of the hub testing process. Overall, states have completed the task of establishing a connection, but have not reached the production readiness phase. Compressed testing schedules create challenges for timely implementation. While most states have made a connection to the federal hub, many have not fully tested the functionality and interoperability of their systems. Legislature Implementation of the Affordable Care Act has been a hot button issue in many state legislatures during every phase of the implementation process. In several states, the controversial nature of these ACA deliberations has resulted in uncertainty about the scope and resources available to the Medicaid agency. Messaging States are developing messaging strategies to reach out to potential beneficiaries. Many states are receiving questions from stakeholders and interested parties regarding expectation for the enrollment go-live date of October 1. States would like more guidance on crafting cohesive messaging that is easily understood by the populations that will be transferring programs and that will be eligible to receive care in the future. Issues Within the Medicaid Agency Enrollment and Waiver Changes States are working on a variety of unexpected enrollment issues caused by ACA implementation that are creating internal challenges. With the addition of the new adult eligibility group, many states are Page 4 of 5
5 making decisions on how to handle populations that are already covered, but will be moved into the new expansion population. States are working to find ways to aligning their current Medicaid program with new requirements and continuing continuity of care. States are discussing solutions to phase these programs out or change them without drastic impacts on members. Contingency Planning As with other major program implementations, states are preparing contingency plans and crisis mitigation procedures. They are also working to synch these with federal implementation activities. Administrative Burden - Staffing is a point of contention for many states because for the present, they are not being compensated for additional workload and the need to hire additional people. Along with current concerns, states do not know what the demands will be on the systems and the call centers, and therefore the amount of additional long term staffing that will be needed. Page 5 of 5
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