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MACPAC Studies Interaction Between Medicaid and Exchanges

By Rebecca Adams, CQ HealthBeat Associate Editor

May 16, 2013 -- The Centers for Medicare and Medicaid Services (CMS) has put out most of the rules to implement coverage changes under the health care law, but a top official recently said that the public should expect more guidance on such issues as outreach and the enrollment of lawmakers and their staffs into the new marketplaces that will start accepting people in October.

Chiquita Brooks-LaSure, the deputy director for policy and regulations at the CMS Center for Consumer Information and Insurance Oversight (CCIIO), offered few new details in her wide-ranging remarks to the Medicaid and Children's Health Insurance Program  Payment and Access Commission (MACPAC). But she did respond to a question about lawmakers' enrollment in the exchanges by saying that CCIIO will be offering more information on that issue.

"They are, as you know, slated to enter the marketplaces and there will certainly be more guidance forthcoming on that," said Brooks-LaSure.

She also reminded the audience that the agency is expected to release a final rule on the navigators this summer. In March, federal officials released a proposed rule on the navigators program, including information about certification. The comment period on that proposal closed this week and federal officials are reviewing the comments.

"Throughout the summer, we will continue to put out more guidance," she said.

She also offered a reminder that the due date to apply for navigator funding through the federal marketplace is June 7.

Navigators will help consumers understand their choices and the application process as they try to enroll in Medicaid or the marketplaces this fall. They will assist consumers with their electronic and paper applications, help them find out whether they might be eligible for tax credits, and give guidance to people as they go through enrollment.

CMS officials have previously said that awards are expected by Aug. 15, about six weeks before the exchanges begin enrolling people on Oct. 1. CMS officials said they would award $54 million in navigator grants in states where the federal government will operate the exchange or where there will be a federal-state partnership. That money had to be shifted from the federal prevention and public health fund created in the health care law (PL 111-148, PL 111-152) when Congress refused to provide money for enrollment.

Premium Assistance

Also during the meeting, MACPAC analyst Chris Peterson provided information to the commissioners about premium assistance, a technique in which Medicaid or the Children's Health Insurance Program pays for private insurance premiums for a beneficiary. In the past, that has typically been used to pay for employer-sponsored insurance, but some states are looking to use the idea by paying for Medicaid beneficiaries' coverage in the new marketplaces.

About 39 states used premium assistance in 2009, according to the Government Accountability Office, but its use was rare. Premium assistance accounted for about 0.06 percent of Medicaid spending in fiscal 2009.

Now states such as Arkansas want to use Medicaid dollars to buy insurance for newly eligible people in the exchanges. Arkansas passed a state law last month endorsing that plan but the state has not yet submitted a detailed proposal to CMS for approval, noted MACPAC Chairwoman Diane Rowland.

MACPAC Commissioner Sara Rosenbaum proposed that the panel devote "considerable MACPAC resources" to studying the issue of premium assistance and coordination between Medicaid and private insurance in the future.

The issue is complicated and policy analysts have many questions about the impact on consumers.

"I think we're going to confront this more and more and more," said Rosenbaum.

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