NHeLP Matters – June 2015

NHeLP Matters – June 2015

Executive Summary

Summary of recent accomplishments of NHeLP, including implementing the Affordable Care Act, expanding Medicaid and protecting women’s health.

Five years later, and the Affordable Care Act continues to be the source of historic coverage expansions and continuing litigation. Now more than ever, NHeLP remains committed to protecting and fully implementing the law. Learn more about NHeLP’s work to expand access to quality, affordable care for all.


The ACA is Here to Stay
The Supreme Court’s decision in King v. Burwell was a vindication of the Affordable Care Act. NHeLP, in partnership with AARP, filed an amicus brief in King supporting the availability of the ACA’s tax credits in all Marketplaces. The brief focused on the importance of the ACA to pre-Medicare older adults, and details how the availability of tax credits is crucial to achieving the ACA’s mission of providing near-universal health care coverage. In addition to having our voice heard at the Court, NHeLP worked to shape the public debate leading up to the decision. With the Supreme Court victory, our work going forward will focus on the remaining 21 states where low-income people could be insured under the Medicaid expansion.

Managing Medicaid Managed Care 
For the first time in a decade, federal officials are overhauling the rules governing Medicaid managed care. The impact of these rules is significant as 75 percent of Medicaid beneficiaries receive services though some type of managed care arrangement – and that proportion will surely rise as additional people become eligible, thanks to the Affordable Care Act (ACA). Since the 1980s, NHeLP has led consumer advocacy efforts to review proposed regulation, as well as monitoring Medicaid managed care trends at the federal, state and local levels. NHeLP’s recently released Guide to Oversight, Transparency and Accountability in Medicaid Managed Care builds on this expertise and provides a robust set of tools, tips and techniques to obtain information about states’ managed care programs. The Guide is a “must-have resource” for advocates working in this arena, particularly as federal regulations change.

Obamacare Victory Puts Reticent States on Notice
Since 2010, states have enacted a number of roadblocks designed to prevent or impair the ability of consumer assisters to enroll people in ACA coverage. In the first case of its kind, NHeLP joined Mehri & Skalet, PLLC and sued Missouri over the restrictions that a state law placed on what consumer assisters could say to potential enrollees and otherwise limited their ability to help consumers. On April 10, the Eighth Circuit Court of Appeals handed down a decided victory that sends a powerful message not only to Missouri, but to policymakers in other states who are trying to make it difficult for their residents to get information about the ACA. The message is clear: states cannot create roadblocks to coverage.


Contraceptive Coverage Battles Continue
Challenges to the ACA’s contraceptive coverage requirement have not ended with the Supreme Court’s Hobby Lobby ruling. NHeLP continues to lead efforts to defend and fully implement the provision that is already benefiting millions of women. The ACA’s contraceptive coverage requirement is backed by law and good public policy. NHeLP filed an amicus brief in the Seventh Circuit Court of Appeals case, Wheaton College v. Burwell, a case brought by a non-profit employer who refuses to even sign a form that would allow employees to obtain contraceptive coverage elsewhere. NHeLP’s brief was joined by 16 organizations, including the American Public Health Association and the National Family and Reproductive Health Association. Thus far, four federal appellate courts- the Third, Sixth, Seventh, and DC circuits- have decided challenges to the non-profit accommodation on the merits. All of the courts have rejected the opponent’s claims.

The New Online LARC Guide 
Long-acting reversible contraceptives (LARC) offer highly safe and effective options for people trying to avoid pregnancy. NHeLP partnered with the American College of Obstetricians and Gynecologists (ACOG), National Family Planning and Reproductive Health Association (NFPRHA), National Women’s Law Center (NWLC) and University of California, San Francisco (UCSF) Bixby Center for Global Reproductive Health to release the “Intrauterine Devices and Implants: A Guide to Reimbursement.” The online guide explains the landscape of LARC public and commercial insurance coverage and serves as a resource for providers navigating stocking, reimbursement and other scenarios that create barriers to the provision of these methods. The guide is intended to help address financial challenges so that providers are better able to offer the full range of contraceptive methods and minimize out-of-pocket costs or delays in care for their patients.


Keeping the “Essential” in Essential Health Benefits 
Essential health benefits ensure that consumers have real value in their Marketplace plans and maximize coverage for enrollees. In response to HHS’ revised standards for the health benefits package in the Marketplace, NHeLP released a series of publications equipping advocates with the information to stay abreast of the latest policy changes, namely transparency in health insurance drug lists and how consumers can get exceptions to coverage limits. Affordability and access remain paramount concerns as enrollment continues to grow.

69 Million Reasons to Defend Medicaid 
When we talk about Medicaid, we talk about two issues: the effectiveness and vitality of the program, and how often it is threatened and comes under attack. Medicaid is vital to the 69 million vulnerable individuals and families who rely on it and includes critical protections not found in other programs. Each time Medicaid is threatened with spending caps and cuts, we come to its defense armed with facts and the reality of how much harm cuts would do to those who need the program most. NHeLP’s Protect Medicaid Funding series breaks down how critical Medicaid is and the dire harm that would result, whether it is to children, women, older adults, individuals with disabilities or providers.


Health Coverage Restored for Vulnerable Californians 
NHeLP successfully challenged and changed an illegal state policy that caused tens of thousands of California residents on Medi-Cal over age 65 or who have a disability to lose their Medi-Cal coverage at the time of annual renewal. The illegal state policy applied wrong and complex income rules, resulting in their termination from coverage when residents failed to respond to requests for tax-based income information (or forms) required under new ACA rules. The state directed California’s counties to halt ongoing terminations and restore eligibility to tens of thousands of beneficiaries. In March through April of 2015, eligibility was restored for thousands of Medi-Cal beneficiaries who were cut off, ensuring this vulnerable population would have ongoing access to health care services without interruption.

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