The Consumer Assistance Program Resource Center is a compilation of materials and information about these programs, which have helped thousands of consumers. It includes information on best practices, profiles of selected state programs, and a discussion of why these programs continue to need federal funding. (Added January 2012)

The Consumer Assistance Program Locator has been updated. Click on your state  and get a list of consumer assistance programs. (Updated July 2011)

Healthcare 411 is a new online resource for health care consumers and providers. The site, available in English and Spanish, offers videos, podcasts, and articles offering a wide range of health tips from the U.S. Agency for Healthcare Research and Quality.

Questions Are the Answer encourages patients to talk to their doctors and suggests questions to ask before, during, and after your appointments. This new web resource is aimed at helping consumers communicate better with their health care providers. It was launched by the federal Agency for Healthcare Research and Quality.

Understanding Evidence-Based Healthcare. This web course has been created by the United States Cochrane Center as part of a project undertaken by Consumers United for Evidence-based Healthcare (CUE), and is designed to help consumer advocates understand the fundamentals of evidence-based healthcare concepts and skills. Registration is open and free of charge.

Most Families USA materials are intended for policy specialists and advocates. However, we do have some materials, listed below, that are written specifically for consumers.

For Consumers

YourHealthNet Consumer Health Research Website People want to be engaged in decision making about health care for themselves and their families. But to make informed decisions, consumers need to have access to high-quality research from independent sources. The Centre for Health Communication and Participation’s website explains evidence-based health research and systematic reviews in a visually appealing and user-friendly way, and it explains how patients can use this information to help make health care decisions. The site also provides recordings of real consumer stories where people describe how they used the reviews to inform their health decision making. Useful links to other consumer-oriented health research websites are included on the Resources page.

Health Law Guide allows you to enter your information and get a customized fact sheet with details about consumer protections and about new coverage options you may be eligible for under the Affordable Care Act. The guide will be updated as implementation of the law continues. (March 2012)

FAIR Health uses its database of billions of billed medical and dental charges to power a free website that enables consumers to estimate and plan their medical and dental expenditures. The website also offers unbiased educational articles and videos about the health insurance reimbursement system.

• FH Reimbursement 101 is a series of guides that use plain language to help consumers better understand their health care costs and insurance reimbursement. Each guide offers comprehensive answers to common questions and directs consumers to resources where they can find additional information.
• FAIR Health’s Consumer Cost Lookup tools help consumers estimate and plan their medical and dental expenses.
• FH Medicare Compare helps consumers estimate their potential out-of-pocket expenses if their plan has converted to Medicare-based reimbursement. The migration of some health plans to a formula using a percentage of Medicare for out-of-network claims has created confusion among consumers and employers. This tool is designed to address this confusion.
  

Five Things Physicians and Patients Should Question was created by nine physician specialty societies, which identified a total of 45 tests or procedures that are common but not always necessary. The societies partnered with Consumer Reports Health to present the information in a user-friendly way. This information will help you and your doctor make informed decisions. (April 2012)

Getting Covered: Finding Health Insurance When You Lose Your Job is designed to help consumers who’ve lost their health coverage sort through possible options for new coverage, including COBRA, Medicaid, CHIP, other federal and state programs, and the individual market. (Updated February 2012)

Consumer Involvement in Guideline Development: Why and How to Participate is a video that explains the process of developing clinical practice guidelines and the need for educated consumers to serve on clinical practice guideline panels. In March 2011, the Institute of Medicine released its report, “Clinical Practice Guidelines We Can Trust.” Standard 3 of this report outlines the expectations for consumer involvement. (March 2011)

Why We Need a Health Insurance Exchange is a one-page handout that cites several reasons why consumers will benefit from the new exchanges, including competition, affordability, and quality. (June 2011)

The Affordable Care Act: Patients’ Bill of Rights and Other Protections is a compilation of all of our fact sheets to date on consumer rights and protections. (April 2011)

Medicare’s New Preventive Care Benefit: What It Means for You A consumer fact sheet on Medicare’s new preventive care benefit under the Affordable Care Act (March 2011)

Medicare’s New Wellness Visit: What It Means for You A consumer fact sheet on Medicare’s new wellnss visit benefit under the Affordable Care Act (March 2011)

The Health Care Law: Good News for Caregivers discusses how the health care law will help build the long-term care workforce, encourage states to expand home- and community-based services in Medicaid, improve resources for caregivers, and expand protections for people in long-term care facilities. | The Affordable Care Act: Provisions that Will Help Caregivers (March 2011)

Exposing Scam Insurance Plans Scam insurance plans often take advantage of consumers during economic downturns. Lately, so-called “associations” have been marketing phony health insurance plans. Before you buy insurance, make sure it is licensed in your state. To check on a policy, contact your state insurance department—you can find their information on the website of the National Association of Insurance Commissioners. Also, check out our report, Buyer Beware: Unlicensed Insurance Plans Prey on Health Care Consumers. (October 2010)

Families USA had prepared a series of fact sheets on the Patients’ Bill of Rights and other consumer protections in the Affordable Care Act that took effect on September 23. (September 2010)

• Ending Annual and Lifetime Limits
• Enhancing Access to Preventive Services
• Ensuring Coverage for Consumers with Pre-Existing Conditions
• Ensuring Fair Treatment When You Need Emergency Care
• Ensuring the Right to Appeal Health Plan Decisions
• Ensuring the Right to Choose Your Doctor
• Making Sure Your Policy Can’t Be Canceled Unfairly

Health Coverage for Young Adults: Health Reform Will Soon Allow You to Stay on Your Parent’s Health Plan is a fact sheet aimed at young adults (and their parents) that is designed to answer important questions about this new opportunity to keep or obtain health coverage for young adults up to age 26. (May 2010)

State Guides to Finding Health Coverage Whether you have recently lost your job, are an early retiree, or have a serious medical condition, these guides include numerous resources that may help you find the coverage you need. (Updated 2009)

Your Medical Bills: A Consumer’s Guide to Coping with Medical Debt covers steps for paying your medical bills, understanding your rights, and other information you need to know if you are struggling with medical debt. The guide also includes links to many useful online resources. | Fact Sheet | State Protections (November 2009)

What Is a “Special Enrollment Opportunity” and Why Should I Care about It? discusses who may have the option of signing up for job-based health coverage when it isn’t open season. (June 2009)

Your Guide to HIPAA Protections The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that helps protect your rights to health coverage when you move from one health plan to another health plan. This guide describes those protections and under what circumstances they may or may not apply. (June 2007)

Consumer Info Need help finding health insurance or learning about your rights to health care? See our list of resources.

For Consumer Advocates

The following materials are resources for advocates and professionals who assist consumers:

FAIR Health uses its database of billions of billed medical and dental charges to power a free website that enables consumers to estimate and plan their medical and dental expenditures. The group’s cost lookup tools can help you assist consumers in your state by helping them estimate out-of-pocket medical costs, negotiate lower out-of-pocket costs, manage high-deductible health plans, or helping uninsured consumers estimate costs before they seek care. You can also help consumers learn about their insurance benefits and the health care reimbursement system by sharing the Reimbursement 101 series with them. The group also has an “Employer Toolkit” that includes an overview of the types of free resources it offers to employers to share with their employees.

Medicare’s New Preventive Care Benefit: What It Means for You A consumer fact sheet on Medicare’s new preventive care benefit under the Affordable Care Act (March 2011)

Medicare’s New Wellness Visit: What It Means for You A consumer fact sheet on Medicare’s new wellnss visit benefit under the Affordable Care Act (March 2011)

Designing a Consumer Health Assistance Program discusses these programs and how health reform will dramatically expand the assistance they provide. It reviews key considerations to keep in mind when designing such programs, including grants and other funding, function, scope, location, staffing, training, and outreach. (August 2010)

Medicaid: Making It Work for Consumers provides resources to help explain how consumer assistance programs, states, and advocates can help with some common Medicaid problems

Private Insurance Legal Rights lists resources on laws and regulations in the private health insurance market.

Welcome! This section of the Web site features materials we hope will be useful to health care advocates across the country.

• Guides that explain the basics of public programs and provide tips for effective advocacy
• Action Kits (includes tool kits from our annual grassroots conferences)
• New on the Web offers you an archive of our periodic e-mail notices of reports and other resources that are available on the Web.
• The Health Care Glossary provides comprehensive definitions for commonly used health care terms and acronyms (updated January 2011).
• Advocacy & Media Tip Sheets offer pointers for writing to your elected officials, holding meetings with them, and otherwise making your advocacy more effective.
• ImPRESSive, Families USA’s archive of media guides, offers tips for working with the media to get your message out.
• Archive of our Conference Call for State Advocates Series.
• Other Tools: information from other organizations.

 

“Of all the forms of inequality,
injustice in health care is the most
shocking and inhumane.”
– Dr. Martin Luther KingRacial and ethnic minorities in the U.S. are more likely to lack health insurance, receive lower-quality care, and suffer from worse health outcomes. While the causes of health disparities are complex, we know the time to take action is now . . .

The Latest

From the California Pan-Ethnic Health Network, the UCLA Center for Health Policy Research, and the UC Berkeley Labor Center:

Achieving Equity by Building a Bridge from Eligible to Enrolled explains the importance of doing culturally and linguistically appropriate outreach and education to facilitate enrollment in health coverage. Without effective multilingual efforts in California, language barriers may mean that 110,000 fewer people with limited English proficiency enroll in coverage through the state’s exchange. (February 2012)

From the Center for Health Care Strategies, the National Academy for State Health Policy, and the Robert Wood Johnson Foundation:

Implications of Health Reform for American Indian and Alaska Native Populations outlines provisions of the Affordable Care Act that uniquely affect these populations, including expanded coverage through Medicaid and the exchanges, outreach to tribal groups, and improved organization and financing of care. (February 2012)

From the National Health Law Program:

Top Ways Health Reform Helps provides the top five ways the Affordable Care Act helps the following groups: Medicaid beneficiaries, older adults and people with disabilities, women, and children and young adults. It also explains how the health care law addresses disparities and helps people get coverage. The lists are divided into provisions that are already in effect and those that are coming soon. (March 2012)

Keep Up-to-Date

Health Equity Connection: This monthly newsletter is designed to keep advocates connected to the most pressing issues affecting minority health. Topics include the latest resources in minority health, how major health policy issues (including health reform) affect communities of color, and comments from leaders in the field of racial and ethnic health disparities.

Let Your Voice Be Heard

If you have questions about minority health, or if you have suggestions about topics that you’d like to see addressed on our website, please let us know. For more information about Families USA and our work in health equity, contact Sinsi Hernández-Cancio, Health Equity Director, at 202-628-3030.

Most Americans receive their health coverage through the private insurance market, usually through their jobs. However, many people buy insurance on their own in the individual market. Since coverage from private companies is the largest source of insurance for Americans, it is likely to be a central part of federal and state health reform efforts.

This section of our Web site keeps you up-to-date on what’s happening in the private health insurance arena.

The Latest

From Families USA:

Making the Most of Accountable Care Organizations (ACOs): What Advocates Need to Know provides an overview of ACOs; the promise they hold; and how they could change Medicare, Medicaid, and the health care landscape. It also identifies key challenges in their development and suggests how advocates can get involved in ways that benefit patients. (Updated February 2012)

Implementing the Patient Protection and Affordable Care Act: A 2012 State To-Do List for Exchanges, Private Coverage, and Medicaid gives state advocates an in-depth blueprint for action in 2012, outlining issues to start thinking about and tasks that deserve immediate attention. (February 2012)

2012 Federal Poverty Guidelines are now available from HHS, and Families USA has calculated the figures for various household sizes by percentage of the federal poverty level.

Regulations and Guidance for the Affordable Care Act: The Centers for Medicare and Medicaid Services (CMS), the Department of Health and Human Services (HHS), the Department of Labor (DOL), and the Internal Revenue Service (IRS) have issued interim final rules and requests for information on several provisions of the health reform law pertaining to private insurance. Families USA has submitted commments on many of these provisions. Click here for our Regulations and Guidance page.

From AARP and Avalere Health:

Health Law Guide allows you to enter your information and get a customized fact sheet with details about consumer protections and about new coverage options you may be eligible for under the Affordable Care Act. The guide will be updated as implementation of the law continues. (March 2012)

From the Alliance for Health Reform:

Trends in Retail Prices of Prescription Drugs Widely Used by Medicare Beneficiaries 2005 to 2009 compares the rate of change in prescription drug prices to the rate of inflation. It finds that the growth in prices for a set of commonly used drugs was almost double the rate of inflation. (March 2012)

Essential Health Benefits: Balancing Affordability and Adequacy answers the following questions: How do states select and design “benchmark” plans that are both comprehensive and affordable? How will states and HHS ensure that benefits are sufficiently standardized so that consumers and employers can choose plans based on differences in premiums and cost-sharing? And are there opportunities for using the essential health benefits to lower health spending? (February 2012)

From the California Pan-Ethnic Health Network, the UCLA Center for Health Policy Research, and the UC Berkeley Labor Center:

Achieving Equity by Building a Bridge from Eligible to Enrolled explains the importance of doing culturally and linguistically appropriate outreach and education to facilitate enrollment in health coverage. Without effective multilingual efforts in California, language barriers may mean that 110,000 fewer people with limited English proficiency enroll in coverage through the state’s exchange. (February 2012)

From the Center for Economic and Policy Research and Georgetown University:

Health-Insurance Coverage for Low-Wage Workers, 1979-2012 and Beyond discusses the steady decline in coverage for low-wage workers over the past three decades, but it also explains that the experience with health reform in Massachusetts suggests that the Affordable Care Act may reverse this trend. (February 2012)

From the Center for Health Care Strategies, the National Academy for State Health Policy, and the Robert Wood Johnson Foundation:

Implications of Health Reform for American Indian and Alaska Native Populations outlines provisions of the Affordable Care Act that uniquely affect these populations, including expanded coverage through Medicaid and the exchanges, outreach to tribal groups, and improved organization and financing of care. (February 2012)

From the Center on Budget and Policy Priorities:

Georgia’s Tax Breaks to Increase Use of Health Savings Accounts Did Not Expand Health Coverage: Plan Promoted by Gingrich Group Has Failed to Deliver explains how this approach, which was designed to reduce the number of uninsured Georgians by 500,000, has actually increased the number of uninsured people by 319,000. (February 2012)

From the Centers for Disease Control and Prevention (CDC):

Financial Burden of Medical Care: Early Release of Estimates from the National Health Interview Survey, January—June 2011 finds that, among many statistics, one in three people was in a family that experienced a financial burden because of medical bills. (March 2012)

From the Centers for Medicare and Medicaid Services (CMS):

Frequently Asked Questions on Essential Health Benefits Bulletin answers questions for advocates and policy makers who are working to define the Essential Health Benefits package in their state. Topics include funding of state-mandated benefits, selection of benchmark plans, and coverage of preventive health services. (February 2012)

From the Commonwealth Fund:

Implementing the Affordable Care Act: State Action on Early Market Reforms explains that 49 states and the District of Columbia have worked to implement certain consumer protections that took effect in 2010. It also suggests that, even if legislative action is difficult, states can still make progress with implementation by issuing sub-regulatory guidance and verifying insurers’ compliance with the law. (March 2012)

The Income Divide in Health Care: How the Affordable Care Act Will Help Restore Fairness to the U.S. Health System explains that the law will narrow the income divide in health coverage and access through expanded Medicaid eligibility, state insurance exchanges, premium tax credits, cost-sharing protections, and the individual mandate. (February 2012)

From the Department of Health and Human Services (HHS):

Under the Affordable Care Act, 105 Million Americans No Longer Face Lifetime Limits on Health Benefitsbreaks down the number of Americans who are enjoying improved coverage without lifetime limits by age group, state, and race or ethnicity. (March 2012)

Fifty-Four Million Additional Americans Are Receiving Preventive Services Coverage without Cost-Sharing under the Affordable Care Act breaks down the number of Americans who are receiving preventive services with no cost-sharing by age group, state, and race or ethnicity. (February 2012)

From Health Affairs:

Employers and the Exchanges under the Small Business Health Options Program: Examining the Potential and the Pitfalls introduces a collection of articles in the February issue of “Health Affairs” that discuss the need for small business exchanges and how they will function. It also examines the difficulties that exchanges will face and the opportunities they will offer to states, employers, and individuals. (February 2012)

From Health Affairs and the Robert Wood Johnson Foundation:

Small Business Insurance Exchanges examines issues that states have to address in designing Small Business Health Option Program (SHOP) exchanges and the challenges advocates and policy makers? are likely to face. Although exchanges for individuals and small businesses will have similar functions, they will have unique attributes reflecting the populations they serve. (February 2012)

From the Kaiser Family Foundation:

Policy and Political Implications of the Supreme Court Case on the Affordable Care Act is a webcast that includes a release of new polling data on the public’s view about the case and the health care law. It also considers the case’s potential implications for the future of the law and for federal and state health policy. (March 2012)

Mapping the Effects of the ACA’s Health Insurance Coverage Expansions allows you to enter a zip code and get an estimate of the share of the population in that region that will benefit from the Affordable Care Act through either Medicaid or tax credits for private insurance in the exchanges. (February 2012)

From the National Health Law Program:

Top Ways Health Reform Helps provides the top five ways the Affordable Care Act helps the following groups: Medicaid beneficiaries, older adults and people with disabilities, women, and children and young adults. It also explains how the health care law addresses disparities and helps people get coverage. The lists are divided into provisions that are already in effect and those that are coming soon. (March 2012)

From the National Women’s Law Center:

Turning to Fairness: Insurance Discrimination against Women Today and the Affordable Care Act discusses the practice of gender rating, in which insurance companies charge women different premiums than men. Gender rating costs women about $1 billion a year, but the Affordable Care Act will outlaw this practice in 2014. (March 2012)

From the Robert Wood Johnson Foundation and the Urban Institute:

The Individual Mandate in Perspective estimates the number of Americans who would be subject to this provision in the Affordable Care Act, identifies their insurance status without the law, and simulates their eligibility for Medicaid or premium tax credits. It finds that 94 percent of people would not be required to newly purchase coverage or pay a fine. (March 2012)

ACA Implementation in Oregon—Monitoring and Tracking is the first of 10 state reports that analyze the effects of the Affordable Care Act on coverage, health expenditures, affordability, access, and premiums. It also assesses Oregon’s progress with implementation of the law. The remaining nine reports will examine the following states: AL, CO, MD, MI, MN, NM, NY, RI, and VA. (February 2012)

As insurance premiums rise and more employers drop coverage, an increasing number of Americans are living without health insurance. Nearly one in three non-elderly Americans—86.7 million people—went without health coverage for all or part of 2006-2007. And four out of five of those individuals were in working families.

Why does insurance matter? People without insurance are more likely to go without preventive care, to delay or forgo medical care, and to die prematurely. When sick, the uninsured may turn to emergency rooms for care, where oftentimes they are charged more for services than insured patients. And when uninsured patients can’t afford their medical bills, the cost of this care is passed on to the insured in the form of higher premiums.

This section of our Web site explores who is uninsured and how we can increase coverage.

For information on how the new health care law will help the uninsured, go to Health Reform Central.

The Latest

From the Center for Economic and Policy Research and Georgetown University:

Health-Insurance Coverage for Low-Wage Workers, 1979-2012 and Beyond discusses the steady decline in coverage for low-wage workers over the past three decades, but it also explains that the experience with health reform in Massachusetts suggests that the Affordable Care Act may reverse this trend. (February 2012)

From the Center on Budget and Policy Priorities:

Georgia’s Tax Breaks to Increase Use of Health Savings Accounts Did Not Expand Health Coverage: Plan Promoted by Gingrich Group Has Failed to Deliver explains how this approach, which was designed to reduce the number of uninsured Georgians by 500,000, has actually increased the number of uninsured people by 319,000. (February 2012)

From the Kaiser Family Foundation:

Mapping the Effects of the ACA’s Health Insurance Coverage Expansions allows you to enter a zip code and get an estimate of the share of the population in that region that will benefit from the Affordable Care Act through either Medicaid or tax credits for private insurance in the exchanges. (February 2012)

From the National Health Law Program:

Top Ways Health Reform Helps provides the top five ways the Affordable Care Act helps the following groups: Medicaid beneficiaries, older adults and people with disabilities, women, and children and young adults. It also explains how the health care law addresses disparities and helps people get coverage. The lists are divided into provisions that are already in effect and those that are coming soon. (March 2012)

From the Robert Wood Johnson Foundation and the Urban Institute:

The Individual Mandate in Perspective estimates the number of Americans who would be subject to this provision in the Affordable Care Act, identifies their insurance status without the law, and simulates their eligibility for Medicaid or premium tax credits. It finds that 94 percent of people would not be required to newly purchase coverage or pay a fine. (March 2012)

Currently, more than 10 million Americans rely on long-term services and supports for their health and well-being. And that number will only increase dramatically as Baby Boomers age. Yet the United States has never had a system that ensures access to affordable and appropriate long-term care.

Health reform lays the foundation for changing that. It provides new opportunities for states to expand and strengthen home- and community-based programs in Medicaid, the major payer for long-term services. Medicaid coverage for these critical services is optional and varies widely from state to state. Health reform also establishes a voluntary insurance program for long-term services, the Community Living Assistance Services and Supports program (CLASS).

This section of our website looks at current long-term services coverage, the new options and programs that are part of health reform, and how these new options can make a difference nationally and at the state level. Even though health reform lays a foundation for improving access to long-term services, much more needs to be done. Under “Other Issues,” you can find information on legislative proposals to improve long-term care, promising practices, and innovative ways to cover and provide care in the United States and internationally.

The Latest

Recent Developments

• On April 27, 2012, CMS released the final rule for the Community First Choice (CFC) option, created by the Affordable Care Act, which provides a 6 percent enhanced federal match for states that offer home- and community-based personal attendant services and supports. Under the final rule, states must meet several specific requirements, including establishing and maintaining a quality assurance system for CFC services; and meeting or exceeding the state’s current level of expenditures for home- and community-based attendant services for the first 12 months of the program. States are also required to use a person-centered service plan that is based on an assessment of functional need and that allows for services to be self-directed. The final rule clarifies that people should be determined to need an institutional level of care to be eligible for CFC services.
• On April 27, 2012, CMS released proposed rules for the Home and Community-Based Services 1915(i) State Plan Benefit, which was originally authorized in 2005 and later improved by the Affordable Care Act to make it easier for states to provide Medicaid coverage for home and community-based services (HCBS). These new rules allow states to offer and receive federal reimbursement for HCBS as part of the regular state Medicaid benefit without the use of a waiver so they can provide a full array of services and supports to people who do not qualify for  institutional care but who have significant service needs. The rule also proposes a definition of “home- and community-based” settings that will serve as a common definition for services offered through the Community First Choice option and the Section 1915(i) state plan benefit. The proposed rule will be open for comment for 30 days beginning on May 3, 2012.
• On April 16, 2012, HHS Secretary Sebelius announced the creation of the new Administration for Community Living, which combines into a single agency the Administration on Aging, the Office on Disability, and the Administration on Developmental Disabilities. This new agency will undertake initiatives to increase access to community-based services and supports and to achieve full community participation for seniors and people with disabilities.
• Maryland is the second state to be awarded a grant under the Affordable Care Act’s State Balancing Incentive Payments Program. Beginning on April 1, 2012, CMS is providing the state with $106.34 million over three years to implement administrative changes that will increase access to home- and community-based services. Maryland has set a target to increase the share of its Medicaid spending on community-based long-term services and supports from 37 percent to 50 percent of the state’s total long-term services budget.
  

• On March 2, 2012, CMS announced the first award under the Affordable Care Act’s State Balancing Incentive Payments Program. New Hampshire will receive $26.5 million over three years to expand home- and community-based services in Medicaid. Under the program, a total of $3 billion is available to states over four years. States are eligible if they spent less than 50 percent of their Medicaid long-term care funds on community-based care in 2009. Grants are in the form of higher Medicaid matching payments. If your state might be eligible, make sure that it is seriously considering applying.
  • State Fact Sheets on Options for Expanding Medicaid Home- and Community-Based Services under Health Reform

• CMS has announced another round of planning grants of up to $200,000 each for states that are not yet participating in the Money Follows the Person (MFP) Rebalancing Demonstration Program. Enacted into law in 2006 as part of the Deficit Reduction Act, these demonstration programs provide states with 12 months of enhanced federal matching funds for Medicaid beneficiaries who are moved from institutional settings to community-based settings. The Affordable Care Act extended the program through 2016. Currently, 43 states and DC operate demonstrations. These grants are an opportunity for AL, AK, AZ, SD, UT, and WY to receive funding to participate in the program. The grants will help states prepare their applications, and recipients will be announced later this year. The deadline for applying is March 6, 2012.

• On December 27, 2011, the Department of Labor released the proposed rule, Application of the Fair Labor Standards Act to Domestic Service. Most public and private workers enjoy minimum wage and overtime protection under the Fair Labor Standards Act. However, home care workers have been exempt from the these requirements. This proposed rule would extend minimum wage and overtime protections to home care workers. Comments are due on February 27, 2012, and can be submitted online.
  • Families USA, along with many other groups, pushed the Office of Management and Budget to release this rule.
  • See the National Employment Law Project fact sheet for background on the Fair Labor Standards Act and answers to commonly asked questions about the changes in the proposed rule.
    

• On December 20, 2011, CMS released a solicitation for applications for the Independence at Home Demonstration that was created by the Affordable Care Act. The demonstration is a voluntary program for Medicare beneficiaries with multiple chronic conditions and functional limitations. It will test the effectiveness of giving incentive payments to health care providers for coordinating care by delivering a complete range of primary care services in a home setting. State applications and Letters of Intent, if applicable, are due on February 6, 2012. Applications and further information on the demonstration are available in the Medicare Demonstrations section of the CMS website.
  • On April 27, 2012, the first 16 organizations that will participate in the new demonstration were announced. The participating health care providers will test whether delivering primary care services in the home can improve the quality of care and reduce costs for patients with chronic illnesses. The demonstration is scheduled to begin on June 1, 2012, and will conclude on May 31, 2015.

From the Kaiser Commission on Medicaid and the Uninsured:

Medicaid Managed Care: Key Data, Trends, and Issues examines the prevalence of managed care in state Medicaid programs, the varied approaches states have used, managed care for long-term services and dual eligibles, and evidence of cost savings. (February 2012)

From the Kaiser Family Foundation:

Medicaid’s Role for Women across the Lifespan: Current Issues and the Impact of the Affordable Care Actdiscusses the importance of Medicaid for the 21 million women that it covers. With Medicaid, low-income women have access to reproductive health care, care for chronic conditions and disabilities, and long-term services. (January 2012)

The state Children’s Health Insurance Program (CHIP) is a federally funded program administered by the states that provides health coverage for American children in working families. States design their own CHIP programs and determine policies and eligibility requirements within broad federal guidelines. In 2009, CHIP provided health coverage for 7.4 million children.

Medicaid and CHIP work together to provide health coverage for children in low- and middle-income families. Still, many children do not have health coverage. Currently, just under 8 million American children are uninsured. (Medicaid and CHIP go by different names in different states. Click here for a list of program names.)

This section of our Web site offers up-to-date information on children’s health coverage, including implementation of CHIPRA and the Affordable Care Act.

From Families USA:

A Nation in Need of Dental Care is a fact sheet about how limited access to dental care in the United States has an effect on overall health, productivity, and financial security. (May 2012)

Key Issues in the Final and Interim Final Rules on Establishing Exchanges and Expanding Medicaid under the Affordable Care Act (April 2012)

2012 Federal Poverty Guidelines are now available from HHS, and Families USA has calculated the figures for various household sizes by percentage of the federal poverty level.

From the National Health Law Program:

Top Ways Health Reform Helps provides the top five ways the Affordable Care Act helps the following groups: Medicaid beneficiaries, older adults and people with disabilities, women, and children and young adults. It also explains how the health care law addresses disparities and helps people get coverage. The lists are divided into provisions that are already in effect and those that are coming soon. (March 2012)

From the Pew Center on the States:

A Costly Dental Destination: Hospital Care Means States Pay Dearly describes the prevalence of emergency room visits among low-income children for preventable dental conditions. The emergency room may be a child’s only source of dental care because low-income families often struggle to find a dentist who practices in their area or who accepts Medicaid. (February 2012)

From the Urban Institute:

Federal Health Expenditures on Children on the Eve of Health Reform: A Benchmark for the Future discusses the key issues that will likely affect federal spending on children’s health in light of the ongoing implementation of the Affordable Care Act. (March 2012)

Louisiana Breaks New Ground: The Nation’s First Use of Automatic Enrollment through Express Lane Eligibility explains that, by using existing state data about family incomes to automatically enroll children in Medicaid, Louisiana has increased coverage for children and generated administrative savings of between $8 and $12 million in the first year alone. (February 2012)

Medicaid provides health coverage for low-income children and adults, medical and long-term care coverage for people with disabilities, and assistance with health and long-term care expenses for low-income seniors. More than 58 million people rely on Medicaid services.

Medicaid is jointly funded by the federal government and the states. Each state administers its own program, and the federal Centers for Medicare and Medicaid Services (CMS) monitors the programs and sets quality, funding, and eligibility standards.

This section of our Web site provides resources on Medicaid laws and regulations and keeps you up-to-date on the battle to sustain and improve this important program.

Children receive health coverage through Medicaid and the state Children’s Health Insurance Program (CHIP). To learn more about CHIP, see the Children’s Health and Massage chair section.

The Latest on Medicaid

The U.S. Supreme Court takes a pass on a question of Medicaid providers’ and beneficiaries’ right to sue over Medicaid cuts: On February 22, 2010, the Supreme Court issued a decision in Douglas v. Independent Living Center, vacating a lower court’s ruling and sending the case back to be argued again. The Supreme Court did not decide the question of whether Medicaid providers or beneficiaries have a right to sue to enforce federal Medicaid requirements when they believe a state has violated those requirements. Click here for more explanation and the opinion.

On February 9, CMS denied two amendments in Florida’s waiver proposal. The amendments sought to allow the state to: 1) charge all Medicaid beneficiaries a monthly premium of $10 and 2) charge a $100 copayment for non-emergency use of an ER. CMS determined that these proposals violated the Medicaid law’s cost-sharing provisions (1916A of the Social Security Act) and the Affordable Care Act’s maintenance of effort provisions. CMS stated that it wanted to work with the state to find other ways to promote cost-effective use of ER services. Florida’s proposal to move most of its Medicaid program into managed care is still pending. (February 9, 2012)

On February 6, 2012, CMS rejected a request California had made on June 30, 2011, to amend its Section 1115 “Bridge to Reform” waiver. The state sought to impose mandatory Medicaid copayments for a wide range of services, including emergency room services (for both emergency and non-emergency care), prescription drugs, hospital care, and outpatient care. Cost-sharing in Medicaid places a heavy burden on low-income families, making it more likely that they will skip needed care. (February 6, 2012)

On January 26, 2012, Kansas submitted a concept paper to CMS to start the process of requesting a waiver to substantially change its Medicaid program. The waiver has two parts: the first seeks approval to place Medicaid recipients who need long-term care into managed care. The second part, which has a longer time-frame, would fundamentally alter the Medicaid program. In that part, Kansas will ask for substantial flexibility in its Medicaid program in exchange for a fixed federal per capita payment. Both parts are extremely concerning. The second part would pose considerable risks to beneficiaries’ access to care.  Families USA will be developing materials for advocates to counter this potentially harmful proposal and others like it as they arise. (January 26, 2012)

From Families USA:

Key Issues in the Final and Interim Final Rules on Establishing Exchanges and Expanding Medicaid under the Affordable Care Act (April 2012)

Medicaid Cuts Will Hurt Illinois’ Economy explains how the governor’s proposed cuts would damage the state’s economy and hurt Illinoisans who depend on Medicaid. (April 2012)

Republicans Again Propose Slashing Funding for Medicaid, Medicare, and Other Health Programs details how the Republican proposal would affect the states. It provides state-level data on the federal funding each state would lose, the additional burden on taxpayers, and the rise in the number of uninsured residents. (April 2012)

How the Affordable Care Act Makes the Section 1115 Waiver Process More Transparent: An Advocate’s Guide explains the new rules that will give advocates and consumers a bigger voice in the waiver process. It describes when advocates can comment on waivers, and it offers tips on how to take advantage of all the opportunities the new rules provide. (April 2012)

Making the Most of Accountable Care Organizations (ACOs): What Advocates Need to Know provides an overview of ACOs; the promise they hold; and how they could change Medicare, Medicaid, and the health care landscape. It also identifies key challenges in their development and suggests how advocates can get involved in ways that benefit patients. (Updated February 2012)

Medicaid: Essential to America’s Hospitals and Communities provides state-level data highlighting how important hospitals are to state residents at every stage of life, whether or not they are covered by Medicaid. It also explains that hospitals are vital economic engines and that federal Medicaid cuts could harm many communities. (February 2012)

Implementing the Patient Protection and Affordable Care Act: A 2012 State To-Do List for Exchanges, Private Coverage, and Medicaid gives state advocates an in-depth blueprint for action in 2012, outlining issues to start thinking about and tasks that deserve immediate attention. (February 2012)

2012 Federal Poverty Guidelines are now available from HHS, and Families USA has calculated the figures for various household sizes by percentage of the federal poverty level.

From the Alliance for Health Reform:

Implementing Health Reform in the States discusses key elements of the Affordable Care Act that states must address and offers an update on the status of implementation. It also discusses the issues of whether states will aggressively promote the Medicaid expansion to those who will be eligible and what will happen if the Supreme Court rules the expansion unconstitutional. (March 2012)

From the Center for Health Care Strategies, the National Academy for State Health Policy, and the Robert Wood Johnson Foundation:

Implications of Health Reform for American Indian and Alaska Native Populations outlines provisions of the Affordable Care Act that uniquely affect these populations, including expanded coverage through Medicaid and the exchanges, outreach to tribal groups, and improved organization and financing of care. (February 2012)

From the Center on Budget and Policy Priorities:

Claimed State Savings from Rhode Island’s Medicaid Cap Heavily Overblown, Report Shows: Rhode Island Does Not Provide Support for Proposals to Convert Medicaid to a Block Grant explains that the state’s savings were modest and unrelated to the cap on federal funding. Instead, the savings came from policy changes like reducing provider payments, cutting waste, and emphasizing home- and community-based services for people who need long-term care. (March 2012)

Federal Government Will Pick Up Nearly All Costs of Health Reform’s Medicaid Expansion refutes the claim that states will face a heavy financial burden as a result of the Medicaid expansion. It also notes that the expansion will reduce costs for uncompensated care, which will offset the added Medicaid costs. (March 2012)

State Considerations on Adopting Health Reform’s ‘Basic Health’ Option: Federal Guidance Needed for States to Fully Assess Option describes the Basic Health option, the issues states should consider, and the areas in which states need federal guidance in order to decide whether the option is appropriate for them. (March 2012)

From the Kaiser Commission on Medicaid and the Uninsured:

A Guide to the Medicaid Appeals Process describes how the appeals process works for applicants and beneficiaries, including the fair hearing process and the appeals process that’s required for managed care organizations. (March 2012)

From the Kaiser Family Foundation:

Policy and Political Implications of the Supreme Court Case on the Affordable Care Act is a webcast that includes a release of new polling data on the public’s view about the case and the health care law. It also considers the case’s potential implications for the future of the law and for federal and state health policy. (March 2012)

The Role of the Basic Health Program in the Coverage Continuum: Opportunities, Risks, and Considerations for States provides a framework for assessing the Basic Health Program option and exploring the associated advantages and risks, including the ability to improve continuity of coverage for low-income residents and the costs of implementation. (March 2012)

From the National Health Law Program:

Top Ways Health Reform Helps provides the top five ways the Affordable Care Act helps the following groups: Medicaid beneficiaries, older adults and people with disabilities, women, and children and young adults. It also explains how the health care law addresses disparities and helps people get coverage. The lists are divided into provisions that are already in effect and those that are coming soon. (March 2012)

From the Robert Wood Johnson Foundation and the Urban Institute:

The Individual Mandate in Perspective estimates the number of Americans who would be subject to this provision in the Affordable Care Act, identifies their insurance status without the law, and simulates their eligibility for Medicaid or premium tax credits. It finds that 94 percent of people would not be required to newly purchase coverage or pay a fine. (March 2012)

Introduction

The Patient Protection and Affordable Care Act (Affordable Care Act), enacted in March 2010, will extend health coverage to millions of Americans by expanding Medicaid to those with the lowest incomes and by creating a tax cut to help low- and middle-income individuals and families afford private coverage. These tax cuts will be provided in the form of new, refundable tax credits that will offset a portion of the cost of health insurance premiums.

This report takes a closer look at these premium tax credits, which will go into effect in 2014 and will help Americans with incomes up to four times the federal poverty level ($88,200 for a family of four in 2010) afford coverage. The unique structure of the tax credits means that individuals and families will have to spend no more than a specified portion of their income on health insurance premiums.

Families USA commissioned The Lewin Group to use its economic models to estimate how many individuals would benefit from the new premium tax credits in 2014 and the value of the dollars going to help pay for insurance (see the Methodology on page 12 for more details). We found that an estimated 28.6 million Americans will be eligible for the tax credits in 2014, and that the total value of the tax credits that year will be $110.1 billion.

The new tax credits will provide much-needed assistance to insured individuals and families who struggle harder each year to pay rising premiums, as well as to uninsured individuals and families who need help purchasing coverage that otherwise would be completely out of reach financially. Most of the families who will be eligible for the tax credits will be employed, many for small businesses, and will have incomes between two and four times poverty (between $44,100 and $88,200 for a family of four based on 2010 poverty guidelines). However, because the size of the tax credits will be determined on a sliding scale based on income, those with the lowest incomes will receive the largest tax credit, which will ensure that the assistance is targeted to those who need it the most.

As this key provision of the Affordable Care Act takes effect, millions of hard-working Americans will enjoy tax relief and the peace of mind that comes with knowing that they and their family members have affordable health insurance that they can depend on, even if they experience changes in income or become unemployed.