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Health Reform Highlights

Welcome to KidsWell’s Health Reform Highlights! This page is updated weekly with the latest health care reform activity across the nation!


This website provides the most up-to-date, comprehensive information on children's coverage and healthcare reform implementation in all fifty states and nationwide.


To find out more about what’s happening in each state, click on State Spotlight. Go to Federal Focus for federal health care reform news and national children’s health insurance coverage data. Check out the National Snapshot maps to get fifty state comparison maps of major health reform news and trends. Finally, search the Health Reform Hub, which has over 4,000 state and federal health care reform and children’s coverage news entries!


After three and a half busy years, the KidsWell Weekly Update’s health care reform tracking effort is winding down. September 30th  will be our last weekly newsletter. It has been a pleasure monitoring state and federal health care reform implementation activity on behalf of Atlantic Philanthropies and our loyal readers. If you are looking for ongoing weekly health care reform updates we hope you will visit and sign up for our national KidsWell partners’ newsletters!

For a printer-friendly version of this report, click here.

Implementation and Opposition

  • Arkansas: Medicaid Director Submitted Request for Amendments to Private Option Waiver

    Arkansas's Medicaid Director, Dawn Stehle, submitted a request to the federal Department of Health and Human Services to amend the state's 1115 waiver for the Private Option. The waiver amendment request would make the following changes to the program:

    • Implement health savings-like accounts called Independence Accounts for Private Option enrollees with incomes greater than 50% FPL;
    • Institute cost sharing for enrollees with incomes between 50-100% FPL; and
    • Limit the non-emergency transportation benefit for Private Option enrollees to eight trip legs per year.
    By statute, Arkansas is required to obtain federal approval for these changes by February 1, 2015.
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  • California: Covered California Launched Marketing and Outreach Campaign

    Covered California (California's State-Based Marketplace) launched a new marketing and outreach campaign to support its enrollment and re-enrollment efforts for the 2015 open enrollment period. The effort includes a $46 million statewide advertising campaign that will include new television commercials that will begin airing throughout the state later in September. In addition, the Marketplace announced that the state awarded $14.6 million in grants to 66 community organizations to support enrollment efforts for populations with common characteristics, including language, ethnicity and geography.
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  • California: Marketplace Board Discussed Consumer Assistance and Qualified Health Plan Updates

    The Board of Covered California (California's State-Based Marketplace) discussed consumer assistance and qualified health plan (QHP) updates. The Board reviewed $14.6 million in grants that were awarded to 66 community organizations to support the state's Navigator program. The Board discussed how the selected grantees will target specific communities, including various minority populations. In addition, the Board discussed the quality rating system for QHPs offered in the Marketplace and discussed guiding principles for monitoring network adequacy. Finally, the Board provided a status update on the provider directory functionality for QHPs.
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  • Colorado: C4HC Board Discussed Approach to Consumer Assistance Sites and Received Marketplace Updates

    The Connect for Health Colorado Board reviewed the list of Network Assistance Sites and the Marketplace's approach to assistance site grants and evaluation. The Board also received Assistance Network Evaluation Findings from the Spark Policy Institute, which examined the activities of the Assistance Sites and proposed recommendations for the next open enrollment period. Lastly, the Board received presentations on current operational readiness and enrollment statistics.
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  • D.C.: Department of Insurance Approved 2015 QHP Rates

    The D.C. Department of Insurance, Securities and Banking approved health insurance plan rates for the DC Health Link for plan year 2015. Four issuers -- Aetna, CareFirst BlueCross BlueShield, Kaiser Permanente and UnitedHealthcare -- will offer plans for individuals, families and small businesses.
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  • Florida: Office of Insurance Announced Six Insurers to Offer Small Group Plans on State's Marketplace in 2015

    The Office of Insurance announced health insurers that would be selling ACA-compliant small group policies in 2015.  Blue Cross Blue Shield of Florida, Health Options, UnitedHealthCare of Florida, and Florida Health Care Plan will be selling policies both off and on the SHOP marketplace. Two insurers, Health First Health Plans and Health First Insurance, will only be selling plans on the Marketplace, and 12 insurers will only be selling plans off the Marketplace.
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  • Maine: Insurance Bureau Approved 2015 Individual Market Premium Rates that are Equal to or Slightly Lower than 2014 Rates

    The State Bureau of Insurance approved final premium rates for the three insurers that will sell individual plans through the Marketplace in 2015. On average, premiums will remain steady for customers of Maine Community Health Options, a member-run health insurer that captured more than 80 percent of the 2014 market. Premiums in Anthem Blue Cross Blue Shield, the only other insurer in the Marketplace in 2014, will decrease by an average of 1.1 percent. A third insurer, Harvard Pilgrim Health Care, will join the Maine individual Marketplace for the first time in 2015.
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  • Minnesota: Largest Health Insurer, PreferredOne, Exited State Marketplace

    MNsure and PreferredOne released a joint statement announcing PreferredOne's decision to no longer offer Qualified Health Plans (QHPs) through the State's Marketplace for the 2015 open enrollment period starting November 15, 2014. According to MPR News, PreferredOne's decision was driven by concerns of financial and administrative sustainability. PreferredOne was the largest health insurer on the Marketplace and accounted for almost 60 percent of MNsure's individual QHPs as of early August, approximately 31,000 Minnesotans. Minnesotans enrolled in PreferredOne plans will be covered through the end of 2014 though they will have to renew or re-enroll in coverage through one of the four remaining health insurers offering QHPs on the Marketplace for 2015.
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  • Minnesota: MNsure Board of Directors Discussed Marketplace Updates for the 2015 Open Enrollment Period

    The MNsure Board of Directors met to discuss essential system improvements as well as contingency planning and customer service updates designed to increase the performance of MNsure for the 2015 Open Enrollment Period. The Board of Directors additionally discussed: board work group reports; policies regarding the creation of additional MNsure advisory committees; a revised legislative engagement policy; county and broker updates; proposed modifications to the carrier business agreement language; and updated enrollment metrics.
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  • New York: State Marketplace Released Insurers Offering Individual and Small Business Plans on the Marketplace

    New York State of Health announced the health insurers that would be offering plans on the Marketplace in 2015. Sixteen health plans will be offered on the State’s Individual Marketplace in 2015. One insurer, Wellcare, is new to the Marketplace and six of the 16 are expanding their offerings in additional regions compared to 2014. Nine insurers – including new entrant Health Insurance Plan of Greater New York (EmblemHealth) –  will offer plans on the Small Business Marketplace. One insurer from the Individual Marketplace – American Progressive – and one from the Small Business Marketplace – Oxford Health Plan – offered plans in 2014 but will not be offering plans in 2015.
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  • Oregon: Study Found Uninsured Rate Dropped 63% in One Year

    A study from the Oregon Health & Science University found that the uninsured rate dropped 63% over the past year. As of June 30, 2013, about 550,000 people, or 14% of the population, were uninsured, dropping to 202,000, or 5% by June 30, 2014 due to the expansion of Medicaid and the introduction of Cover Oregon.
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  • Utah: Legislative Health Reform Task Force Discussed Updates to Medicaid Expansion and Addressing the Coverage Gap

    The Legislative Health Reform Task Force continued to discuss Governor Herbert's Medicaid expansion initiative that proposes to cover Utahans earning up to 138 percent of the Federal Poverty Line (FPL). According to the Desert News, the Utah Department of Health Director David Patton said in the meeting that the State has begun to work with the Utah Legislature on language for the Medicaid waiver process. The Task Force additionally discussed: the relationship between health insurance enrollment and the criminal justice system and options for justice system partnerships; options for helping individuals below the FPL obtain health care; premiums for 2015 group plans sold in the State's Small Business Exchange (SHOP) Marketplace, Avenue H; and recent federal regulations that may impact health reform implementation.
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  • Vermont: State Marketplace, Vermont Health Connect, Taken Offline for Maintenance

    Governor Shumlin (R) announced that the State's Marketplace, Vermont Health Connect, will be taken offline temporarily in order to make necessary security and functional improvements prior to the 2015 open enrollment period that starts November 15, 2014. In addition, the Governor's announcement indicated the oversight of Vermont Health Connect will be transitioned from the Department of Vermont Health Access to Senior Advisor Lawrence Miller, who will in turn report directly to Human Services Secretary Chen and Governor Shumlin. According to VTDigger, Vermont Health Connect was taken offline as it was unable to meet a federal checklist of security requirements by the set deadline of September 10.
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  • Washington: Exchange Operations Committee Discussed IT and Finance Report

    The Washington Health Exchange Board Operations Committee discussed IT updates, including the status of fixes around payments not being sent to carriers, incorrect grace periods, and incorrect invoice adjustments, as well as the finance report on establishment grant expenditures. Additional agenda items included QHP renewals and 2015 operating budget funding sources.
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Federal News

  • CDC Survey Found Drop in Uninsurance Rate

    The CDC's National Health Interview Survey found that the number of uninsured Americans dropped by 8 percent, or 3.8 million people, in the first quarter of 2014 as compared to 2013. States expanding Medicaid experienced a three percentage point reduction in the uninsured rate among 18-64 year olds while States not expanding their Medicaid programs experienced only a one percentage point drop, which was deemed not statistically significant.
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  • CMS Released Guidance on Process for Amending Alternative Benefit Plans

    For certain Medicaid populations, states have the flexibility to design an ABP, which is a benefit package entirely based on commercial market benefits or the state’s approved Medicaid state plan, or a combination of both. CMS released an informational bulletin detailing timeframes and requirements for amending Medicaid Alternative Benefit Plans (ABP) to ensure  alignment with the Medicaid state plan. CMS’s new guidance clarifies that this alignment must be maintained on an ongoing basis and incorporate any changes to a state’s approved Medicaid state plan, and provides additional time for ABP submissions to ensure proper alignment.
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  • CMS Released July Medicaid/CHIP Figures Showing Total Enrollment Growth of 8 Million Since October 2013

    Approximately 8 million individuals have enrolled in Medicaid and CHIP since October 2013, according to CMS’ newly released July 2014 Medicaid/CHIP Enrollment Report. States expanding their Medicaid programs experienced particularly high growth, with enrollment rising by over 20% compared to the July to September 2013 period. States not expanding their Medicaid programs saw only 5% growth in Medicaid enrollment over the same period. The report also features new enrollment figures by state for children in  Medicaid/CHIP.
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  • GAO Released Report Detailing Privacy and Security Risks associated with

    The U.S. Government Accountability Office (GAO) released a report detailing security and privacy protection vulnerabilities in that could put users’ personal information at risk. The GAO found that despite the progress made by CMS since was deployed, significant weaknesses remain in the processes used for managing information security and privacy as well as the implementation of IT security controls. HHS has vowed to continue improvements to the website and described the updates that are currently underway while testifying to a House Subcommittee this month.
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  • HHS Report Found 25 Percent Increase in Number of Issuers on 2015 Health Insurance Marketplace

    There will be a twenty-five percent increase in the number of issuers offering coverage on Health Insurance Marketplaces in 2015, according to a new report released by HHS. Across the 44 states for which HHS has data, the Federally-facilitated Marketplace, operated in 36 states, will see 57 more issuers in 2015. Eight states operating State-based Marketplaces, on the other hand, will see 6 more issuers in 2014. HHS suggested this increase will likely result in lower costs for consumers, citing recent estimates that an increase of one issuer in a rating area is associated with a 4% average decline in second-lowest cost silver plan premiums.
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  • HHS Secretary Sebelius Released Report Showing that Consumers Saved $1 Billion From Lower Health Insurance Rates; Announced $25 Million in Rate Review Grant Awards

    The ACA helped consumers save $1 billion in 2013 from lower than expected health insurance rates, according to a new report released by HHS Secretary Sebelius. Small employers saved approximately $703 million, and individuals and families saved $290 million. In addition, Secretary Burwell announced rate review grant awards totaling $25 million will be provided to 21 states. The grant awards are intended to help states enhance their rate review processes and strengthen transparency around rate increases.
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  • Senate Hearing Held to Discuss Future of CHIP

    The Senate Finance Committee met to discuss the future of the Children's Health Insurance Program (CHIP), after Senator Jay Rockefeller (D-WV) and Representative Harry Waxman (D-CA) introduced bills that would extend federal funding of the program through 2019. The program -- which has helped cut the uninsurance rate for children in half since its enactment in 1997 -- is currently set to expire in September 2015. While it generally has strong bipartisan support, some argue CHIP is no longer necessary under the ACA construct of Medicaid and Marketplace QHP coverage.
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