You are here

Supremes, 2013 budget & more ACA news

1. SUPREME COURT VICTORY. Last week the Supreme Court upheld the constitutionality of the individual mandate provision in the Affordable Care Act (ACA) but ruled that Congress could not authorize the Secretary to deny all Medicaid funding to states that refused to expand Medicaid to all individuals under 133% of poverty as contemplated by the Act. 
Here in Massachusetts where the expansion of Medicaid in 2014 would largely mean a higher matching rate for individuals already covered under the MassHealth demonstration, the Court's decision clears the way for the Administration to carry on with full ACA implementation. However, the court's analysis is all about a restrictive view of Congressional power. Follow this link for NHelp's concise 5-page summary of the decision & some of its consequences.​f [Editor's Note: Link is no longer active]

2. ACA implementation in Massachusetts. The Administration has developed a key set of recommendations for implementing the ACA & the legislature has authorized several basic steps forward in two recent supplemental budgets. c. 96 St. 2012 designates the Connector as the Exchange. c. 118 St. 2012 authorizes the Administration to develop a Basic Health Plan for individuals not otherwise eligible for Medicaid with income under 200% of poverty &  authorizes the Connector to make premium assistance payments so that it may further subsidize premium costs for individuals from 200-300% of poverty. Both these authorizations contemplate that Commonwealth Care, now funded under the MassHealth demonstration, will be replaced with new programs authorized under the ACA with primarily federal funds, but using state options to assure that coverage is no less affordable than Commonwealth Care. EOHHS's powerpoint on its recommendations is posted in this section:

Legislation also authorizes the state to proceed with a demonstration project to integrate Medicare & Medicaid for 21-64 year olds dually eligible for both programs; the state has submitted its proposal for dual eligibles to CMS &  recently posted an RFR as well --with CMS approval, individuals could enroll as early as April 2013. EOHHS materials on the duals project are posted here:

3. The FY 2013 budget. The conference budget (H. 4200) for the fiscal year beginning July 1 is now on the Governor's desk.  Generally the conference budget requires no programmatic changes in FY 13 compared to FY 12; savings are anticipated from provider rates & managed care contracts. The Administration had asked for $2M to address delays at MassHealth but received only $1 million & only $750K of the $3.125M it had wanted for health reform implementation. The conference budget again authorizes reduced MassHealth adult dental benefits but would require that composite fillings for front teeth be covered in addition to existing coverage for preventive & emergency care; it also would add a hospice benefit to MH Essential/Basic subject to amendment of the demonstration. The conference budget would protect bedhold days for nursing home residents & the current personal needs allowance of $72.80. It includes no funding for outreach & enrollment grants & no provisions to improve redeterminations & address churning. Unlike past years, there is no general authorization to "restructure" MassHealth benefits as needed. Presumably any future benefit cut would require further authorizing legislation. The Affordable Care Act continues to protect against eligibility restrictions until 2014.