Implementing Health Care Reform

By Lape, Megan; Wiecezak, Jessica | Policy & Practice, February 2011 | Go to article overview
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Implementing Health Care Reform

Lape, Megan, Wiecezak, Jessica, Policy & Practice

"EXCITING" AND "CHALLENGING" are just two of the words that might describe the constantly progressing and changing landscape of health care reform and its implementation. As the federal government continues to clarify and refine the intent of the Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act (P.L. 111-152) through guidance and regulations, states are working to implement the many requirements mandated in the law.


In the wake of one of the worst recessions in the country's history, state fiscal situations remain distressed, with great uncertainty around the costs of federal funding for many health-related programs. Despite the short-term fiscal relief provided from the extension of the American Recovery and Reinvestment Act's increased Federal Medical Assistance Percentage through June 30, 2011, many states are scrambling to fill the gap in their fiscal year 2011 and 2012 budgets in the face of an increasing number of individuals receiving medical assistance.

The administration has been listening closely to the states' concerns about financing their activities. In November 2010, the Centers for Medicare and Medicaid Services issued a proposed regulation that will greatly increase federal support for states' development of their eligibility systems. Under the proposal, federal match for the maintenance and development of new or existing eligibility systems would be increased from 50 percent to 75 percent or 90 percent. The proposed rule is currently in the 60-day public comment period and the increase would not be effective until the rule is final. This change will provide key financial support toward the successful implementation of health reform.

Environment of Collaboration

Given the monumental task of implementing the ACA, collaboration among the many vested stakeholders is critical. States, the federal government, member organizations and industry partners are working toward their respective and joint goals of health reform implementation as evidenced by the many activities surrounding education, clarification and peer-to-peer information exchange concerning the requirements of health reform.

The State Consortium on Health Care Reform Implementation

The State Consortium on Health Care Reform Implementation, comprised of the National Governors Association, National Academy of State Health Policy, National Association of Medicaid Directors, National Association of Insurance Commissioners and the Health Services Division of APHSA, was formed to provide coordinated and trusted information and technical assistance to states about requirements, offer options and best practices and synthesize feedback to federal agencies on issues that affect state implementation of health care reform. The consortium members' web sites contain resources on aspects of the health reform law that are most immediate to the states' implementation efforts--the expansion of Medicaid; the establishment of health insurance exchanges, insurance regulations, and delivery system initiatives; and important governance, coordination and timing issues for states. More information is available at

The state consortium brings together key stakeholders--governors, Medicaid directors, and state insurance commissioners--with a vested interest in health reform and provides clear information, guidance and tools to determine the best course for their states. The Obama Administration, in conjunction with the state consortium, holds weekly calls to discuss new developments in health reform and provides a forum for addressing state questions related to implementation issues.

Multi-State Collaborative on HIT

Health information technology plays a critical role at the state level not only for health reform, but also with respect to legislative requirements in ARRA and the HITECH Act.

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