Recently in State Health Policy Category

By Mike Odeh (Children Now) and Kristen Golden Testa (The Children's Partnership) with the 100% Campaign 

And we're off! Implementation of the Affordable Care Act (ACA) is officially underway! Less than six months after Congress passed the ACA, California has blazed the trail as the first state in the nation to create a statewide Health Insurance Exchange under the Act. Two complementary pieces of legislation create the California Health Benefit Exchange and are headed to Governor Schwarzenegger's desk for an expected signature - (AB 1602 creates the Exchange and SB 900 creates a decision-making board).

By creating the Exchange, the State has built a framework that will dramatically improve the way many Californians, particularly the uninsured, get health coverage and will set the right trajectory for health reform implementation by providing new affordable coverage opportunities for millions of children and their families!

Make no mistake - creating the Exchange was no easy task. The legislation that created the California Health Benefit Exchange only came about (on party-line votes) through strong legislative and gubernatorial leadership, thoughtful and dedicated staff, and the efforts of a broad coalition of health and consumer advocates. Certain insurers (ones that are apparently afraid of transparency and a little competition) worked throughout the process to water down the legislation and tried desperately to kill the bill in the final hours. Thankfully, other insurers were supportive and engaged earnestly in negotiating amendments.

CCF's recent blog and issue brief on Health Insurance Exchanges lays out some of the primary responsibilities of an Exchange and identifies some opportunities within the broader federal framework to coordinate among the Exchange and existing programs, like Medicaid and CHIP.

So, as many of you probably know, the ACA allows states to make some important choices, not least of which is the decision whether or not to create a state Exchange in the first place. Given that California is home to nearly 1.5 million uninsured children,  the infamous 39% premium increase proposal and a seemingly infinite state budget stalemate, we really need a custom-designed Exchange that will work for California. Alan Weil and Jon Kingsdale cautioned the California Legislature that making an Exchange work by 2014 would require a lot of strategic planning, thoughtful coordination and time. It's a good thing the Legislature was listening and has been able to take the first step forward for California.

Although the authorizing Exchange legislation creates a governance structure and outlines a framework for the core responsibilities of the Exchange in California, some of the details of coverage in the Exchange, such as the benefit design for the child-only insurance products, will be determined by the governing Exchange Board along with future federal guidance. That's why we believed it was very important that the Exchange be run by a qualified Board with expertise and the authority to negotiate health plan contracts based on price and value while not having conflicting financial interests.  The board also needs representation from those that recognize the importance of coordinating with existing health care programs, systems, agencies, and regulators, so that children are protected and don't fall through the cracks and lose health coverage unnecessarily. Along with minimum benefit standards and cost-sharing limits in the federal law, we believe these factors are critical to ensuring that the coverage offered in the California Exchange is much more meaningful and more affordable than coverage today.

In fact, one of the key features is that the five-member appointed Board is authorized to be an "active purchaser" and will select health plans to participate in the Exchange through a competitive bidding process. Because Exchange board members will be required to have experience with health coverage, administration, and financing, they will be qualified and savvy in negotiating contracts with health plans based on price and value for an estimated 8.3 million lives (including 3.8 million small-business owners and employees and their dependents). 

The legislation also lays out the overall duties and responsibilities of the Exchange, many of which are explicitly required in the federal law (e.g., operating a toll-free telephone hotline and website with comparative plan information) and some of which just make good sense (e.g., authorizing the Exchange board to maximally collaborate with existing health agencies and applying the same standards for insurers and health plans inside and outside the Exchange). It also will allow California to be one of the first states to apply for the federal planning grants that can be used to establish the Board, promulgate strong consumer protections regulations, and develop a process to coordinate effectively with existing state health insurance programs like Medi-Cal (Medicaid) and Healthy Families (California's CHIP).

Since the federal law builds upon (and protects) Medi-Cal and Healthy Families, it is critically important that the Exchange coordinate with existing state and local programs as much as possible. The Children's Partnership and the Kaiser Commission on Medicaid and the Uninsured point out in a recent issue brief that the ACA requires enrollment systems that are consumer-friendly, coordinated, simplified, and technology-enabled. But getting into the "nuts and bolts" of creating enrollment systems that will effectively talk to one another and be easy for families to use requires thoughtful planning and sufficient lead time. That is why we continue to recommend that, as the Board develops the enrollment system for the Exchange and its subsidies, the State buckle down now and start planning for the streamlining and coordination of the other enrollment systems, like Medi-Cal and Healthy Families.

The hard work is just beginning! The 100% Campaign and our partners will continue to advocate (administratively) for better and more program coordination among the Exchange and other programs - not just at enrollment but also during renewal (something we didn't get in the final bill) and at transitions (included in the bill but could still be strengthened). Coordination is especially important when families will be split across programs, for example, when a parent is covered through the Exchange while their child is enrolled in Healthy Families. We will be laying out detailed recommendations for the Board on seamless enrollment, renewal and transition coordination and protections to ensure that only the minimum necessary information is collected from families to determine eligibility for coverage.

While we pushed to get the state Exchange law as strong as possible, we recognize that many detailed decisions of the Board will be determined by federal guidance. That's why we are sharing our thoughts and concerns with the Office of Consumer Information and Insurance Oversight about how the Exchange should coordinate with other programs, and urge them to provide helpful regulatory guidance on the issue. Like stakeholders in other states, we are weighing-in as the federal government develops these guidelines, rules, and regulations, but here in California we are in the unique position of simultaneously sailing ahead into uncharted waters.

So we can't wait passively for guidance to be issued and instead need to focus like a laser on ensuring that we get clear federal guidance that will address such critical issues such as children's benefit design, access to databases for existing eligibility information, and assurances of a coordinated and streamlined enrollment system.

Furthermore, as part of our effort to ensure that families know about and actually enroll in available coverage, we continue to recommend a preferential role for experienced community-based organizations as navigators. Based on our experience here, health care advocates in other states should be prepared for attempts to narrow the navigator role to licensed brokers/agents.

In the end, our State did not develop a perfect bill - the 100% Campaign and our partners had hoped for greater public/consumer representation on the Exchange board, stronger conflict-of-interest prohibitions, more comprehensive coordination requirements, and a preferential navigator role for experienced local community-based organizations. Yet, we are pleased to have a strong starting point and hope to make improvements in the months and years ahead. The new legislation helps structure the incredible amount of work that will be needed to turn the concept of an "Exchange" into an actual gateway to affordable coverage for millions of Californian kids and their families when 2014 rolls around.

Editor's Note: The views expressed by Guest Bloggers do not necessarily reflect the views of the Center for Children and Families.

Health care "exchanges" are critical to fulfilling the promise of the Affordable Care Act and how states decide to meet their responsibility to establish them will have an enormous impact on children and families.  Today, the Department of Health and Human Services is hosting a stakeholder conference to discuss exchanges. To coincide with the conference, my colleagues, Dawn Horner and Sabrina Corlette, released an issue brief that takes a deeper look at exchanges and what's at stake for children and families. 

HHS's day-long conference is intended to engage stakeholders on the important policy decisions surrounding the establishment and operation of exchanges.  CCF's Jocelyn Guyer will take part in a panel discussion and Dawn Horner will attend the conference. (You can view the conference via be webcast here.)

We'll hear more from them about the conference tomorrow, so let's get back to the issue brief.  "Health Exchanges: New Coverage Options for Children and Families" provides a comprehensive overview of exchanges and key questions policymakers must consider when establishing exchanges.  It outlines the funding and design decisions the states will have to make fairly quickly and points out the broad responsibilities exchanges will have in ensuring that consumers can make informed health care coverage choices.  

For example, the Affordable Care Act requires plans to offer child-only policies (reflecting the importance policymakers placed on the need to ensure that children could secure coverage even if their parents were ineligible for an exchange plan).  Beyond the essential benefits packages, exchange plans must provide children with a comprehensive package of preventive care services (referred to as Bright Futures), including immunizations, well-child visits, vision and hearing tests, health and behavioral assessments, and developmental screenings, with no cost-sharing.  These federal standards are only a floor and states can require plans to cover services for adults and children that are not in the minimum package.  In fact, a number of states already have policies mandating that plans cover specific services, some of them critical to children. (Sixteen states and the District of Columbia mandate that insurers offer at least some level of services for autism.)

Another issue that could impact many families is how well states meet the "no wrong door" policy established by the new law.  It is vital that exchanges coordinate closely with Medicaid and CHIP because many people will move back and forth between subsidized exchange coverage and public program eligibility as their income fluctuates.  The brief points out that states should consider ensuring that some plans offered in the exchange also serve Medicaid and CHIP beneficiaries, creating overlapping provider networks and requiring plans to help facilitate transitions for those in the middle of treatment.

The brief also covers the importance of dynamic technology applications to the success of the exchanges.  The exchange procedures envisioned under the ACA rely heavily on the application of smart technology systems. States should consider setting up a working group now to begin to build these systems. As a first step, a state can pave the way toward electronic interfaces by implementing the proven Medicaid and CHIP automated linkage with the Social Security Administration allowed under CHIPRA to verify citizenship status.

These are but a few of the insights included in the issue brief.  I hope you'll take the time to read it for yourself and share it with others in your state.  We would also love to hear from you on how your state is approaching the establishment of its exchange.

Under the Affordable Care Act, states will have considerable flexibility, within federal guidelines, to design Medicaid benefit packages and cost-sharing rules that are appropriate for newly-eligible adult beneficiaries. The often-extensive health care needs and very low incomes of the newly-eligible adults are important considerations for states as they put the new law into effect, according to a new issue brief written by CCF and the Kaiser Commission on Medicaid and the Uninsured. 

Half of all uninsured adults below 133 percent FPL have income below 50 percent FPL. When it comes to their health status, about one-third have a diagnosed chronic condition, such as hypertension or depression, and about 1 in 6 are in fair or poor health.  Given the limited income and often-extensive health care needs of newly-eligible adult Medicaid beneficiaries, it will be critical that they be provided with benefits designed to reflect their unique needs if health reform is to work as intended.

Both the federal and state governments will play important roles in making sure the new law works for newly-eligible adult Medicaid beneficiaries. The issue brief identified two key areas for policyakers to consider as they move forward on implementing the new law:

• Benefit Packages: The content of the coverage provided to the millions of low-income adults slated to secure Medicaid coverage under the health reform law will depend, in part, on how the federal government addresses key issues, such as the definition of "essential health benefits." In addition to covering these essential benefits, the coverage for the newly eligible must be equal to coverage provided under one of three "benchmarks." Importantly, states can also provide additional benefits on top of the benchmark.
• Continuity of Care: Given that changes in income, health status, and other factors are common, coordination and consistency of coverage between Medicaid groups and over time are key aims. Because individuals may also shift between eligibility for Medicaid and Exchange coverage, identifying ways in which states can promote continuity of care between the two systems is a priority.

The responsibility of creating a coherent program that provides the full range of groups served by the Medicaid program with the benefits that they need when they need them falls mainly to the states. Thankfully, the federal government has helped make it easier on the states by making a commitment to finance the full cost of care for the newly-eligible Medicaid adults for the first three years of reform and at least 90 percent of the cost thereafter.

Hope for uninsured low-income adults is on the horizon.  Let's hope policymakers finish the job by making wise choices in how they design the benefit packages and address the need for continuity of care for newly eligible Medicaid beneficiaries.  

By Christine Barber, Community Catalyst

We've all heard the recently-passed Affordable Care Act (ACA) provides a lot of new opportunities for improving health care coverage and access - but we also hear most Americans don't understand what the law actually means for them. At Community Catalyst, we think a major opportunity created by national health reform is improving consumers' access to clear information about their health care options from trusted sources. Consumer assistance programs (CAPs) are a critical way to make this happen.

The ACA included $30 million in grants for 2010 to fund state CAPs and ombudsman offices (Section 1002) to help real people understand their health care options. And the Department of Health and Human Services Office of Consumer Information and Insurance Oversight (OCIIO) just released the grant guidelines for the program late last week. Overall, we at Community Catalyst applaud the guidelines.

A few highlights:

• The grant criteria take steps to ensure that the selected programs are independent. In particular, we are happy to see that the guidelines clearly welcome states to contract with non-profit organizations to provide consumer assistance.
• CAPs must assist people with all types of coverage and provide assistance that is culturally appropriate. In addition, programs must collect data about any problems and questions, which we hope will provide real-time, on-the-ground information about what's working and what's not. Regular feedback to state and local policymakers can help improve health reform implementation.
•  Each state is eligible for one grant award. Therefore, it is important that states know about this grant program, so consumers can get help, no matter their zip code.

Examples like Health Care for All Massachusetts's Helpline, New York's Community Health Advocates, and Health Assist Tennessee have shown us that strong consumer assistance programs can mean the difference between a failed attempt and successful reforms. The Helpline in Massachusetts saw their call volume increase by 400 percent after Massachusetts's health reform law passed. People still call with questions, from enrollment assistance to help with paperwork to navigating the health system.

We hope that states will partner with community-based non-profits wherever possible to help provide consumer assistance. We have seen these models work, and know that they are trusted sources of health care information for communities and for families looking for help in understanding a system that's about to get bigger and more complex.

The CAPs grants are an important step in making sure the public understands and can navigate the health system as it changes. Grant applications are due September 10, and year-long grants will be awarded to states this October.

By Jon Peacock, Wisconsin Council on Children and Families

It isn't often that state policymakers have to make program changes and policy choices because of a law passed in another state or territory of the U.S.  Thus, it came as a big surprise to learn that a law enacted in Puerto Rico forces states to make a choice about how they administer public benefit programs, including Medicaid and CHIP.    

The Puerto Rico law invalidates all certified copies of birth certificates issued by the Puerto Rico Health Department before July 1, 2010. The law was adopted by the commonwealth last year after it was informed that stolen birth certificates were being used fraudulently. Beginning on October 1, 2010, states may no longer use those birth certificates to document citizenship to identity those eligible for public benefit programs.  The new law was initially scheduled to take effect on July 1, but states and program applicants have been given three additional months to prepare for the change.

The older certified copies will not be valid for new applications starting October 1, but states have the option of not requiring Puerto Ricans who are already enrolled to obtain a new birth certificate when they come up for their annual review of eligibility.  Additional information on the new law, as well as application forms for new copies of birth certificates, can be found here. 

Wisconsin recently became one of the first states to tackle this issue:  the state decided not to make current program participants obtain new copies of their birth certificates. (See Operations Memos # 10-39.) The WI Department of Health Services (DHS) decided that requiring all enrolled Puerto Ricans to obtain new birth certificates would be a burden for those individuals and wouldn't be a cost-effective use of time for caseworkers.  

Wisconsin's BadgerCare Plus program has been extremely effective in giving nearly all Wisconsin children access to quality affordable health insurance, and in making enrollment and renewals easier for eligible families.  However, Wisconsin still has room for improvement in streamlining renewals, and DHS is working toward that goal.  The department's choice not to require new birth certificates for already-enrolled Puerto Ricans prevents what could have been a setback to Wisconsin's efforts to reduce churning among program participants.

For new Puerto Rican applicants, states can mitigate the potential burden of the law by taking advantage of the CHIPRA option to use Social Security numbers for automated verification of citizenship and identity.  Although Wisconsin does not currently employ that option, DHS is preparing to put it in place this fall--and many states are already up and running with it.    

There is no avoiding the fact that the Puerto Rico law will affect Medicaid and CHIP programs across the U.S and is likely to delay some applications.  However, the choices made in Wisconsin illustrate that states can minimize the additional burdens for program applicants, participants and caseworkers.  Especially when budgets are tight, smart decisions that avoid additional red tape can pay off for both state budgets and uninsured kids.

The views expressed by Guest Bloggers do not necessarily reflect the views of the Center for Children and Families.

By Eugene Lewit and Liane Wong

The David and Lucile Packard Foundation

The percent of uninsured children has consistently declined, despite deterioration of coverage for adults and the economy. This is one of the significant but frequently overlooked good news stories of recent years.

The gains in children's coverage have been due in large part to actions taken by states to simplify enrollment and retention processes for their Medicaid and CHIP programs while expanding eligibility for those programs. In many states, policy advocacy groups have played important roles in spurring and supporting progress in their states. These organizations are likely to continue to be important players in the implementation of CHIPRA and broader health care reform. Yet, there has been little rigorous, systematic research on how advocacy groups do their work and the strategies they employ to achieve their objectives.

Two recently released issue briefs based on findings from an on-going evaluation of the David and Lucile Packard Foundation's Insuring America's Children: States Leading the Way (IAC) grantmaking strategy attempt to fill some of this knowledge void. The briefs examine some of the state-based advocacy work supported through IAC and identify the lessons that have been learned regarding how to effectively support and promote growth of children's health coverage.

In the first brief, State-Based Advocacy as a Tool for Expanding Children's Coverage: Lessons from Site Visits to Six IAC Grantee States. Evaluation Brief 1, the authors summarize key findings gleaned from in-depth site visits to states where IAC has made its most substantial investment in advocacy through multiyear "Finish Line" grants. These findings describe how persistence, flexibility, creativity and commitment to conducting effective states-based advocacy, especially in a changing environment, can benefit coverage expansion to all children. They also describe the importance of building strong and broad-based coalitions that include both grassroots and state-level stakeholders, an often key step toward maintaining a unified voice among a sometimes crowded community of advocates working to improve children's well being. While acknowledging that much work remains, the brief pinpoints a number of important gains in children's coverage since the IAC efforts began -- gains that have resulted despite a severe and ongoing economic downturn.

The second brief, Strategic Engagement of Policymakers is Key to Advancing a Children's Health Care Policy Agenda. Evaluation Brief 2, examines the benefit that positive engagement of policymakers can have for advocates to move the children's health care coverage agenda forward in states, as well as the strategies for making this engagement happen. Understanding states' unique political environments is one important first step toward this engagement. Further strategies include identifying, nurturing, and supporting political champions; creating strategic links between grassroots organizations and policy advocacy groups; creating effective, appealing messages for policymakers; establishing advocacy groups as the "go-to" resource for reliable data and information; and sharing ownership of agendas and successes with champions and key policymakers.

These briefs provide objective validation of the advocacy strategies and tactical innovations employed by veteran advocates throughout the country. They also offer practical and field-tested ideas for advocates looking for new ways to accelerate the pace of change. Most importantly, they remind us that tough, smart advocates can guide and support leaders in continuing the children's coverage success story.   

As we've noted previously Congress has yet to reach agreement on extending the increased Medicaid funding it originally granted in the 2009 economic recovery legislation.  The increased payments are scheduled to end in December 2010, but most state budgets are looking no better than they were a year and a half ago.  It seems like federal lawmakers would like to help states maintain Medicaid for the children and families who need it--Medicaid fiscal relief has passed both houses of Congress separately, but never in the same piece of legislation, so it is not law.

About half the states responded to this demonstrated interest by Congress--they included a six month extension of the increased Medicaid funds in their fiscal year 2011 budgets (see the map that employs data from the National Conference of State Legislatures) .  Since fiscal 2011 is already underway, states will be forced to make jarring budget adjustments if the extension does not come through.  

(Click to enlarge graphic)

In its absence, states will face budget holes of tens of millions in smaller states to more than a billion dollars in states like New York and California.  That means cuts to services state residents depend on or tax increases at a time when the economy remains fragile.  And because federal law protects eligibility standards and procedures in Medicaid, only limited parts of the program can be cut by state policymakers.  That makes the Medicaid funding extension an issue for all parts of the state budget--from education to economic development to the support for local governments that funds police and fire services.  Failure to extend Medicaid funding will have a ripple effect through the budgets and economies of many cash-strapped states.

The U.S. Senate moved yesterday toward extending unemployment benefits for those who have lost their jobs, recognizing that the recovery has not yet reached many workers.  It hasn't reached state budgets either, so an extension of Medicaid fiscal relief would help states maintain the services that families are counting on now more than ever.        

This last weekend, the nation's Governors came together for their annual meeting in Boston where the main topic of conversation was the economic crisis that continues to cripple state budgets.  One of the key policies many of the Governors made a pitch for was an extension of fiscal relief for strapped states through the extension of increased federal support for Medicaid (aka FMAP) .  As my colleague Joe Touschner pointed out in a blog last month: "That extra support has helped states through one of the worst fiscal crises on record and has been vital in stabilizing Medicaid coverage for children and others in families facing job loss."

My colleague Jocelyn Guyer also blogged about this topic earlier this week and I wanted to follow-up her comments with another look at why the Governors (and many others) think it is so critical for Congress to act sooner rather than later on an FMAP extension.  To do that, I pulled out a brief that Jocelyn and I, along with our colleague here at CCF, Martha Heberlein, did back in 2008 when the economic crisis we are currently in, began.

In this brief, we noted the astonishing progress that states had made over the last decade in covering uninsured children and explained that that progress was at risk due to the worsening economic climate facing states and a dramatic increase in the number of uninsured seeking coverage through Medicaid and CHIP.  We cited research from the Urban Institute that found that a one percentage point rise in the national unemployment rate can be expected to cause the number of uninsured people to grow by 1.1 million and to increase Medicaid and CHIP enrollment by one million (including 600,000 children and 400,000 non-elderly adults).

At the time, we considered the implications of this study if the unemployment rate reached 7.5 percent. Today, we face an unemployment rate of around 9.5 percent- and the model employed two years ago would suggest that as a result, the number of people that have lost employer-based coverage is 11.2 million; 4.7 million have likely enrolled in Medicaid or CHIP and about 5.1 million more people have become uninsured.

In the 2008 brief, we outlined key policies that lawmakers were considering to assist families through this crisis- reauthorizing CHIP and temporarily increasing the federal funding for Medicaid through increasing the FMAP.  CHIP has been reauthorized, the FMAP was increased until the end of this fiscal year and health care reform was been signed into law. However, the economic crisis continues and has likely resulted in millions of more people seeking coverage through Medicaid and CHIP just when the federal commitment to help states weather this economic storm appears to be eroding. While help is on the horizon in 2014 when states will receive new federal support through health reform, states need help now to meet the unprecedented demand for publicly-funded health care coverage.  It would be a mistake for the federal government to turn its back on the states before our nation has clearly pulled itself out of the recession. 

While there is much work to be done implementing the many facets of the health reform, creating the exchange marketplace(s) is one of the tasks that receives much of the attention. Not only is it a new concept to most states but, along with the expansion of Medicaid, it is the mechanism for insuring the 32 million Americans who are expected to gain coverage.

People tend to look to Massachusetts for lessons learned because the exchange concept in national reform is based on that state's health reform model. In fact, early this year the State Coverage Initiatives (SCI) hosted a meeting of state officials in Boston to provide the nuts and bolts of how the Massachusetts exchange known as the Health Connector works. This two-day meeting drew more than 100 participants from 42 states, including representatives from state insurance departments, Governor's offices, and the state department responsible for health programs. The SCI program, funded by the Robert Wood Johnson Foundation and administered by AcademyHealth, provides technical assistance to state leaders to help them move health care reform forward at the state level.

It's important to note that other states beyond Massachusetts have made advances in health reform that can inform our efforts moving forward. SCI documented a number of the important issues in its report,"Implementing State Health Reform: Lessons Learned for Policymakers," on the experience of five states: Massachusetts, New Mexico, Tennessee, Vermont and Wisconsin.

The report and its companion webinar focus on key questions and takeaways in a number of areas including enrollment and eligibility, marketing and outreach, staffing and coordination, and reporting and evaluation. It asks critical questions like:

• "Are current state information systems equipped to perform the necessary eligibility and enrollment functions for the health insurance expansion?"

• "To what extent can the state's current CHIP and Medicaid outreach activities be modified to include outreach and marketing for the health insurance expansion?"
  

Some states are already moving beyond forming a key group of state officials charged with beginning the planning process. Wisconsin, one of the early state implementers of health reform, has recently issued a request for proposals (RFP) to add exchange functionality to its current eligibility system. Connecticut and the District of Columbia are early adopters of the new option to cover adults (both parents and adults without dependents) now without waiting for health reform.

And speaking of waiting...let's not forget that with 5 million uninsured children already eligible for Medicaid or CHIP, kids don't also have to wait for health reform.

Yesterday, CMS issued two additional guidance letters related to implementation of the Children's Health Insurance Reauthorization Act (CHIPRA) of 2009. The first of these letters is on new federal support for covering for lawfully residing children and pregnant women who have been in the country less than five years. This long-awaited guidance explains that there is new federal support for states that have previously covered these populations using state-only funds and offers a new opportunity to expand to states that do not cover these populations due to the lack of federal  support for doing so.

Prior to CHIPRA, close to 20 states used state-only dollars to cover these children and/or pregnant women. Now, these states can receive federal matching funds for this coverage -- freeing up state funds during a time when state budgets are tight. It is important to note that since CHIPRA was enacted and this new opportunity for federal support, another six states have taken up the new option to cover this population, resulting in almost half of the states offering coverage to lawfully residing children and pregnant women.

The second guidance letter issued by CMS is about a provision in CHIPRA that gives states the opportunity to receive enhanced federal support to better serve Medicaid and CHIP beneficiaries for whom English is not their primary language.

There is much more to say on both of these topics, but not enough time before the long holiday weekend to do them justice, so please check back on our website next week.

Happy Fourth of July!