Health Center State Policy

State Affairs: A Year In Review

As the year comes to a close, and many states are gearing up for the 2016 legislative session, our team at State Affairs reflects on the highlights of the year. Apart from the various changes that came about due to the most recent November elections, the key issues involving or impacting health centers have been around coverage options for the uninsured, payment reform, state funding for health centers, and community partnerships.

Medicaid Expansion

As of December 2015, 30 states and the District of Columbia have expanded coverage for individuals with incomes under 133% of federal poverty level.  In 2014, 26 states had expanded coverage. In FY 2015, New Hampshire and Indiana had 1115 waivers approved and Pennsylvania decided to move to traditional expansion rather than implementation of its previously approved 1115 waiver. In FY 2016, Alaska’s governor decided to accept federal funding to expand Medicaid, and Montana’s 1115 waiver was approved. At the close of this year, four additional states have been discussing potential ways to increase coverage in their states: South Dakota, Utah, Wyoming, and Louisiana.

What’s Not New?

Similar to other waivers, Montana includes cost-sharing, such as some premiums and co-pays for individuals with incomes at or below 100% FPL. To date, CMS has not approved any waivers that allow individuals below 100% FPL to be dis-enrolled from coverage, even if they fail to pay premiums.

Although some states have been discussing the addition of work requirements or high cost-sharing for eligible individuals, CMS has not approved waivers with these elements to date.

What’s New?

Indiana and Montana both include a provision that “locks out” individuals with incomes above 100% FPL who fail to pay premiums for a specified period of time.

Montana’s waiver will be the first to use a third-party administrator to run the program.

States that have already expanded are planning to submit new waiver requests, and may include additional restrictions such as increased cost-sharing, premiums, life time enrollment limits, and changes in benefits. Michigan’s waiver to allow the continuation of their expansion program was approved, and includes new elements that include healthy behavior incentives.  States to watch in 2016 include Ohio, Arizona, Kentucky and New Hampshire.

Payment Reform

To help health centers assess their current readiness for engagement in payment reform, NACHC contracted with JSI in to develop the Payment Reform Readiness Assessment Tool. This year, NACHC was excited to launch a web-based version of the tool to facilitate an experience that is more user-friendly and accessible. Contact Kersten Lausch at to learn more.

NACHC’s State Affairs team hosted a webinar series on payment reform for health centers. Recordings of these webinars can be accessed below.

In 2015, California approved legislation, sponsored by the California Primary Care Association, to authorize a voluntary 3-year alternative payment methodology (APM) pilot for FQHCs in the state. The PPS-equivalent capitation payment model is intended to provide health centers with greater flexibility to deliver care to each patient in a manner that best meets his or her needs.

State Funding

According to NACHC’s Annual PCA Policy Survey, for FY2015, twenty-nine states reported that their state provides direct funding for health centers for a total of $305 million as compared to thirty-one states providing approximately $400 million in FY2014. Looking towards the future, twenty-four PCAs were able to provide estimates of their funding for SFY2016, and of those twenty-four, nine are expecting an increase in funding, seven are expecting funding levels to stay the same, and eight are expecting a decrease in funding.

Health Center-Hospital Partnerships

Our Partnership project with America’s Essential Hospitals and George Washington University launched their website: earlier this year. On this website, you will find information about the four local communities that worked with the National Partnership in 2014-15 on a common priority area and leveraging health center-hospital collaboration to implement, respond to, or influence policy. Check out the website to learn more about the innovative and important work these local partnerships are doing around increasing access to coverage, increasing access to specialty care, and outreach and enrollment in Medicaid and in the Marketplace.

It has been a busy year in state health policy, and we are looking forward to working with you and supporting you in your efforts in 2016.  Thank you for the work you do for health centers and your communities! Wishing you happiness and health in the New Year and beyond!

NACHC State Affairs: Dawn McKinney, Heidi Emerson, Luke Ertle, and Kersten Burns Lausch