State agencies have more information about implementing the Patient Protection and Affordable Care of 2010 (PPACA) than they had a year ago, but they still need more details from Washington.
Stuart Wright, a deputy inspector general at the Office of Inspector General at the U.S. Department of Health and Human Services (HHS), has come to that conclusion in a report on state PPACA implementation efforts.
PPACA calls for state and federal agencies to work together to expand enrollment in Medicaid and the Children's Health Insurance Program (CHIP), and to set up a new system of "exchanges" that will serve as health insurance supermarkets.
PPACA Section 1413 requires HHS to help the states with the PPACA "health subsidy" program efforts by developing a streamlined health program application form.
Section 1413 requires each state to develop a "secure electronic interface for exchange of information among program," and to "participate in data-matching agreements for obtaining eligibility information from various sources," Wright wrote in his report.
In March 2012 and April 2012, inspector general's office investigators surveyed the states to get their views on how implementation was going and what kinds of additional help they needed from the Centers for Medicare & Medicaid Services (CMS), the HHS arm in charge of PPACA implementation efforts.
At that time -- about a year ago -- 35 of the 45 states that responded said they expected to be able to meet the PPACA requirements by Jan. 1, 2014, Wright said.
"States also reported needing information and guidance, particularly on the secretary’s application form, the planned federal data services hub, and the calculation of modified adjusted gross income," Wright said.
Since then, HHS has posted details about the exchange individual and group coverage application forms.
HHS also has posted technical information on how states can shift to using PPACA modified adjusted gross income (MAGI) in place of ordinary taxable income or other income measures when deciding which applicants qualify for which programs.
Regulators in 24 states that have been requiring asset tests for enrollees Medicaid or CHIP plans are still wondering whether CMS and HHS will really require them to open up their government health programs to lottery winners.
State regulators are also still asking questions about the HHS data services hub.
Earlier this month, for example, Don Hughes, an Arizona health care policy advisor, said uncertainty about the status of the federal data services hub project was one reason the state decided not to try to set up a state-based exchange or a state-federal "partnership exchange" in 2014.
Marilyn Tavenner, the CMS acting administrator, said in a response to the inspector general's report that CMS has "shared a significant amount of key Hub documentation and technical specifications since September 2012."
States now have business service descriptions for multiple hub services in final formats, Tavenner said.
CMS also has held one-on-one conversations with states about the hub and what the state-hub connection testing process will require, and it has been holding calls with states on topics such as Internal Revenue Service safeguards and remote identity proofing, Tavenner said.