New Jersey in jeopardy of losing nearly $8 million in federal ACA grant funds
With the February 20th deadline for New Jersey to spend $7.67 million in federal Affordable Care Act (ACA) grant funds rapidly approaching, U.S. Congressman Bill Pascrell, Jr. (D-NJ-09) today joined local health care advocacy groups and health care consumers to call on Governor Christie to use the available federal funds to promote ACA enrollment or obtain a no-cost extension to spend the funds during the next open enrollment period. The grant, awarded in February 2012, has remained largely unspent and will be recaptured by the federal government this week if no action is taken
"We have nearly a million uninsured people in New Jersey who, thanks to the Affordable Care Act, have access to quality, affordable coverage, some for the first time in their lives," said Rep. Pascrell. "Sadly, Governor Christie has prided himself on being an impediment to providing healthcare to New Jerseyans instead of being a partner in implementing this law. It's clear that obstruction is the name of the game for radical Republicans governors across the country."
New Jersey was awarded a $7.67 million Section 1311 grant, which under the state’s current agreement with HHS, must be spent by February 20, 2014. To date, New Jersey has spent only $3,000. In October, Rep. Pascrell wrote to Governor Christie urging him to spend the remainder of the ACA grant in order to avoid losing the federal funds to help educate New Jerseyans about the ACA as well as facilitate enrollment.
In January, Rep. Pascrell introduced H.R. 3884, the Ensuring Full Use of Federal Health Care Funding Act - legislation that would allow the federal government to recoup any unspent grant funds and make them available to qualified entities to engage in ACA outreach, education, and enrollment activities.
“Uninsured New Jerseyans who want and need health insurance deserve to know about the new options available to them to get and pay for health insurance," said Maura Collinsgru with NJ for Health Care Coalition. "For some, that knowledge could be difference between life and death. By failing to use these funds to share that news, Governor Christie is putting the well being of our residents at unnecessary risk.“
"In NJ we see clearly different results between Medicaid and the Marketplace. Medicaid involves state coordination and is on target to make projected goals. These funds intended to support Marketplace enrollments went unspent," said Elnora Watson, Executive Director of the Urban League of Hudson County. "As a result there are entire swaths of the state where uninsured, largely minority communities are hugely underserved. And those residents are suffering needlessly."
A recent report from New Jersey Policy Perspectives found that, for many people, this funding is literally the difference between being with or without health insurance. According to the report, if this funding is not spent, 95,000 New Jerseyans will go without health insurance. Of that 95,000 people, 11,000 are children; 14,000 are seriously mentally ill; and 83,000 are “poor” or have “low and moderate income.”
New Jersey is not alone. Despite the fact that these grants have already been awarded and cost states none of their own funds, a good deal of this money remains unspent or has already gone back to the Treasury – primarily in states where Governors oppose the ACA. For example, Texas was awarded a $1 million grant, and Governor Rick Perry allowed $900,000 of that to return to the U.S. Treasury. The impact of this obstruction is evident in enrollment numbers in states with cooperative Governors when compared to states with uncooperative Governors.
A recent study from a Harvard University Professor found that fully cooperative states have enrolled 43% of their target Medicaid population, and enrolled 37% of their target population in private coverage. States where Governors refused to expand Medicaid or set up their own Exchange have only enrolled 1.5% of their potential Medicaid population and only 5.6% of their goal for enrollment in private insurance. In New Jersey, only 34,751 residents are enrolled in coverage through the Health Insurance Marketplace.
According to a December 2013 Kaiser Family Foundation poll, 44 percent of Americans feel that they don’t have enough information about the ACA to understand how it will impact them and their families. 62 percent have heard “only a little” or “nothing at all” about the Marketplace. In New Jersey, 31 percent of residents don’t believe they understand the law at all, according to a recent poll from the Monmouth University Polling Institute and the New Jersey Health Care Quality Institute.
These numbers show there is a clear need for additional outreach and education surrounding the ACA, and the federal Section 1311 grant can facilitate this at no cost to states, while helping the 32 million currently uninsured Americans get health insurance – many for the first time.
Grants made available through Section 1311 of the ACA provide states with a very flexible funding source to conduct education and outreach around the ACA, as well as facilitate enrollment. HHS has provided states with a detailed list of permissible uses for the funds.
Here is a statement attributable to HHS spokesman Fabien Levy:
“As we have always made clear to the State of New Jersey, we are eager to work with them to re-scope their grant for activities that are allowable under the law and that are in line with guidance and regulations. We have reached out to the state numerous times over the last few months in order to avoid a last minute scramble, but unfortunately the state has yet to send us a request to re-scope their grant for any allowable activities. We are committed to working with New Jersey to support their efforts to successfully implement their Marketplace.”
Additionally, on background:
• If a state needs to modify their award, CMS works with them in that modification. The state submits a revised work plan, budget, budget narrative, and project narrative to reflect the new Exchange model and timeline that the State is pursuing. CMS will evaluate the scope of each State’s proposed projects to determine if it is allowable and a cost reasonable request. CMS conducts a very careful review of the applicant’s proposal, both through the Office of Grant and Acquisition Management (OGAM) and the Center for Consumer Information and Insurance Oversight (CCIIO), as well as through an internal review by our subject-matter experts.
• All states who were transitioning from planned SBM’s to the FFM were given the opportunity to re-scope their grants for allowable purposes under the FFM model. Guidance on these purposes are in the Funding Opportunity Announcement. In addition, we released two FAQs in April and May with additional detail on allowable uses for 1311 funding in FFM states. Public links to all documents are below.
http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/marketplace-funding-marketing-faq.html (April 23, 2013)
http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/spm-ffm-funding.html (May 13, 2013)
• The grant funding is for activities related to building a State-based Marketplace. New Jersey’s original request included unallowable costs and therefore, those costs were denied.
• The grant by HHS was originally awarded two years ago in February of 2012. Despite numerous attempts by HHS to work with New Jersey to re-purpose the grant for allowable activities, the state only today requested we reconsider their request to repurpose their grant for unallowable activities.
• The state has through close of business on February 20, 2014 to re-scope the grant and work with CMS to gain approval on a modification of what the award would be used for.
• However, if the $7.6 million grant is not re-purposed, it will expire. New Jersey will need to re-scope their grant award in order to spend the grant funding. If they do not re-scope the award, their grant will be closed out.