Affordable Care Act - Consumer Assistance Program Grants

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On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act. On March 30, 2010, the Health Care and Education Reconciliation Act of 2010 was also signed into law. The two laws are collectively referred to as the Affordable Care Act. The Affordable Care Act includes a wide variety of provisions designed to promote accountability, affordability, quality, and accessibility in the health care system. The Affordable Care Act also includes significant grant funding for States to work with the Federal government to implement health reform.Section 1002 of the ACA added section 2793 of the PHS Act, which provides for federal grants to States to establish, expand, or provide support for the establishment of independent offices of health insurance consumer assistance or ombudsman programs. Section 2793 of the PHS Act requires that, as a condition of receiving grant funds, consumer assistance or ombudsman programs must: assist consumers with filing complaints and appeals, assist consumers with enrollment into health coverage, and educate consumers on their rights and responsibilities with respect to group health plan and health insurance coverage. In addition, these programs must collect data on consumer inquiries and complaints to help the Secretary identify problems in the marketplace and strengthen enforcement of health laws such as the ACA and the Mental Health Parity and Addiction Equity Act by providing States and the U.S. Department of Health and Human Services (HHS) with information about potential situa tions in which health plans and issuers are not in compliance with the laws. Starting in 2014, programs must also help resolve problems with obtaining premium tax credits for coverage through Affordable Insurance Exchanges (Exchanges) established under section 1311 of the ACA. As health reform is implemented, consumers will need to understand new programs, avail themselves of new protections, and navigate the system to find the most affordable coverage that meets their needs. HHS interprets the statutory requirement to include providing assistance to uninsured individuals to obtain group health plan or health insurance coverage, and, if appropriate, referring them to other sources of coverage such as Medicaid, the Children?s Health Insurance Program (CHIP), or the Pre-existing Condition Insurance Plan (PCIP). For data collection activities, programs collect data on a range of consumer inquiries related to private coverage. In addition, programs collect data on the types of problems and inquiries encountered by consumers relating to public coverage, State high risk pools, and PCIP. Programs do not need to be capable of providing direct assistance to consumers on issues and problems related to Medicare, Medicaid, and CHIP. However, programs must be capable of making appropriate referrals for such consumers.

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