American Rescue Plan – Health Provisions

“Yee Haw” for Help for West Virginians

On March 11, 2021, President Biden signed the American Rescue Plan Act (ARP), a package of positive financial relief for West Virginia families and for state and local government.

The law’s health provisions strengthen the Affordable Care Act as well as Medicaid.  My reaction – as a gal who loves horses - was a big “Yee Haw” and I think you will be as happy as me to hear some of the details.  The more I learn the more excited I am about the ARP. It is truly a historic Act that shows how government can be there to help and support families during tough times.

Overall, the ARP will send at least $4 billion to West Virginia in new federal funding for COVID recovery and infrastructure improvements.  The help will flow to individuals and to state and local government. The state will receive $1.25 billion and each county and city will directly receive additional, significant, funds.  To see how much different counties and cities receive, and for a summary of all the provisions in ARP with West Virginia specifics and dollar amounts, see this great resource from Senator Manchin.

But before I highlight the ARP health provisions, I want to say a huge thank you to Senator Joe Manchin who supported the ARP.  Too often we are ready to call our elected officials to complain, but it is important we also remember to thank them for their good work like the passage of the ARP.  You can send the Senator a thank you here.

American Rescue Plan Builds on the ACA Premium Tax Credits

As we celebrate the 11th anniversary of the passage of the Affordable Care Act (ACA), the ARP builds on the ACA foundation to make health insurance more affordable.  The ARP dramatically increases the ACA premium tax credits available to folks who enroll in health insurance through the ACA marketplace at HealthCare.gov.

The additional help is available to people who are currently eligible and expands eligibility to people with incomes that were previously too high for financial help.  The ARP lowers the share of premiums that a person must pay so that everyone will see cheaper premiums no matter your annual family income.  And for family incomes under 150 percent of the Federal Poverty Level (FPL), your share of premiums will be ZERO.  (150 percent of FPL depends on your family size; for an individual it is $19,140 a year and for a family of three it is $32,580).  People above 400 percent FPL will no longer face a premium tax credit “eligibility cliff” and will have to pay no more than 8.5 percent of their family income based on a benchmark plan premium for marketplace health insurance coverage.  The ARP also forgives any premium tax credit repayment for tax year 2020!

The changes will be in place on April 1 and will be for 2021 and 2022. For those who already purchased a plan on the ACA marketplace, to reduce your share of premiums for the rest of this year you need to go to HealthCare.gov and reset your information.  If you don’t take action, you still will have the additional premium tax credit applied when you file your taxes (now due May 17) and it will change what you owe or the size of your tax refund. If you have not purchased a plan through the ACA marketplace, a special open enrollment period runs through May 15 at HealthCare.gov.  Rumors in Washington, D.C. are circulating that this special open enrollment period may be extended longer – but best to not wait.  GOOD NEWS!  The special open enrollment period was extended to August 15!  

In addition, the ARP creates a special rule for ACA premium tax credit eligibility and unemployment compensation. A taxpayer who has received, or has been approved to receive, unemployment compensation for any week during 2021 will be eligible for free ACA marketplace health insurance.

Other Significant Health Provisions for West Virginia

In addition to the ARP’s significant increase and extension of the ACA premium tax credits, other health provisions will help West Virginians. 

• The ARP created a state option to extend Medicaid postpartum for 5 years with just a simple state plan amendment.  

This is especially important for West Virginia.  In 2019, our state extended Medicaid and CHIP public health insurance coverage to all pregnant women up to 300 percent of the Federal Poverty Level.  But the coverage only continues for two months postpartum.  With this change in federal law, West Virginia can easily extend coverage for new months from 2 to 12 months after the birth of the baby.  HB 2266 is under consideration in the House right now.  See our Fact Sheet for more information about HB 2266 and how you can help make sure it passes.

• The ARP invested in vaccine supply and distribution, including no cost vaccine and treatment for Medicaid/CHIP enrollees – and a state option to use 100 percent federal Medicaid dollars to cover any uninsured person for COVID testing, COVID vaccines and their administration, any COVID treatment including prescription drugs, and treatment for conditions that complicate COVID treatment, for the duration of the public health emergency.  The COVID public health emergency will continue at least through the end of 2021.  This is an option that our state will take up and use to help uninsured West Virginians and to reimburse our often financially struggling rural providers and rural hospitals who deliver these services.
• The ARP increases the federal Medicaid match by 10 percent for home- and community-based services (HCBS) for one year starting April 1, 2021.  In West Virginia, total spending on HCBS will be increased by almost $63 million. 

Specifically, the law requires states to use the funds to "supplement, and not supplant, the level of State funds expended for home and community-based services for eligible individuals through programs in effect as of April 1, 2021." The state is not allowed to make any decisions that limit funding or eligibility for these services and funds must be invested so that the state can maintain and grow its offering of community services. A list of allowable uses for the funding include:

increasing direct care worker wages, paying for transportation expenses to and from the homes of those being served, purchasing personal protective equipment for workers and those they are supporting, and providing hazard pay. The extra dollars also can be used to support family caregivers, recruit and train additional direct care workers and for technology to facilitate services. Finally, the funds can help provide services for individuals on the HCBS waiting lists. As Advocates we need to weigh in with DHHR about the use of these funds.  West Virginians for Affordable Health Care’s Medicaid Coalition LTSS Work Group is already considering recommendations.  Contact Nancy Tyler to join the LTSS Work Group at [email protected].

• The ARP covers 100 percent of the premium for COBRA continuation coverage through September 20, 2021.  West Virginians who missed the 60-day enrollment window for COBRA prior to the availability of this help can go back and enroll.  
• The ARP Increased investment in substance use services & supports, including investments in the workforce.
• The ARP increased investment in behavioral health teams for children.
• The ARP provides new funding for rural hospitals and providers.

Additional Resources

• For more details on the ARP health provisions, check out American Rescue Plan Act:  Health Coverage Provisions Explained published by the Georgetown University Health Policy Institute and authored by our colleagues Edwin Park and Sabrina Corlette. 
• For a digestible summary of all the provisions in the ARP that help West Virginia families, including the new child tax credits, check-out American Rescue Plan Act Will Help Millions and Bolster the Economy prepared by the national Center on Budget and Policy staff. 
• For a great fact sheet that highlights ARP provisions that help children, check-out The American Rescue Plan:  A Prescription for Child Health and Stability During the COVID-19 Pandemic from our good friends at Community Catalyst and the Children’s HealthWatch. 

Finally, again please thank Senator Manchin for voting for this amazing, historic victory for West Virginia families.  And join us in celebrating this sweet victory and share a West Virginia “Yee Haw” for the American Rescue Plan Act.