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Board Oks Budget, Legislative Priorities, Conference Sites NATIONAL ASSOCIATION OF COUNTIES n WASHINGTON, D.C. VOL. 44, NO. 24 n December 17, 2012 Board OKs budget, legislative priorities, conference sites By Tom Goodman consideration for all three levels of PUBLIC AFFAIRS DIRECTOR government. At the federal level, 70 percent of the cuts recommended NACo’s Board of Directors by the Simpson-Bowles panel have adopted a $15.8 million budget been enacted. “We’ve already felt for 2013, seven key legislative the pain,” Chase said. priorities and approved three future At the state level, NACo needs sites for the Annual Conference at to be aware of trends, he said, their fall meeting, held this year in especially unfunded and under- Shelby County (Memphis), Tenn. funded mandates. It is also vitally Dec. 7–8. important that NACo understands NACo Executive Director Matt the factors facing counties, he said. Chase also gave a presentation Chase, who became executive on the state of the association director on Sept. 17, maintained and outlined the “One NACo that NACo has to work with a Strategic Blueprint.” Chase said the blueprint is being crafted with See BOARD page 10 Colo. counties face decisions, uncertainty after pot vote By Charlie Ban Douglas County, south of Photo by Tom Goodman STAFF WRITER Denver, got out of the gate quickly During the fall Board of Directors meeting in Memphis, Tenn., NACo’s female leadership, joined by NACo following Election Day, having President Chris Rodgers, gathers round the Christmas tree for a holiday belles portrait. Amendment 64’s passage in Col- its first reading of an ordinance orado may have legalized marijuana banning marijuana cultivation and possession, use and cultivation, but retail sale. some counties aren’t inhaling. Under “It’s become one of the models the new law, counties can regulate for counties exercising local con- NACo joins Supreme Court brief commercial sales and cultivation. trol,” said county spokeswoman They may in fact, prohibit licensing Wendy Holmes, who added that in Medicaid preemption case for retail operations. Colorado Counties, Inc., the state’s association of counties, distributed By lisa soronen North Carolina’s statute allows recipient with a significant portion the ordinance to counties statewide. SLLC EXECUTIVE DIRECTOR the state to recoup a set amount of of his or her tort settlement “We like to help other counties, and money from a Medicaid recipient’s “E.M.A.” is an unidentified CountyNews there are others who aren’t on board NACo signed onto an amicus tort settlement that doesn’t fully minor who was injured at birth. with this (legalization).” curiae brief filed by State and Lo- reimburse the state for its Medicaid Features The Board of Commissioners’ cal Legal Center (SLLC) in a U.S. costs and still leaves the Medicaid See MEDICAID page 8 Supreme Court case involving the See POT VOTE page 12 question of whether Medicaid preempts a state statute. Quick Takes The specific issue the court will decide in Delia v. E.M.A. is whether a North Carolina statute allowing NACo extends its best the state to recover one-third of a Reindeer Medicaid recipient’s settlement from wishes for a Happy Towns a personal injury lawsuit is preempted by Medicaid’s anti-lien provision. Holiday Season and a Blitzen, Ore. Donner, Fla. This case matters to counties be- Comet, Mont. Rudolph, S.D. cause in some states in some instances New Year filled with Cupid, Neb. Vixen, La. counties will pay for at least part of the Dasher, Ga. Medicaid costs of someone injured by the fault of another person. As the peace, joy and success! facts of Delia v. E.M.A illustrate, those accuracyproject.org costs can be substantial. 2 December 17, 2012 CountyNews • Affordable Care Act implementation moves to states By aniTa Cardwell or implement a partial expansion PROGRAM MANAGER such as expanding the program to State Decisions For Creating Health cover individuals only up to 100 While some por- Insurance Exchanges in 2014 (as of Dec.) percent instead of 133 percent of the tions of the Afford- federal poverty level and still receive CONTENT able Care Act (ACA) the enhanced federal match rate. Default to Federal Exchange Declared State-based Exchange may change Presi- The guidance stipulates that dent Obama’s re-election means the Planning for Partnership Exchange Undecided states will not be able to receive the health reform law does not face a full 100 percent match rate for a partial repeal in the coming years. expansion, although HHS will However, there are a number consider and provide the regular of important decisions at the state match rate for demonstration project level that will significantly affect the proposals from states that include a ACA’s implementation and have partial expansion of the program. important implications for counties Another factor at play in state in terms of their local health care decision-making involves Medicaid delivery systems. disproportionate share hospital (DSH) payments. Between 2014 Medicaid Expansion and 2019, the ACA will cut $14 bil- As originally outlined in the lion from DSH payments that help ACA, Medicaid would be expanded hospitals offset the costs associated in 2014 to cover all individuals with providing care to uninsured up to 133 percent of the federal individuals. These cuts were ex- poverty level (FPL). To cover the pected to be offset to some degree costs associated with the expansion, by expanded Medicaid coverage for for the first three years the federal previously uninsured people. But government would provide 100 now that some states may choose percent of the funding, phasing not to expand Medicaid, the DSH down to 90 percent in 2020 and all Source of data: Kaiser Family Foundation Health cuts will have an even greater impact Reform Source • healthreform.kff.org subsequent years. in these states because there will be However, earlier this year the U.S. Supreme Court ruled that the While the high federal match rate publication — had not yet made a be moderate and some states could See ACA page 7 expansion was unconstitutionally is intended to serve as an incentive decision, and there is no deadline even experience net savings by doing coercive because the ACA stipulated for states to expand Medicaid, and for them to do so. The U.S. Depart- so because of the high federal match that if a state chose not to expand as of now 13 states and the District ment of Health and Human Services rate and fewer costs associated with Medicaid, the federal government of Columbia plan to do so, currently (HHS) has indicated that states that providing uncompensated care for could withhold all existing federal eight states — Alabama, Georgia, decide to expand Medicaid would be uninsured individuals. President | Chris Rodgers Medicaid funds. Louisiana, Maine, Mississippi, able to change course and opt out of Some states are also concerned Publisher | Matthew Chase Public Affairs Director | Tom Goodman With the ruling effectively mean- Oklahoma, South Carolina and the expansion at a later date. that the federal match rate for the Executive Editor | Beverly Anne Schlotterbeck ing that the federal government Texas — have indicated that they A number of governors have expansion population may be reduced Senior Staff Writer | Charles Taylor cannot require states to expand do not intend to implement the expressed concern about the costs at some point, either because the Staff Writer | Charlie Ban Graphic Artist | Jack Hernandez Medicaid, states are now in the expansion, and six others are leaning associated with implementing the federal government may require states Editorial Assistant | Christopher Johnson process of determining whether they toward not expanding. Medicaid expansion. These costs to pay more of the cost in the future will implement the expansion. Many states — 23 at the time of are predicted to vary across states or because the rate may be cut as part ADVERTISING STAFF depending on the number of unin- of an entitlement-reform package in Job Market/Classifieds representative Christopher Johnson sured individuals and current levels a larger deficit-reduction deal. National Accounts representative of coverage. A recent analysis by On Dec. 10, HHS issued guid- Beverly Schlotterbeck 2013 Achievement Award the Kaiser Family Foundation and ance that some states had indicated (202) 393-6226 • FAX (202) 393-2630 Published biweekly except August by: the Urban Institute found that as a they were waiting for: specifically, National Association of Counties applications available online whole, state costs associated with whether they might be able to gradu- Research Foundation, Inc. implementing the expansion would ally phase in the Medicaid expansion 25 Massachusetts Ave., N.W. Applications for the 2013 Award Application Overview, STE. 500, Washington, D.C. 20001 Achievement Award program Frequently Asked Questions, video (202) 393-6226 | FAX (202) 393-2630 E-mail | [email protected] are now available online. The tutorial, and electronic applications Online address | www.countynews.org awards recognize innovative and are available on the NACo website In Case You Missed It state-of-the-art county government at http://www.naco.org/achievemen- The appearance of paid advertisements in County News News to use from past County News in no way implies support or endorsement by the Na- programs. Last year, the program tawards. tional Association of Counties for any of the products, honored more than 400 county All application materials, in- services or messages advertised. Periodicals postage paid at Washington D.C. and other offices. programs from 99 counties in 30 cluding application fees, must be » ‘Smart Justice’ theme announced for 2013 NCGM Mail subscriptions are $100 per year for non-members. states. submitted by Feb. 21, 2013, 11:59 NACo President Chris Rodgers recently announced that the April $60 per year for non-members purchasing multiple cop- 2013 theme for National County Government Month (NCGM) will ies.
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