States will need to conduct a fiscal analysis to ensure that their budgets include sufficient funds to pay their share of ACA implementation costs. Also, states will want to consider cost when choosing among implementation options.

*Milestone details:

*Full name: Conduct a fiscal analysis of the components of implementation.

*Relevance to the ACA:

The ACA does not require a fiscal analysis, but states will want to understand the fiscal implications of the law to enable analysis of implementation options and to enable sound budgeting for implementation activities. The fiscal implications of each provision will vary by state, based on individual circumstances and state choices. Some of the provisions of ACA with direct fiscal implications for states are:

§1311 – Requires states to establish insurance Exchanges and provides planning and establishment grants for these activities.

§1302, §1311 – Establishes the essential benefit package levels that define qualified health plans, including those offered through the Exchange (§1302) and allows states to add additional benefit requirements to qualified health plans; costs would be borne by states rather than the federal government (§1311).

§2001 – Extends Medicaid eligibility to all persons below 133 FPL and increases FMAP for these newly eligible Medicaid beneficiaries.

§2101 – Increases CHIP FMAP in 2013.

§2501, §2503, and §1206[HR4872] – Changes the way Medicaid prescription drug rebates are calculated

Additional provisions of the ACA will have indirect fiscal implications for states. Among these are:

§1501 – Requires that all persons, with certain exceptions, maintain minimum essential health insurance coverage.

§2201 – Requires coordinated enrollment for Medicaid, CHIP, and Exchange plans.