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Washington, DC Update 12/21/22
Legislative Updates
We have a draft Omnibus bill… and 3 days to pass it! The continuing resolution to fund the government ends on December 23rd, so Congress has until midnight on that day to either pass this bill or another continuing resolution to avoid the government shutdown.

4,155 pages long, the Omnibus includes provisions for children’s health and their families.

Georgetown CCF has a great, and much shorter, blog with high level overview of Omnibus provisions for children.

  • Required 12-month continuous eligibility for children and adolescents
  • Permanent state plan option to give 12-month postpartum coverage
  • Medicaid Money Follows the Person extended through Sept 30, 2027 at $450M/year
  • HCBS Spousal impoverishment protections extended through Sept 30, 2027
  • New requirements that Medicaid managed care plans maintain accurate, searchable provider directories that include information about providers' linguistic capacities, accessible office space and equipment, and whether accepting new patients. This includes LTSS providers "as appropriate." Enforcement mechanism is not clear.
  • Support for Medicaid crisis response services
  • $7B for the Medicaid Improvement Fund (this funds oversight and evaluation programs)
  • Pre-release Medicaid screenings for youth in public institutions up to 30 days prior to release

  • Extends CHIP coverage for two years through fiscal year 2029
Medicaid for the U.S. Territories
  • The Omnibus extends Puerto Rico’s higher federal Medicaid match of 76 percent through fiscal year 2027 and permanently extends a higher federal Medicaid match of 83 percent for American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, and the U.S. Virgin Islands. 

NOTE: Georgetown CCF blog discussing Medicaid for Puerto Rico and Territories

Mental Health Care: 
  • Reauthorizes the National Suicide Prevention Lifeline Program, the Community Mental Health Service Block Grants, and the renamed Substance Use and Prevention, Treatment, and Recovery Block Grants
  • Bill also includes grant funding to support the maternal mental health programs, establishes a maternal mental health hotline and a related task force
  • Extends mental health parity to state and local government workers and bolsters the mental health and substance use disorder workforce through increased capacity and training

Pandemic Preparedness: 
  • New authorities for improving the Strategic National Stockpile to ensure critical pandemic supplies are operational, resilient, and ready to deploy in times of need.
  • Support to the public health workforce by encouraging investments in the next generation of health care workers through grants and public health loan forgiveness

Unwinding of PHE:
  • Creates a graduated wind down of the 6.2% FMAP boost established during COVID
  • Reduces to 5% starting 4/1/2023, then 2.5% from 7/1/2023 to 9/30/2023, then 1.5% from 10/1/2023 through end of 2023
  • COVID continuous coverage requirement ends Mar. 31, 2023, but states must report monthly through 6/2024 on redetermination activities to continue to receive the enhanced match. Also, states must:
  • Maintain eligibility standards and services that were in place on Jan 1, 2020 and maintain the cost sharing protections of FFCRA
  • Comply with federal requirements on redeterminations and post-eligibility verifications of eligibility
  • Make a good faith effort to maintain up-to-date contact information for beneficiaries, including attempting to contact anyone through more than one modality prior to disenrollment
  • States that don't fulfill reporting requirements get penalized up to 1% FMAP.
  • If CMS finds that a state did not comply with fed requirements on redeterminations, it can require a prompt corrective action plan.

  • Re-authorizes and increases funding for the Maternal, Infant and Early Childhood Home Visiting (MIECHV)

  • ABLE Age Adjustment (pg. 2155) changes ABLE eligibility requirement to include individuals whose disability began before age 46 (up from 26 in current law)

Social Security Administration
  • $14.1 billion, an increase of $785 million (or 6 percent), for SSA’s administrative expenses, is the largest increase in more than a decade. The pandemic, combined with budget limitations, has created significant challenges for SSA, which has produced backlogs in key workloads and long wait times for individuals just to talk to someone at SSA about the benefits they have earned from years of work. 
From the Administration
ICYMI: The CDC expanded use of the updated (bivalent) COVID-19 vaccines for ages 6 months to 5 years.

White House: Free At- Home COVID Tests
The White House has announced a new limited round of free at-home COVID-19 tests for the winter. Households can now order either standard at-home tests or tests that are more accessible for people who are blind or have low vision. Shipping is free.

Older adults and people with disabilities who need support ordering the free at-home tests can contact the Eldercare Locator (800-677-1116) or the Disability Information and Access Line (DIAL, 888-677-1199). Staff are available to assist from 8 AM to 9 PM ET Monday through Friday. They can provide information about testing options, including connections to accessible instructions and helping with test administration.

OPM: Government-wide DEIA Summit
The Office of Personnel Management recently hosted the first annual government-wide diversity, equity, inclusion, and accessibility summit. Check out the recap of this momentous summit here.
State Policy
Manatt Health: New 1115 waivers
Recently, the Centers for Medicare and Medicaid Services (CMS) approved the renewal of, and amendments to, innovative section 1115 demonstrations for ArizonaArkansasMassachusetts and Oregon. These waivers focus on continuous Medicaid enrollment and social drivers of health—which CMS calls health-related social needs (HRSN)—along with other features promoting access, equity and delivery system reform. In a new blog post for The Commonwealth Fund, Manatt Health shares highlights of the new waivers. Click here to read the full blog post or to read a summary post.

To register for the upcoming webinar, hosted by Manatt Health, discussing the innovative 1115 waivers and how they implement HRSN initiatives, click here. The webinar will feature a panel of state leaders from Arizona, Massachusetts and Oregon providing insights into the HRSN approval process—and real-world lessons for other states considering their own HRSN programs.

A couple of highlights to note:
  • Oregon and Massachusetts will demo two types of continuous enrollment waivers (OR Children and MA- recently incarcerated and homeless adults)
  • CMS placed very interesting guardrails on the Health Related Social Needs (HRSN). Approval of these waivers are conditioned on states’ meeting parameters for Medicaid payment rates. If a state’s Medicaid rates for primary care, behavioral health and obstetrics are less than 805% of Medicare rates, then the state must close the gap. Additionally, the waiver funding for HRSN cannot replace existing state funding for such needs- it must add resources. However, CMS also requires that the state cap the amount of waiver funding for HSRN so that help with such services do not take away from coverage of basic health services.

NOTE for F2Fs - Community Care Hubs as strategy to address HSRN
Medicaid agencies are increasingly looking beyond the health care system for community-based solutions to improve health outcomes. Community-based organizations (CBOs) are emerging as critical partners in state efforts to address social determinants of health (SDOH). Trusted by the communities they serve, CBOs have deep relationships, knowledge of the local environment and critical expertise in the delivery of social care. Despite their promise, challenges around the establishment and sustainability of relationships between CBOs and health care organizations persist, reflecting the different histories, institutions, cultures, business practices and funding streams of today’s siloed health and human services infrastructures. Community Care Hubs (CCHs) are community-centered entities that organize and support networks of CBOs to meaningfully and efficiently integrate CBOs and the health-related services they provide into the health care continuum.

F2Fs are a type of CBO - ones that are uniquely and powerfully family-led!
To read more, check out this blog by Manatt. It is full of examples and links to current efforts. Follow the links to the Community Care Hub National Learning Collaborative to figure out how to get connected in your state.

PHE Unwinding: State Tracker
This blog by Georgetown Center for Children and Families provides a summary of and link to a detailed state tracker, as well as links to previous “Unwinding Wednesday” blogs that dive into specific aspects of the unwinding. The state tracker examines 6 elements: whether a state has a public state unwinding plan or summary, if there are communications materials/toolkits available, and if the state is planning to have an unwinding data dashboard or publicly post unwinding data.

Blog & Tracker: Medicaid Managed Care
If you want to know more about the managed care industry in your state and across the nation, and what steps for oversight and accountability are being taken, consider reading this blog by Georgetown Center for Children and Families. The blog offers a sweeping analysis and also links to the KFF MCO tracker and other materials to learn more about managed care organization (MCOs) in your state and beyond.

A blog discussing a groundbreaking California report on MCOs that has led to quality performance, sanctions and transparency.

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Family Voices is a national organization and grassroots network of families and friends of children and youth with special health care needs and disabilities that promotes partnership with families--including those of cultural, linguistic and geographic diversity--in order to improve healthcare services and policies for children.