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Washington, DC Update 1/11/23
Legislative Updates
On January 3rd, the 118th Congress began its session. The House of Representatives will be controlled by the Republicans, who have 222 seats. The House Minority Leader will be Representative Hakeem Jeffries (D-NY-8), and the Speaker of the House will be Representative Kevin McCarthy (R-CA-23).

The Democrats will continue to control the Senate. The Democrats have 50 seats. Senator Bernie Sanders (I-VT) and Senator Angus King (I-ME) are Independents who caucus with the Democrats. The Republicans have 48 seats.

Committee assignments are expected in the coming days.

Note to F2Fs: Watch for news on committee assignments for your members of congress.
  • Committees of Jurisdiction for the F2F program: Finance and Energy and Commerce
  • Key Committees for Medicaid: Finance and Energy and Commerce
  • Key Committees for Children’s health issues: HELP, Finance and Ways & Means


The Omnibus
On December 29th, President Joe Biden signed into law the Consolidated Appropriations Act 2023 (CAA), a $1.7 trillion spending package, before Congress recessed for the year. The omnibus spending bill (AKA the CAA) combined all twelve Fiscal Year 2023 appropriations bills into a single package. It includes a number of provisions related to Medicaid and the Children’s Health Insurance Program (CHIP). This includes, among others:
  • delinking the Medicaid continuous coverage requirement from the COVID-19 public health emergency and starting its unwinding after March 31, 2023
  • requiring all states to provide 12 months of continuous eligibility for children in both Medicaid and CHIP
  • extending federal funding for CHIP for an additional two years
  • making permanent a state option to provide 12 months postpartum coverage in Medicaid and CHIP
  • significantly increasing federal Medicaid funding for Puerto Rico and the other territories over the next five years and
  • instituting several Medicaid and CHIP improvements related to mental health and juvenile justice.

This issue brief by Georgetown Center for Children and Families explains the Consolidated Appropriation Act’s Medicaid and CHIP provisions in a detailed and clear manner.

The CAA also included several policy provisions that improve the lives of people with disabilities, such as:
Unwinding of the Public Health Emergency
Manatt Health: Focus on Unwinding Provisions of CAA
The Manatt Health Expert Perspective for State Health and Value Strategies gives an overview and detailed explanation of the Unwinding Provisions in the 2023 Consolidated Appropriations Act.

Among the health policies included in the package, section 5131 of the legislation provides a fixed end date for the Medicaid continuous coverage guarantee (March 31, 2023), a gradual phase-down of the Families First Coronavirus Response Act (FFCRA) enhanced federal match rate, and new conditions, reporting requirements, and enforcement mechanisms to prioritize coverage retention and smooth coverage transitions during the “unwinding.”

Some highlights from the Perspective:
  • Currently, as a condition of receiving Families First Coronavirus Response Act (FFCRA) 6.2-point bump to the federal Medicaid match rate, states cannot terminate or reduce benefits for most Medicaid enrollees during the COVID-19 PHE. The omnibus legislation makes several key changes to the existing limits
  • Changes the end date for continuous coverage from the end of the month in which the PHE ends to March 31, 2023. This change provides states with approximately 100 days to make their final preparations for the start of unwinding on April 1, 2023—a longer period of time than the 60-day notice that the federal government had previously committed to provide before the end of the PHE.
  • Delinks the FMAP bump from the PHE and provides for a phase-out of enhanced funding over nine months for states that adhere to certain conditions. Instead of ending at the same time as continuous coverage, the new schedule for the phase out of the enhanced FMAP will be gradual.
  • Receipt of enhanced FMAP from April 1, 2023 to December 31, 2023, will be contingent upon the following new conditions:
  • States must conduct eligibility redeterminations and renewals in compliance with federal requirements and any other strategies approved (or required at a later date) by the Department of Health and Human Services, such as temporary section 1902(e)(14) waiver flexibilities.
  • States must “attempt to ensure” they have up-to-date enrollee contact information (including mailing addresses, phone numbers, and email addresses) by using the United States Postal Service National Change of Address Database, state health and human services agencies, or other reliable sources of contact information.
  • States must not disenroll anyone who is determined ineligible for Medicaid based on returned mail, without first making a good faith effort to contact the individual using more than one modality (e.g., telephone and email).
  • To improve transparency and support CMS oversight during the unwinding process, states must submit to CMS a monthly report—which will be made public—detailing activities related to eligibility redeterminations, as described below. 
  • CMS has targeted oversight powers related to eligibility redeterminations and reporting during the unwinding period. These powers supplement, and in some cases overlap with, CMS’ existing enforcement mechanisms.
 

CMCS: Information Bulletin Unwinding timeline
The Center for Medicaid and CHIP Service has released a timely informational bulletin (CIB) with details about the implementation of the unwinding provisions enacted by Congress just before the end of last year.

Beginning April 1, states may resume disenrollment of people who are no longer eligible for Medicaid, but only after the state has conducted a fresh and complete renewal, including examining eligibility for all categories of Medicaid. The CIB reaffirms that states have 12 months to initiate renewals and an additional two months to complete processing.

For more information and a look at the timeline chart, read this Georgetown Center for Children and Families Say Ahh! blog.


Unwinding Resource Page
State Health and Value Strategies (SHVS) developed this resource page for states to serve as an accessible one-stop source of information for states in “unwinding” when the Medicaid continuous coverage requirement ends. This resource is designed to support states' planning for this major coverage event, including developing processes that prioritize coverage retention following the conclusion of the continuous coverage requirement. Of particular interest to F2Fs may be the resource page for consumer communications and outreach.

Note to F2Fs: As noted, this information is created to support state agencies. While they are not materials created for families, they do provide keen insights into the guidance directing state agencies through this transition so that F2Fs can be ready to partner.
From the Administration
CMS: Health Related Social Needs
The Centers for Medicare and Medicaid Services (CMS) issued guidance for state Medicaid programs on how they can provide services to address unmet health-related social needs among enrollees through the use of "in lieu of services and settings" (ILOS).
  • As detailed in the letter to state Medicaid directors, ILOS allow states to offer alternative benefits to address a range of health-related social needs, including housing and food stability.
  • States must also ensure that the ILOS designations align with six principles for the "appropriate and efficient" use of these flexibilities, including: (1) advancing the objectives of the Medicaid program; (2) providing services in a manner that preserves enrollee rights and protections; and (3) appropriate monitoring, oversight, and respective evaluation, among others.
 
Read the full Health and Human Services news release HERE.
 

CMS: Connecting Kids to Coverage
Families from racial or ethnic minority populations often face barriers to obtaining health coverage, such as mixed immigration status within the household, limited access to enrollment assistance, or limited access to culturally and linguistically appropriate care. For example, Hispanic children have more than twice the uninsurance rate compared to their white peers. This puts families at risk for missing out on important preventive and routine care. Equitable outreach is a key priority of the Connecting Kids to Coverage National Campaign to ensure eligible families of all backgrounds have access to affordable and comprehensive coverage that Medicaid and the Children’s Health Insurance Program (CHIP) offers.
The Campaign’s ready-to-use materials highlights important Medicaid and CHIP enrollment information for families across the country.
  • In-Language Materials: Many of the Campaign’s materials are translated into Amharic, Arabic, Armenian, Burmese, Chinese, English, Farsi, French, German, Greek, Haitian Creole, Hmong, Italian, Khmer, Korean, Lingala, Marshallese, Polish, Portuguese, Russian, Somali, Spanish Tagalog and Vietnamese.
  • Immigrant Family Fact Sheet: This fact sheet shares important information for immigrant families to know about when applying for Medicaid and CHIP benefits.
  • American Indian/Alaska Native (AI/AN) full catalog of tools: CMS’ Division of Tribal Affairs has developed free AI/AN resources, including customizable fact sheets on Medicaid and CHIP basics, a report discussing barriers to AI/AN access to Medicaid and CHIP, enrollment strategies, tribal-state collaborations, and other best practices, and more.

Additionally, the Campaign’s Multicultural Outreach Initiative page provides outreach tools tailored to getting ethnically diverse families the important coverage they need, including those in non-English speaking households.


USCIS: Public Charge Rule
US Citizenship and Immigration Services (USCIS) published a final “public charge” immigration rule in September, which became effective on December 23, 2022. USCIS has now published an update to its Policy Manual to provide guidance to USCIS officers on how to implement the new public charge rule fairly and consistently and to better inform the public about how the rule will be implemented. The new rule and updated policy manual went into effect on Dec. 23, 2022 and applies prospectively to adjustment of status applications filed (or electronically submitted, if applicable) on or after that date.

The policy update will supersede the public charge inadmissibility guidance found in the 1999 Interim Field Guidance, and any related guidance addressing public charge inadmissibility.

To learn more about how USCIS is applying the public charge ground of inadmissibility, visit the USCIS Public Charge Resources page.

ACL published this blog explaining the new public charge rule and its impacts on people with disabilities.


HHS OCR: Rights of Conscience
U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) announced a Notice of Proposed Rulemaking (NPRM), entitled Safeguarding the Rights of Conscience as Protected by Federal Statutes, which proposes to restore the longstanding process for the handling of conscience complaints and provide additional safeguards to protect against conscience and religious discrimination.

In 2019, OCR issued a regulation that provided broad definitions, created new compliance regulations, and created a new enforcement mechanism for several statutes related to the conscience rights of certain federally funded health care entities and providers. The 2019 Final Rule was held unlawful by three federal district courts. Considering these court decisions, and consistent with the Administration’s commitment to safeguard the rights of federal conscience and religious nondiscrimination while protecting access to care, this NPRM proposes to partially rescind the Department’s 2019 rule while reinforcing other processes previously in place for the handling of conscience and religious freedom complaints.

The NPRM can beviewed here.

Public comments on the NPRM are due 60 days after publication of the NPRM in the Federal Register.


HHS: Long COVID in the Office of the Assistant Secretary
The Assistant Secretary for Health, Admiral Rachel Levine, continues to work across 14 U.S. Government agencies to coordinate a whole-of-government response to Long COVID. This work furthers the research priorities outlined in the National Research Action Plan on Long COVID. The Health+ Long COVID Report, an independently produced report commissioned by HHS, complements the existing landscape of Long COVID scientific literature and anecdotes with the narratives and expertise of caregivers, frontline workers, and people experiencing Long COVID and its associated conditions. Input on this report or anything related to long COVID can be sent to longcovid@hhs.gov.
State Policy
NASHP: Serious Illness Policy Institute
The National Academy for State Health Policy (NASHP), supported by The John A. Hartford Foundation, invites state applications to participate in its 2023-2025 State Policy Institute to Improve Care for People with Serious Illness.

This institute will engage up to five teams of state leaders for two years to develop and/or strengthen policies and strategies to improve access to palliative care. Each state team will receive customized technical support from NASHP and subject matter experts on serious illness and palliative care policy during the two-year period. State applications may include a team of up to four members, comprised of at least two senior state officials or administrators (such as Medicaid officials, governor’s health policy leaders, legislators, etc.). The team may include additional state staff and others who can directly support team goals (e.g., serious illness advocacy organizations, palliative care taskforce members or providers, etc.).

Informational webinar January 24, 2023 3-4pm EST learn more about webinar and register HERE.

Applications due February 24, 2023

Visit this link for more information about the opportunity.
Other CYSHCN Policy Related Materials of Interest
USOC: Health Equity Guide
United States of Care released a new guide on health equity called "Advancing Equity through Health Insurance Coverage.” It provides a menu of policy options that state advocates, policymakers, and regulators can consider to create more equitable insurance coverage.


National Council on Disability: Roundtable on Home and Community Based Services
On January 26th, from 12:00 pm – 3:00 pm EST, the National Council on Disability (NCD) is planning on hosting a virtual roundtable about the status of home and community-based services (HCBS). The conversation will focus on the current system and opportunities for improvement including a plan on how we can expand HCBS for more people. The webinar will focus mostly on the findings of this NCD report Strengthening the HCBS Ecosystem: Responding to Dangers of Congregate Settings during COVID-19. To register for the virtual roundtable, click here.


KFF: Waiting lists for Home and Community-Based Services from 2016 to 2021
Even though HCBS waiting lists are an imperfect measure of unmet need, there are no other measures available. Therefore, waiting lists remain a source of concern to policymakers and proposals to eliminate them have been put forth by both Republicans and Democrats. This data note from the Kaiser Family Foundation (KFF) provides new information about waiting lists from their most recent survey of state Medicaid HCBS programs, highlighting why waiting lists are an incomplete measure of unmet need and why they are not comparable across states or over time. KFF also recently provided new waiting list indicators on State Health Facts to help people better understand who is on waiting lists and what those waiting lists mean. See also, More Than Half a Million People in the U.S. Are On Waiting Lists for Medicaid Home- and Community-Based Services, But Waiting Lists Can Both Overstate and Understate Unmet Need from KFF.


Recorded Live: Who's Caring? Family Care in America
On December 15, 2022, Administration for Community Living Acting Administrator Alison Barkoff, Dr. Meena Seshamani, Director, Center for Medicare, Centers for Medicare and Medicaid Services; Meg Kabat, Senior Advisor for Families, Caregivers, and Survivors, U.S. Department of Veterans Affairs; and Rep. Suzanne Bonamici, (D-OR), Chair, Civil Rights and Human Services Subcommittee, Education & Labor Committee participated in a conversation on POLITICO Live about the recent release of the National Strategy to Support Family Caregivers. The conversation focused on how federal action can improve the lives of family caregivers across America. Watch the video on Facebook. 

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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.