Washington, DC Update 7/12/23

Budget and Appropriations - Recap and Way Forward

On June 3^rd, President Biden signed The Fiscal Responsibility Act of 2023 (P.L. 118-5). The bi-partisan bill suspends the debt ceiling through January 2025 in exchange for spending caps, new work requirements for TANF and food stamp recipients, rescinding unspent pandemic aid, and other changes. The bill has no impact on Medicaid.

The bill established budget caps for Fiscal Years (FY) 2024 and 2025 for both defense and non-defense discretionary (NDD) spending. There is also an incentive for Congress to act on all appropriations bills before January 1, 2024. If they do not, FY 2023 spending levels will be cut by an additional 1 percent until all bills are passed; this applies to both defense and non-defense spending.

So, what are the next steps? Congress returns this week, following the 4^th of July recess, and sprints over the next 3 weeks to accomplish this and other priorities prior to the August Recess.

The House of Representatives' Appropriations Committee and Senate Appropriations Committee have released their top-line agreements for each of the 12 appropriations bills (known as 302(b) allocations). These represent how much money each of the appropriations subcommittees can spend for FY 2024. Both Committees have also begun the process to mark up each of the 12 appropriations bills. You can see some of the details at Senate 302bs and House 302bs.

Assisting Caregivers Today (ACT)

The bipartisan, bicameral Assisting Caregivers Today (ACT) Caucus has been re-launched by Caucus Co-Chairs, Senators Michael Bennet (D-CO) and Shelley Moore Capito (R-WV) and Representatives Jen Kiggans (R-VA) and Debbie Dingell (D-MI). The ACT Caucus will provide education about the challenges family caregivers face and advocate for policies that support them. Here are links to the press release from ACT Caucus Co-Chairs: Sen. Bennet, Sen. Capito, and Rep. Dingell, along with a recent blog from AARP’s Nancy LeaMond, Executive Vice President and Chief Advocacy & Engagement Officer, that discusses the ACT Caucus and some other recent actions to support family caregivers.

NOTE: This caucus appears to primarily support caregiving for adults with disabilities and elderly; however, it does signal change in terms of caregiving provided by family, and this benefits everyone.

Update on State-Level Efforts in Paid Family Caregiving

Several states brought forward paid family caregiving bills in their legislative sessions. Below are those that passed. Additionally, bills were proposed in CT, IN, CA and TX. As the blog linked above from the AARP indicates, there appears to be some movement in favor of family caregivers.

• FL House: click here, signed by the governor
• NJ Senate: click here, signed by the governor
• MT House: click here, signed by the governor on 5/19/23, effective 7/1/23
• MA Current Promulgate Rules: click here, targeted to start 7/1/23
• WA House (A Legislative Study on the Model): click here, signed by the governor
• ME House: click here, on the governor’s desk awaiting signature

Equality for Families with Disabilities Act: On June 22^nd, Representative Cherfilus-McCormick (D-FL) introduced the Equality for Families with Disabilities Act (H.R. 4282). The bill seeks to eliminate discrimination against parents and guardians with disabilities in state child welfare proceedings. The bill will “require individualized, fact-based evaluations of parenting capabilities to prevent state agencies from restricting parental rights solely based on disability status.” The bill will also “require state child welfare plans to include support for parents, guardians, and other caregivers with disabilities” and support state courts through grants to assess accessibility of child welfare proceedings and require the U.S. Department of Health and Human Services and the Department of Justice (DOJ) to revise and update technical assistance materials for states.

Follow the link above to see if a Representative from your state is a co-sponsor of this bill.

NASHP: Most States Keeping PHE flexibilities in HCBS

During the COVID-19 public health emergency (PHE), states received approval from the federal government to implement Appendix K amendments to 1915(c) home-and community-based waivers and 1115 demonstration waivers to ensure that Medicaid beneficiaries were able to receive needed services during the pandemic. With the end of the COVID-19 PHE declaration on May 11, 2023, states must decide if and what types of flexibilities will be sustained long-term.

The National Academy for State Health Policy (NASHP) fielded a 50-state survey and scanned state websites examining which of nine flexibilities the state planned to sustain post-PHE in at least one of the state’s aging/physical disability waivers. They identified the plans of 47 states and Washington, DC and found that 41 states and DC planned to sustain at least one flexibility post-PHE through waiver amendments, legislation, and/or regulations. You can examine the results here. In the meantime, take that at least 23 states will continue to allow Medicaid payment to parents, spouses, and/or legally responsible individuals.

Georgetown CCF: Is Retroactive Eligibility the Answer?

As we have heard, alarming numbers of children and families are being procedurally disenrolled from Medicaid. Some argue that high rates are nothing to worry about and want people to believe that these folks have “other sources of coverage”, “don’t want Medicaid”, “can easily get back on”, or are “simply irresponsible”. One of the misleading arguments that we’ve heard is that Medicaid’s 90-day retroactive eligibility period is another reason not to worry – those who lose coverage can simply be reinstated if they were eligible 90 days prior to termination. But is it really that simple? Check out this Georgetown Center for Children and Families blog to read in more!

Trackers and Resources:

• Georgetown CCF 50 State Unwinding Tracker
• Georgetown CCF Unwinding Resources
• Kaiser Family Foundation Unwinding Tracker- Overview, State Data, National Data, and Data Debrief
• Medicaid.gov Unwinding Resources

NAMD: Medicaid Unwinding Data

About 50 percent of current Medicaid members have never experienced the standard eligibility process. All Medicaid programs need data and accurate data analysis to really understand what is happening on the ground with the unwinding processes, where their efforts are succeeding, and where course correction is needed. In this moment -- where we implement continuous improvement efforts -- this never-before-attempted undertaking can succeed by ensuring that people still eligible retain coverage and those ineligible transition to other forms of health insurance.  

Medicaid programs need your support to make this moment meaningful through both partnerships and a growing understanding of the nuances of the data. Here are a few resources that the National Association of Medicaid Directors (NAMD) has shared as helpful in that effort. 

• Understanding unwinding data: Learn more about some key elements to help put the data from individual states in context.  
• CMS assessment of early unwinding efforts: Check out a factsheet from CMS on early efforts and where we can all do more to help Medicaid members.  
• Check out how states are reporting their own unwinding data: State Health and Value Strategies is keeping an up-to-date interactive map that will connect you to individual state reports on unwinding.

CMS OMH: Disability Pride Month and ADA Anniversary

Throughout July, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) celebrates Disability Pride Month and the anniversary of the Americans with Disabilities Act (ADA). Enacted on July 26, 1990, the ADA prohibits discrimination on the basis of disability in employment, transportation, public accommodations, telecommunications, communications, and access to state and local government programs and services. During this observance, CMS OMH highlights the unique health care challenges and barriers faced by those living with a disability. 

NOTE: Many of these resources are geared towards adults with disabilities (with regard to terms and data, for example); however, many of the materials can be used for children as well. For example, the guides on how to improve accessibility of health care spaces improve accessibility for all.

• Visit CMS OMH’s Improving Access to Care for People with Disabilities webpage to find tools and resources that can help you improve services and help patients understand their rights. This webpage is also available in Spanish.
• Download CMS OMH’s Getting the Care You Need: Guide for People with Disabilities, now available in eight languages and in Braille.
• Review the Autism Spectrum Disorder (ASD) Disparities in Medicare Fee-For-Service Beneficiaries data snapshot to learn more about racial and geographic ASD disparities among those enrolled in Medicare fee-for-service.
• Download the How to Improve Physical Accessibility at Your Health Care Facility resource, which helps health care providers, staff, and administrators in a variety of outpatient settings improve the accessibility of their health care facility.
• Take the Modernizing Health Care to Improve Physical Accessibility training to learn about solutions for increasing the physical accessibility of health care settings and services for individuals with disabilities.

Visit ADA.gov to learn more about the rights available to individuals with disabilities under the ADA.

HHS: Junk Health Plans, Surprise Medical Bills and Medical Debt

As part of “Bidenomics”, the U.S. Department of Health and Human Services (HHS) announced actions to protect consumers from junk health plans, surprise medical bills, and excess costs that lead to medical debt. These actions build on the Biden-Harris Administration’s effort to eliminate hidden fees in every sector of the economy and lower health care costs for American seniors and families.

• The Biden-Harris Administration is cracking down on junk insurance. New proposed rules would close loopholes that the previous administration took advantage of that allow companies to offer misleading insurance products that can discriminate based on pre-existing conditions and trick consumers into buying products that provide little or no coverage when they need it most. These plans leave families surprised by thousands of dollars in medical expenses when they use health care services like a surgery. If finalized, the rule would limit so-called “short-term” plans to truly short time periods, close loopholes, and establish a clear disclosure for consumers of the limits of these plans.
• The Administration is releasing important guidance on rules against surprise medical billing. Biden-Harris Administration rules are already preventing as many as 1 million surprise medical bills every month. New guidance will help prevent providers from gaming the system by evading the surprise billing rules with creative contractual loopholes that still leave consumers with unexpected costs.
• The Administration is announcing new steps to protect consumers from unfair medical debt. For the first time in history, the Consumer Financial Protection Bureau, HHS, and Treasury are collaborating to explore whether health care provider and third-party efforts to encourage consumers to sign up for these products are operating outside of existing consumer protections and breaking the law. Medical credit cards and loans often lead to higher costs without consumers fully understanding the risks.

FACT SHEET: President Biden Announces New Actions to Lower Health Care Costs and Protect Consumers from Scam Insurance Plans and Junk Fees as Part of “Bidenomics” Push | The White House

ACL: UCEDD Awards

ACL is awarding grants to 17 University Centers for Excellence in Developmental Disabilities Education, Research, and Service (UCEDDs) to begin a new five-year cycle to address issues, find solutions, and conduct research to advance the needs of individuals with developmental disabilities (DD) and their families. These 17 centers are part of the 67 federally designated UCEDDs located nationwide in states and territories. UCEDDs are interdisciplinary education, research, and public service units of universities, or public or nonprofit entities associated with universities. They are authorized by the Developmental Disabilities Assistance and Bill of Rights Act and funded by ACL.

The funds awarded will be used to pay for the federal share of the cost of the administration and operation of programs. UCEDDs contribute additional resources to expand the activities and impact of their work, while serving as a national and international resource in the areas of education, research, and service — and providing a link between the university and the community.

Additionally, 50 UCEDDs will be awarded continuation grants. Each of the 67 grantees will be awarded $606,330, for a combined total of $40,624,110 for FY2023. As a network, the UCEDDs collaborate with people with disabilities, including individuals with intellectual and developmental disabilities, to improve quality of life and community inclusion for people with disabilities. The centers accomplish this mission through advocacy, community partnerships, interdisciplinary training, and the translation of research into practical applications. 

Mathematica: Engaging People with Disabilities in Policies, Programs and Evaluation

Efforts to infuse equitable and inclusive practices into all phases of federally-funded evaluations can transform our understanding of how—and for whom—policies and programs work. Up to one in four adults in the United States has a disability, and many participate in an array of federal programs. As federal agencies seek to center equity in the design, implementation, and communication of their projects and evaluations, they have recognized the importance of engaging people with lived experience, including those with disabilities. Disability-focused programs and offices that have sought to embed equity into their work can provide valuable insight on how to incorporate the lived experience of people with disabilities into policies, programs, research, and evaluations.

Join Mathematica’s Center for Studying Disability Policy and some of its federal partners on Tuesday, July 18, 2023, from noon to 1:00 p.m. ET for a virtual roundtable discussion about agencies’ successes, challenges, and lessons learned as they incorporated lived experience and equitable research practices into their disability-related programs and policies. Register here.

Annie E. Casey Foundation: Kids Count Data Book

Last month, the Annie E. Casey Foundation’s 2023 Kid Count Data Book was released. In addition to the 50-page report, other resources are also available, including state-by-state data on child well-being using 16 different indicators. Links to 50 State Data Profiles on Child Well-Being in English and Spanish can be found here.