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Washington, DC Update 5/24/23
Legislative Updates
Debt Ceiling
Leadership is unable to reach agreement on key aspects of the budget, leading to uncertainty about whether default can be avoided by the June deadline.

Want more information about the debt ceiling?

For additional resources, you can find NHeLP’s Protect Medicaid 2023 webpage here.

Tools to communicate about effects of proposed budget cuts and default:

Healthcare Extension and Accessibility for Developmentally Disabled and Underserved Population Act
Representative Seth Moulton (D-MA-6), Representative Brian Fitzpatrick (R-PA-1), Representative Debbie Dingell (D-MI-6), and Representative Joseph Morelle (D-NY-25) introduced the Healthcare Extension and Accessibility for Developmentally Disabled and Underserved Population Act (HEADs UP Act) (H.R 3380). The bill directs the Health Services and Resources Administration in the U.S. Department of Health and Human Services to designate people with intellectual and developmental disabilities (I/DD) as a Medically Underserved Population. This designation will give people with I/DD access to new primary care and specialist services, incentivize new research, and authorize more favorable reimbursement rates for providers who treat those with I/DD. Read the press release from Representative Moulton.
Unwinding of Medicaid Continuous Coverage and the PHE
Op-Ed: How to Ensure Millions of Children Don’t Lose Medicaid Coverage Erroneously
Written by Dr. Richard E. Besser of RWJF and Joan Alker of Georgetown CCF. Click here to read the article. 

State-Specific Updates that Inform Us All

ICYMI: Resources
  • These Unwinding Dashboards analyze the states (13 total, including Arkansas and Florida) that are already publicly reporting unwinding data.
  • Princeton Pulse podcast “Why Millions of Americans May Lose Their Health Coverage” that features a discussion led by Heather Howard, Director of Princeton State Health Value Strategies with Kate McEvoy, Executive Director of the National Association of Medicaid Directors, and Dr. Kemi Alli, a pediatrician and CEO of Henry J. Austin Health Center, a federally qualified health center in Trenton, New Jersey.

State Health and Value Strategies: Communication Strategies
The unwinding of the Medicaid continuous coverage requirement represents the largest nationwide coverage transition since the Affordable Care Act. As a result of the Medicaid renewal process, which resumed in April of 2023, it is expected that millions of people across the country will lose Medicaid [and in some cases, the Children’s Health Insurance Program (CHIP)] coverage. This presents State-Based Marketplaces (SBMs) with an opportunity to target outreach efforts to those who have recently lost Medicaid or CHIP to help eligible individuals retain access to affordable healthcare through the Marketplace. This expert perspective focuses on best practices for timing and strategy in outreach to consumers that are no longer eligible for Medicaid to help states develop a consumer “chase campaign” and is a follow-up to an earlier expert perspective, State Strategies for Sequencing Enrollee Communications When Medicaid Continuous Coverage Ends, which focused on communications to consumers when unwinding began.
From the Administration
CMS: NEW Guidance for Medicaid Billing for School Services
Last week, Centers for Medicare & Medicaid Services (CMS) released a comprehensive guide for Medicaid school-based services to make it easier for schools to deliver and receive payment for health care services to millions of eligible students. Developed in consultation with the US Department of Education, the 184-page Comprehensive Guide to Medicaid Services and Administrative Claiming - PDF outlines flexibilities states can adopt to make it easier for schools to get paid for these critical health services delivered to children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), which together provide health coverage to more than half of all children in the United States.
Medicaid and CHIP cover more than half of all children in this country. That’s more than 41 million children spending over 30 hours weekly in school during most of the year. This comprehensive policy guide helps states and schools leverage Medicaid and CHIP and offers a roadmap of how they can build a bridge between education and health care, including mental health care, to support children enrolled in these programs and help them thrive.  

The guide clarifies, consolidates, and expands on a wealth of CMS guidance on how schools can receive payment for providing care for Medicaid- and CHIP-enrolled students, and how states can ease the administrative burden on school-based health providers to promote their participation in Medicaid and CHIP while meeting federal statutory and regulatory requirements.

The goal is streamlined and uniformed processes for families, schools and Medicaid to ensure all kids get what they need. This includes helping states and schools operationalize: 
  • How payments can be made for school-based services under Medicaid and CHIP; 
  • How states can simplify billing for school-based services, including in rural and small or under-resourced communities, where care may be particularly challenging. 
  • Examples of approved methods that state agencies have used to pay for covered services; and  
  • How to enroll qualified health care providers to participate in Medicaid and furnish services within school settings. 

In the months to come, CMS plans to release more resources to help ensure states can optimize children’s access to school-based services. As outlined by Bipartisan Safer Communities Act, these resources include $50 million in grant opportunities and a school-based services technical assistance center, in partnership with ED. For more information on the guide, visit Medicaid.gov

This Georgetown Center for Children and Families blog introduces the guide and breaks down the guidance into some additional digestible pieces.

Administration for Community Living: I/DD Counts
In November 2022, ACL organized a national summit that included people with I/DD, representatives from federal agencies, advocacy groups, researchers, and health care providers. The group discussed progress on its 2030 roadmap for health data equity, remaining gaps, and priorities for the future. The I/DD Counts Summit Report and Executive Summary are now available and summarize the key ideas from the summit and actions recommended by and for the I/DD Counts initiative.
Although public health surveillance of people with disabilities has improved, the lack of data on the health of people with I/DD persists. Health surveys often exclude I/DD altogether, and when information about people with I/DD is collected, it often lacks demographic data, such as age, sex, ethnicity and race. In addition, the way data is collected varies widely between states and even within states. In many cases, I/DD is not tracked at all unless a person is receiving services through a state or federally funded program.

The lack of data leads to health disparities in a number of ways. It is more difficult to identify issues that may uniquely or disproportionately affect people with I/DD, or to identify groups within the population of people with I/DD who may be disproportionately affected by any given issue. This can result in policies and programs do not meet the needs of people with I/DD as well as they could – or needs that are not being addressed at all.

Additional links on the topic:

HHS: Surgeon General’s Report Workplace Mental Health
This 30-page Surgeon General’s Framework for Workplace Mental Health and Well-Being offers a foundation that workplaces can build upon to become engines of well-being that show workers they matter, their work matters, and that resources are available to them. The report is easy to follow and full of unique infographics and links to more information/ resources.
Other CYSHCN Policy Related Materials
Georgetown CCF: More data on Behavioral Health, Rural Health and more
This blog by Georgetown CCF offers a tour of the child health data dashboard library. New to the dashboard is behavioral health, but it also includes MCO-specific data, quality of care and maternal/infant health. This dashboard library pulls from state Medicaid agency websites, all in one place.

Also, CCF has new interactive maps for Medicaid coverage in rural counties/small towns for 2020-2021, for both children and adults. Hover over counties for more data.

NHeLP Webinar: Risks/Rewards of Demographic Data Collection
Demographic data can be a powerful tool to build equitable health systems. But with heightened attention toward misuse and misappropriation of data, individuals may be skeptical about sharing personal information with health care providers, programs, and plans. In this webinar, NHeLP and partners Movement Advancement Project, Race Forward, Disability Rights and Education Defense Fund, and Justice in Aging, will review current issues in data privacy that impede collection and use of demographic data for health equity and present findings from their papers as part of NHeLP's series, "Risks and Rewards of Demographic Data Collection: How Effective Data Privacy Can Promote Health Equity."

This webinar will be recorded. The recording and slides will be sent to all registrants approximately 48 hours after the conclusion of the webinar. The slides will also be sent to all registrants 24 hours prior to the webinar.

June 6, 2023 | 3pm EST | Register here

Manatt Health: Access and MCO NPRM’s
This piece by Manatt Health provides an overview and breakdown of themes connecting the two CMS proposed rules: Managed Care Access, Finance, and Quality (or the “Managed Care Proposed Rule”) and Ensuring Access to Medicaid Services(or the “Access Proposed Rule” which focuses on fee-for-service (FFS) delivery systems and program improvements for home- and community-based services (HCBS) across delivery systems). Although the two rules largely focus on different delivery systems, they share common goals and themes, with some provisions in each applying across multiple delivery systems.

To learn more, register for Manatt’s free webinar, Proposed Rules to Enhance Access and Quality for Medicaid HCBS and Strengthen the HCBS Workforce. Join Manatt on June 1 for an in-depth discussion of the key reforms that CMS has proposed for Medicaid HCBS. 

This summary was also published on the Robert Wood Johnson Foundation’s State Health and Value Strategies webpage.

Health Justice Webinar: Innovative Solutions to Youth Mental Health
Families USA is excited to be hosting “Innovative Approaches to Address Youth and Family Mental Health,” a Health Justice Now Network Webinar.

This one-hour webinar will explore both policy and advocacy solutions to address the youth and family mental health crisis with three panelists: T-Kea Blackman, MPS, CPRS, the founder of the Mental Health Empowerment Agency, Dr. Sean Joe, Ph.D., MSW, a nationally recognized authority on suicidal behavior among African Americans, and Jennifer Wang, J.D., the Senior Director of National Policy and Advocacy at Fountain House. The discussion will also connect to Families USA’s 2023 health equity policy agenda.

May 31, 2023 | 3pm ET | Register HERE

Research Update: Medicaid Helps People Work
This blog counteracts current efforts to impose work requirements with solid data. For example, when excluding adults who qualified for Medicaid on the basis of disability, the Kaiser Family Foundation (KFF) estimates that more than 61% of adult Medicaid beneficiaries work, with another 30% not working because of school attendance, a disability, or caregiving responsibilities.

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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.