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Washington, DC Update 10/31/22
Legislative Updates
Both chambers of Congress will return to Washington after the November 8 midterm elections. The next votes in the House and Senate are scheduled to occur during the week of November 14.
From the Administration
Final Rule: Family Glitch
The final rule for fixing the Marketplace "family glitch" has been released!

The new rule addresses what its supporters have called the "family glitch." Under the ACA, employees and family members are not eligible for a premium tax credit to buy subsidized coverage on the ACA's health insurance marketplaces if the employee has access to "affordable" health insurance through an employer—meaning, as adjusted for 2023, an offer of self-only coverage that does not exceed 9.12 percent of the employee's income.

Current regulations, however, define employer-based health insurance as affordable if the coverage solely for the employee, and not for family members, is affordable, making family members with limited income ineligible for a premium tax credit for an ACA marketplace plan.

Starting in 2023, under the new rule, if coverage for the family as a whole costs more than 9.12 percent of household income under the lowest-cost employer-sponsored option, then the nonemployee family members will be eligible for financial assistance in the ACA marketplace.

"About 1 million Americans will either gain coverage or see their insurance become more affordable as a result of the new rule," according to a White House statement. "This marks the most significant administrative action to implement the Affordable Care Act since the law was first put into place."

IRS: ABLE Account Gift Tax Exclusion Increased
IRS increased the gift tax exclusion amount for 2023 will go from $16,000 to $17,000. The gift tax exclusion amount is the amount that can be placed into an ABLE account per year. Read more here.

CMS: Update Information with Medicaid - Preparing for the PHE Unwinding
Consider sharing information from the CMS sites linked below with families to encourage them to update their information with Medicaid before the unwinding of the public health emergency so they do not lose their health coverage.

CMS: Flu Vaccine
The messaging below is from the CMS Connecting Kids to Coverage National Campaign. Check out more information on flu and other resources for flu vaccine-focused outreach including videos, social media graphics and more, so parents can rest a little easier during this season knowing their children’s vaccinations are covered.

The Centers for Disease Control and Prevention (CDC) estimates that between 6,000 and 26,000 children younger than 5 years are hospitalized each year in the United States because of influenza. Children under 5 years of age and adults over the age of 65 are at higher risk of complications from flu. Best practices to fight the flu include covering coughs and sneezes, washing hands, staying away from anyone who is sick, and getting a flu vaccine.
The flu vaccine is the most effective way to reduce the severity of illness in individuals and the risk of flu-associated hospitalizations. A 2022 study shows that flu vaccination reduced children’s risk of severe influenza by 75 percent. Getting vaccinated reduces the spread of flu to others who may be more vulnerable to serious flu illness, like babies and young children, older people, and people with certain long-term health problems. Children as young as 6 months can get a flu vaccine.
Medicaid and CHIP cover yearly flu vaccinations and also cover a wide range of other health services, including vision and dental care, mental and behavioral services, well-child visits, blood lead screening tests, and other routine vaccinations.

ACL: National Center to Strengthen Direct Care Workforce
The Administration for Community Living has awarded a five-year grant totaling over $6 million to establish a national center to expand and strengthen the direct care workforce across the country. In support of the Biden-Harris Administration’s commitment to strengthening the care economy, this initiative will provide technical assistance to states and service providers and facilitate collaboration with stakeholders to improve recruitment, retention, training, and professional development of the direct care workers who provide the critical services that make it possible for people with disabilities and older adults to live in their own homes and communities.

Long-standing workforce shortages have reached crisis levels during the COVID-19 pandemic; today, more than three-quarters of service providers are not accepting new clients and more than half have cut services as a result of the direct care workforce shortage. High turnover – averaging nearly 44 percent across states – also mean that people who are able to get services often experience service disruptions and receive inconsistent care. As a result, increasing numbers of people are left with no option but to move to nursing homes and other institutions, people who want to leave these facilities cannot, and the health and safety of those who live in the community is at risk. In addition to undermining people’s civil right to community living, this leads to poorer health outcomes and higher costs of care, which are most often borne by taxpayers.

With the demand for home and community-based services increasing, due in part to the rapidly growing populations of older adults and people with disabilities, more than 1.3 million new jobs for direct care workers will be created by 2030. A coordinated, national effort to improve our national capacity to recruit, train and retain a high-quality, competent, and effective direct care workforce has never been more important.

The national Direct Care Workforce Capacity Building Center will serve as a hub, providing tools, resources and training to assist state systems and service providers and to support the development and coordination of policies and programs that contribute to a stable, robust direct care workforce. The center’s website will share resources from the federal government, highlight state and local model policies and best practices that can be replicated or adapted, and share training and technical assistance materials. In addition, the center will facilitate peer-to-peer sharing of lessons learned and promising practices through learning collaboratives and support collaboration between state systems, including Medicaid, aging, disability, and workforce agencies; service providers; and aging, disability and labor stakeholders. 

ACL: Rehabilitation Engineering Research
ACL’s National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) is announcing three 2022 Rehabilitation Engineering Research Centers (RERC) Program  grantees. The planned project period for these grants is September 1, 2022 – August 31, 2027 with an estimated award amount of $925,000 per year for each grantee. 

The purpose of the RERC program is to improve the effectiveness of services authorized under the Rehabilitation Act by conducting advanced engineering research on and development of innovative technologies that are designed to solve particular rehabilitation problems or to remove environmental barriers. RERCs also demonstrate and evaluate such technologies, facilitate service delivery system changes, stimulate the production and distribution of new technologies and equipment in the private sector, and provide training opportunities.

RERC Grant Recipients
  • RERC on Recreational, Sport, and Exercise Technologies for People with Disabilities: University of Alabama at Birmingham, Birmingham, AL. This project will conduct research and development to address barriers to participation in healthful recreation, sport, and exercise among people with disabilities of all ages, including adapted equipment, telehealth programs to promote physical activity, a platform to offer physical education inclusion solutions, and a data repository to expedite research and practice.
  • RERC on Blindness and Low Vision: Smith-Kettlewell Eye Research Institute, San Francisco, CA. This project will develop research to explore problems faced by blind and visually-impaired people concerning access to education and information, navigation and spatial interactions (such as digital maps with audio interface), and optimizing function with residual vision.
  • RERC on Rehabilitation Strategies, Techniques, and Interventions: North Carolina State University, Raleigh, NC. Stroke remains the leading cause of major, long-term disability in US adults due to sensory-motor impairments. This project will address challenges with adopting and using wearable assistive devices by stroke survivors for helping them with movement challenges.

View more details about these projectsContact Tom Corfman at NIDILRR if you have questions about the RERC Program. 

HRSA: Investment in Nursing to Bolster Workforce
The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), awarded $13 million to bolster nursing education and training to grow the nursing workforce and improve access to nursing education. These awards are part of a series of Biden-Harris Administration investments across HHS and the Department of Labor to support pathways into good-quality nursing jobs. This investment works to reverse this trend.

HRSA is awarding over $8.4 million to 10 awardees through the Clinical Faculty and Preceptor Academies Program. These awards will support partnerships among academics, clinicians, and the community designed to support clinical nursing faculty and preceptors, which will help increase the capacity of program to train more nurses.

HRSA is also awarding $4.75 million to 14 awardees through the Registered Nurse Training Program to increase the number of nursing students trained in acute care settings. This program aims to improve health outcomes and health equity by strengthening the capacity and skillset of undergraduate student nurses prepared to provide high quality culturally sensitive care in underserved communities.

The ongoing COVID pandemic has further highlighted the need for a well-trained and culturally competent nursing workforce. Registered Nurse Training Program awardees will address this need through innovative nursing education models with a strong focus on nursing needs in acute care. These models will prepare nursing students to practice collaborative inter-professional team-based care in acute care settings, identify and understand the social determinates of health present in underserved communities, and address complex care needs of populations at highest risk for health disparities.

See a list of award recipients here:

HRSA: Supporting Mental Health from a Variety of Angles
The U.S. Department of Health and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration (SAMHSA), announced more than $100 million last week in funding from the Bipartisan Safer Communities Act (BSCA) to states and territories for mental health emergency preparedness, crisis response, and the expansion of 988 Suicide & Crisis Lifeline services. BSCA, signed into law by President Biden earlier this year, provided unprecedented funding to address the nation’s mental health crisis and make our communities safer. 

HHS also awarded $59.4 million to states and territories through the Community Mental Health Services Block Grant (MHBG) program, with the recommendation that the funding be spent to address mental health emergency preparedness and crisis response efforts. SAMHSA sent a letter - PDF to state mental health commissioners recommending that state behavioral health systems examine requirements to address mental health needs in communities in the aftermath of traumatic events such as mass shootings.

HHS also announced the availability of another $50 million in supplemental grant funding, provided by BSCA, to help states and territories expand and enhance 988 Suicide & Crisis Lifeline services. The funding is available to the 54 states and territories that received $105 million in American Rescue Plan funding earlier this year. These state and territory supplemental awards will range from about $458,000 to $2 million and will be distributed before Dec. 31. In total, the Biden-Harris Administration has invested over $432 million in Fiscal Year 2022 for the 988 Suicide & Crisis Lifeline – 18 times more funding than the previous administration – to build capacity and to get the hotline up and running.

Finally in response to reports of “quiet quitting” and the “Great Resignation,” Surgeon General Vivek Murthy released a new Surgeon General’s Framework outlining the foundational role that workplaces should play in promoting the mental health and well-being of workers and our communities.
Other Policy-Related Materials of Interest
NASHP: National Forum Proceedings - Care Coordination
In June 2022, NASHP convened a national forum with state health officials (e.g., public health, Medicaid, mental health) and other stakeholders (e.g., health plans, providers, families of CYSHCN) to discuss innovations, strategies, and opportunities to improve high-quality, equitable care coordination for CYSHCN. This event built upon NASHP’s work in developing and supporting the implementation of the “National Care Coordination Standards for Children and Youth with Special Health Care Needs”, released in 2020. These standards outline the core system-level components of high-quality care coordination for CYSHCN and are complementary to the “National Standards for Systems of Care for Children and Youth with Special Health Care Needs”, released in 2017. You can find the report from the Forum Proceedings HERE.

NASHP: Medicaid Structured Family Caregiving
NOTE: This program is different than consumer-direction and is not available for children; however, it is an interesting approach to paid family caregiving and worth reading about.

At least seven states (ConnecticutGeorgiaIndianaLouisianaMissouriNorth Carolina, and South Dakota) cover structured family caregiving (SFC) services provided to older adults and/or people with physical disabilities under their Medicaid programs. SFC services consist of a package of services that support home and community-based services (HCBS) waiver participants’ primary caregivers and includes payment, individualized training based on the needs of the waiver participant, coaching, back-up or respite care, and other supports. SFC services enable HCBS waiver participants who do not self-direct services to receive the personal care they need in their homes from people they know and trust.

Georgetown CCF: Medicaid Unwinding Wednesday blogs
The Georgetown Center for Children and Families continues their Unwinding Wednesday blog and in #5 focuses on communication toolkits. You can find the link to this blog as well as other unwinding blogs of interest here. This blog has a great collection of examples of different states' communication approaches and examples. Be sure to scroll all the way to the end for the link to Georgetown CCF’s complete tracker and resource link.

Georgetown Center on Health Insurance Reforms: Blogs of interest
Analysis of the Republican Healthy Future Taskforce outlining their Health Agenda can be found here. Republican members of the House of Representatives have put out their own, separate health policy agenda through their Healthy Future Task Force. Since announcing its creation last year, the Republican task force has put out a series of recommendations relating to healthcare modernizationtreatmentsecuritydoctor-patient relationships, and affordability. This blog focuses on several of the task force’s affordability recommendations, which signal the approach to health insurance reform House Republicans may take if they regain the majority in the midterm elections.
Overview of the Federal State Partnerships to Implement No Surprises Act can be found here. This law took effect in January 2022 and aims to protect consumers facing surprise medical bills after receiving care from out-of-network providers under circumstances beyond their control. This blog highlights key aspects of a Commonwealth Fund report on progress thus far with the landmark law.

ICYMI Manatt and LPFCH: Unwinding of Medicaid PHE and Partnership
In “Working with Community-Based Organizations and Individuals with Lived Experience to Support Continuity of Coverage at the End of the Public Health Emergency,” an issue brief prepared in partnership with the Lucile Packard Foundation for Children’s Health, Manatt Health provides an overview of various strategies states can use to partner with CBOs and family-led organizations to engage Medicaid enrollees in their communities and limit the number of children and families who lose coverage after the end of the PHE. Download here.

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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.