Washington, DC Update 9/27/23

All eyes, ears, and efforts in both chambers of Congress will be focused on the federal budget. It expires on 9/30/23- and agreement to pass appropriation bills and/or a temporary continuing resolution appear nowhere in sight.

Federal Agency Website Accessibility: On September 21^st, Senator Casey (D-PA), Senator Fetterman (D-PA), Senator Blumenthal (D-CT), Senator Duckworth (D-IL), Senator Gillibrand (D-NY) and Senator Sanders (I-VT), introduced the Federal Agency Accessibility Compliance Act (S. 2910). The bill requires federal agencies to certify that their websites are fully accessible. Section 508 of the Rehabilitation Act requires federal agencies to ensure equal access to electronic information and data. The introduction of this bill comes after the Special Committee on Aging hearing and a report by Senator Casey on the accessibility issues of several federal agency’s websites. Senator Casey’s announcement can be found here.

HHS: 30 State Pause on Procedural Disenrollments

Health and Human Services (HHS) announced last week that it has helped half a million children and families regain their Medicaid and Children’s Health Insurance (CHIP) coverage. CMS sent a letter on August 30 to all states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands requiring them to determine and report whether they have a systems issue that inappropriately disenrolls children and families, even when the state had information indicating that they remained eligible for Medicaid and CHIP coverage. Last week HHS posted an overview - including a table that presents preliminary state-reported information about the ability of states’ systems to conduct automatic renewals at the individual level, consistent with federal requirements, as of September 21, 2023. States were asked to submit information on the affected populations and the state’s plan and timeline for reinstatement and implementation of mitigation strategies, if applicable. As of September 21, 2023, 23 states and territories (including Puerto Rico and the U.S. Virgin Islands) attested to correctly conducting automatic renewals at the individual level. Thirty states and territories (including the District of Columbia) indicated they are not conducting automatic renewals at the individual level or are still working to reinstate affected individuals. As a result, to avoid CMS taking further action, all 30 states were required to pause procedural disenrollments for impacted people unless they could ensure all eligible people are not improperly disenrolled due to this issue.

CMS Resources

Reaching Out to American Indian and Alaska Native People about Medicaid and CHIP Renewals: Use this one-page handout to help reach American Indian and Alaska Native people and share information about Medicaid and CHIP renewals.

NOTE: The Communications toolkit linked below also contains Tribal specific graphics.

Reaching Out to Hispanic or Latino People about Medicaid and CHIP Renewals (English and Spanish): Use this one-page handout to help reach Hispanic or Latino people and share information about Medicaid and CHIP renewals.

Reaching Out to People with Disabilities about Medicaid and CHIP Renewals 

(English): Use this one-page handout to help reach people with disabilities and share information about Medicaid and CHIP renewals.

Medicaid and CHIP Renewals Communications Toolkit: The Medicaid and CHIP Renewals Communications Toolkit provides key messages and materials for states and stakeholders to use when communicating with people about Medicaid and CHIP renewals restarting. The toolkit is available in both English and Spanish and includes tribal specific graphics to help get the word out to Tribal communities. Some of the Toolkit materials, including drop-in articles, a fact sheet, and a post card are also available in 中文/Chinese, हिन्दी/Hindi, 한국어/Korean, Tagalog, and TIẾNG VIỆT/Vietnamese. These are modifiable to make specific to your F2F/AO and state.

CDC: New Vaccine Guidance

Summary of recent changes for clinical guidelines (last updated September 15, 2023):

• Recommendations for use of the 2023–­2024 formulations of Moderna COVID-19 Vaccine and Pfizer-BioNTech COVID-19 Vaccine:
• Everyone ages 5 years and older is recommended to receive 1 dose of updated (2023–­2024 Formula) mRNA COVID-19 vaccine
• Children ages 6 months–4 years
• Initial vaccination: should receive either 2 doses of updated (2023­–2024 Formula) Moderna or 3 doses of updated (2023–­2024 Formula) Pfizer-BioNTech COVID-19 vaccine
• Received previous mRNA doses: need 1 or 2 doses of updated (2023–­2024 Formula) Moderna or updated (2023­–­2024 Formula) Pfizer-BioNTech COVID-19 vaccine, depending on the number of prior doses
• People who are moderately or severely immunocompromised
• Initial vaccination: should receive a 3-dose series of updated (2023–­2024 Formula) Moderna or updated (2023–­2024 Formula) Pfizer-BioNTech COVID-19 vaccine
• Received previous mRNA doses: need 1 or 2 doses of updated (2023­–2024 Formula) Moderna or updated (2023–­2024 Formula) Pfizer-BioNTech COVID-19 vaccine, depending on the number of prior doses
• May receive 1 or more additional updated (2023–­­2024 Formula) mRNA COVID-19 vaccine doses
• Bivalent mRNA COVID-19 vaccines are no longer recommended in the United States
• Updated guidance for COVID-19 vaccination and myocarditis or pericarditis
• Updated guidance for COVID-19 vaccination and Multisystem Inflammatory Syndrome (MIS) in children (MIS-C) and in adults (MIS-A)
• Reorganization and consolidation of sections on contraindications and precautions, including allergic reactions to COVID-19 vaccines

You can find more information (such as updated guidance on and links related to this guidance on CDC's website, which has tables that break down vaccine information by age groups, as well as clear guidance for COVID-19 vaccination and Multisystem Inflammatory Syndrome (MIS) in children (MIS-C), and outlines of immunocompromising conditions and treatments.

HHS Secretary Becerra wrote this letter in response to reports that people were having trouble getting COVID-19 vaccinations covered by insurance. In it, he details communications and guidance from CMS to payors.

Key takeaways from the CDC guidance can be found in this AAPNews article:

• Everyone 6 months and older should get an updated COVID-19 vaccine.
• Everyone ages 5 years and older should receive one dose of an updated mRNA vaccine. The updated dose should be given at least two months after any previous COVID vaccine dose.
• Children ages 6 months through 4 years should complete a multidose initial series (two doses of Moderna or three doses of Pfizer-BioNTech) with at least one dose of the updated vaccine. All doses should be from the same manufacturer.
• People who are moderately or severely immunocompromised should complete a three-dose initial series with at least one dose of the updated vaccine and may receive additional updated vaccine doses.

Rise in Pediatric COVID 19 Hospitalizations

This AAPNews article shares that in the past three months, the number of children with confirmed COVID-19 at hospital admission has risen consistently, with children under 5 years at highest risk. These findings come from an AAP analysis of data gathered by the U.S. Department of Health and Human Services (HHS).

Free At-home COVID-19 Test

Place an online order for 4 free at-home COVID tests. Need help placing an order for your at-⁠home tests? Call 1-800-232-0233 (TTY 1-888-720-7489).

The U.S. government will continue to make COVID-⁠19 tests available to uninsured individuals and underserved communities through existing outreach programs. Please contact a HRSA health center, Test to Treat site, or ICATT location near you to learn how to access low- or no-cost COVID-⁠19 tests provided by the federal government. This HHS press release details the Administration’s investment in manufacturing tests for use at home.

NIH: Designation of People with Disabilities as Population with Health Disparities

Eliseo J. Pérez-Stable, M.D., director of the National Institute on Minority Health and Health Disparities (NIMHD), designated people with disabilities as a population with health disparities for research supported by the National Institutes of Health. The decision was made in consultation with Robert Otto Valdez, Ph.D., the director of the Agency for Healthcare Research and Quality, after careful consideration of a report delivered by an NIMHD advisory council, input from the disability community and a review of the science and evidence. A report issued in December 2022 by the Advisory Committee to the (NIH) Director (ACD), informed by the work of the Subgroup on Individuals with Disabilities, explored similar issues faced by people with disabilities. The designation is one of several steps NIH is taking to address health disparities faced by people with disabilities and ensure their representation in NIH research. Read the full news release.

Read the NIMHD Director’s Statement and read the NACMHD Report.

Last month the NIH also issued a notice of funding opportunity calling for research applications focused on novel and innovative approaches and interventions that address the intersecting impact of disability, race and ethnicity, and socioeconomic status on healthcare access and health outcomes. 

DOE: School Based Mental Health

Last week, the Department of Education announced a $2.6 million award to support mental health services and professionals in schools, further delivering on a key priority of the Bipartisan Safer Communities Act (BSCA). The Board of Regents of the University of Wisconsin System will establish a national Mental Health Evaluation, Training, Research, and Innovation Center for Schools (METRICS) to increase support and offer new resources for schools nationwide on training mental health professionals and providing school-based mental health services. This award is made possible by the historic Bipartisan Safer Communities Act, which President Biden signed into law on June 25, 2022. Over the next five years, BSCA will invest over $1 billion in school-based mental health programs, making substantial progress towards the President's goal, as part of his Mental Health Strategy, to double the number of school counselors, social workers, and other mental health professionals available to support students' mental health needs.

The new METRICS Center will support grantees of the U.S. Department of Education's (Department) two programs for increasing the number of mental health providers in schools—School-Based Mental Health (SBMH) and Mental Health Services Professionals (MHSP). METRICS will also distribute resources to states, districts, and schools nationwide to help them implement high-quality projects to address the social, emotional, and mental health needs of PK-12 students and increase the number of school-based mental health services providers. 

The Board of Regents of the University of Wisconsin System, in partnership with the University of South Florida, School Mental Health Collaborative; the University of Iowa, Scanlan Center for School Mental Health; and University of California, Santa Barbara's International Center for School-Based Youth Development, which is an Hispanic Serving Institution, will support the 264 new MHSP and SBMH grantees and disseminate resources and information to state educational agencies (SEAs), local educational agencies (LEAs), institutions of higher education (IHEs), and other stakeholders through METRICS. This new resource is critical to increasing the numbers of providers and skills of the existing workforce, in a time when the health and well-being of our nation's children and youth has been challenged by the COVID-19 pandemic, which exacerbated pre-existing inequities.

A full list of previously announced mental health grantees under BSCA can be found here. 

Nemours recently published two papers on school-based mental health services- one lays out policy recommendations for policymakers and philanthropy, and the other outlines best practices from around the nation.

CMS Innovation Center: How an Idea Becomes a Model

The CMS Innovation Center, established for the purpose of testing “innovative payment and service delivery models to reduce program expenditures ... while preserving or enhancing the quality of care” for individuals with Medicare, Medicaid and/or the Children’s Health Insurance Program (CHIP), published a webpage that explains how models are formulated, vetted, and selected to become models. The page also provides an overview of model development and evaluation and includes a list of resources to learn more about the work being done by the Innovation Center.

CMS: State Plan Amendment Approval- School-Based Services

CMS approved a “Free Care” state plan amendment (SPA) for Indiana Medicaid, allowing the program to reimburse medically necessary school-based nursing services, psychologist testing services (if done by a licensed individual), and school-based transportation for qualified Medicaid enrolled children. Free Care SPAs are based on CMS guidance that gives states the option to provide physical and behavioral health care services to any school student who is enrolled in Medicaid — and to get federal Medicaid reimbursement for those services.

ACL: Grants Awarded to Support Family Caregiving

ACL is pleased to announce four new cooperative agreements for ACL’s 2023 grant initiative in support of the 2022 National Strategy to Support Family Caregivers (the Strategy). The project period for these new grants is September 30, 2023-September 29, 2027. The collective award amount is over $3.6 million. Funds for this initiative are drawn from Title III-E formula funds and use the demonstration authority found in Sec 373(i) of the Older Americans Act.

Through these four-year awards, grantees will develop, test, and disseminate new approaches for supporting family caregivers, using the Strategy as a roadmap. Each grantee will focus on one goal within the Strategy:

• Community Catalyst
• Goal 1: Increase awareness of and outreach to family caregivers
• Regents of the University of California, San Francisco
• Goal 2: Advance partnerships and engagement with family caregivers
• USAging
• Goal 3: Strengthen services and supports for family caregivers
• National Alliance for Caregiving
• Goal 5: Expand data, research, and evidence-based practices to support family caregivers

At this time, no project has been funded to address Goal 4: Ensure financial and workplace security for family caregivers. To address this important priority, ACL will be issuing a Notice of Funding Opportunity in October 2023 requesting applications that will increase awareness of — and access to — the resources available to address financial and workplace security for family caregivers, as well as identify unmet needs. 

ACF: Diaper Distribution Pilot

Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services (HHS) announced the award of $8.1 million to fund the third cohort of grant recipients of the diaper distribution demonstration and research pilot program, bringing the total funding to $24.3 million since the program’s inception in September 2022. 

The seven new grants will serve families in Connecticut, Maine, New Hampshire, New York, Oregon, Pennsylvania and the Ponca Tribe of Nebraska. Grant recipients will work with local partners to strengthen and expand their existing diaper distribution infrastructure and provide wrap-around support services to assist families experiencing diaper need. These support services can include job training, educational support and housing services.  

For more information about the diaper distribution pilot, watch this animated video in English , Spanish  or Mandarin.

To learn about ACF’s Office of Community Services’ other anti-poverty strategies, visit www.acf.hhs.gov/ocs/help. 

First Focus on Children: Children’s Budget

Despite overwhelming public support for investing in children, policies enacted have more than doubled child poverty last year, increased the number of children without health insurance, and inflicted other debilitating — and completely avoidable — hardships on them. Children’s Budget 2023 tracks the systemic disinvestment in children that threatens their future and the economic, social, and political health of the U.S. and the world.

There is a different vision, however. For example, President Biden’s latest budget request included increases in the Child Tax Credit, childcare and early learning, and paid family leave. Such a pathway is one that invests in our nation’s children and families. First Focus hosted the Children’s Budget Summit on September 22, 2023. A full recording- detailing a different way forward- is available HERE.

CLASP: Youth Peer Support

The existing mental health system is failing to meet the needs of young people, particularly Black, brown, and Indigenous young people, 2SLGBTQIA+ young people, and young people with disabilities. Within the current mental health system, they often experience the effects of institutionalized racism such as harsher treatment, stigmatization, and professionals minimizing their mental health symptoms. The current mental health system is also experiencing a workforce shortage, with many young folks unable to access care, particularly in mental health deserts—geographic areas with no or limited access to mental health services like psychologists and counselors.  

Youth peer support offers a solution to both these problems: peer support is a non-clinical practice rooted outside of Western medicine that taps into a new provider workforce – peers. Research shows peer support is an effective and equitable practice.

Despite the promise of youth peer support, it remains unavailable to most young people and is generally concentrated in grant-funded programs. In an ideal scenario, young people would be able to easily access youth peer support services in a variety of locations, including schools, community centers, and more.

To better understand the current policy landscape of youth peer support, we conducted 14 in-depth interviews with multiple stakeholders, including experts in peer support policy, peer supporters, and state officials who run peer support offices. One of the biggest concerns we heard from interviewees was the fear of peer support being coopted by medical models, meaning peer support will exist in name but will not be practiced as it was intended. Because Medicaid is designed around clinical practices and thereby forces non-clinical practices to adopt certain procedures to get reimbursed, Medicaid currently facilitates the cooptation of peer support. This paper seeks to answer how a non-clinical practice like youth peer support can be reimbursed by Medicaid without it being incorporated into a medicalized model. Receiving Medicaid reimbursement for youth peer support without youth peer support being coopted requires states to explore creative payment options under Medicaid. Read this Center for Law and Social Policy (CLASP) framework for more insights.

This is a very thoughtful read for many reasons, with the lens of how family-to-family support is similarly situated, viewed, funded and implemented.

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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.