Work in DC requires keeping your ear to the ground and listening/reading what people are saying. This week a lot was said about renewed discussions for Build Back Better. Although details are not known, several reports indicate that Senator Manchin (D-WV) is willing to discuss a narrow revival of reconciliation that focuses on three issues: climate change, prescription drug prices, and deficit reduction. At the same time, other reports indicate that a number of Democrats were circulating letters reiterating the need for universal preschool and any of the other care-economy proposals that were included in the package. So where are we? Who knows! Spring has sprung and perhaps as nature regenerates in the mall and other green spaces around the Halls of Congress, so too will negotiations over reconciliation revive and regenerate!

On Monday, March 28, the White House released President Joe Biden's fiscal year (FY) 2023 budget request.

What does this budget mean? The President’s budget isn’t a bill that can move through Congress, it is simply a request. It outlines proposed funding levels for each federal agency, which Congress can use to write spending bills or…ignore. Many describe the President’s budget as a “statement of values,” a “wishlist,” or a “blueprint.” It isn’t a guarantee of anything beyond what the administration plans to fight Congress for in the coming fiscal year.

What are the next steps? Office of Management and Budget (OMB) Director Shalanda Young will testify before the House and Senate Budget Committees to field inquiries on the President’s budget request. Congressional appropriators are expected to ramp up their appropriations activities in the coming weeks, starting with a House Appropriations Committee hearing on Thursday, March 31, 2022, featuring Secretary Xavier Becerra to review the HRSA FY 2023 budget request. HRSA’s congressional justification for the FY23 President’s Budget would provide $8.503 billion in discretionary funding for HRSA ($53 million less than the $8.556 billion in FY22 HRSA funding that was recently passed and enacted).

Family-to-Family Health Information Centers (F2Fs) are on pages 269-273, but why isn’t there a request for increase in F2F program funding? This is a budget for discretionary programs. Discretionary programs are subject to the appropriations process, whereby Congress sets a new funding level through the budget process every year. Discretionary programs can increase, decrease, or be cut. The F2Fs are a mandatory spending program that is established by Congress under the authorization of laws. The legislation for the spending (increase, decrease, or change) on mandatory programs is carried out by Congress outside of the annual appropriation bill process.

Then why are the F2Fs included in this budget? According to the laws that authorize mandatory programs, Congress must appropriate the required funds to keep the program running each year. Wait what? So do F2Fs go through appropriations or not? As the F2F funding stands right now, the answer is no, however, Congress is mandated (aka required) to appropriate funds (put money in the budget) for the F2Fs every year. But that F2F funding amount in the annual budget is not subject to discretion, increases or decreases in funding through the appropriations process. 

(H.R. 7076/ S. 3864) was introduced in the House and Senate earlier this month. This bill will reauthorize the Pediatric Mental Health Care Access program at HRSA for five years and make exciting improvements to the program.

The REAADI for Disasters Act (H.R. 4938) (S. 2658) upholds the rights, freedoms, and safety of older and disabled Americans, before, during, and after disasters and public health emergencies. The DRMA (Disaster Relief Medicaid Act) (H.R. 4937) (S. 2646) allows Medicaid (including CHIP) services to follow the person in disasters. These are the focus of this upcoming Congressional Briefing. All interested stakeholders are invited!

Communication Access Real-Time Translation (CART) and American Sign Language (ASL) will be provided. If you need additional accommodations, please contact Marcia Gordon at Marcia.Gordon@acl.hhs.gov.

The Biden-Harris Administration has expressed its commitment to supporting our Nation’s children, and empowering their communities to help them thrive. This is why the Department of Health and Human Services (HHS) and the Education Department (ED) have joined together to provide additional technical assistance, resources, and support to schools that will provide guidance on the federal funding available for school-based physical and behavioral health services. This webinar will highlight successful models of health center service delivery in schools, as well as approaches, needs, and opportunities to support partnerships between schools and health centers. Read more here. View the list of HHS resources for School-based Health.

Related, in case you missed it: A new letter to educators and parents from Education Secretary Miguel A. Cardona addresses ways that schools and parents can work together to ensure that students with disabilities -- who are at higher risk of severe complications due to COVID-19 -- can safely attend school in-person. The letter and other relevant resources are available on the Department’s COVID-19 disability rights page. The letter also was covered by U.S. News and World Report.

CCBHCs must meet federal standards for the range of services that they provide, and they are required to get people into care quickly. An important feature of the CCBHC model is that it requires crisis services that are available 24 hours a day, 7 days a week. CCBHCs must also provide routine outpatient care within 10 business days after an initial contact so people don’t languish on waiting lists. Equally important, CCBHCs are required to serve anyone who requests care for mental health or substance use, regardless of their ability to pay, place of residence, or age - including developmentally appropriate care for children and youth.

Provider Relief Fund payments have played a key role in the nationwide response to COVID-19, helping health care providers prevent, prepare for, and respond to the coronavirus. Health care providers can use the payments to continue supporting patient care and respond to workforce challenges through recruitment and retention efforts - PDF.

The Centers for Medicare & Medicaid Services (CMS) released the 2021-2030 National Health Expenditure (NHE) report, prepared by the CMS Office of the Actuary, that presents health spending and enrollment projections for the coming decade. The report notably shows that despite the increased demand for patient care in 2021, the growth in national health spending is estimated to have slowed to 4.2%, from 9.7% in 2020, as supplemental funding for public health activity and other federal programs, specifically those associated with the COVID-19 pandemic, declined significantly. The report finds that annual growth in national health spending is expected to average 5.1% over 2021-2030, and to reach nearly $6.8 trillion by 2030. The report covers a variety of trends and breaks down expenditure by payors such as Medicaid, Medicare, private/ out-of-pocket, hospital, physician and clinical services, and retail prescription drugs. The report can be found HERE. 

The National Information and Referral Support Center (I & R Center), a grantee of the Administration for Community Living, is launching a contest to identify and share promising practices for disaster and emergency preparedness and response in disability information & referral/assistance (I&R/A) programs. Organizations are encouraged to think broadly about the roles of their I&R/A services in disasters and emergencies. Submissions from national, state, and community programs are welcome. View the submission guidelines prior to starting an application. For the submission form in an alternate format, or for more information, contact Nanette Relave.  

If an eligible individual cannot open their ABLEnow account, or would prefer to have assistance, an Authorized Representative can open and manage the account for them. Now, a representative payee can serve as an Authorized Representative for an eligible individual. More information HERE.

Learning from COVID-19-Related Flexibilities: Moving Toward More Person-Centered Medicare and Medicaid Programs is an issue brief and companion policymaker playbook prepared by Manatt Health and HMA for The SCAN Foundation that provides a person-centered assessment framework to aid policymakers in making these complex decisions. The issue brief examines the benefits and risks of COVID-19 flexibilities, describes the person-centered assessment framework, and offers recommendations for flexibilities that should be considered for permanence if person- and community-centered care for older adults and people with chronic conditions or disabilities is the primary goal. The companion playbook is an actionable guide for using the person-centered assessment framework and describes potential authorities for making flexibilities permanent. View the blog post and find the Issue Brief & Playbook download HERE.

Georgetown University’s Center on Health Insurance Reforms (CHIR) and the Center for Children and Families (CCF) have published two new resources examining state-level preparations for the end of the COVID-19 public health emergency and the redetermination of the Medicaid eligibility of close to 85 million people. Although the date of the end of the public health emergency is uncertain, many observers expect the Biden administration to extend it just one more time and allow it to expire in less than four months (most likely mid-July, 2022). This is not much time for state officials to take the necessary steps to ensure that the estimated 16 million people expected to be disenrolled from Medicaid do not lose access to health insurance coverage and essential services.

In case you missed it: Recorded web event from March 16 - Looking ahead to the Unwinding hosted by Kaiser Family Foundation (KFF) with panelists from a variety of State Medicaid agencies and Medicaid policy experts.

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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.