Hope everyone had a wonderful Thanksgiving Holiday!

This week’s Washington Update will begin by quoting some news article titles circulating about what is going on as Congress returns from Thanksgiving Holiday:

Welcome to “the December Pileup!”

Get ready for “Friday’s Funding Follies!”

There are just 2 weeks until the scheduled (heavy emphasis on scheduled) holiday recess and there is a LOT to juggle.

The debt ceiling is an amount set by law as to how much money the federal government can borrow to pay for “its bills.” This is different from the CR but they are coming to a head at the same time. Treasury Secretary Janet Yellen recently wrote to Congress to let them know that the federal government will run out of money and default on their debts on December 15, 2021. Senate Democratic and Republican leadership have been in discussions about raising the debt ceiling but bipartisanship on such action appears unlikely. Pressure is on the Democrats to use reconciliation to raise the ceiling.

On November 18, 2021, the Congressional Budget Office released the complete cost estimate of the Build Back Better package, which can be found here. The score showed that Build Back Better will make historic investments in America’s families while also reducing inflation and saving taxpayer dollars. The next day, November 19, the House passed its version of Build Back Better. The Senate Parliamentarian has begun reviewing the bill. Her review could result in provisions of the House-passed bill being cut as “extraneous” to budget resolution rules. Senate negotiations of the bill also continue. And so while there was celebration in House passage of the bill, we are still not at the finish line.

What does this mean for CYSHCN and Families? There is still time to educate Senators about the importance of policies such as paid leave and home & community-based services (HCBS), for example.

Interested in doing a bit more reading about Build Back Better? Consider these articles:

A key to tackling and containing COVID-19 is free and accessible testing. If you are like me, you have been wondering where have all the drive-up, free testing sites gone? This Center for Health Insurance Reforms blog post explains the state of testing and offers suggestions for a way forward.

This thoughtful blog post by Manatt Health suggests how pandemic efforts to facilitate easier access to SNAP are beginning to demonstrate an impact on improving health outcomes and lowering Medicaid spending that could inform future policies.

Section 9817 of the American Rescue Plan Act (ARPA) gives states an opportunity to receive a 10% increase in the federal medical assistance program (FMAP) for Medicaid home and community-based services (HCBS) through March 31, 2022. States submitted spending plans to the Centers for Medicare and Medicaid Services (CMS) for review; most states have received approval or partial approval pending clarifying questions from CMS. States are using these one-time funds to support transitions from institutional settings into the community through housing navigation, employment placement, assistance with transition costs and other social determinant supports, as well as by investing in affordable and accessible housing for HCBS populations to remain within the community. Explore this map to find out how funds are being used in your state.

HRSA has begun distributing $7.5 billion in American Rescue Plan (ARP) Rural payments to providers and suppliers who serve rural Medicaid, Children's Health Insurance Program (CHIP), and Medicare beneficiaries. The Biden-Harris Administration is committed to providing much-needed relief to rural providers who historically operate on thin margins and have had their financial challenges further exacerbated during the pandemic. The average payment is approximately $170,700 with payments ranging from $500 to approximately $43 million. More than 40,000 providers in all 50 states, Washington, D.C., and six territories will receive ARP Rural payments. Find information about fund distribution in your state.

One-on-One Conversation with Daniel Tsai, Deputy Administrator & Director, Center for Medicaid & CHIP Services, Centers for Medicare & Medicaid Services, US Department of Health and Human Services

Daniel Tsai will join Health Affairs Editor-in-Chief Alan Weil in a conversation to discuss the proactive policy agenda for children laid out by CMCS focused on three key areas: coverage and access; equity; and innovation and whole-person care.

The COVID-19 pandemic has led to drastic changes in the way people with disabilities engage with and access their communities for work, play, and building and maintaining relationships. The COVID-19 pandemic has also increased the urgency to address health disparities, inaccessibility, ableism, and shift from segregated settings to accessible opportunities to engage in all aspects of life. This webinar will feature a panel of people with disabilities, family members, direct support professionals, and advocates reflecting on the lessons they have learned during the pandemic.

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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.