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Washington DC Update 6/30/21
This is a re-send of the June 30 issue of the Washington Update. Links to the last three articles have been added.
What is Hoppin’ ??
An update to share a few things hoppin’ on the Hill and to help you keep things hoppin’ in your state.
Hoppin’ on the Hill
Better Care Better Jobs Act
On June 24th, leaders in both the Senate  (Sens. Bob Casey Jr. (D-PA), Ron Wyden (D-OR), Chuck Schumer (D-NY), Patty Murray (D-WA), Tammy Duckworth (D-IL), Maggie Hassan (D-NH), and Sherrod Brown (D-OH)) and House (Reps. Debbie Dingell (D-MI), Frank Pallone (D-NJ), Jan Schakowsky (D-IL), and Doris Matsui (D-CA) ) introduced the Better Care Better Jobs Act (S.2210H.R. 4231), which provides the legal authority $400 billion investment in Medicaid home- and community-based services (HCBS) that President Biden committed to in the American Jobs Plan. Under the bill, states would be eligible for HCBS planning grants as well as permanent enhanced federal Medicaid match funding to expand and strengthen HCBS access and the workforce. The bill not only lays out to create and improve direct care jobs, but builds in requirements for quality and accountability. States would be required to show improvement over time, including reduced disparities in access to HCBS across populations.  

NOTE: Although this bill includes FMAP bumps, it is a new bill and in addition to the FMAP bump already provided through ARPA. The above linked summary provides section by section breakdown of the proposals illustrating the depth and breadth of the investment in our children, people with disabilities and elderly, as well as the direct care workers.
Work Without Worry Act
Senate Finance Committee Chairman Ron Wyden, (D-Ore), Senator Bill Cassidy (R-La), and Congressmen John B. Larson (D-CT) and Tom Reed (R-NY) have introduced the Work Without Worry Act (S. 2108H.R.4003), which is legislation to remove a Social Security work disincentive for Americans with disabilities. The Act promotes financial security by ensuring that any earnings from work – no matter how much – will not prevent an individual from receiving a Social Security DAC benefit from their parent’s work history if they have an eligible medical condition that began before age 22. 
Paid Leave

Members of Congress and their staff are working with universal paid family and medical leave proposals from President Biden’s American Families Plan and House Ways & Means Committee Chairman Richard Neal’s Building an Economy for Families (BE Families) Act. This explainer by the Better Life Lab at New America offers a very digestible overview of both these policies with a breakdown of what is at stake.

Leave Reports

  • The Department of Labor published an analysis, Even Prior to Pandemic, Working Women Couldn’t Take Time Off When They Needed, finding that just over 10 percent of employed women in the United States needed to take time off from work in the prior month, but did not. Top findings included:
  • Black (15.4 percent) and Latina women (10.4 percent) were especially likely to experience unmet need for leave.
  • By occupation, service workers were most likely to have unmet need for leave (13.5 percent), followed by sales (10.7 percent) and professional workers (10.5 percent).
  • Among those with unmet need, the most common reason for needing leave was for their own health (41.6 percent), and nearly one in five (19.8 percent) needed it to care for a sick family member.
  • Barriers to leave included no leave or insufficient leave (16.5 percent), inability to afford income loss (12.5 percent), fear of job loss or retaliation (9.7 percent) or having a request denied (11.4 percent).

  • For decades, misguided “marriage promotion” policies, often shaped by racist assumptions about kinship and culture, have ignored the real factors that make it difficult for people who want to be married to do so. As this research article describes, stress, including from financial security and inflexible, insecure jobs that make sharing domestic work difficult, is a primary factor in relationship dissolution -- not poor decision-making or lack of family values. Gender-neutral, family-inclusive policies, including a strong national paid leave program, will help families of all types have the financial stability and time they need to give children a good start in life and care for all of their loved ones.
Executive Order
On June 25, 2021, President Biden signed an Executive Order articulating very concrete and specific ways to advance diversity, equity, inclusion and accessibility in the Federal Government. It is not a law, but an executive order; however, it does come with a lot of explicit charges, direction and requirements for action to move the order forward in all levels and corners of the Federal government.
Want to keep these things hoppin’ on the Hill? Talk to your members of congress! Share and educate about how these proposals help CYSHCN and families in your state!
Here are some reports, analysis and guides to keep or get things hoppin’ in your state for families, Medicaid MCOs, and youth aging out of foster care:
A key aspect of ARPA explained by Child Trends: the Child Tax Credit
The American Rescue Plan represents a dramatic departure from an individual-focused understanding of child poverty to a societal understanding because of a subtle, but critical, detail in how it delivers a key tax credit to families: The legislation expanded the Child Tax Credit (CTC), a program that uses children themselves as the basis of eligibility for key benefits, instead of determining whether children are eligible to receive benefits based on requirements (e.g., work, citizenship, etc.) that only their parents can meet.

  • The big “So what” of the child tax credit? Does this apply to me and how do I receive the credit?? Most households will begin receiving monthly payments without any further action required. Other eligible families-those who have not yet filed taxes in 2019 or 2020 and who did not sign up for Economic Impact Payments like the $1,400 rescue payments included in the American Rescue Plan-can still sign up to receive monthly Child Tax Credit payments. On Monday, June 14, 2021, the IRS launched a new Non-filer sign up tool  on its website. This non-filer portal is for non-filers claiming advance payments of the child tax credit.
All eyes on this!! Groundbreaking report on regulatory culture of Medicaid managed care
This Georgetown CCF blog discusses the Children Now report that should help change the regulatory culture in Medicaid managed care. The report concluded that “overall health plan performance on children’s preventive care services was abysmal” leaving much room for improvement. Extensive research done for the California Health Foundation also finds a lot of room for improvement in risk contracts and identifies steps to hold MCO’s to a higher standard of performance on access, quality, and health equity. Andy and others will be keeping close tabs on the California MCO procurement process and will share any lessons learned for other states.
ALERT ALERT!! Medicaid for Youth Aging out of Foster Care-help could be on the way!
Another key Georgetwon CCF blog about recent legislation introduced to eliminate barriers and expand eligibility to Medicaid coverage for youth aging out of the foster care system. Nearly 40 child health and welfare groups, including the American Academy of Pediatrics, support these proposed bills that align with the Affordable Care Act's vision of ensuring all young people have continuity of health coverage.
Nitty Gritty Guide of Interest: Medicaid Managed Care Rate Development Guide
Recently, the Centers for Medicare & Medicaid Services (CMS) released the 2021-2022 Medicaid Managed Care Rate Development Guide for use by states in setting their capitation rates for contract rating periods between July 1, 2021 and June 30, 2022 for managed care programs subject to the actuarial soundness requirements. This guide includes information that states must include in their rate certifications to ensure that CMS can determine compliance with the applicable provisions in federal regulation and statute.
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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.