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Washington DC Update 3/18/2021
Greetings from Washington, D.C. The major issues covered in this Update are:
  •  The new COVID-relief law – The American Rescue Plan Act of 2021
  • CDC Updated Guidance for Operating Child Care Programs during COVID-19
  • CDC Updated Guidance for Nursing Home Visitation
  • “Public charge” rule permanently blocked

Important links and reminders:
The Courts
Public Charge Rule Permanently Blocked
As explained in a March 10 blog post from the Georgetown Center for Children and Families, the “public-charge” rule has been permanently blocked. This is good news for immigrant families. Now, the previous, and much less restrictive policy from 1999 will apply, meaning that an individual may only be considered to be or likely to become a public charge if (s)he is primarily dependent on cash assistance or institutional long-term care. As a result, families no longer need to fear that a family member’s immigration status will be jeopardized as a result of using use the public benefit programs, such as Medicaid, WIC, SNAP, or IDEA. 
The Administration
First Native American to Serve in a President’s Cabinet
U.S. Rep. Deb Haaland (D-NM) won Senate confirmation, by a vote of 51-40, to become Secretary of the Interior, which includes the Bureau of Indian Affairs, Bureau of Land Management, and other programs affecting American Indians, Alaska Natives, and Native Hawaiians. She will be the first Native American ever to serve in a presidential Cabinet. 

Senate Will Consider Nominee for Secretary of HHS
On March 11, the Senate voted 51-48 to allow the nomination Xavier Becerra's for Secretary of Health and Human Services to be considered by the full Senate. Earlier in the month, the Senate Finance Committee deadlocked over whether to recommend the nomination. 

Senator Susan Collins (R-ME) was the only Republican to join Democrats in the March 10 vote, but both she and Senator Joe Manchin (D-WV) have announced their support for Becerra's nomination. See Xavier Becerra headed for confirmation as health secretary with support from Manchin and Collins (CBS News, 03/12/21).
On March 11, the president signed the “American Rescue Plan Act of 2021” (H.R. 1319). The House-passed bill was amended and passed in the Senate on March 6, and the then approved the amended bill on March. No Republicans voted for it. 

The bill includes some largely temporary health-related and other provisions that will help families, including:
  • $1400 stimulus payments to individuals, including adult dependentsThe Senate amendments reduced income threshold for these payments, meaning fewer people will get the payments. Payments will not count for purposes of means-tested programs and are not taxable.
  • Enhanced Medicaid funding dedicated to home and community-based services;
  • A state option to provide 12-month-postpartum Medicaid eligibility;
  • Medicaid coverage for vaccines and COVID treatment;
  • Incentives for states to take up the ACA Medicaid expansion;
  • Subsidies for COBRA coverage;
  • More generous ACA premium tax credits;
  • Funding for public health, including community health centers, the public health workforce, mental health and substance use services, tribal health centers, and the Indian Health Service;
  • Emergency paid leave for certain businesses;
  • A significant increase in the child tax credit (predicted to reduce child poverty by 50%);
  • State Medicaid and CHIP programs coverage of COVID-19 vaccines and treatment without cost-sharing, with full federal funding for vaccines; and
  • Funding for states and localities to help them avoid cuts in essential services.

Below are some resources explaining parts of the bill of special interest:
Health care

Stimulus Checks


Early Intervention, Early Childhood, Child Care
Medicaid & CHIP
Blog post: Too Many Babies Miss Out on Medicaid Infant Coverage, Promising Practices Point the Way for States (blog of the Georgetown Center for Children and Families 03/10/21). This post discusses ways that states can improve continuous enrollment for infants, as discussed at greater length in the report, Too Many Babies Miss Out on Medicaid Infant Coverage, Promising Practices Point the Way for States (Johnson Consulting Group, Jan. 2021); executive summary
Streamlining Medicaid Renewals through the Ex Parte Process (Center on Budget and Policy Priorities, 03/04/21) 
State Medicaid Policies for Maternal Depression Screening at Well-Child Visits (National Academy for State Health Policy, 02/24/21)
Affordable Care Act/Private Insurance
Updated Resources on ACA Subsidies
Special Enrollment Period (SEP): Feb. 15 - May 15
This new SEP applies to the 36 states using the Healthcare.gov exchange or platform. Other states may choose to open their enrollment periods. 

These states and their enrollment periods are listed on page 2 of this fact sheet from the Young Invincibles – New COVID Open Enrollment Period: An Explainerwhich also provides suggested media messages. 
Guidance from the CDC:
To help educate your community about COVID-19 and about COVID vaccines, see:
Other News & Resources
CMS Behavioral Health Information Especially for American Indians & Alaska Natives

The website includes an interactive tribal behavioral health service locator tool for all 50 states, the District of Columbia, and several U.S. territories. Additionally, the website reviews the different types of behavioral health care coverage available through:
  • Indian Health Service
  • Medicaid and the Children's Health Insurance Program
  • Medicare
  • The Marketplace

To help people make their first behavioral health appointment, the website defines common behavioral health terms and lists sample questions that patients may wish to ask their provider. The questions cover topics such as treatment plan development and scheduling.


This guidance is intended for all types of child care programs, including child care centers, family child care homes, Head Start programs and other pre-kindergarten programs. Changes include:
  • Expanded guidance background for what is known about COVID-19 and transmission in child care settings
  • Updated guidance for mask use for child care
  • Updated guidance on ventilation and water systems
  • Updated guidance for children with special needs and disabilities
  • Updated guidance on cohorting and staggering strategies
  • Updated guidance for communal spaces, food service, playgrounds and play space.
  • Updated guidance on recognizing signs and symptoms of COVID-19 and screening
  • Updated guidance on protecting people at higher risk
  • Updated guidance for Direct Service Providers (DSPs)
Information and Guidance from the CDC:


TRICARE and Military Health System
Your Input Sought
DUE March 24, by 5:00 pm ET: Comments for Virtual Meeting of the Advisory Panel on Outreach and Education, which will be held on March 31, 12:00-5:00 ET. The registration deadline for the meeting is also March 24, 5:00 pm ET. For more information, see the “Webinars” section below.
  • The HHS Office for Civil Rights (OCR) has announced a 45-day extension of the public comment period for the Notice of Proposed Rulemaking (NPRM) to modify the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.
  • Among the proposed changes to the HIPAA Privacy Rule is facilitating greater family and caregiver involvement in the care of individuals experiencing emergencies or health crises. OCR encourages and will carefully consider comments from all stakeholders, including patients and their families.
Medicaid Learning Lab (about the roles Medicaid, and the Children’s Health Insurance Program play in providing health coverage to children, pregnant women, and families)
The Georgetown University Center for Children and Families
  • Thursday, March 18, 1:00 ET
  • Thursday, April 15, 1:00 ET
  • Thursday, May 20, 1:00 ET
  • Thursday, June 17, 1:00 ET
Bridging the Digital Divide for HCBS Beneficiaries (Parts I and II)
Administration for Community Living and the Centers for Medicare and Medicaid Services
Friday, March 19, 10:00-12:00 ET
NEW Equity and COVID-19: A Fireside Chat with Dr. Marcella Nunez-Smith (Chair of the Biden-Harris Health Equity Task Force)
Tuesday, March 23, 11:30–12:30 ET
COVID Collaborative
Tuesday, March 23, 2:30-3:30 ET
Patient-Centered Outcomes Research Institute (PCORI)
Thursday, March 25, 1:00-2:00 ET
Social Security Administration
Wednesday, March 24, 2:00 ET
American Association on Health & Disability
Thursday, March 25, 2:00 ET
The Arc
Wednesday, March 31, 11:30 am - 12:45 pm ET 
Bipartisan Policy Center
Wednesday, March 31, 12:00-5:00 ET
Department of Health and Human Services
The Advisory Panel on Outreach and Education advises the Secretary of the U.S. Department of Health and Human Services and the Administrator of the Centers for Medicare & Medicaid Services on opportunities to enhance the effectiveness of consumer education strategies concerning the Health Insurance Marketplace®, Medicare, Medicaid, and the Children's Health
Deadline for presentations, special accommodations, and comments is Wednesday, March 24, 5:00 ET. Submit to Lisa Carr, Designated Federal Official (DFO), at [email protected].  
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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.