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 The Year in Title V MCH Policy – Looking Back (At Bullets We Largely Dodged) and Looking Forward (To Living in the Era of Tightening Budget Caps)

By AMCHP Policy Staff (Brent Ewig, Carolyn Mullen & Karen VanLandeghem)

While AMCHP, along with our members and partners, worked to meet our strategic goal of effectively voicing the critical importance of maternal and child health issues, this past year was marked by continued and perhaps deepening, divisiveness here in Washington, D.C. In practical terms, this means that nothing gets done in Congress until the last moment – and usually only then with maximum acrimony. This political posturing from both parties overshadows a year in which the number of people living in poverty and without health insurance reached record highs.

Against these stark determinants of MCH status, the year was also marked by intense budget battles and continued planning for both implementation and challenges to the Affordable Care Act. This column takes a look at highlights from the AMCHP work in both categories.

On the budget front, it seems hard to imagine but it really was less than a year ago, Feb. 9, 2011, when the U.S. House of Representatives proposed a stunning $210 million cut to the Title V MCH Services Block Grant for FY 2011. Recognizing the gravity of this threat, AMCHP members, partners and staff mounted an all out advocacy effort to demonstrate the devastating impact this would have on MCH populations. Notable successes in this effort included thousands of phone calls and e-mail messages to policymakers, as well as three strategically placed op-eds promoting the value of state Title V MCH programs by AMCHP CEO Mike Fraser in conjunction with Mother’s Day.

With the support of members and the help of partners too numerous to mention, we collectively and successfully advocated against these deep cuts. By May 2011, we received confirmation that Congress restored Title V MCH funding to the nearly flat level $656 million in the final government-shutdown averting deal. From this effort, we demonstrated that targeted advocacy; engagement with key stakeholders, partners and champions in the administration and Congress; and convincing documentation of potential negative impacts truly can make a difference.

Action in Congress this year also set in motion the process that provides a series of both annual budget caps, as well as automatic cuts virtually guaranteeing that we will face the continued threat of MCH program cuts for years to come.

The effect of these caps quickly became apparent when the Senate Appropriations Committee proposed and approved a $50 million reduction to the Title V MCH Block Grant in September. Once again, AMCHP provided leadership to mobilize against further cuts. A highlight here included a new partnership with the National WIC Association and the National Family Planning & Reproductive Health Association that delivered an unprecedented National Mobilization for Women, Children and Families. On Oct. 26, we combined forces to flood Capitol Hill with a unified message opposing MCH and women’s health program cuts. Our message was simple "we urge our senators and representatives to oppose any efforts to cut core programs for women, children and families, including the Title V MCH Block Grant and Home Visiting Program, WIC and Title X."

Once again, our efforts paid off when, on Dec. 17, Congress finally approved an Omnibus Appropriations Bill, which provides $646 million for the Title V Maternal and Child Health Services Block Grant – a $10 million decrease from the FY 2011 level of $656 million. The legislation specifies that the reduction will be applied to the Special Projects of Regional and National Significance (SPRANS) component of the Title V MCH Block Grant. A subsequent provision applies a 0.189 percent across the board cut bringing the MCH Block Grant total closer to $645 million. While significant, the $10 million reduction is much less than the $50 million cut approved by the Senate Appropriations Committee in 2011. It will likely take some time to learn details on how the reductions will be applied.

It is important to pause and reflect on what you accomplished last year. During the February FY 2011 budget fight, the House proposed to slash the Title V MCH Block Grant by $210 million. Together we defeated that proposal and ended up with a small cut to the block grant. Then earlier this year the Senate proposed a $50 million cut to the MCH Block Grant in the FY 2012 Senate appropriations bill. That cut has been reduced to $11.2 million. While this cut is not insignificant in these trying times, it is important for us to pause for a moment and know that our voice was heard. So, once again, on behalf of AMCHP and the millions of women, infants and children served by Title V MCH programs we thank you for your advocacy.

The FY 2012 budget process begins again in earnest on Feb. 6, when the president submits the administration’s budget proposal and action subsequently turns back to Capitol Hill. This year will be even more challenging, but 2011 should be a testament to the power of our collective advocacy. We will be calling upon this power again soon for the next budget cycle!

A Look Back…National Center for Health Reform Implementation

In the past year, we also monitored and reported on a series of challenges to the Affordable Care Act, including efforts to repeal, defund and litigate the law. In perhaps the most significant development, the U.S. Supreme Court has

scheduled arguments about the case for March 2012. A ruling is expected sometime this summer, and it is clear the law will be an issue in the November elections as well.

Against this complicated backdrop, this past year the AMCHP National Center for Health Reform Implementation continued to provide assistance to state MCH programs and their key partners (e.g., state Medicaid and CHIP programs, community health centers, local health departments, providers) to understand challenges and optimize the opportunities presented by health reform for women, children, including children and youth with special health care needs (CYSHCN), and their families. We are extremely grateful for support from and partnership with the Health Resources and Services Administration (HRSA), the Centers for Disease Control and Prevention (CDC), the Commonwealth Fund and the Kellogg Foundation to support our work this past year.

Some of our notable accomplishments include:

  1. Featured state strategies for integrating public/ private systems and building medical homes through the Affordable Care Act through two national webinars with over 500 participants. Our first webinar focused on integrated service delivery systems for women, children and their families, while the second national webinar described the health home provisions of the Affordable Care Act – known as Section 2703 after the section of the law that provides the authorization – and how states may include children in the state plan amendments. Both of these webinars are archived on the AMCHP webinar archive page.
  2. Helped build state capacity to improve preconception health through the Affordable Care Act with six states through a national meeting and targeted technical assistance.
  3. Highlighted state strategies and best practices for integrating service delivery systems. Drafted policy briefs on integrated service delivery systems for women, infants and children. In addition, AMCHP drafted policy briefs detailing how states can use evidence-based practice, like The Community Guide, to drive policy. These policy briefs will be released this spring.
  4. Provided timely information on implementation of key provisions of the Affordable Care Act through widely distributed fact sheets and comments on the Affordable Care Act health insurance exchange regulation.
  5. Promoted the importance of preventive services for women in testimony before the Institute of Medicine (IOM). The majority of the AMCHP recommendations were included in the IOM report adopted by the U.S. Department of Health and Human Services (HHS) identifying eight gaps in preventive health for women.
  6. Advocated for the unique needs of women and children and the role of Title V in key provisions of the Affordable Care Act, including but not limited to quality measures, the Prevention and Public Health Fund, and the National Prevention and Health Promotion Strategy.
  7. Promoted the importance of state Title V MCH programs in helping to improve MCH through the National Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Improvement Workgroup and a number of coalitions working to implement provisions of the Affordable Care Act.

A Look Ahead…

AMCHP is excited to continue working on health reform implementation and providing states with technical assistance and resources to optimize the opportunities afforded in health reform. Our work for the next year will encompass a broad array of projects designed to improve birth outcomes, integrate service delivery systems and include children in health home state plan amendments.

We intend to closely follow and report on the Supreme Court decision on the Affordable Care Act. Moreover, we will provide comments on potential regulations on essential health benefits and how this will affect all populations but specifically children and youth with special health care needs. Finally, AMCHP plans to develop resources for states to think through the tough questions regarding assuring access to care and supporting adequate capacity in state MCH programs after 2014, and how these issues will potentially shape and redefine the roles of Title V in a post health reform world.

Specifically, our work on health reform implementation and providing states with technical assistance and resources to optimize the opportunities afforded in health reform during the next year will encompass a broad array of activities, including:

  • Promoting comprehensive benefit package design, including application of the Bright Futures for Children guidelines for all plans and development of Bright Futures Guidelines for Women. 
  • Assisting states in building capacity to implement important provisions, including the expansion of medical homes through the ACA and other national opportunities. 
  • Continuing to contribute state MCH expertise to state exchange design, including creation of the essential benefits package. 
  • Supporting efforts to strengthen and expand Medicaid, including strengthening the role of state Title V MCH programs in working with Medicaid, CHIP agencies in building and improving systems of care for MCH populations. 
  • Developing strategies to address increased demand for access to providers and relating the role of Title V in assuring provision of enabling services, care coordination, population-based prevention and systems-building services. 
  • Crafting strategies to help assure health system capacity and other crucial activities leading up to the 2014 coverage expansion. 
  • Identifying and promoting the role of Title V MCH programs in a reformed health care system and providing strategies and assistance to state Title V programs and their partners in doing so. 
  • Assuring strong MCH representation on national boards and commissions, including but not limited to the National EPSDT Improvement Workgroup, Key National Indicators Development and Adult Medicaid Quality Measures, with opportunities to focus on women’s health, preconception and maternity care. 
  • Continuing an intensive learning collaborative with state MCH programs and their key partners (e.g., state Medicaid agencies, local health departments, community health centers) in selected states to increase their effectiveness and capacity to optimize implementation of the Affordable Care Act to address preconception health, adolescent health and reproductive health. 
  • Providing capacity building assistance to state MCH leaders and their key partners in optimizing recent advances and opportunities in breastfeeding promotion. 
  • Identifying, strengthening and replicating successful state efforts to forge collaborative partnerships among state and local MCH programs and key stakeholders to improve birth outcomes with a focus on reducing the rate of preterm birth inductions and unnecessary C-sections.