A Look Back/Look Ahead: Sequesters and Shutdowns and Websites, Oh My!

By the AMCHP Policy Team (Brent Ewig, Karen Van Landeghem and Carolyn McCoy)

In the world of maternal and child health policy, the year 2013 will likely be remembered as the year sequester hit and was partially repealed; the year partisan bickering led to a two-week federal government shutdown; and the year the Affordable Care Act (ACA) enrollment got off to a rocky start due largely to a less-than-optimally functioning website. Amidst this backdrop, significant progress was made to address birth outcomes via the Collaborative Improvement and Innovation Network (CoIIN) led by states and the Maternal and Child Health Bureau (MCHB). We also saw substantial action to transform the Title V Maternal and Child Health (MCH) Services Block Grant under the banner of the MCH 3.0 Transformation, led by MCHB Associate Administrator Dr. Michael Lu. This column will look back on some of these highlights, and look ahead to what the election year of 2014 holds in store for MCH policy.

Federal Budget: State Title V leaders have endured budget cuts for years, but a new and even more stringent era of austerity began last Mar. 1 when indiscriminate across the board cuts were implemented. These cuts were due to the sequester previously passed by Congress and intended to prod lawmakers to work together to find more targeted savings, but negotiations broke down into partisan wrangling and no agreement was reached.

The impact on the Title V MCH Services Block Grant was a $32 million cut, which – along with about $2 million in additional taps – brought the level of funding for FY 2013 down to an estimated $604 million. This represented a $124 million reduction since FY 2003 bringing federal funding for this program to its lowest level since 1991. Thankfully, a subsequent agreement reached at the year’s end cleared the way for an omnibus spending bill signed into law on Jan. 17. This bill provided substantial sequestration relief and funded the Title V MCH Block Grant at $634 million, an increase of nearly $30 million more than the FY 2013 post-sequester level, restoring 87 percent of the sequester cut. This is considered a substantial victory and shows that the AMCHP advocacy messages are making a difference.

As we look ahead, the next major milestone in the federal budget process will be the Mar. 4 release of President Obama’s FY 2015 budget proposal. This will provide us with another sense of administration priorities and sets the stage for Congress to begin assembling FY 2015 appropriations bills. AMCHP will continue to share details as available and strive to be your voice in Washington as the process continues.

Implementing the ACA: The ACA has been in the backdrop for a few years now and seemingly reached a crescendo on Oct. 1, 2013 with the long-anticipated opening of the health insurance marketplace. Nationally, the news was full of reports on how the whole health insurance reform effort was a failure and could possibly disappear. However, the federal and state marketplaces are just one part of the massive national and state health reform puzzle. As leadership and staff of state MCH programs know, insurance reforms, investments in public health programs, establishment of essential health benefits, new protections for families, such as workplace accommodations for breastfeeding moms, and many other policies were and are still moving forward despite what the news cycle says. Title V programs work tirelessly to meet the unique health needs – needs that extend well beyond the receipt of an insurance card – of our nation’s women, children and youth, including those with special health care needs and their families. This system is now poised o transform at a more rapid pace due to the ACA.

In 2013, AMCHP continued to play a role at the national level in monitoring the implementation of the ACA and analyzing the potential impact on Title V programs with more of a shift toward how states were implementing the law and sharing best practices. W.K. Kellogg funding provided AMCHP the opportunity to continue to analyze the potential impact of the ACA on MCH populations. AMCHP released an issue brief and hosted a webinar on State Strategies for Breastfeeding Promotion, a fact sheet on “Who Will Be Covered for What in 2014?”, a fact sheet on how Title V programs can get involved in outreach and enrollment and other resources on the National Center for Health Reform Implementation website. AMCHP also continued its ongoing work to support state Title V programs in their work to improve birth outcomes by hosting a national-level meeting entitled “Connecting the Dots: A National Meeting on Improving Birth Outcomes” with support from the W.K. Kellogg Foundation. Nearly 50 leaders representing federal health agencies, state departments of health and Medicaid agencies, professional associations, provider groups, nonprofit leaders, think tanks, private funders, and academia met in Washington, DC. This was an important opportunity to coalesce and discuss how to effectively coordinate and maximize the impact of efforts to improve birth outcomes, particularly for states and community groups. The proceedings of the meeting can be found here.

Looking forward, AMCHP is honored to be part of the University of North Carolina led Maternal and Child Health Workforce Development Center. The mission of the workforce development center is to make sure Title V leaders and staff have all the right tools to carry out the public health core functions of assessment, assurance, and policy development, and the 10 essential functions of public health. We also will support state efforts to drive improvements in access, quality, integration, equity and accountability, all of this in an era of health transformation. The AMCHP policy team is leading the Access to Care Core, one of the four “core” teams that make up the center. Through this role, AMCHP will provide technical assistance on access to care topics in an era of health reform to state Title V leaders and their staff. AMCHP also will provide ongoing analysis, input and support for Title V programs through the National Center for Health Reform Implementation and has a host of topics and emerging issues to cover, so stay tuned!

Developing Standards for Systems of Care: This past year, the policy team collaborated with the child and adolescent health team to work on developing standards for systems of care for CYSHCN, with support from the Lucile Packard Foundation for Children’s Health. The overall goal of phase one of the project, National Consensus Framework for Improving Quality Systems of Care for Children and Youth with Special Health Care Needs, has been to compile, define, and reach consensus among a diverse group of stakeholders on the necessary process and structural standards for health care systems serving CYSHCN.

Creating a comprehensive, quality system of care for CYSHCN has been one of the most challenging areas for state health leaders and other stakeholders such as state Title V maternal and child health programs, pediatricians and family physicians, health plans, state Medicaid and Children’s Health Insurance Program (CHIP) agencies, and families. The ACA has further heightened this need as states prepare to extend coverage to millions of uninsured children and adults, design essential health benefits, and implement new provisions to achieve the “Triple Aim” of: 1) improving the patient experience of care (including quality and satisfaction), 2) improving the health of populations, and 3) reducing or bending the curve of health care costs.

The products and efforts from the first phase of this project are the following:

  1. A background white paper highlighting the findings from the project research
  2. Case studies highlighting promising state practices in developing and implementing system standards of care for CYSHCN
  3. Convening of a national work group to guide and reach consensus on the desired capacity and performance of systems of care serving CYSHCN
  4. Development of a core set of national system standards that was guided, informed, and endorsed by key stakeholders at the national level and state level

The standards were disseminated at the 2014 AMCHP Annual Conference as a pre-press copy and will be nationally disseminated in early March. Additionally, work on Phase II of the project, also supported by the Lucile Packard Foundation for Children’s Health, will commence in April. Phase II work will include development of a Web-based toolkit that provides resources for translating the standards in states, targeted technical assistance to selected states, and further national dissemination including national webinars.

Perhaps one of the most critical efforts to the sustainability and longevity of the Title V MCH Services Block Grant in the past year has been the AMCHP work on the MCH 3.0 Transformation. At its February 2013 Board of Directors meeting, then AMCHP president, Stephanie Birch, established the Future of Title V Work Group. Comprised of current and former AMCHP board members, the work group spent the majority of 2013 developing recommendations on behalf of the states and providing guidance and input to the MCH 3.0 Transformation, outlined by MCHB. That input, to date, has been summarized in a series of three memos found here that were sent to MCHB from the AMCHP Board of Directors and provided to AMCHP state delegate members as tool for use on their own input to MCHB. AMCHP commends MCHB, and in particular associate administrator Dr. Michael Lu, for their leadership with the transformation and for the active engagement of states and AMCHP. AMCHP will continue to keep members apprised of its work in this area through Member Briefs, Pulse and targeted e-mail updates.