Legislative Corner

In Case You Missed It – Senate Committee Cuts $50 Million from Title V
Despite our strong objections, on Sept. 21 the Senate Appropriations Committee approved a $50 million cut to the Title V Maternal & Child Health Services Block Grant in the FY 2012 Senate Labor, Health and Human Services and Education Appropriations bill. The future of this bill, along with the House of Representatives action on health appropriations, is still unclear. However, the Senate action underscores the difficult work ahead to protect critical MCH funding. The new fiscal year begins on Oct. 1 and since Congress has not yet approved any appropriations bills, a short-term continuing resolution to keep government operations running is expected soon.  For additional background, see our Legislative Alert page here.

New AMCHP Report Details Impact of Budget Cuts
To illustrate the importance of protecting Title V MCH Block Grant funding, AMCHP released a new report, Critical Condition: How Federal and State Budget Cuts are Hurting the Health of Our Nation’s Mothers and Children. The report shows how the combination of increased poverty, the number of Americans lacking health insurance and previous budget cuts approaching nearly half a billion dollars are combining to create a perfect storm endangering the health of our nation’s mothers, infants and children, including those with special health care needs. The report provides a snapshot illustrating the combined impact of $74 million in previous federal reductions to the Title V MCH Block Grant along with over $313 million in state cuts to MCH programs since 2007, when the economic downturn began. A press release highlighting key messages and a link to the report is available here.

Combating Autism Reauthorization Act Passes House, Stalls in Senate
On Sept. 20, the House of Representatives passed the bipartisan Combating Autism Reauthorization Act of 2011 (H.R. 2005) by voice vote. As of press time, Sen. Tom Coburn (R-OK) is blocking a final vote in Congress to renew the landmark 2006 law. This bill extends the Combating Autism Act of 2006 for an additional three years without an increase in funding levels and allows research, training, and state and national coordination activities to continue.

Congress needs to reauthorize the Combating Autism Act before Sept. 30 when many of its important provisions will expire, however, the continuing resolution being considered in the House contains language to maintain funding for activities under the Combating Autism Act until Nov. 18 in case Congress does not pass the reauthorization bill before Sept. 30 – the day the original law expires.

For more information, please see the alert from our colleagues at the Association of University Centers on Disability (AUCD) at their Action Center, which provides an opportunity to contact your members of Congress.

President Offers Deficit Reduction Plan – Details on Health Provisions
On Sept. 19, President Obama unveiled a deficit reduction proposal for the Supercommittee’s consideration. The president’s recommendations amount to $4.4 trillion in cost savings over the next decade. Specifically, the plan includes $320 billion in health savings over the next 10 years, $248 billion from Medicare and $73 billion to Medicaid and other health programs.

AMCHP is deeply concerned that the administration’s proposal proposes to cut the Prevention and Public Health Fund by $3.5 billion over the next 10 years. With the additional cuts to domestic discretionary programs looming on the horizon any further cuts to public health programs will greatly undermine efforts to improve MCH. AMCHP continues to work with the broader public health community advocating for the Fund and helping Congress better understand the value of maintaining an investment in public health.

MCH leaders may also be interested to know the savings in Medicaid are proposed to be achieved by the following mechanisms:

  • Prohibiting states from using federal funds as the state share of Medicaid or Children’s Health Insurance Program (CHIP), unless specifically authorized by law.
  • Giving states the flexibility to use a “benchmark” benefits plan for optional populations with income above 133 percent of the federal poverty line. It also would consolidate and streamline redundant error-rate programs. 
  • Accelerating state innovation waivers by making the health reform law’s State Innovation Waivers available starting in 2014, three years earlier than under current law. These state strategies would provide affordable insurance coverage to at least as many residents as without the waiver, and must not increase the federal deficit.  
  • Limiting Medicaid provider taxes by phasing down, but not eliminating, Medicaid provider taxes. By delaying the effective date until 2015, the proposal gives states time to prepare for the change. This proposal is projected to save $26.3 billion over 10 years.  
  • Simplifying federal Medicaid payment formulas for states by replacing the current formulas with a single matching rate specific to each state based on enrollment starting in 2014 that automatically increases if a recession forces enrollment and state costs to rise. The full federal funding for people gaining Medicaid coverage in 2014 through 2016 would be preserved. The proposal may improve coverage since it gives states a financial incentive to enroll newly eligible individuals for Medicaid early. The more newly eligible people they enroll in the first year or so of the program, the higher the blended matching rate will be in 2017. This proposal is projected to save $14.9 billion over 10 years.  
  • Re-base Medicaid formula for supporting hospitals that serve low-income Americans in 2021. Supplemental disproportionate share hospital payments are intended to help support hospitals that provide care to disproportionate numbers of low-income and uninsured individuals. The administration proposes to better align these future Medicaid supplemental payments to hospitals with reduced levels of uncompensated care. This proposal is projected to save $4.1 billion over 10 years.  
  • Updating income definition. Starting in 2014, eligibility for Exchange premium tax credits and cost-sharing reductions, Medicaid, and CHIP will be determined based on an individual’s or family’s modified adjusted gross income (MAGI). The administration proposes to amend this definition for purposes of health insurance assistance programs to include total social security benefits, consistent with current Medicaid practice. This proposal is projected to save $14.6 billion over 10 years.

CMS National EPSDT Improvement Workgroup Promoting Medical Home and Care Coordination
The Centers for Medicaid and Medicare Services (CMS) continues to convene its National Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Improvement Workgroup – a national workgroup comprised of national organizations, federal agencies, and state Medicaid and Title V MCH program agency representatives to discuss core issues regarding improving Medicaid’s EPSDT program. Two issues of particular import to state Title V MCH programs – medical home and care coordination – were discussed in recent meetings of this workgroup’s EPSDT Integrated Care Sub-Workgroup.

Fan Tait of the American Academy of Pediatrics presented to the sub-workgroup on medical home. Judy Shaw of the Vermont Child Health Improvement Program, Lisa Honigfeld with the Child Health and Development Institute of Connecticut, and Darcy Lowell with Child First, also in Connecticut, presented to the sub-workgroup on care coordination. While specific recommendations for improving EPSDT have not been discussed at this stage, the workgroup continues to be an important opportunity for AMCHP to provide leadership in discussing the importance of Title V MCH program involvement and coordination with EPSDT and areas for improvement. AMCHP will continue to keep its members apprised of key outcomes from this Workgroup. For more information, contact AMCHP Senior Advisor, Karen VanLandeghem