Legislative & Policy Corner

Sequestration: AMCHP Frequently Asked Questions Fact Sheet
At the request of our members, AMCHP created a fact sheet about sequestration and the impact this will have on the Title V Maternal and Child Health Services Block Grant and other MCH funding. Click here to view the document. This fact sheet goes through a series of questions and answers detailing what sequestration means, the expected percentage cut set to take place Jan. 2, 2013 under current law, exempt programs and other additional information. If you have any questions about this document, please do not hesitate to contact Carolyn Mullen or Brent Ewig.

AMCHP Convenes Friends of Maternal and Child Health Meeting to Strategize on Sequestration
Last week, AMCHP and the American College of Obstetricians and Gynecologists co-hosted a meeting with the leading national MCH organizations to discuss sequestration and the impact this will have on maternal and child health. During the course of this meeting, organizations sought to define messaging about sequestration, articulate its impact and develop strategies to combat sequestration with the overarching theme being that the MCH community needs to speak with one voice about sequestration. The organizations agreed to develop a fact sheet depicting the impact that an 8 percent cut would have on MCH programs and to urge Congress to provide a “balanced approach” to deficit reduction. The MCH community will also partner with the broader public health community to articulate the impact of sequestration on public health as a whole. AMCHP will continue to keep you updated as this process unfolds.  

House Efforts to Replace the Sequester
On May 8, the U.S. House of Representative Budget Committee approved two separate pieces of legislation that would replace sequestration, the automatic spending cuts that are scheduled to occur on Jan. 2, 2013, but replaces them with cuts to discretionary and deep cuts to domestic mandatory programs. It is important to note that the House legislation protects the Department of Defense from sequestration. The House approved this legislation by a vote of 218-199. The Senate leadership considers this legislation dead on arrival because in their view it does not provide a balanced approach to deficit reduction. Below are some of the measures related to health that are included in this legislation:

  • Reduces the cuts to non-defense discretionary programs from $38.7 billion to $27 billion
  • Eliminates the authority of the U.S. Department of Health and Human Services (HHS) to award grants to states for the development of health insurance exchanges
  • Repeals the Prevention and Public Health Fund
  • Rescinds unobligated balances provided for the Consumer Operated and Oriented Plan program
  • Eliminates state maintenance of effort requirements for Medicaid and the Children’s Health Insurance Program (CHIP)
  • Repeals the CHIP performance bonus payments for states that provide more low income children with health coverage
  • Eliminates the Social Services Block Grant
  • Cuts $36 billion from the Supplemental Nutrition Assistance Program
  • Repurposes the Disproportionate Share Hospital allotment for uncompensated care 
  • Repeals increased federal Medicaid funding cap and match for territories
  • Reduces the state provider tax threshold to 5.5 percent, down from the current threshold of no higher than 6 percent of the net patient service revenues

Senate Agriculture Appropriations Bill
On Apr. 26, the Senate Appropriations committee approved the fiscal year 2013 Agriculture Appropriations bill that includes $7.041 billion for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), an increase over the fiscal year 2012 level of $6.618 billion. According to the Senate committee, the proposed level will fully fund participation in the program. This level also provides $60 million for breastfeeding peer counselors, $14 million for infrastructure and $30 million for management information systems. The next step in this process is that the Senate must vote on this bill and the House must consider their version of the bill before the funding level for this program is finalized. 

An Update: Defending the Prevention and Public Health Fund
The Prevention and Public Health Fund continues to be at the center of the debate about the interest rate increase for student loans. Last month, the House approved legislation preventing a hike in interest rates but in order to pay for this they propose repealing the Prevention and Public Health Fund. The Senate democratic leadership and President Obama are opposed to using the fund as an offset. Currently, the Senate is considering legislation using different pay fors to address this issue. AMCHP continues to promote the value of the fund as an important investment in public health and oppose efforts to repeal the fund. AMCHP developed this fact sheet on how the fund promotes the health of women and families and will continue to keep you updated as this process unfolds.

Take 5 for Title V
During the month of May, AMCHP encourages everyone to take five minutes out of their day for Title V and draft a letter to the editor articulating the value of this important program. Most congressional offices scan their hometown newspapers daily to see what is going on “at home” and who is participating in the public discourse about a variety of issues. For a template letter to the editor and tips for submitting, please visit here. If your letter is published, please share a copy with AMCHP to the attention of Carolyn Mullen so we can track coverage.

CMS to Develop Strategy Guides for EPSDT
The Centers for Medicaid and Medicare Services (CMS) continues to convene the National EPSDT Improvement Workgroup, which is a national workgroup comprised of national organizations, federal agencies, and state Medicaid and Title V MCH program agency representatives. The primary focus of the workgroup is to identify strategies for improving Medicaid’s Early Periodic Screening, Diagnosis and Treatment (EPSDT) program. At a recent meeting of the workgroup, CMS announced its intent to develop two EPSDT strategy guides for states and regional CMS offices: 1) Medical Necessity and 2) Outreach and Awareness.

One of the many issues discussed within the workgroup has been the need for clarifying the definition of medical necessity under EPSDT and raising awareness about the program. In developing the strategy guide for medical necessity, CMS wants to address the top frequently asked questions and commonly held misconceptions about medical necessity in EPSDT, and highlight states with exceptional EPSDT medical necessity processes or practices.

The workgroup is an important opportunity for AMCHP to discuss with CMS colleagues and other leaders in the child health field key issues with EPSDT implementation, the need for Title V MCH program involvement and coordination, and strategies for improvement. For more information, or if you have specific recommendations for the EPSDT strategy guide for medical necessity, please contact Karen VanLandeghem, Senior Advisor.