Legislative & Policy Corner

Home Visiting, PREP, and F2F Program Extension Signed into Law
On Apr. 1 (no joke!), President Obama signed into law the Protecting Access to Medicare Act (PL 113-93) to amend the sustainable growth rate formula that governs Medicare payment rates for physicians. The law also includes $400 million for a six-month extension for the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV) (Section 511 of Title V Statute); $75 million one-year extension of PREP (Section 513 of Title V); and $5 million for the Family-to-Family Health Information Centers (Section 501(c)(1)(A) of Title V). The law also includes $50 million for a one-year extension of the abstinence education program.

In the final push to passage, AMCHP helped lead the development of a sign-on letter [post and link] joined by 52 national organizations in support of the extension, which starts October 2014 and ends March 2015. We will continue to advocate for a full five-year reauthorization of the program.

What We’re Hearing on Capitol Hill
Apr. 4 was an important deadline for members of Congress to share their programmatic priorities with the chairs of the House and Senate Appropriations Committees and, of course, we want Title V to be on those lists! Accordingly, the AMCHP policy team conducted 18 meetings over the past few weeks with key Hill staff that advise influential members to specifically ask them to include Title V on member priority lists.

In general, we are getting much better feedback that staff understand the continued need for Title V funding even as more women and children get coverage. We are, however, getting some critical questions about duplication with the Centers for Disease Control and Prevention (CDC), requests for more specific examples of how Title V supports population health services, and across the board feedback that in this budget capped environment even the $5 million increase for Title V we are requesting is a very heavy lift. We are highlighting the process underway to sharpen Title V performance measures as part of MCH 3.0, and also talk about innovations in the field to operationalize ‘pre-conception health’ and ‘life course theory’ – although those terms are not readily recognized by Hill staff so we continue to incorporate that education and translation as part of our advocacy.

Accountability and Block Grants in the Spotlight
On Apr. 2, AMCHP staff attended a hearing on the MIECHV program in the House Ways and Means Committee Subcommittee on Human Resources. At that hearing, members from both sides of the aisle expressed strong support for home visiting and a commitment to extending the program for a longer period next year.

At this hearing, Subcomittee Chair Dave Reichert (R-WA) also put down a marker that underscores the scrutiny we should continue to expect for public health funding. He said: “For my part, I am interested in how we can apply the basic discipline of this program [i.e. home visiting] – which uses taxpayer funds to support what we know works to help children and families – to other government programs that today can’t say the same thing.”

With that focus and expectation for evidence from randomized controlled trials as the gold standard for future investments, the focus of MCH 3.0 to link new performance measures with evidence-based or informed process and structure measures becomes even more important.

Also last week, House Budget Chairman Paul Ryan (R-WI) released his latest budget proposal entitled The Path to Prosperity. Although the proposal is more of a blueprint and not expected to become law, we did note with interest the proposal to terminate the Social Services Block Grant on page 52 here. Calling this grant “duplicative,” the proposal provides this rationale:

The Social Services Block Grant is an annual payment sent to states without a matching requirement to help achieve a range of social goals, including child care, health services, and employment services. Most of these are also funded by other federal programs. States are given wide discretion to determine how to spend this money and are not required to demonstrate the outcomes of this spending, so there is no evidence of its effectiveness. The budget recommends eliminating this duplicative spending.

As a reminder, while President Obama’s 2015 budget proposal included level funding for the Title V MCH Block Grant, his budget did once again propose the elimination of the Preventive Health Services Block Grant (which Congress has not adopted when previously proposed for elimination). AMCHP will continue to monitor these indirect threats and keep you posted.

Health Reform Implementation
As you probably know, on Monday, Mar. 31 at 11:59 p.m., open enrollment closed for 2014 for the ACA. As you also may know, this is not a door that is shut and locked for those who are “in line” and are eligible for a special enrollment period to still purchase health insurance from the marketplace (see below for more). For those states running their own marketplace, the decision to extend the deadline was left up to them.

To qualify for a special enrollment period, one of the following must apply to you:

  • You have a qualifying life event like getting married, having a baby, moving to a new area, or losing other health coverage
  • You have a complex situation related to applying for coverage in the Health Insurance Marketplace learn more about these special circumstances

Learn more about both ways to qualify for a special enrollment period.

7.1 million people signed up for coverage during the 2014 open enrollment season.

The other very important detail is that people can apply for Medicaid and the Children's Health Insurance Program at any point through the year and not need a special enrollment period. The updated healthcare.gov website now includes this message on the front page.

The next open enrollment period is Nov. 15, 2014 – Feb. 15, 2015. A shorter period than 2014 and much of it consumed by holidays – it will most likely require a large push just the same to get numbers up to the next enrollment benchmark.