January 11, 2013

January 11 Washington Update

Greetings from Washington!  This update provides more information on the F2F funding extension, as well as other news.

Funding for Family-to-Family Health Information Centers (F2Fs). As we announced last week, funding for Family-to-Family Health Information Centers (F2Fs) was extended for one more year at the current level of $5 million (although this is subject to sequestration; see below). 

The original F2F law was drafted in such a way that it does not need an appropriation (it is considered "direct" or "mandatory" funding), so the extension automatically makes the money available. 

The extension is through federal FY 2013, which goes from October 1, 2012, through September 30, 2013.  But, since the F2F grant cycle usually runs through the May following the end of the relevant fiscal year, we assume the FY 2013 money will provide grants running through May 2014.  It will be up to HRSA to determine the mechanism for making the money available.

This legislative victory would not have been possible without the involvement of constituents like you, who are able to convey to their elected officials the importance of F2Fs for CYSHCN and their families.  So, please take a moment to pat yourselves on the back!

...Okay, now that you've enjoyed that moment, we have to say that it is not too early to begin our efforts to get funding for future fiscal years.  The first step of this process is to thank the Members of Congress who supported the funding legislation.  So, if you have not already done so, and if one of your Members of Congress was a cosponsor of the legislation (listed at the end of this update), please send a note of thanks for their support of F2Fs.  To gain future funding, it is vitally important for Members to know that F2Fs really help their constituents, and that their constituents appreciate their support of the program.

Extension of other programs and policies.  The F2F funding extension was included in the "fiscal cliff" law, the American Taxpayers Relief Act (ATRA), which also included a number of other "health extenders."  Those that might be of interest include:

Extension of the Medicaid and CHIP Express Land Eligibility (ELE) option, which allows state Medicaid and CHIP offices to rely on data from other state offices, like SNAP and school lunch programs, in making income eligibility determinations for children.  ATRA extends ELE it through September 30, 2014.

Extension of Transitional Medical Assistance (TMA), which allows certain low-income families to maintain their Medicaid coverage for 6 to 12 months as they transition into employment and increase their earnings.  States also have the option to offer wraparound assistance to supplement coverage available through an employer.  ATRA extends TMA until December 31, 2013. 

Extension of funding outreach and assistance programs. ATRA provides a one-year extension of funding for State Health Insurance Counseling Programs (SHIPs), Area Agencies on Aging (AAAs), Aging and Disability Resource Centers (ADRCs), and The National Center for Benefits Outreach and Enrollment.    

Payment for Medicare Outpatient Therapy Services.  Current law places annual per beneficiary payment limits of $1,880 for all outpatient therapy services provided by non-hospital providers, but includes an exceptions process for cases in which the provision of additional therapy services is determined to be medically necessary.  ATRA extends the exception process, as well as the cap to services received in hospital outpatient departments, through December 31, 2013.

Extension of the Qualifying Individual (QI) Program, which allows Medicaid to pay the Medicare Part B premiums for Medicare beneficiaries with incomes between 120 percent and 135 percent of poverty.  ATRA extends the QI program until December 31, 2013. 

Sequestration.  Now that F2Fs are funded in FY 2013, they could be subject to an across-the-board cut under the sequestration provisions of the 2011 Budget Control Act (BCA).  Under the BCA, non-exempt mandatory programs were subject to a cut of a certain number of dollars in FY 2013, estimated to be come to a cut of about 7.6 percent across the full fiscal year.  The fiscal-cliff law just enacted (ATRA) delayed this sequester until March 1, 2013.  The sequester amounts could be changed (up or down) by whatever deal, if any, is made among the House, Senate and President in the interim.  It is unlikely, however, that the F2F program would escape a cut of some degree.

What next?  Medicaid and SSI at risk?  Medicaid was exempt from sequestration under the BCA.  During the next round of budget negotiations, however, the program could be vulnerable to cuts and/or structural changes (e.g., a per capita cap), since some in Congress are anxious to cut entitlement spending and constituents of the Medicaid program generally have less political clout than those on Social Security or Medicare.  Also vulnerable is the SSI program, particularly SSI for children, since it has been subject to criticism that it is being abused.  Family Voices will be working in conjunction with other children's health groups to defend these programs.

On a related point, some health-consumer advocates were pleased with the President's nomination of Jack Lew to be Treasury Secretary, since he has been known to protect Medicaid in past negotiations.   See http://thehill.com/blogs/healthwatch/medicaid/276675-medicaid-advocates-thrilled-with-lews-treasury-nomination#ixzz2HiCKHzRC.


The National Academy on State Health Policy (NASHP) recently released updated versions of the Children's Health Insurance Program (CHIP) Fact Sheets with 2011 information.  The fact sheets provide: general program information, data on enrollment and participation rates, eligibility and cost sharing requirements, enrollment and renewal simplifications, and other program highlights.  The fact sheets can be found at http://nashp.org/childrens-health-insurance-fact-sheets.

Online Services for Key Low-Income Benefit Programs.  On January 11, the Center for Budget and Policy Priorities posted a paper providing links to state information available online SNAP (Supplemental Nutrition Assistance Program, formerly known as Food Stamps), Medicaid, CHIP (Children's Health Insurance Program), TANF (Temporary Assistance for Needy Families), and child care assistance.

An issue brief on Implementing New Private Health Insurance Market Rules was recently published by the Kaiser Family Foundation.  The brief looks at three proposed federal regulations released in late November 2012 that address: private insurance market reforms, essential health benefits and actuarial value, and wellness programs offered or required by employers under group health plans. The brief explains the key provisions in each regulation and notes where there are outstanding issues as stakeholders comment on the rules. It also examines areas where the regulations seek to balance tradeoffs, and how these choices may impact consumers. 

Kaiser Health News recently published a Guide To Health Insurance Exchanges.


On January 7, the Center for Medicaid and CHIP Services (CMCS) issued a solicitation for applications for Connecting Kids to Coverage Outreach and Enrollment Grants.  A total of $32 million is available for grants to states, local governments, community-based and non-profit organizations, Indian health care providers, and tribal entities.  (In addition, a separate funding opportunity exclusively for Indian health care providers and tribal entities will be made available for outreach and enrollment grants at a later time.)

Proposals are due on February 21, 2013, with grant award notification anticipated on June 1, 2013. Grants are expected to range in size from $250,000 to $1 million for a two-year period, beginning June 1, 2013 and ending May 31, 2015.  This round of grants (Cycle III) will support outreach strategies similar to those conducted in previous grant cycles, and also may be used to build community-based resources for assisting families with the application process.  

CMCS will hold at least two teleconferences to provide interested parties an opportunity to ask questions. The first teleconference will take place on January 16, 2013, from 2 p.m. to 3 p.m. eastern time. The dates, times, and call-in numbers for this and future teleconferences will be posted on the InsureKidsNow.gov website at www.insurekidsnow.gov/professionals/outreach/grantees.

The solicitation announcement, which includes full instructions for how to apply, can be found at http://www.grants.gov/search/search.do;jsessionid=7HLcQrnbZzyKpyvgJkFVpggTRFhWRfxMrWCrdlHXmKWpNGppqZSC!-804278280?oppId=214153&mode=VIEW .


As always, please feel free to contact us with any questions. 

Best, Janis & Brooke

Brooke Lehmann, MSW, Esq.

Janis Guerney, Esq.


To reach your Members of Congress, go to http://www.congressmerge.com/onlinedb/index.htm.  You can submit a message through their contact forms, and/or call their offices. 

 Cosponsors of Representative Pallone's bill (H.R. 4083):

Rep Carson, Andre [IN-7] - 4/26/2012
Rep Cicilline, David N. [RI-1] - 2/17/2012
Rep Engel, Eliot L. [NY-17] - 2/17/2012
Rep Green, Gene [TX-29] - 3/5/2012
Rep Hanabusa, Colleen W. [HI-1] - 7/18/2012
Rep Langevin, James R. [RI-2] - 2/17/2012
Rep Michaud, Michael H. [ME-2] - 2/17/2012
Rep Norton, Eleanor Holmes [DC] - 2/17/2012
Rep Pingree, Chellie [ME-1] - 2/17/2012
Rep Rangel, Charles B. [NY-15] - 3/8/2012
Rep Roybal-Allard, Lucille [CA-34] - 3/20/2012
Rep Waxman, Henry A. [CA-30] - 7/9/2012
Rep Welch, Peter [VT] - 11/16/2012 

Cosponsors of Senator Menendez's bill (S. 2123):

Sen Akaka, Daniel K. [HI] - 6/4/2012 
Sen Bingaman, Jeff [NM] - 2/17/2012 
Sen Conrad, Kent [ND] - 2/17/2012 
Sen Franken, Al [MN] - 6/5/2012 
Sen Inouye, Daniel K. [HI] - 8/2/2012 
Sen Kerry, John F. [MA] - 3/13/2012 
Sen Klobuchar, Amy [MN] - 5/8/2012 
Sen Lautenberg, Frank R. [NJ] - 2/17/2012 
Sen Schumer, Charles E. [NY] - 9/21/2012 
Sen Snowe, Olympia J. [ME] - 2/17/2012 
Sen Whitehouse, Sheldon [RI] - 2/17/2012 
Sen Wyden, Ron [OR] - 9/19/2012