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March 30, 2023 | Volume 27, No. 2| Archives

Budgets Are Moral Documents

In This Issue: 
  • Medicaid Redeterminations: Starting…NOW
  • New Fact Sheet: Health Insurance Coverage in the HCH Community
  • A Closer Look: Budgets are Moral Documents
  • Treatment for Opioid Use Disorder—Next Steps
  • Policy Journal Calls for Abstracts on Housing and Health
  • What (Else) We’re Reading 
Medicaid Redeterminations: Starting ... NOW
    We talked about Medicaid redeterminations in last month’s Mobilizer, but it can’t be said often enough: All hands on deck are needed to prevent coverages losses as states redetermine Medicaid eligibility for all enrollees!
    Short summary: Policies enacted during the COVID-19 pandemic that prohibited states from dis-enrolling people from Medicaid (in exchange for additional funding) are ending. States are now required to redetermine eligibility for every Medicaid enrollee, and every state will be going about this process differently.
    Bottom line: 15 million people are anticipated to lose Medicaid coverage—nearly 7 million of them will still be eligible. Incomplete applications, missed deadlines, and other administrative barriers will disproportionately impact people who are homeless. People in states that did not expand Medicaid are especially at risk.
    The big problem: 64% of adults on Medicaid don’t even know this is happening.
    Analysis: States can reduce the likelihood of coverage losses by doing automatic (called ‘ex parte’)  determinations using data they already have in their systems. However, not all states are doing this—and let’s be honest—some states want to kick as many people off the rolls as possible. Health insurance plans are trying to stop coverage losses by updating contact information and doing outreach, and a number of insurers and other stakeholders have joined together to establish Connecting to Coverage, a coalition dedicated to minimizing disruptions in coverage. Check out their website because they’ve got a lot of great resources there!
    🚨 HEADS UP 🚨 
    Five states will start dis-enrolling people from Medicaid on April 1 and 15 states will start dis‑enrolling on May 1.
    Is your state one of them?
    What’s your state’s redetermination plan?

    Take Action on Medicaid Redetermination: 

    Advocate your state conduct automatic redeterminations and take other steps outlined in our fact sheet to minimize coverage losses. Listen to our March 14 webinar discussion with our national partners on this topic.
    Spread the word so that everyone knows this is happening.
    New Fact Sheet: Health Insurance Coverage in the HCH Community
    There are nearly 300 Health Care for the Homeless programs in the country—and they served over 900,000 people in 2021. Our newest analysis looked at the health insurance data that all health centers submit to HRSA and used it to make comparisons with other health centers and the general public. We also compared states that expanded Medicaid to states that continue to refuse to do so. Finally, we conducted a state-by-state analysis to show the wide variation in health insurance across the country for patients at HCH programs. See Tables 1 and 2 in the brief to find out the insurance mix in your state! Use this data to advocate for expansion—or for better outreach and enrollment practices.
    A Closer Look: Budgets Are Moral Documents
    President Biden issued his budget on March 9, which outlined the Administration’s policy priorities and vision for federal spending in the next year. Important for the HCH Community, the HHS and HUD budgets include significant expansions to health care and housing programs, largely paid by making the rich pay their fair share in taxes. Key take-aways from our recently updated Appropriations chart and fact sheet of the more impactful provisions:
    • $1.7 billion more for health centers, to include a major expansion of behavioral health services (requiring all health centers to provide behavioral health services)
    • A new federal program to close the Medicaid coverage gap in non-expansion states
    • Significant increases in state funding for mental health and substance use treatment, as well as more funding for harm reduction programs and services
    • Major new funding for rental assistance, to include an entitlement for youth coming out of foster care and low-income veterans
    • New funding for public housing, eviction prevention, and increasing the housing supply
    This budget stands in stark contrast to the budget that Republicans in Congress envision pushing forward. While details have not yet been released, there are strong assertions that severe cuts to Medicaid will be a priority. Proposals include imposing a nationwide work requirement, changing the financing of the program from an entitlement to a limited block grant or capped program, and/or eliminating the law that expanded Medicaid to single adults. Any of these changes would be devastating to the ~90 million people currently on the program—but remain long-standing goals of the Republican Party. In response, the White House released a fact sheet outlining the impact of these policies and the critical importance of Medicaid to the health of the nation.
    It is worth noting that in order to become Speaker of the House, Rep. Kevin McCarthy agreed to balance the budget by cutting trillions of dollars from the budget—and to tie those cuts to any agreement on increasing the national debt limit. Broadly, they want to cut most programs back to 2022 funding levels, which would devastate just about all safety net programs (to include food and housing assistance, among others).
    Budgets are moral documents in that they illustrate the priorities that actually get funded (as opposed to what policymakers might SAY is important to them). Hence, what Congress chooses to fund—and chooses not to fund--are conscious choices, not accidents.

    Take Action on the Budget: 

    Contact your Congress member and let them know what moral values you want to see in the budget: expansions to health and housing plus a more equitable tax structure.
    For many, losing Medicaid is a death sentence.
    Treatment for Opioid Use Disorder: Next Steps
    Last month, we reported on a big advocacy WIN related to substance use treatment and the availability of buprenorphine to treat opioid use disorder (OUD). The Mainstreaming Addiction Treatment Act (or MAT Act) repealed the regulatory barriers for providers prescribing buprenorphine (sometimes known by its trade name, Suboxone). The regulations added needless paperwork for providers, perpetuated stigma, and made it more difficult for patients to access care. Our advocacy (together with other organizations) ended the need for providers to obtain a special waiver to get permission to prescribe, but the question remains: what happens now?
    In 2021, Health Care for the Homeless programs served only 3% of all patients in the broader health center program, yet they account for 1/3 of the buprenorphine-prescribing providers and patients receiving this treatment (see figure below based on the 2021 annual health center data).
    Providers must be willing to screen and treat patients with OUD—and they no longer have the “it’s too much paperwork” excuse that shielded them before. But let’s be honest—no public policy can automatically erase the deep-seeded stigma the health care community holds against substance use disorders (SUD) generally—and OUD specifically—that has prevented millions of people from accessing needed treatment. Some states are allowing pharmacists to prescribe and dispense buprenorphine, which could open access to treatment. But health centers have to do more too.
    New proposed rule: Unfortunately, other barriers are being proposed by the Biden Administration. The Drug Enforcement Agency (DEA) is currently looking to restrict buprenorphine prescriptions that were initiated via telehealth by requiring an in-person visit within 30 days. These are only proposed rules, and we will be submitting a letter to the DEA in response to this with our strong objections. We cannot continue to stigmatize a drug—a safe and effective drug—because of the potential for it to be diverted to another person. Insulin prescribed for diabetes is more dangerous—and sometimes shared among people who cannot afford their own. Yet no restrictions are ever proposed for insulin (or any other medication for chronic illness). We have to end the stigma behind seeking SUD/OUD treatment and delivering needed care. 

    Take Action on OUD Treatment: 

    Advocate for increased buprenorphine prescribing at your health center, medical respite care program, or other health care providers (such as pharmacists)
    Fight local or state laws that may restrict access to buprenorphine.
    Policy Journal Calls for Abstracts on Housing and Health
    Health Affairs is a leading policy journal in the health care field. They are planning a theme issue on housing and health, to be published in February 2024, and are aiming to publish approximately 20 peer-reviewed articles— including original research, analyses, commentaries, and Narrative Matters—from leading researchers, scholars, analysts, and health care stakeholders. Their vision for the theme issue is not only to inform discussion of housing and health with the latest scholarship, but also to feature forward-looking work that can help shape the agenda for research and policy. Their goal is to include content at the intersection of housing and health across a range of policy issues, with a focus on health equity. They are interested in highlighting evidence-based strategies, best practices, and lessons learned in communities across the country, to advance an equitable path to improvement in housing stability, homelessness prevention, and population health outcomes in the years ahead.
    Interested in submitting an idea for a paper? Abstracts are due on April 17. More information is available at the Health Affairs request for abstracts page.
    What (Else) We're Reading
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    Barbara DiPietro
    Senior Director of Policy
    National HCH Council
    Baltimore, MD
    (443) 703-1346

    This publication and all HCH advocacy are funded by dues from Organizational Members of the Council and by private donations. Consider joining the Council to support this work.
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