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October 26, 2023 | Volume 27, No. 8| Archives

Four (and a Half!) Good News Items

In This Issue: 
  • Speaker of the House of Representatives and the Budget
  • Medicaid Redeterminations—8.8 Million Kicked Off
  • A Closer Look: Interview with Etel Haxhiaj
  • Street Medicine "Game-changer": New Place of Service Code 
  • A Temporary? Advocacy Win on Substance Use Disorder
  • Partner Highlight: Racial Disparities in Homelessness Persist: A Data Snapshot
  • What We’re Reading (and Watching)
Scavenger hunt: Four—and a half—good news items are marked—find them!
Speaker of the House of Representatives and the Budget
    empty speaker seat
    Yesterday, the House of Representatives elected Rep. Mike Johnson (R-LA) as Speaker of the House. While this brings needed authority to run the business of the House, note that Rep. Johnson is a staunch conservative who played a key role in trying to overturn the 2020 election results, voted against legalization of same-sex marriage, and is in favor of a national abortion ban as well as limiting gender-affirming care.
    However, with a Speaker now in place, Congress can return to passing a federal budget, which has added importance because the current continuing resolution on the budget expires on Nov. 17—giving precious little time to come to an agreement about the funding of programs moving forward. Keep in mind that the House Republican majority wanted to see significant cuts to the budget—far more than what was agreed to in the debt ceiling agreement back in May, and more than the Senate and White House will be willing to consider. Given these differences, it remains to be seen whether reaching agreements is even possible in such a short period of time, whether a longer continuing resolution will be enacted, or whether a government shutdown will re-emerge as a possibility.
    Health Center budget: As the budget negotiations start once again, stay tuned for more specific advocacy actions to protect discretionary funding for health care programs. Separately, remember that the mandatory funding for the Community Health Center Fund, which provides 70% of health center funding, expired on Sept. 30 and needs to be re-authorized. Our partners at the National Association of Community Health Centers are asking the health center community to contact their representatives and ask them to support the Lower Costs, More Transparency Act (H.R. 5378), which would extend funding through CY2025 at $4.4 billion per year, but the House has yet to call a vote on this legislation. 
    alert sign
    Medicaid Redeterminations — 8.8 Million Now Kicked Off 
    As of October 16, more than 8.8 million people have been disenrolled from Medicaid. At the highest end, Texas kicked 66% of those being redetermined out of the program; however, at the lowest end, Illinois has disenrolled only 11%. Across all states reporting data, 72% of all people disenrolled had their coverage terminated for procedural reasons (such as not receiving a response to a mailed letter). We have to give a shout-out to Oregon, who has only disenrolled 4% for procedural reasons—unlike in New Mexico, where nearly all disenrollments have been procedural (97%). Recall that CMS is continuing to offer states a lot of flexibility to prevent catastrophic coverage losses, and encouraged states to pause disenrollments so they could refine their systems.
    Related reading:
    GOOD NEWS #1: NEW Continuous Enrollment Requirements for Children: The Consolidated Appropriations Act from 2023 directed CMS to require all states to implement continuous enrollment (CE) for children under age 19 in Medicaid or CHIP. A letter sent to states on Sept. 29 outlines the new rules, which start on Jan. 1, 2024:
    • States must permit CE for all children under 19 for a full 12-month period starting on Jan. 1 (this applies to 17 states + DC)
    • States that previously had more limited provisions for CE are required to update their Medicaid plans with CMS
    • States can request longer CE periods, or extend these provisions to adults, through an 1115 waiver. 
    BAD NEWS & GOOD NEWS (#1/2) IN GEORGIA—IT’S COMPLICATED: Georgia has a new Medicaid waiver in place that brings good news—and bad news. The good news: They expanded eligibility for coverage to people earning up to 100% of the federal poverty level (FPL, $1,215/month). The bad news is that they are not expanding under the Affordable Care Act’s provisions to go up to 138% FPL so they don’t cover the additional people and they forfeit the additional federal matching rate. Also bad news: They’ve added a work requirement so that anyone newly qualifying under this waiver must demonstrate they’ve worked 80 hours each month in order to continue being eligible. A federal court ruled in favor of Georgia’s plan because more people will be newly accessing coverage, but it’s a shockingly poor economic and humanitarian decision from Georgia. Unsurprisingly, only 1,343 people have managed to navigate the arduous process in order to enroll (though this is tenuous coverage since continued eligibility requires demonstrating ongoing compliance).
    Remember that during the Trump Administration, 13 states got permission to add work requirements in Medicaid—though only Arkansas moved ahead into implementation (and subsequently kicked 19,000 people off the program before a federal judge stopped it). A reminder: Work requirements don’t work! We are concerned policies like this will be successful in more courts—or that a different Administration may return to approving these harmful policies. Here’s our issue brief explaining why we strongly oppose work requirements.

    Take Action on Medicaid: 

    • Use our issue brief on Medicaid Redeterminations to find specific strategies health centers can take to improve internal processes.
    • Advocate to your state Medicaid agency to adopt the new HHS strategies listed above (as well as those listed in our issue brief).
    • Raise awareness among patients/clients to ensure they know redeterminations are happening (many people don’t know!). 
    • Raise attention to this issue in the media and be sure to indicate how coverage losses are impacting the health and well-being of those newly disenrolled.
    • Raise awareness of the new continued enrollment requirements for children—and the possibility that states can get a waiver to extend these provisions to adults as well!
    • Be on the lookout for whispers of adding work requirements to your state’s Medicaid program—and fight hard to stop those discussions early.
    A Closer Look logo
    Interview with Etel Haxhiaj
    By Barbara DiPietro, PhD, Senior Director of Policy
    Good news #2! Etel Haxhiaj is our new Senior Policy Manager! Etel will be taking over this Mobilizer, staffing our Policy Committee, leading our Congressional relations, and managing a number of our advocacy initiatives. Be on the lookout for Etel’s communications!
    In the meantime, let’s get to know Etel a little better through the interview below:
    What have you learned from your experience as a community organizer and advocate in your community?  
    I have learned much from community organizing, especially my work organizing mothers to fight for a livable climate. I trained mothers and other community members to use their stories to talk to lawmakers. We crafted our stories together and practiced having one-to-ones with other mothers. We learned what building power with others means and how to set concrete campaign goals. We learned that we must celebrate our wins, big and small. In my organizing work with moms, we used our collective advocacy to win concrete things like convincing our gas company to fix all the gas leaks around schools, daycares, and parks. Organizing and advocacy require precision in our goals, continuously sharpening our tactics, centering people with lived experience, and a commitment to building power. 
    Read Etel's full interview
    heart hands
    Street Medicine 'Game Changer': New Place of Service Code
    Good news #3! Reimbursements for street medicine just got easier now that CMS added a new “place of service” billing code specifically for outreach sites and street medicine. Use of this code should enable Medicaid and other third-party insurers to more easily reimburse for services delivered in “a non‑permanent location on the street or found environment, not described by any other POS code, where health professionals provide preventive, screening, diagnostic, and/or treatment services to unsheltered homeless individuals.” Providers of street medicine call this new code a “game-changer” because it will make it easier to get paid for the care they provide. Note this code is different from existing codes for homeless shelters, mobile units, and federally qualified health centers.
    Related reading:

    Take Action on Street Medicine: 

    • Ensure your program is maximizing its ability to conduct street medicine and deliver care outside traditional clinic settings.
    • Promote use of the new place of service code so that more services are reimbursable through insurance (primarily Medicaid).
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    A Temporary? Advocacy Win on Substance Use Disorder
    Good news #4! Avid Mobilizer readers will recall that back in March, the Drug Enforcement Administration (DEA) asked for comments on their proposal to require an in-person medical evaluation within 30 days of being prescribed buprenorphine—a Schedule III drug used to treat opioid use disorder—through a telemedicine appointment. We sent a letter strongly opposed to this provision based on three points:
    • This rule jeopardizes patient safety and pre-empts clinical decision-making.
    • This rule undermines access to care by wrongly prioritizing fear of diversion.
    • This rule goes against the President’s stated policies and priorities.
    Advocacy works! The DEA received a record 38,000 comments—most of them against the proposed change. Fortunately, the DEA initially agreed to temporarily extend the ability to continue full telehealth access through November 2023, and now has issued another extension on this issue—through December 31, 2024. The DEA says it will finalize a rule on this issue by Fall 2024—at which time it will be clear where the Administration’s true priorities lie regarding access to medications for opioid use disorder. But at least this gives one more year of more flexible access to care.
    Related reading:
    Sign: End systemic racism
    Partner Highlight: Racial Disparities in Homelessness Persist: A Data Snapshot 
    We’re raising up racial disparities data that our friends from the National Alliance to End Homelessness published this week, based on data collected in HUD’s 2021 Annual Homelessness Assessment Report to Congress.  
    Chart shows that most BIPOC groups experience sheltered homelessness disproportionately.

    Take Action on Racial Disparities: 

    • Compare local and state data from the U.S. Census and your Point in Time reports to illustrate racial disparities among homeless populations in your community.
    • Add in your program data to discern whether you have disparities in whom you are serving—and then adjust your services accordingly.
    What 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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