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September 28, 2023 | Volume 27, No. 7| Archives
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| Reversing Progress on Poverty
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| In This Issue:
- FY2024 Budget—Where We Currently Stand
- Government Shutdown
- Medicaid Redeterminations—7.2 Million Kicked Off
- A Closer Look: Reversing Progress on Poverty
- Substance Use Disorder in the News
- Partner Highlight: United Nations’ Reports & the National Homelessness Law Center
- COVID Corner: New Shots & Tests Available
- What We’re Reading
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| FY2024 Budget — Where We Currently Stand
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There’s so much to say about the level of dysfunction in our political system right now. Once again, our entire economy is being threatened by a small group of extremists in Congress who refuse to use the established, democratic process for even the most basic of job-related responsibilities—such as passing a federal budget. Weeks ago, we were on the threshold of a default on our economy, and now, we’re at the brink of a government shutdown starting on Saturday.
What’s happening? The House has not completed its markup of the 12 Appropriations bills (an annual process). The House Freedom Caucus is demanding significant cuts to the budget (over and above what was agreed to from the recent bipartisan debt ceiling negotiation), along with insisting on including funding for more immigration enforcement on the southern border. Because Republicans hold a slim majority in the House, Speaker McCarthy needs these votes to pass any budget, and the House Freedom Caucus has threatened to remove McCarthy from his position if he does not meet conservative demands or if he relies on any Democratic votes to pass any bill. They will not consider a temporary continuing resolution (CR) to keep the government open unless it includes their demands. It’s truly a political debacle of the worst kind.
Meanwhile, the Senate has passed budget bills on a bipartisan basis, and has been waiting on the House to do that same so it can negotiate a final budget and send to the President for signature. Although spending bills generally have to originate in the House, the Senate has sent a CR to the House to keep the government open until November 17 in the hopes that will allow enough time to get the budget done (this bill also includes funding for both Ukraine and for disaster assistance). Unfortunately, House Republicans have snubbed this overture and time is running out before the government no longer has a budget as of September 30.
What happens now? McCarthy could bring the Senate’s bill to a vote in the House, but he has not indicated (yet) that he will do so. This is a dynamic situation so much could change quickly. However, if the government shuts down on Saturday, it’s unclear how an agreement will come together to re-open it anytime soon.
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Take Action on the Budget: - Call your representatives in the House and tell them to support desperately needed increases in the budget, not drastic cuts to life-saving services.
- Tell them to stop jeopardizing the entire economy in order to advance an extremist agenda.
- Illustrate how cuts to health care, housing, and other services would impact you, your program, and your community.
- Schedule a site visit next time your lawmaker is back home from DC! Call their office and invite your representative to visit your program to illustrate how federal dollars support jobs, health care, and greater stability for the entire community.
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| A note on mandatory health center funding: The Community Health Center Fund contains multi-year mandatory funding that comprises the bulk of health center funding. Unfortunately, this funding is due to expire on September 30. Without a new budget, this funding is at risk (along with the rest of the appropriations). The Senate HELP committee has already passed The Bipartisan Primary Care and Health Workforce Act, which would reauthorize the health center fund through FY2026, and increases funding to $5.8 billion per year. Four House committees passed a similar bill, 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. The National Association of Community Health Centers (NACHC) is asking the health center community to contact their House members and ask them to pass their bill so that health center funding is not in jeopardy. NACHC has resources and action alerts available to make this advocacy easier.
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| Government Shutdown
- Health centers should expect to continue operations as usual. HRSA staff will continue programs and activities that are funded through carryover funding, or user fees, which include the Health Center program.
- Medicaid payments will continue, though there may be slight delays in claims processing. CMS will have sufficient funding for Medicaid to fund the first quarter of FY24.
- SAMHSA will continue substance abuse and mental health programs, including those that provide critical behavioral health resources in the event of a natural or human-caused disaster (e.g, such as the 988/Suicide Lifeline) to connect people in crisis with life-saving resources.
- Social security checks (SSI/SSDI) will continue to go out, and SNAP benefits will continue to be allocated.
- However, applications for new social security or Medicare benefits and requests for new cards or changes may experience significant delays.
Please note that most federal staff will be furloughed during this time and will be prohibited from working during the shutdown. Agencies likely will be running only with a skeleton crew, so you may not be able to get in touch with your federal partners during this time. Also please note that these federal workers will not be getting paid during the shutdown—but members of Congress continue to get a paycheck! A bill has just been introduced that would withhold pay for Members of Congress in the case of a federal government shutdown (the name of the bill will make you laugh).
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| Medicaid Redeterminations — 7.2 Million Now Kicked Off
As of Sept. 21, nearly 7.2 million people have been disenrolled from Medicaid. At the highest end, Texas kicked 69% of those being redetermined out of the program. Across all states reporting data, 73% of all people disenrolled had their coverage terminated for procedural reasons (such as not receiving a response to a mailed letter). CMS has offered 23 policy options and encouraged states to pause redeterminations to reduce the number of procedural terminations, however, Florida is an example of a state that has refused any assistance.
In August, the Centers for Medicare and Medicaid Services (CMS) sent a call to action letter to states after it became clear that entire families were being automatically disenrolled from Medicaid, rather than having an individual assessment conducted. Because different groups have different eligibility levels, it is not possible to accurately redetermine an entire household automatically. The letter reminded states of their legal obligation, and CMS has been actively working with state to correct course, reinstate eligibility for impacted people, and implement strategies to ensure these errors do not continue.
On Sept. 21, CMS announced that nearly 500,000 individuals have been reinstated after correcting for these errors, which had occurred in 30 states. CMS required all 30 states to pause procedural disenrollments for impacted people unless they could ensure all eligible people are not improperly disenrolled due to this issue.
This issue isn’t going away—and losing health insurance is devastating to people in need of care. Please continue working both internally to your program and externally with your policymakers and community partners to ensure people experiencing homelessness are appropriately redetermined for health coverage.
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Take Action on Medicaid Redeterminations: - 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 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 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.
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| Related Medicaid reading:
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| A Closer Look: Reversing Progress on Poverty
By Barbara DiPietro, PhD, Senior Director of Policy
The U.S. Census Bureau released its annual report on income, poverty, and health insurance this month, reflecting 2022 data. The chart below shows poverty rates from 2019 to 2022 across racial groups—and you probably notice three things right away:
- Black and Brown folks experience poverty at about twice the rate of White folks
- Something happened in 2020 and 2021 to significantly reduce poverty for all groups
- Something happened in 2022 that erased all that progress—and made it worse
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| Note: This data uses the supplemental poverty measure because it includes more information relevant to discussing poverty.
So what happened?
The short answer: At the onset of the COVID-19 pandemic, Congress quickly enacted a significant safety net that helped millions of people escape poverty. Then, Congress pulled it all back.
The long(er) answer: Congress passed at least three major aid packages in 2020 and 2021 that bolstered aid across many areas, to include cash payments; significantly expanded unemployment benefits; expansions in food, utility assistance, and housing aid; expanded tax credits; paid sick and family leave; and continuous eligibility for Medicaid (which offsets expenditures for health care).
More specifically:
- Three rounds of Economic impact payments (aka “stimulus checks”): In March 2020, these provided $1,200 per adult + $500 for each child for those earning below $75,000. In December 2020, another round of payments went out up to $600 per adult and child. In March 2021, a third round went out for $1,400 for single adults, $2,800 for married couples, plus another $1,400 for each dependent.
- Federal Pandemic Unemployment Compensation program: Between April and July 2020, weekly supplements to expanded state unemployment aid added $600 per week to benefits (later reduced to $300 per week between December 2020 and September 2021)
- Aid to food/nutrition programs: Additional funding for the Women, Infants, and Children (WIC) program as well as the Supplemental Nutrition Assistance Program (SNAP, or food stamps)
- Aid to housing/homelessness programs: Additional funding for tenant- and project-based rental assistance, public housing, Housing for Persons with HIV/AIDS (HOPWA), and others. Also expanded energy assistance through the Low Income Home Energy Assistance Program (LIHEAP)
- Moratoriums on evictions: Prohibited evictions of renters in homes with federally backed mortgages and most federally subsidized apartments
Three NHCHC fact sheets from the pandemic provide more detail about each round of funding:
The combined impact of this aid lifted millions out of poverty, reducing poverty for all racial groups through 2020 and 2021. Unfortunately, Congress chose not to continue this aid—allowing one Senator to hold up many program extensions. Also recall that the original Build Back Better legislation (November 2021) was to include historic health and housing investments—which were never included in the final Inflation Reduction Act of 2022. So households are largely back to the pre-pandemic safety net, which is why poverty shot back up (and over) where it was before. Decreases in poverty were due to conscious public policy choices—in exactly the same way that current increases in poverty are from undoing those exact same policy choices. It’s not an accident.
So what can you do?
- Most directly, call your Congressional representative and tell him/her why you think chronically underfunding—and flat-out DEfunding—critical programs is wrong! Call your Senators too! There’s a specific group of very conservative legislators (ironically named The Freedom Caucus) that is opposed to just about all funding, and is seeking massive reductions in federal spending. These are the folks who are focused on shutting down the government over their extreme demands (see the other section in this month’s Mobilizer).
- Educate your elected officials! Invite them to site visits to see your program and meet those you serve. Organize roundtable discussions with them and your clients and staff. Maybe you won’t change them completely, but maybe they’ll soften their approach (harm reduction!).
- Vote! Make sure you are registered, and take steps to register others as well. Hold voter registration and voter turnout events at your program (yes, this is legal).
- Get other people elected! If you don’t like who represents you in Congress, work to change that. Get behind those who reflect your values and are proposing solutions that align with what you want to see happen.
- Focus on REDUCING racial disparities! Advance policies that disproportionately benefit BIPOC groups, such as higher wages, more child care, and more equitable educational and employment opportunities. Structural racism in our policies is a conscious choice too (just sayin').
- Participate in the revolution! Something BIG has to change in order for us to prevent and end homelessness. I can’t say I know what “the revolution” is specifically — only that we desperately need one.
In Solidarity,
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| P.S. The good news from the Census report is that health insurance was at an all-time high — with the 2022 rate of uninsured at 7.9%. Of course, with the Medicaid continuous eligibility component now expired and millions being kicked off Medicaid (see Mobilizer section on this issue!) — coupled with increasing health insurance expenses — look for a spike in uninsured in NEXT year’s Census data. Increases in uninsured will not be an accident—they are directly caused by conscious public policy choices.
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| Substance Use Disorder in the News
The Biden Administration officially proclaimed Aug. 27 through Sept. 2, 2023, as Overdose Awareness Week, and then allocated $450 million in new funding to strengthen prevention, harm reduction, treatment, and recovery support services. This funding includes $80 million for HRSA to allocate to rural communities to create/expand treatment sites and provide medications to treat opioid use disorder.
In March, the FDA approved naloxone (the opioid overdose reversal medication, sometimes known by the brand-name, Narcan) for over-the-counter sale. Now, anyone can buy naloxone without a prescription or special permission; however, a box of two doses is now retailing for $45. Notably, the sale price for “public interest groups” is $41. It may be that increasing access for some people will mean LESS access for others as they get priced out. It remains to be seen whether public health departments and safety net service providers (like the HCH Community) will continue to have access to no/low-cost naloxone supplies. Be on the look-out for changes in supply and/or cost!
As another way of expanding access to naloxone, the Administration is also encouraging employers to keep supplies on hand so they are able to respond quickly to workplace incidents.
Related reading:
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| Partner Highlight: United Nations' Reports & the National Homelessness Law Center
A shout-out to our partners at the National Homelessness Law Center who are working with the United Nations (UN) to call out the United States for its role in continuing to violate human rights. The NHLC has long-lead the Housing Not Handcuffs campaign against criminalization of homelessness and offers extensive resources for helping communities fight back against these policies. Now, two reports from the UN highlight ongoing issues worldwide (yes, to include the U.S.), with the NHLC issuing accompanying reports that give a fuller picture of how these issues manifest in the U.S.
👉 NHLC report: Criminalization of Homelessness and Mental Health in the United States (September 2023): This report illustrates that criminalization of homelessness continues to be pervasive in the U.S., especially after COVID-19 protections expired. Numerous examples of violence committed against unhoused people are cited (to include forced removal policies), as well as the systemic failures to ensure safe, adequate housing. The report asks the UN to force the U.S. to identify actions it is taking to prevent states from criminalizing homelessness, to ensure federal agencies are not using resources to engage in criminalization either, to ensure individuals are not penalized for providing food and aid to unhoused people, and to stop civil involuntary commitments.
👉 NHLC report: UN Mechanism on Racial Injustice & Law Enforcement in the United States (February 2023): This report provides detailed examples of human rights abuses in the U.S., requests the UN visit the U.S.—which they subsequently did, and recommends local law enforcement collect more data, decriminalize homelessness, prohibit encampment evictions absent housing, take strong enforcement action, and recognize the human right to housing.
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| COVID Corner: New Shots & Tests Available
Updated vaccines: A new COVID-19 vaccine is now available that is specifically made to more closely target the current variants and to provide better protection against serious consequences of COVID-19. Everyone over age 6 months is eligible for this single-shot vaccine. According to HRSA, the CDC’s Bridge Access Program will temporarily provide no-cost 2023-2024 COVID-19 vaccine for adults without health insurance and adults with insurance that does not cover all COVID-19 vaccine costs. Health center patients can access the new COVID-19 vaccine at health centers, safety-net and public health providers designated by state and local health departments, and more than 20,000 retail pharmacy locations nationwide.
Related reading:
More at-home tests: Beginning on Sept. 25, the Biden Administration is re-opening the website to allow people to order up to four COVID-19 tests per household. This comes as infection rates are on the rise, and anticipated to continue into the fall/winter season.
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Did you receive Mobilizer as a forwarded email or hear about it via social media? Register now to receive our action alerts each month!
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Barbara DiPietro
Senior Director of Policy
National HCH Council
Baltimore, MD
bdipietro@nhchc.org
(443) 703-1346
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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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