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September 29, 2022 | Volume 26, No. 8| Archives
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| Budget Update, Reproductive Health, and the End of the Public Health Emergency
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| In This Issue:
- MAT Act Update
- Administration: Reproductive Care, Substance Use Disorder, and Harm Reduction
- Congress: Continuing Resolution
- Courts: Weakening ACA’s Preventive Services
- Reproductive Rights Update
- Human Rights in Jeopardy: California CARE Courts
- A Closer Look: Medicaid and the End of the Public Health Emergency
- Highlight on Local HCH Advocacy
- COVID Corner
- What We’re Reading
- Good News Corner!
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We are currently meeting with Senate offices for our big end-of-the year push!
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The Mainstreaming Addiction Treatment (MAT) Act will increase access to Medication Assisted Treatment for Opioid Use Disorder by removing barriers to buprenorphine. Buprenorphine is the gold standard for treatment of opioid use disorder, and it cuts the risk of overdose death in half.
Currently, a legal restriction called the “X-waiver” creates barriers to prescribing by requiring extra trainings, patient caps, and regulatory hurdles. We MUST repeal the X-waiver and increase access to buprenorphine in order to prevent more overdose deaths and increase recovery. The MAT Act has already passed the House but we need Senators to sign on so this has a chance to become law before the end of the year!
Our coalition sent a letter to Senate leadership encouraging them to vote on this measure during this term. Thank you to the HCH programs who signed on to this letter! For additional reading on the X-waiver click here.
ACTION TO TAKE: Reach out to your Senators to advocate for the passage of the MAT Act. Here is a contact list for Senators from every state!
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Reproductive Care
On July 8, President Biden issued an executive order instructing the Department of Health and Human Services to issue a report regarding securing reproductive rights. HHS’s report, released at the end of August, contains steps to enforce the ACA provisions to ensure availability of birth control and to expand comprehensive contraception counseling through Medicaid funds.
Additional grants are being requested for community health centers to bolster voluntary family planning services and provide technical assistance to providers. HHS has also launched a website -- reproductiverights.gov -- to combat misinformation and to inform patients where they can obtain contraception. The report also covers these additional topic areas:
- Medication Abortion
- Pharmacy Guidance
- Office of Civil Rights Enforcement
- EMTALA
- HIPAA/Privacy Concerns
- Maternal Health Research
Substance Use Disorder and Harm Reduction
On September 22, President Biden announced $1.6 billion in funding for combatting the opioid epidemic and promoting recovery. SAMHSA will distribute the funds to states and tribal areas. More than $100 million will go to rural areas to expand treatment access and for preventive efforts. The grants also allocate $20.5 million for recovery supports and mental health programs across the country. The Administration issued guidance aimed at increasing access to naloxone products and for employers to develop “Recovery Ready” workplaces.
While this funding is excellent news during National Recovery Month, there are also some pressing concerns that still need to be addressed. Fentanyl users have a high risk of overdose. Fentanyl test strips allow people with to test their substances to determine if fentanyl is present but, unfortunately, fentanyl test strips are still illegal in many states despite their lifesaving effects. Likewise, the Administration has yet to approve overdose prevention sites, which have a wide evidence base to them, and have been successful in many countries, including Canada.
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Continuing Resolution: On Tuesday (September 27), Congress passed a continuing resolution (CR) to keep the government funded until December 16, 2022. (Here’s a section-by-section description of what’s in the bill.) By the end of the year, an omnibus spending package that contains both spending and policy measures is possible.
West Virginia Senator Joe Manchin agreed to remove his policy measure that makes it easier for energy permits to be issued, in order to keep the CR “clean” (meaning no policy issues) and amenable to Republican lawmakers. The CR also includes extra funding for Ukraine, heating assistance for low-income people, and the water crisis in Mississippi and other disaster aid. The CR does not include any of the funding requested by the Biden Administration for additional resources to respond to monkeypox and COVID-19. Of particular interest to the HCH community, the CR includes a measure to permanently extend Federal Tort Claims Act (FTCA) coverage for volunteers at health centers -- which is great news!
More details on the budget will be featured in October’s Mobilizer!
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Weakening ACA’s Preventive Services: The ruling has come down for the newest challenge to the Affordable Care Act. On September 7, Texas Judge Reed O’Connor stuck down certain provisions that guaranteed coverage for preventive services.
The lawsuit, brought by Braidwood Management and a few private citizens, argued that the company should not have to pay for contraception or the HIV/AIDS prevention medication PrEP because the plaintiffs believe these medications encourage behavior they consider immoral. They further asserted the law was unconstitutional because ACA regulatory officers had not been appointed by the President and confirmed by Congress.
Judge O’Connor has yet to issue an order ending enforcement for preventive care requirements or to indicate if his ruling applies to the whole country or just his district. More than152 million people benefit from the preventive care coverage requirement, which covers a wide range of services for adults, women, and children. Preventive services that save lives, such as cancer, diabetes, and depression screenings, as well vaccinations, may again be prohibitively expensive for millions of Americans. Many insurers are poised to reinstitute copays should the ruling be enforced, though new costs are unlikely to go into effect in 2023. HHS Secretary Becerra is already appealing the decision and the case is likely to go before the Supreme Court.
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Reproductive Rights Update
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Intrauterine devices (IUDs) and emergency contraception may be in danger of becoming illegal due to the concept of fetal personhood.
Many anti-abortion groups and conservative lawmakers argue that a fertilized egg has full human rights. They argue that emergency contraception and IUDs prevent a fertilized egg from implantation and violate the fetus’ rights. As of September 2022, no states have banned these forms of contraception, but five states -- Alabama, Arizona, Georgia, Kansas, and Missouri -- have fetal personhood laws that may further put reproductive rights in jeopardy.
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Human Rights in Jeopardy: California CARE Courts
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In our July issue of the Mobilizer, we described serious concerns with Assisted Outpatient Programs. California Governor Newsom has taken a step further to strip people with disabilities of their rights by implementing an even more coercive program through “CARE Courts.” The Community Assistance, Recovery, and Empowerment (or CARE) Act allows community members, law enforcement, and family to petition the court for forced treatment of an individual with mental illness. The law requires people living with mental illness to follow a court-ordered treatment plan including mandatory medication for up to two years.
Disability Rights California says they are “ready to file suit” against the law and ACLU California is also closely following the CARE Court implementation. Our partners at the National Low Income Housing Association are fighting a similar bill in Georgia. Advocates for people living with mental illness can follow Disability Rights California and ACLU California for updates.
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A Closer Look: Medicaid and the End of the Public Health Emergency
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Medicaid requirements and flexibilities during the COVID-19 public health emergency have protected the most vulnerable populations in our country. Lack of medical treatment is often a cause of homelessness and continued barriers to care perpetuate suffering and poverty.
Medicaid opens the door for our patients to receive wraparound care for physical and social determinants of health. In conjunction with preventative and chronic disease care, Medicaid beneficiaries gain access to targeted case management that can assist with housing and social services navigation.
Medicaid provided an additional 17.7 million people with health insurance during the public health emergency; an increase of almost 25%. During the PHE, states were required to adopt continuous enrollment which prevented churn, or the frequent periods of disenrollment and re-enrollment, and in return received a 6.2% increase in the Federal Medicaid Assistance Percentage (FMAP). This has meant enrollees have not had to worry about losing coverage for the duration of the PHE; however, when it ends (currently set for January 15, 2023), the continuous enrollment provisions end.
The Centers for Medicare and Medicaid Services (CMS) have identified some grim statistics. States will begin redetermining eligibility for Medicaid enrollees 60 days prior to the end of the PHE and people who are ineligible will lose insurance the last day of the month the PHE ends. If the PHE ends on January 15, 2023, the end date for continuous enrollment will be January 31, 2023. CMS projects that 9.5% of enrollees will lose coverage due to being ineligible, and an additional 6.8 million (or 7.9%) of Medicaid enrollees will lose coverage as a result of administrative churning even though they remain eligible. These patients may not have received their application due to an incorrect address, or may not have returned their forms on time.
People experiencing homelessness are disproportionately affected by administrative churn as they often have no reliable address where they can receive mail. To minimize this impact, enrollees should act now to update their contact information and health centers should learn their state’s process to complete redetermination on enrollees.
CMS, looking ahead to this possibly catastrophic and needless loss of coverage, has issued a proposed rule that should improve the redetermination process. The rule seeks to reduce administration burden by requiring electronic verification of income and assets for enrollees. States must make every effort to find the correct addresses for consumers before terminating coverage by searching their own databases, such as social services agencies and reliable third-party providers including managed care organizations. Under the proposed rule, redeterminations could not occur more than once a year, which will reduce the level of administrative churn. Implementing this rule will protect our consumers.
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NEW COUNCIL RESOURCE
Medicaid redeterminations will likely occur beginning in January 2023, with disenrollments likely beginning in February. Our fact sheet describes how the HCH Community should prepare for Medicaid redeterminations as part of the public health emergency unwinding.
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Highlight on Public Advocacy
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In Miami, consumers led a protest against the city's proposal to create a homeless encampment on an island in Biscayne Bay. The isolated site, located in a flood zone and next to a toxic sewage plant, would be miles away from employment opportunities and health care services. Worse, the planned encampment site would be on the same island as Miami's historic segregated beach, thus raising the specter of the reimposition of Jim Crow segregation of Miami's majority-Black homeless population.
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In public comments to the city commissioners, opponents urged the city to use public funds to create permanent supportive housing rather than deporting the homeless to an isolated island. Due to the overwhelming opposition to the proposal, city commissioners voted to indefinitely postpone the final vote on the encampment proposal, thus effectively killing the plan. (David Peery, Miami Coalition to Advance Racial Equity)
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Boosters: The FDA authorized and the CDC endorsed an updated COVID-19 booster shot called “bivalent” that protects against two different COVID-19 strains: the original and the highly contagious Omicron variant.
The new booster is manufactured by both Pfizer (available to people 12 years of age and older) and Moderna (available to those 18 years of age and older). This authorization rescinds the authorization of the monovalent (original) booster shot for anyone 12 years of age and older. This booster is now available and encouraged for anyone who is eligible to receive one. Your booster dose does not need to be from the same manufacturer as other COVID-19 vaccines doses you have received, and you are encouraged to have the flu vaccine co-administered with your COVID-19 booster.
Recognizing Our HCH Heroes: Jocelyn Pedrosa, MD, chief medical officer at Yakima Neighborhood Health Center in Yakima, WA, was awarded the Samuel U. Rodgers MD Achievement Award for Excellence in Clinical Practice and Leadership by the National Association of Community Health Centers at the annual Community Health Institute. Click here to watch to Dr. Pedrosa’s inspiring message about providing care to her health center patients.
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NEW COUNCIL RESOURCE
How many people experiencing homelessness are vaccinated in your community? That’s the key question guiding protective measures and other interventions, particularly among homeless services and health care providers. Our new fact sheet describes how to calculate these estimates and provides examples from six communities about how they estimate their rates of vaccination.
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We are often sharing bad policy news, but we’re committed to finding good policy news out there! Here are stories we found this month that lifted our spirits:
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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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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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