Inside the Beltway - April 2024 - NAPNAP

Inside the Beltway – April 2024

Inside the Beltway – April 2024

Inside the Beltway is a member-only benefit developed by NAPNAP’s Health Policy Team to keep members up to date on key policy issues at the federal level.

Providing Health Care Access for Immigrant Children

Contributed by Health Policy Committee member Noelia MaGowan, CPNP-PC

There has been a 19% rise in the number of immigrant and migrant children in the United States since the early 2000s, with the greatest increases seen in California (44%), New Jersey (41%), New York (36%), Florida (34%), Massachusetts and Nevada (both 33%) and Texas. In 2022, approximately 17.6 children under the age of 18 resided with at least one immigrant parent, and most were U.S. born. Because these children will play an integral role in the future of our country, it is essential they are provided high quality, equitable pediatric health care as early as possible.

Pediatric nurse practitioners, family nurse practitioners and their APRN colleagues caring for children are uniquely positioned to promote more equitable access to health services for children of immigrant families. Children have multiple ways to access potential benefits based on their parents’ immigration status, years of residence, sector of employment and years of formal employment. Programs such as Medicaid, Children’s Health Insurance Program (CHIP), Temporary Assistance for Needy Families (TANF), and Supplemental Nutrition Assistance Programs (SNAP) are available but have eligibility restrictions in place that may prevent some families from accessing these important services. For example, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) made authorized immigrants ineligible for TANF, SNAP, and Medicaid during their first five years of qualified immigration status, although many immigrants have lived in the U.S.  for years before they retain this qualified status. In 2023, the HEAL for Immigrant Families bill was introduced in Congress by Senator Booker (NJ) to improve access to these important child- or family-focused health and well-being services.

Immigration status and related eligibility are not the only barriers for children to get needed health care. Some immigrant parents and caregivers lack accurate, understandable information about their ability to apply for services. In worst case situations, there is misinformation in communities creating unnecessary barriers. Many families face language barriers that make filling out the applications difficult within an already complex process. Often there is limited access to technology required to navigate the online platforms for services and funding. For those who seek assistance, transportation and time constraints make it challenging to get to assistance or health care locations. For some families that do not have permanent housing, changing addresses make it a challenge to qualify for and/or receive assistance. Finally, there is a fear of immigration consequences, as in the case of the “public charge” principle, and/or and cultural stigmas about accepting government assistance which can deter some families.

Addressing these barriers requires a multifaceted approach, including community outreach, language support services, clear communication about immigration implications, simplification of application processes, and ensuring access to technology and personal assistance for applicants. All pediatric-focused APRNS should become knowledgeable about their state’s requirements and what federal funding programs are available so they can counsel patient families about the opportunities and processes specific to health care access. As experts in pediatrics and advocates for children, NAPNAP members are highly encouraged to start a dialogue with their state legislators to advocate for initiatives that provide comprehensive, high-quality health coverage to all children.


Join the Health Policy Committee

Applications for NAPNAP’s national Health Policy Committee (and six other committees) are open now. Learn more and apply by the May 19 deadline. Selected members will begin their terms on July 1. This is a great opportunity to share your expertise, network with colleagues, expand your leadership skills and enhance your CV.

Feds Move to Streamline Medicaid, CHIP Enrollment

The Centers for Medicare and Medicaid Services (CMS) last month released long-awaited final rules streamlining eligibility and enrollment processes for Medicaid and the Children’s Health Insurance Program (CHIP), establishing a consistent state-to-state renewal process and removing red tape and barriers to enrollment including limiting coverage renewals to once a year, giving applicants 30 days to respond to information requests and requiring states to prepopulate renewal forms in certain cases.

In addition to prohibiting states from conducting renewals more than once every 12 months, CMS said states can no longer impose annual and lifetime limits on CHIP benefits, lock out CHIP beneficiaries for failure to pay premiums, and implement pre-enrollment waiting periods. The final rule also directs states to deduct medically needy program expenses, such as prescription drugs and home care, from applicants’ incomes when determining their financial eligibility for Medicaid and CHIP. CMS also lifted its requirement that enrollees apply for other benefits to remain eligible for Medicaid. The agency also announced that the administration is widening a critical window for low-income Americans to enroll in Affordable Care Act marketplace coverage, giving tens of millions of people dropped from Medicaid coverage until Nov. 30 to sign up for new coverage, an extension from the July 31 deadline initially set for the special enrollment period.

With the estimated number of disenrolled Medicaid and CHIP beneficiaries rapidly approaching 20 million, CMS also took the unusual step of issuing detailed reminders to states of what not to do when processing Medicaid and CHIP renewals, listing 10 examples. States cannot conduct ex parte renewals at the household level, make renewal forms or notices available only in English, or terminate Medicaid coverage without first determining eligibility on all other bases, the agency said.

Child Tax Credit Expansion Stalls in Senate

Efforts to expand eligibility for the Child Tax Credit (CTC) have run aground in the Senate after the bipartisan “Tax Relief for American Families and Workers Act” (H.R. 7024) overwhelmingly passed the House in January. Despite broad support for proposals to cut taxes for working families and restore corporate tax breaks, Senate Republicans are demanding changes in the $78 billion package that will require the backing of 60 senators to advance. Republicans led by Sen. Mike Crapo (R-ID), the top-ranking Republican on the tax-writing Senate Finance Committee, want the CTC provision allowing taxpayers with no income in a given year to meet the eligibility requirement to be modified, although it’s unclear how many Republicans would support the bill even with the change. Negotiations between Crapo and Finance Committee Chair Ron Wyden (D-OR) have made little progress.

The House bill would expand eligibility for the child tax credit among the lowest-income families and adjust payments for inflation for the 2024 and 2025 filing years. Democrats contend that allowing people claiming the credit to use their previous year’s income would protect people who drop out of the workforce because they have a baby, for example, from losing out on the credit. Republicans are concerned that it is a step toward loosening requirements that people must have income in order to qualify for the credit. Supporters are also disappointed that the bill isn’t as generous as the policies Congress adopted in the 2021 American Rescue Plan Act, which reduced child poverty by 46 percent.

FDA Misses Deadline For Menthol Cigarette Prohibition

The Department of Health and Human Services and the Food and Drug Administration (FDA) are being sued by public health groups the African American Tobacco Control Leadership Council after failing to finalize a rule that would ban menthol cigarettes and flavored cigars and missing multiple estimated publication dates including a self-imposed April 1 deadline. The agency initially delayed the rule in December and then said in its latest regulatory agenda it would finalize the rule in March of this year. Since delaying finalization of the rule in December, the White House budget office has held numerous meetings on the issue with health stakeholders, tobacco industry representatives and others.

At a press conference, plaintiffs emphasized the disproportionate effect of menthol on people of color. The African American Tobacco Control Leadership Council said Black Americans accounted for 41 percent of premature deaths from menthol cigarettes despite making up only 12 percent of the population.

Data Privacy Debate Includes Online Safeguards for Children

Key Senate and House leaders released a draft legislative plan this month aimed at eliminating a patchwork of state requirements while protecting more stringent state privacy laws on health care records, information and certain medical testing, and taps the Federal Trade Commission as the federal privacy enforcer. The proposal drafted by House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) and Senate Commerce, Science, and Transportation Committee Chair Maria Cantwell (D-WA) would set more clear national data privacy rights and protections and establish enforcement mechanisms to hold violators accountable, including a private right of action for individuals. The draft bill would not preempt, displace or supplant state laws, rules, regulations or requirements of laws that protect the privacy of health information, medical information, medical records and HIV status or testing. The draft also includes specific definitions of health-related data and information that will make it easier to regulate health technology.

Lawmakers are pressing to adopt measures to protect children from harmful online content including a version of the “Kids Online Safety Act” (S. 1409).  The Senate Commerce Committee is working on a comprehensive package of children’s online safety policies that could advance this spring. Meanwhile, senators expressed concerns that the popular social media app TikTok could pose a serious national security threat to the U.S. but were cautious about taking up the House-passed “Protecting Americans from Foreign Adversary Controlled Applications Act” (H.R. 7521) potentially outlawing the app, preferring to work on their own legislation.

Administration Issues Limits on “Forever Chemicals”

The Biden administration set the first-ever national limits seeking to reduce the amount of per- and polyfluorinated substances (PFAS), toxic and pervasive “forever chemicals,” in drinking water earlier this month. The substances used to make waterproof and nonstick products have seeped into a significant portion of the nation’s water. They have been linked to increased risk of prostate, kidney and testicular cancer, weakened immune systems, developmental delays in children, decreased fertility and high blood pressure in people who are pregnant. They have been nicknamed “forever chemicals” because they tend to persist in nature instead of breaking down.  While some states had previously set their own limits for the amount of PFAS, there was previously no restriction that applied nationwide.

Water systems will have three years to monitor for the chemicals. If they find levels above the Environmental Protection Agency’s standards, they will have to implement a system to reduce them within five years. In addition to the limit on PFAS, the administration announced that $1 billion will be available through the bipartisan infrastructure law to help both water systems and private wells address PFAS.

In Other News

Nursing Sees Small Gains In Final Fiscal 2024 Funding
After almost six month of delay and debate Congress finally passed measures last month to fund federal programs through the rest of fiscal year 2024, providing a modest $5 million increase for nursing workforce programs. The “Further Consolidated Appropriations Act, 2024” (H.R. 2882) signed into law by President Joe Biden March 23 boosted funding for the Health Resources and Services Administration’s Nurse Education, Practice, Quality, and Retention (NEPQR) Program “to increase the supply of registered nurses” and kept allocations for the other nursing programs under Title VIII of the Public Health Service Act at their current levels for an overall total of $305.47 million. Lawmakers also rejected a House proposal to eliminate all funding for the Nursing Workforce Diversity Program.

Republican Speaker Mike Johnson had to rely on Democratic votes to secure House passage of the final spending deal, angering conservatives in his party. Georgia Republican Rep. Marjorie Taylor Greene filed a motion to “vacate the Chair” and remove Johnson from the speakership but didn’t push for an immediate vote, describing the move as “basically a warning” as Johnson faces challenges to pass supplemental foreign aid and disaster relief funding and national security legislation.

Congress Launches Debate on Fiscal 2025 Budget
Even before the final fiscal 2024 spending agreement was enacted, President Biden submitted a $7.3 trillion budget proposal for fiscal year 2025 to Congress, including a $20 million increase in the Title VIII nursing workforce developments programs. Many appropriators expect this election-year budget cycle to be even more difficult than the last one, with spending caps adopted in the 2022 Inflation Reduction Act restricting any funding increases.

The President’s budget proposes a total of $320.5 million for nursing workforce programs, focusing on increasing the number of certified nurse midwives to expand maternal health care options and access as well as grow the nursing workforce to support sustaining labor and delivery services. Within the $20 million proposed increase, the budget provides a $10 million increase for the Advanced Nursing Education program and a $10 million increase for the Nurse Education, Practice and Retention program – all other Title VIII programs are funded at their fiscal 2023 levels. The budget also proposes $10 million for a Health Care Workforce Innovation program to incentivize the development of innovative ways to recruit and train health professionals to accelerate progress in addressing workforce shortages.

The budget also continues to advocate for the administration’s priorities of permanently extending enhanced premium tax credits for Affordable Care Act marketplace plans, creating a Medicaid-like coverage program for people who live in the 10 states that have not expanded Medicaid eligibility, lengthening continuous Medicaid and Children’s Health Insurance Program eligibility for children from 12 months to 36 months and allowing states to implement continuous eligibility from birth to age 6.

Biden Pushes Plans to Forgive Student Loan Debts
President Biden continues to try to salvage his campaign pledge to relieve student loan debts after the Supreme Court struck down an initial plan last year. Days after heralding its latest student debt forgiveness plan, the Biden administration announced another round of loan cancellation through existing debt relief programs, cancelling a total of $7.4 billion in debts with most of relief going to 206,800 borrowers enrolled in the “Saving on a Valuable Education” (SAVE) repayment plan, bringing the total loan forgiveness approved by Biden to $153 billion for nearly 4.3 million people. The latest action will allow SAVE enrollees who borrowed less than $12,000 to have their debt wiped clean after 10 years of payments, compared with wait periods of 20 to 25 years under other income-driven repayment (IDR) plans. Another 65,700 borrowers who have been repaying their loans for more than 20 or 25 years will also have their balances canceled through a temporary waiver of IDR rules. Earlier this month the White House released plans that could lower or erase loan balances for more 30 million Americans, approving $146 billion in loan forgiveness for 4 million public servants, defrauded students, disabled borrowers and other groups entitled to cancellation under existing programs.

Working through a through a negotiated rulemaking process, the Department of Education plans to released proposed regulations in the coming weeks that would create new paths to loan forgiveness for more borrowers who owe far more than they originally borrowed because of interest, those who have been paying for at least 20 or 25 years, those who attended career training programs that led to high debt loads or low earnings, those who are eligible for existing forgiveness programs but never applied, and those experiencing hardship. A key feature of the plan is the elimination of up to $20,000 in accrued interest regardless of a borrower’s income. Single borrowers earning less than $120,000 or married couples earning less than $240,000 could qualify to have all of their accrued interest forgiven if they are enrolled in an income-driven repayment plan.


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