Inside the Beltway – February 2023

Critical Juncture for Pediatric Patients Covered by Medicaid

Contributed by Health Policy Committee member Allison Grady, MSN, PPCNP-BC

In the waning days of 2022 President Biden signed into law a sweeping Stop-Gap budget to fund essential agencies through until September 2023. One portion of the law that might be overlooked by many is the end—or, unwinding—of continuous Medicaid.

What is continuous Medicaid and what does it mean to unwind? Under the traditional rules of Medicaid, children need to be enrolled in the program on an annual basis. Fluctuations in family income and data checks from other government agencies during the year could expel a patient off of the Medicaid rolls at any time. With the initiation of continuous Medicaid, originally part of the Public Health Emergency of March 2020, coverage would only be cancelled if a child aged out of the program, moved out of state, withdrew from the program, or failed to pay specific premiums (1). Annual enrollment was not necessary.

In the new budget, Medicaid enrollment will now be continuous over 12 months, but annual enrollment requirements will resume. States can petition for longer periods of continuous enrollments but must fill out additional paperwork and provide additional funding (2). To date, Oregon is the only state to have extended their continuous enrollment with eligibility from birth to six years. Unwinding of continuous Medicaid will officially begin on April 1 and last for approximately one year.

Why should PNPs and pediatric-focused APRNs care about this change? Medicaid is the primary insurance for approximately 41 million children, representing 46.5% of the entire Medicaid population (3). African American and Latinx patients make up one-third of the US population, but over half of the Medicaid recipients (includes adults) (4). This inequity places children of color at greater risk of gaps in coverage and delay in care that can result in worse outcomes if there is only intermittent coverage or lack of coverage all together.

As individual states begin reviewing all cases to determine eligibility, barriers to maintaining coverage for all who are eligible include:

Difficulties in locating families by mail to confirm information about housing, age and income.
Paperwork: Long forms that have technical language and lost forms that need to be completed again can also lead to delays in enrollment or even lack of coverage if not properly filled out.
Lack of staff to process paperwork, locate patients and answer questions.
Language barriers that lead to missed deadlines and disenrollment.

How you can help:

Talk with your patients about Medicaid changes. Encourage them to be proactive in re-enrollment.
If you have a high percentage of non-native English speakers, consider hosting an event with a person who is bilingual and can assist with paperwork.
If you believe that continuous re-enrollment for more than one year is important for your patient population, contact your local government offices to advocate for this change.

References

William E, Tolbert J, Burns A, Rudowitz R. Implications of continuous eligibility policies for children’s Medicaid enrollment churn. Kaiser Family Foundation. Available at: https://www.kff.org/medicaid/issue-brief/implications-of-continuous-eligibility-policies-for-childrens-medicaid-enrollment-churn/. Accessed February 7, 2023.
Alker J. Medicaid unwinding will begin in April but there’s good news in Congressional funding agreement. Georgetown University Health Policy Institute. Available at: https://ccf.georgetown.edu/2022/12/20/medicaid-unwinding-will-begin-in-april-but-theres-good-news-in-congressional-funding-agreement/. Accessed February 7, 2023.
October 2022 Medicaid & CHIP Enrollment Data Highlights. https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html. Accessed February 7, 2023.
Erzouki F. States must act to preserve Medicaid coverage as end of continuous coverage requirement nears. Center on Budget and Policy Priorities. Available at: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.cbpp.org/sites/default/files/1-17-23health.pdf. Accessed February 7, 2023.

COVID-19 Federal Emergencies to End on May 11

Nearly three years after then-President Donald Trump declared a national emergency and then-HHS Sec. Alex Azar added a public health emergency in response to the spreading coronavirus pandemic, President Biden on Jan. 30 informed Congress that he will end the twin emergency designations on May 11. The move will significantly restructure the federal response to the virus, which continues to claim an average of nearly 500 lives in the U.S. every day.

The end of the public health emergency will also mark the termination of a host of waivers that removed barriers to patient care, although Congress acted last year to extend broad telehealth waivers through 2024. The Drug Enforcement Administration is expected to propose rules allowing the continued prescribing of controlled substances and buprenorphine via telehealth after the emergency designations end. Lawmakers already took steps to end emergency policies that kept millions of Americans enrolled in health coverage during the pandemic. Combined with the drawdown of most federal COVID-19 relief funds, the end of the emergencies will also shift the development of vaccines and treatments away from federal control into commercial markets.

House Republicans are also eager to bring COVID pandemic policies to an end. Despite the administration’s announcement, the House voted along partisan lines to pass legislation ending the public health emergency and the “Freedom for Health Care Workers Act” (H.R. 497) to end the COVID-19 vaccine mandate for employees at some health facilities. The White House strongly opposed both bill and the Democratic-controlled Senate is unlikely to consider them.

Calling Chapter Legislative/Advocacy Chairs and Presidents

Join us for our annual in-person meeting on March 14 at 1:30-2:30 p.m. ET in Orlando at the Rosen Shingle Creek during NAPNAP’s 44th Conference on Pediatric Health Care. If you did not include the meeting on your conference agenda during registration, please email [email protected] to be added.

Although the Health Policy Committee meeting will be available to in-person attendees, NAPNAP is live streaming key conference sessions on March 15 and March 16. Click here to register for the live stream so you can access sessions on March 15 and 15, or watch the streamed sessions on-demand following the conference.

Administration Proposes New School Nutrition Rules

The Biden administration on Feb. 3 proposed more stringent nutrition standards for school meals, reviving efforts to improve the health of millions of students in public schools in the face of rising childhood obesity and other diet-related diseases. The new effort echoes actions by the Obama administration, which required school cafeterias to increase offerings of fruits and vegetables, serve only skim or low-fat milk, cut trans-fat from the menu, dramatically reduce sodium in school cafeteria food and increase whole-grain offerings.

The new guidelines will be rolled out gradually. In the fall of 2024, school offerings will have to include primarily whole-grain foods, with only occasional products containing less healthy refined grains such as those used in white pasta and white breads. In the fall of 2025, there will be a limit imposed on high-sugar products like sweetened yogurts and cereals, a reduction of weekly sodium limits by 10 percent for school breakfasts and lunches, and limits on added sugars for flavored milks such as chocolate milk. Further reductions in added sugar and sodium are slated for following years.

White House Weighs Abortion Protections As Legal Challenges Loom

HHS Sec. Xavier Becerra said Jan. 30 that the Biden administration is actively weighing additional actions to help people access abortions, which may include a declaring a public health emergency. He added that a “full assessment” on what a declaration on abortion would look like and whether conditions merit it hasn’t been completed yet. Reproductive rights advocates have urged the administration to take such a step to respond to the overturning of Roe v. Wade to address a crisis in access to reproductive health services.

Becerra’s comments came as a widely expected legal battle over whether federal policies supersede state laws took shape Jan. 25 with the filing of lawsuits seeking to stop restrictions on abortion pills in two states. The challenges, targeting laws in North Carolina and West Virginia that block patients from receiving abortion pills by mail or from retail pharmacies or ban the use of the pills entirely, will likely have national implications, as more than a dozen states have imposed laws limiting how, when and where patients can obtain abortion pills.

Congress Focuses on Social Media’s Role in Fentanyl Crisis

House Energy and Commerce Committee Republicans on Jan. 25 accused social media and technology firms of facilitating the deadly trafficking of fentanyl during a roundtable session that could signal future legislation. Led by Chair Cathy McMorris Rodgers (R-WA), the panel plans to continue examining the tech firms’ role in allegedly contributing to the fentanyl crisis. At the meeting, McMorris Rodgers railed against tech firms for not doing enough to prevent sales of the drug on their platforms.

Some lawmakers are interested in removing longstanding protections the tech firms enjoy for user-generated content and raised the possibility of broadening the scope of their inquiry into the firms’ algorithms for targeting users with content and ads. Committee members suggested revising the legal protections for user-generated content, which Congress passed in Section 230 of the 1996 Communications Act, so that tech firms lose their immunity shield if their algorithms promote some user-generated content.

In Other News

State of the Union Address Underscored Health Policy Challenges
In a 72-minutes speech Feb.7 during which the sharp partisan acrimony in Washington, D.C. was unmistakable, President Biden delivered a State of the Union address to a joint session of a divided Congress. The most acrimonious moment in came when the President vowed to stop proposals from some Republicans to sunset Medicare and Social Security – loud protests erupted inside the House chamber, with Rep. Marjorie Taylor Greene (R-GA) yelling “Liar!” at Biden, while others booed. The President pointed to Republican lawmakers’ desire to tie entitlement program changes to the debt ceiling debate and Sen. Rick Scott’s (R-FL) reported plan to sunset all legislation including mandatory programs every five years.

The President’s remarks called on Congress to “finish the job,” alternating between a condemnation of Republicans’ policies and calls to forge bipartisan deals including on health policies ranging from ending cancer, addressing the opioid epidemic, tackling the country’s mental health crisis and supporting veterans. Biden called on lawmakers to pass strict standards to minimize how much data companies can collect and use, including health and geolocation data, and to require them to build safety and privacy safeguards for children into their products, pointing to evidence that social media can be harmful to children’s mental health. He also called for making permanent tough penalties on suppliers of fentanyl and extending access to prevention and treatment service. The administration is less likely to find bipartisan support for capping insulin costs, closing Medicaid coverage gaps, or permanently extending enhanced premium subsidies for Affordable Care Act health plans.

White House, Congress Face Debt Limit Confrontation
After an initial Feb. 1 White House meeting, President Biden and House Speaker Kevin McCarthy both expressed cautious optimism about talks to negotiate a deal to increase the nation’s debt limit and avert a potential economic catastrophe. However, the two leaders agreed only to continue talks to bridge the gaping differences in their positions: House Republicans continue to demand billions of dollars in federal spending cuts and budget reforms in exchange for raising the debt ceiling, while the White House and congressional Democrats refuse to negotiate over cuts and press for a “clean” increase in borrowing authority to cover past federal spending. The debate over federal spending will heat up when the White House sends its fiscal 2024 budget proposal to Capitol Hill on March 9.

With Social Security and Medicare apparently off the negotiating table, severe cuts in funding could be proposed for a wide range of federal programs including Medicaid, the Children’s Health Insurance Program, nursing and health professionals education, and nutrition assistance. House Republicans have raised the idea of demanding work requirements for Medicaid and nutrition programs and rescinding approved but unspent COVID-19 relief funds as part of a possible debt limit deal.

ICYMI

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