The Biden-Harris Administration is announcing that as many as 720,000 pregnant and postpartum people across the United States could be guaranteed Medicaid and Children’s Health Insurance Program (CHIP) coverage for a full 12 months after pregnancy thanks to the American Rescue Plan (ARP). Medicaid covers 42 percent of all births in the nation, and this new option for states to extend Medicaid and CHIP coverage marks the Biden-Harris Administration’s latest effort to address the nation’s crisis in pregnancy-related deaths and maternal morbidity by opening the door to postpartum care for hundreds of thousands of people.

In addition to related updates in the 2023 federal budget request, for example, in December 2021, Vice President Kamala Harris hosted the first-ever federal Maternal Health Day of Action, where she announced a call to action to both the public and private sectors to help improve health outcomes for parents and infants in the United States. Today’s announcements are a part of the Biden-Harris Administration’s continued response to that call to action to support safe pregnancies and childbirth, and reduce complications and mortality in the year following birth.

“Having postpartum care can be life-saving and lead to better long-term health outcomes for new parents and newborns,” said Health & Human Services (HHS) Secretary Xavier Becerra. “Thanks to President Biden’s American Rescue Plan, we are able to make it easier for states like Louisiana to give thousands more pregnant and postpartum people across the country access to high-quality, affordable coverage for the essential first year after birth. The Biden-Harris Administration has made maternal health and equity a priority, and we are working to ensure every parent has access to the care they and their child deserve.”

Louisiana, the first state CMS is approving to take advantage of this new state plan opportunity under the ARP, today began offering its enhanced coverage to an estimated 14,000 pregnant and postpartum people. CMS is also working with an additional nine states to extend postpartum coverage. In 2021, Illinois, New Jersey, and Virginia were the first states to use Medicaid demonstration authority to provide 12 months of continuous postpartum coverage for all Medicaid and CHIP enrollees. In addition, a number of other states have announced that they are working to extend Medicaid coverage to 12 months after pregnancy, and CMS looks forward to working those states. In order to receive federal funds and to ensure consistency with federal standards, including those set by the ARP, states must go through a formal process run by CMS.

“This is an historic step for states to partner with us to provide life-saving coverage for postpartum people—and meaningfully address the maternal health crisis. For too long, families have been left behind by a health care system that breaks connections to care when they are needed most,” said CMS Administrator Chiquita Brooks-LaSure. “Everyone deserves an opportunity to attain and maintain health. The American Rescue Plan created a pathway to connect pregnant people to vital health coverage through that first critical year after birth, and I urge every state to adopt this option to extend lifesaving postpartum coverage.”

Under existing requirements, many Medicaid and CHIP enrollees receive coverage through the end of the month in which their 60-day postpartum period ends. Maintaining Medicaid and CHIP coverage for a full year provides access to critical health care services during the first year after pregnancy, which can help to address persistent health disparities. One-third of maternal deaths occur between one week to a year after the end of pregnancy, and rates of maternal mortality are up to five times higher among Black and American Indian/Alaska Native people than their white peers.

Beginning April 1, 2022, the ARP’s new state plan option offers state Medicaid and CHIP agencies an opportunity to provide 12 months of continuous postpartum coverage. States choosing to extend postpartum coverage must elect this option in both Medicaid and their separate CHIP programs, if applicable, and submit required state plan amendments to CMS. The new ARP state plan option is currently limited to a five-year period that ends on March 31, 2027.

States like Louisiana that adopt the new extended postpartum coverage must provide coverage to all eligible individuals who were enrolled in Medicaid or CHIP while they were pregnant. This extended coverage period will last from the day the pregnancy ends through the end of the month in which their 12-month postpartum period ends.

The postpartum coverage option extends to current beneficiaries who are enrolled in Medicaid or CHIP while pregnant but are no longer pregnant when the state implements the ARP option, if the individual is within their 12-month postpartum period when their state implements the option. It also applies to individuals who were pregnant at some point during the three months prior to applying for Medicaid, if they met the eligibility requirements at that time.

Advancing this state plan option comes at a critical time for pregnant individuals and families, many of whom are relying on continued Medicaid and CHIP coverage for the ongoing care they need during the postpartum period. Continuity of coverage can help postpartum people manage chronic conditions, like hypertension and diabetes, that last well beyond the first 60 days postpartum, as well as provide access to behavioral health and other mental health care services.

Other states interested in learning about extending postpartum coverage through the ARP can contact their CMS state lead or consult the state health official letter CMS issued in December 2021.

Funding opens door for more than 20 states/territories to participate in Medicaid’s Money Follows the Person program, which has contributed billions to help seniors and people with disabilities safely transition from institutional care to independence in their homes and communities

The Centers for Medicare & Medicaid Services (CMS) announced it will offer more than $110 million to expand access to home and community-based services (HCBS) through Medicaid’s Money Follows the Person (MFP) program. First authorized in 2005, MFP has provided states with $4.06 billion to support people who choose to transition out of institutions and back into their homes and communities. The new Notice of Funding Opportunity (NOFO) makes individual awards of up to $5 million available for more than 20 states and territories not currently participating in MFP. These funds will support initial planning and implementation to get the state/territory programs off the ground, which would ensure more people with Medicaid can receive high-quality, cost-effective, person-centered services in a setting they choose.

“Everyone deserves the opportunity to live at home, in their communities, and with their loved ones,” said Health & Human Services (HHS) Secretary Xavier Becerra. “This funding will bring dignity and peace of mind to even more seniors and people with disabilities across the country. We will continue expanding these programs to ensure all Americans have equitable access to the high-quality health care they deserve—no matter where they live.”

“Our health care system works best when it meets us where we are and helps us get to where we want to be,” said CMS Administrator Chiquita Brooks-LaSure. “With this new funding opportunity, we’re expanding a program with a proven track record of helping seniors and people with disabilities transition safely from institutional care to their own homes and communities. Letting ‘money follow the person’ is key to those successes, and to the Biden-Harris Administration’s commitment to affordable, accessible, person-centered care.”

HCBS is a critical component of the Medicaid program and the Biden-Harris Administration’s commitment to help older adults and individuals with disabilities live safely and independently in their homes and communities. The MFP program has been a critical tool, now with the potential to do more in a broader array of states and territories thanks to this latest NOFO.

To help additional states and territories implement MFP, these awards will support the early planning phase to get an MFP program off the ground. This includes:

• Establishing partnerships with community stakeholders, including those representing diverse and underserved populations, Tribal entities and governments, key state and local agencies (such as state and local public housing authorities), and community-based organizations;
• Conducting system assessments to better understand how HCBS support local residents;
• Developing programs for the types of community transitions MFP supports;
• Establishing or enhancing Medicaid HCBS quality improvement programs;
• Recruiting HCBS providers as well as expert providers for transition coordination and technical assistance; and
• Conducting a range of planning activities deemed necessary by the award recipients and approved by CMS.

State Medicaid agencies not currently participating in the MFP demonstration may apply through the NOFO no later than May 31, 2022. To access the NOFO, visit Grants.gov or here https://www.grants.gov/web/grants/view-opportunity.html?oppId=334196

For states already participating in MFP, CMS also announced that the agency is increasing the reimbursement rate for MFP “supplemental services.” These services will now be 100% federally funded with no state share. Further, CMS is expanding the definition of supplemental services to include additional services that can support an individual’s transition from an institution to the community, including short-term housing and food assistance. These changes will help further address critical barriers to community living for eligible individuals, as well as increase community transition rates and the effectiveness of the MFP demonstration overall. For more information on current and previous grantees, visit Medicaid.gov. CMS will provide additional information on these changes to MFP grantees.

In March, HRSA announced the winners of the Promoting Pediatric Primary Prevention Challenge, $66.5 million to support community-based vaccine outreach efforts, more than $560 million in pandemic relief payments to health care providers, funding to increase virtual care quality and access, and new funding to support primary care residency programs.

In March, the Health Resources and Services Administration, the division of the U.S. Department of Health and Human Services devoted to improving health outcomes in underserved communities, promoting health equity, and supporting the health workforce, took the following actions:

Statement of HRSA Administrator Carole Johnson on President Biden’s National Mental Health Strategy
HRSA is working to implement President Biden’s national mental health strategy by taking action to dramatically expand the supply, diversity, and cultural competence of the mental health and substance use disorder workforce. As part of this strategy, HRSA Administrator Carole Johnson visited Nationwide Children’s Hospital in Columbus, Ohio to discuss the importance of mental health services, alongside Second Gentleman Doug Emhoff and HHS Assistant Secretary for Health Admiral Rachel Levine.

New HHS Study in JAMA Pediatrics Shows Significant Increases in Children Diagnosed with Mental Health Conditions from 2016 to 2020
A new HHS study, conducted by HRSA, finds significant increases in the number of children diagnosed with mental health conditions. The findings highlight the critical importance of HRSA’s work to support children’s mental health and well-being through expanding access to mental health services and growing the mental health workforce.

Fact Sheet: American Rescue Plan One Year Anniversary
HRSA marked the first anniversary of the American Rescue Plan by highlighting American Rescue Plan-funded efforts to support COVID-19 vaccination, testing, treatment, and masks for underserved populations and rural communities across the country; keep the doors of health centers open as they led the fight against the pandemic; provide direct resources to rural clinics and hospitals to help rural communities respond to COVID; make record numbers of scholarships and loan repayment awards to clinicians; and expand support for families and children’s essential needs.

HHS Recognizes One-Year Anniversary of Health Center COVID-19 Vaccine Program to Advance Equity in Pandemic Response
HRSA recognized the one-year anniversary of the Health Center COVID-19 Vaccine Program. To date, health centers have administered more than 20 million vaccines in underserved communities across the country through the HRSA program and partnerships with states.

HHS Distributing an Additional $413 Million in Provider Relief Fund Payments to Health Care Providers Impacted by the COVID-19 Pandemic
HRSA made more than $413 million in Provider Relief Fund (PRF) payments to more than 3,600 providers across the country. These funds help health care providers prevent, prepare for, and respond to the coronavirus.

Statement of HRSA Administrator Carole Johnson on the Affordable Care Act Anniversary
HRSA Administrator Carole Johnson recognized the anniversary of the Affordable Care Act and highlighted the sea change the law represented for HRSA’s ability to provide equitable access to high-quality health care. In honor of the anniversary, Deputy Administrator Diana Espinosa participated in a celebration hosted by the Centers for Medicare & Medicaid Services.

ICYMI: HRSA Promotes Access to Gender Affirming Care and Treatment in the Ryan White HIV/AIDS Program
HRSA released a letter encouraging Ryan White HIV/AIDS Program service providers to leverage their existing infrastructure to provide access to gender affirming care and treatment services to transgender and gender diverse individuals with HIV.

A Conversation with HHS Women Leaders to Celebrate Women’s History Month
To honor Women’s History Month, HRSA Administrator Carole Johnson joined women leaders across the Department of Health and Human Services (HHS) for a conversation that highlighted HHS’ commitment to advancing the health and well-being of all women.

See News & Announcements on HRSA.gov.

The Center for Medicare and Medicaid Innovation (Innovation Center) recently released a Request for Applications (RFA) to solicit a cohort of participants for the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. 

CMS is hosting three (3) webinars intended for Safety-Net Providers interested in learning more about the ACO REACH model and how to participate in Performance Year (PY) 2023.  This target audience includes, but is not limited to, Rural Health Centers, Community Health Centers (CHCs) also known as Federally Qualified Health Centers (FQHCs), Critical Access Hospitals (CAH) Method II, and Sole Community Hospitals (SCH). These webinars will be presented via Zoom and will occur on the following the dates/times: 

• Wednesday, April 6th at 10:30 -11:30 am EST (9:30 CST; 8:30 MST, 7:30 PST) 
• Thursday, April 7th at 10:00 – 11:00 am EST (9:00 CST; 8:00 MST, 7:00 PST)  
• Thursday, April 7th at 4:30 – 5:30 pm EST (3:30 CST; 2:30 MST, 1:30 PST) 

Please register in advance to attend the webinar at https://cms.zoomgov.com/webinar/register/WN_y8fynDtKTSWmqcnQ7FHgTg 

ACO REACH is a redesign of the Global and Professional Direct Contracting (GPDC) Model in response to stakeholder feedback, participant experience, including a commitment to advancing health equity. Its new name better reflects the purpose of the model: to improve the quality of care for people with Medicare through better care coordination, reaching and connecting health care providers and beneficiaries, including those beneficiaries who are underserved. 

Details on the ACO REACH model, as well as eligibility requirements can be found in the Request for Applications (RFA). Interested stakeholders should submit their application via web portal by April 22, 2022 at 11:59 PM EDT. 

Also, please monitor the ACO REACH website for future announcements and contact the model’s helpdesk at ACOREACH@cms.hhs.gov with any questions. 

U.S. Department of Agriculture (USDA) Under Secretary for Rural Development Xochitl Torres Small today announced that Kellie Kubena has been designated to serve as USDA’s Rural Health Liaison, a position created by Congress in the 2018 Farm Bill. The role is administered by the USDA Rural Development Innovation Center.

In her role, Kubena will work with the U.S. Department of Health and Human Services to improve the health of rural communities by expanding access to health care and sharing data and information about relevant departmental programs with stakeholders, partners and customers. The role ensures that USDA is well positioned to address the growing health care needs in rural communities.

Kubena has served as the Acting Rural Health Liaison since 2021. She has also served as the Deputy Chief Innovation Officer for USDA Rural Development since 2019. Previously, she served as the Director of the Engineering and Environmental Staff for USDA Rural Development’s Water and Environmental Programs in the Rural Utilities Service. During her tenure in the Rural Utilities Service, she also served as the Acting Assistant Administrator for Water and Environmental Programs in 2017 and the Acting Deputy Assistant Administrator for the Telecommunications Program in 2018. Prior to joining USDA, Kubena served in various positions at the U.S. Environmental Protection Agency for 17 years, focusing on risk assessment, water quality regulations and sanitation infrastructure. Kubena holds a bachelor’s degree in wildlife and fisheries with a minor in oceanography from Texas A&M University. She also holds a master’s degree in fisheries from the University of Washington.

USDA encourages rural health stakeholders to reach out to Kubena in her new role to build upon existing partnerships and facilitate new ones.

If you’d like to subscribe to USDA Rural Development updates, visit our GovDelivery subscriber page.

President Biden released his Fiscal Year (FY) 2023 budget, formally beginning the appropriations process for the 2023 federal budget. Typically, the President’s budget is viewed as a starting point for the heading into negotiations on Capitol Hill, highlighting the administrations priorities. Overall, the National Rural Health Association (NRHA) is pleased to see the President’s commitment to rural health-related line items in the FY 23 budget. Below are details on what is included, what isn’t included, and what NRHA plans to fight for in FY 23.

The Department of Health and Human Services (HHS)

The President’s budget request includes $127.3 billion in discretionary funding for HHS, an increase of $19 billion from the $108.3 billion included in the FY 22 budget.

The Federal Office of Rural Health Policy (FORHP): The President’s discretionary includes $374 million to carry out rural health activities at the Federal Office of Rural Health Policy for FY 23, which is $43 million above the FY 22 enacted budget.

• Included in the President’s budget is $57.5 million for the Medicare Rural Hospital Flexibility Grants Program, a decrease of nearly $5 million from FY 22 enacted levels. NRHA will continue working with lawmakers to see the Medicare Rural Hospital Flexibility Grants Program see increased funding in FY 23 as we know these programs are critical to rural provider sustainability.
• The request includes $21 million for the Small Hospital Improvement Grant Program, equal to the funding allocated in FY 22.
  • The request does not include the $5 million to establish a Rural Emergency Hospital (REH) Technical Assistance Program, as we saw in FY 22.
  • The President’s budget includes $12.5 million for the State Offices of Rural Health, equal to what was allocated in FY 22.
• The President’s budget includes $12.7 million for the Rural Residency Development Program, an increase of $2.2 million over FY 22 enacted levels.
• The President’s budget includes $165 million for the Rural Communities Opioid Response Program, an increase of $30 million over FY 22 enacted levels.
• The President’s budget includes $10 million for the new Rural Health Clinic Behavioral Health Initiative. This newly proposed initiative allows clinics in rural areas where there are no existing behavioral health providers to fund the salary of a behavioral health provider, address provider burnout, and expand the availability of services such as mental health screenings, counseling, and therapy.

The Health Resources and Services Administration (HRSA): The President’s discretionary request includes $13.3 billion for HRSA, an increase of $41 million above the FY 22 enacted budget.

• The President’s budget includes $210 million for the National Health Service Corps, an increase of $92 million over the FY enacted levels.
• The President’s budget includes $44 million for telehealth programs within HHS, an increase of $10 million from the FY 22 enacted level.
• The President’s budget includes $17 million for the $340B Drug Pricing Program/Office of Pharmacy Affairs. This is an estimated $7 million increase over the FY 22 enacted level.

The Centers for Disease Control and Prevention (CDC): The President’s discretionary request includes $9.9 billion for the CDC, an increase of $1.4 billion from the record $8.5 billion included in the FY 22 budget.

• Unfortunately, not included in the President’s budget is set aside funding for the creation of an Office of Rural Health within CDC. NRHA will continue working with Appropriators on Capitol Hill to see this office set up as outlined in S.3159/HR 5848 Rural Health Equity Act.

The Department of Agriculture, Rural Development, Food and Drug Administration, and Related Agencies (USDA): The President’s budget request includes $28.5 billion in discretionary funding for USDA, an increase of $3.375 billion from the $25.125 billion included in the FY 22 budget.

• Included in the President’s budget is $3.3 billion for the Rural Community Facilities Program at USDA, a decrease of $150 million from the $3.45 billion included in the FY 22 enacted budget.
• Unfortunately, the President’s budget once again zeroed out the USDA Rural Hospital Technical Assistance Program. In FY 22, Congress allocated $2 million for this critical program. NRHA will again work to see funding restored for this vital program.

As the House and Senate Appropriations Committee’s begin working on the FY 23 budget, NRHA will work to see funding levels increased for these rural health line items. For more information see the Fiscal Year 2023 Budget in Brief.