In late December, President Biden signed a sprawling appropriations package (HR 2617) which sets the federal budget for Fiscal Year 2023. Many elements of the omnibus budget prioritized kids and families including reauthorizing the MIECHV program, increasing child care funding, and enhancing CHIP and Medicaid programs across the country.

The omnibus contained language from the Jackie Walorski Maternal and Child Home Visiting Reauthorization Act of 2022, which passed the House in November and included:

1. Reauthorization of the MIECHV program through 2027
2. An initial increase in funding of $100 million, bringing the program’s full appropriation to $500 million
3. Subsequent funding increases of $50 million annually (except for a $150 million increase in 2027)
4. Establishing a publicly available dashboard that reports program outcomes
5. Requiring activities to reduce unnecessary data collection, reporting, and other administrative requirements of the program
6. Allowing for virtual home visits

In a victory for the child care sector, the budget contained a 30.1% increase for the Child Care Development Block Grant (CCDBG) to over $8 billion. Pennsylvania will get about $56.3 million more in 2023 compared to 2022. It also contained increases for Head Start and the Individuals with Disabilities in Education Act (IDEA).

The omnibus also contained multiple provisions related to Medicaid and CHIP. First, it delinked the Medicaid continuous coverage requirement from the COVID-19 public health emergency and set the gradual decrease of the federal match for Medicaid to begin on March 31, 2023. In an exciting win for advocates, the law now requires all states to provide 12 months of continuous eligibility for children in both Medicaid and CHIP (previously only available for children up to age 4 in Medicaid, but all children in CHIP). Funding and authorization for the CHIP program extended two years to 2029, and the 12-month postpartum coverage option for CHIP and Medicaid was made permanent (this provision was initially supposed to sunset after five years). If you’d like to read more about the health care provisions of the omnibus, please check out SayAhhh!, the blog by our partners at the Georgetown University Center for Children and Families.

From The American Prospect, December 27, 2022

Insurer UPMC and its new pharmacy benefit manager Express Scripts are squeezing local independent pharmacies, with residents caught in the crossfire.

In late November, at a strip mall in the rural Pennsylvania town of Bedford, Stephanie Over worked behind the Fisher’s Pharmacy counter, filling prescriptions into translucent orange pill bottles and administering shots. As strip mall pharmacies go, Fisher’s stands out. A recently restored art deco facade juts out, and the store’s name runs down vertically in Broadway font. The store is a local fixture in Bedford, population under 3,000, and has been around for almost 100 years, of which Stephanie has worked nearly 30.

Stephanie was about to check out for her lunch break when the letters flooded in. Regulars at Fisher’s began marching up to the counter, clutching notices from the University of Pittsburgh Medical Center (UPMC), a leading health insurer in Western Pennsylvania, and Express Scripts, the pharmacy benefit manager for UPMC.

The letter told them that under a new policy, UPMC’s insurance plan would not cover prescriptions at Fisher’s anymore. Instead, UPMC’s beneficiaries would be encouraged to go to other pharmacies in the health plan network for their own “convenience,” which meant national chains like Rite Aid, Walmart, or Giant Eagle, a regional grocery chain. Bedford is a remote town, 100 miles from both Harrisburg and Pittsburgh. Residents, many of whom had gone to Fisher’s for decades, would have to drive several towns over, maybe 30 or 40 minutes, just to get their prescriptions filled. Fisher’s knew them, their families, and medical history, a personal touch that would be lost at a chain.

“Why should our people have to drive through 20 signal lights to get a prescription filled when they could just call us and we’d have it ready,” said Over.

The letter offered no explanation for the policy change. Stephanie called the owner, Jennifer Leibfreid, who had not been notified by UPMC. Fisher’s tried calling other local pharmacies and associations to piece together whether other independents were receiving the same letters from customers.

Most had. In an overnight purge, UPMC, the third-largest insurer in the state and the most powerful hospital network, dropped over 1,200 pharmacies from its health plan, around half of the stores it previously carried. Most were independents. The decision impacted tens of thousands of individuals who bought their insurance on the state health insurance exchange, known as Pennie, as well as company plans for businesses with fewer than 50 employees. Patients covered by Medicare and Medicaid are not affected by the change.

The UPMC kill-off will have devastating consequences for pharmacies and patients across rural Pennsylvania. Fisher’s estimates that it might lose 20 percent of its customers, some of whom need prescriptions filled every other day. They’ll have to decide whether to drive several towns over or pay out of pocket at Fisher’s for generic drugs.

Thirty miles south of Bedford, Potomac Valley Pharmacy in Hyndman was another retailer cut out from UPMC’s plan. Pharmacist Dan Iseminger doesn’t know how much business he’ll lose because “frankly, I’ve been too scared to look.” In that area, as in many other rural parts of the state, UPMC is often the only health plan locals can afford.

Read the full article here.

ARC announced our first-ever Appalachian Regional Initiative for Stronger Economies (ARISE) award! Connect Humanity will help 50 underserved communities in Appalachia plan for broadband growth.

The Connect Humanity team will work with local partners across 12 Appalachian states to help communities develop tailored digital equity plans, secure funding for high-speed internet expansion, provide digital literacy and broadband job training, and more.

“Broadband access is essential for Appalachia to thrive and compete in a global economy; without this support, our most rural communities may be left further behind. I commend our states and community partners in every Appalachian subregion for coming together in order to fully participate in our digitalized world,” said ARC Federal Co-Chair Gayle Manchin.

The details on the funding are:

• Location: 50 underserved communities across every subregion of Appalachia (TBA)
• Local Partners: Center on Rural Innovation, Empire State Development, Enterprise Center, Fair Count, Generation WV, Mississippi Alliance of Nonprofits & Philanthropy, NC State University Institute for Emerging Issues, SOAR, Student Freedom Initiative, Center for Strategic Partnerships at the Pennsylvania Department of Community & Economic Development, Virginia Funders Network
• Community Need: Helping underserved communities in Appalachia compete for some of the $45 billion from the Broadband Equity, Access, and Deployment and Digital Equity Act funding, driving large-scale transformation around broadband access.
• Solution: Connect Humanity will help communities develop tailored digital equity plans designed to ensure high-speed and affordable internet, device access, and digital literacy training.
• Grants Received: $6.3 million ARC ARISE grant

Appalachian communities can get involved at connecthumanity.fund/arise.

CMS released a State Health Official (SHO) letter that provides guidance to states on policy for Medicaid and the Children’s Health Insurance Program (CHIP) to allow one provider to discuss a Medicaid or CHIP beneficiary’s case with a specialist, with or without the beneficiary present, and to pay the specialist for their services directly. The current policy only allows payment in this circumstance if the provider who is seeking the consultation is paid for the consulted provider’s services and then pays the consulted provider directly. This change more directly “links” routine care with specialty care, allowing more people to benefit from practitioners with specialized knowledge.

For more, read the full letter https://www.medicaid.gov/federal-policy-guidance/downloads/sho23001.pdf

CMS issued an informational bulletin on the provisions included in the Consolidated Appropriations Act, 2023 (CAA, 2023) related to the Medicaid continuous enrollment condition.

The CAA, 2023 updates various Medicaid and CHIP provisions, including significant changes to the continuous enrollment condition of the Families First Coronavirus Response Act. Under the CAA, 2023, expiration of the continuous enrollment condition will no longer be linked to the public health emergency (PHE) and instead the condition will end on March 31, 2023. Following the end of the condition, states will have up to 12 months to initiate, and 14 months to complete, a renewal for all individuals enrolled in Medicaid, the Children’s Health Insurance Program, and the Basic Health Program. As of January 2023, the PHE is still in effect.

Read the Informational Bulletin for more detail.

During January, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) recognizes National Poverty in America Awareness Month. The United States measures poverty based on how income compares to a federal guide. In 2021, an individual was considered to be living in poverty if their income was lower than $12,880, $26,500 for a family of four.  The poverty rate in 2021 was 12.8%, an increase from the 11.4% rate recorded in 2020. American Indian/Alaskan Native individuals were the most impacted (25.9%), followed by Black Americans (21.7%), Hispanic Americans (17.6%), Asian/Native Hawaiian and Pacific Islanders (10.2%), and White Americans (9.5%).

Poverty in the United States is concentrated in specific regions, counties, and neighborhoods. These areas face obstacles such as poor housing and health conditions, higher crime and school dropout rates, lower employment opportunities, and lack of healthy foods, contributing to social determinants of health. Rural poverty rates continue to be higher than urban rates, with Black Americans being the most likely to live in poverty in nonmetro areas. The Southern United States had the highest rural and urban poverty rates (19.7% and 13.8) between 2015 and 2019 while the Northeast had the lowest (12.9% and 12%).

Poverty is shown to influence health outcomes, with unmet social needs, environmental factors, and barriers to accessing health care contributing to worse health outcomes for people with lower incomes. Those who qualify as impoverished may have more difficulty obtaining health insurance or paying for expensive procedures and medications. Children comprise the largest age group experiencing poverty and childhood poverty is associated with developmental delays, toxic stress, chronic illness, and nutritional deficits.

CMS OMH calls for an advancement in health equity for American’s during National Poverty in America Month. Visit the below resources for additional information on how to help during National Poverty in America Awareness Month.

Resources

• Review the CMS Framework for Health Equity 2022–2032 to learn how we’re working to further advance health equity, expand coverage, and improve health outcomes for those supported by CMS programs, including those affected by persistent poverty.
• See the Medicare Savings Program website for Medicare qualifications.
• Details on insulin savings within Medicare can be found here
• Insure Kids Now has an Outreach Tool Library to identify resources to help connect kids to coverage and spread the word about Medicaid and CHIP resources.
• Medicaid has Outreach Tools that provide materials and messages states may use and adapt to support outreach activities.
• Prevention Resources to learn more about preventive services available to adults, teens, children, and infants at no cost.
• See the CDC’s Social Determinants of Health Map for more information on poverty percentages by state.
• Check out the Health People 2030 website to learn more about economic stability’s impact on health.

Visit the ASPE’s FAQs for poverty guidelines and general poverty.

The Pennsylvania Department of Drug and Alcohol Programs (DDAP) and Pennsylvania Department of Community and Economic Development (DCED) joined C&J Catering employees to discuss substance use disorder (SUD) in the restaurant and hospitality industries, highlighting the importance of SUD education and prevention for employees and employers.

“Just below the construction and mining industries, the restaurant industry has a high rate of substance use disorder among its employees,” said DDAP Special Assistant to the Secretary Steve Ross. “Long, irregular hours and high-pressure, physically demanding work can all have an impact on an individual’s behavioral health. We must ensure that employers and employees know about every resource available to them to support individuals living with the disease of addiction. It is also critical to keep providing education to all employers and all Pennsylvanians to address the stigma still faced by those who are struggling with substance use disorder.”

Thomas Jefferson University Hospital reported an increase in opioid overdose deaths among restaurant-industry workers in Philadelphia in 2020. According to the U.S. Bureau of Labor and Statistics, the restaurant industry holds more than four million available positions across the country and is projected to grow faster than the average for all occupations from now until 2031.

“We need to make sure we are providing employees in the tourism industry, and their families, with the SUD resources and support they need to navigate these difficult situations,” said DCED Executive Director of Tourism Michael Chapaloney. “In the tourism industry, the restaurant industry – in all industries – we want employees to be both physically and mentally healthy.”

Pennsylvania Governor Wolf’s Administration’s Just Five initiative is a self-paced program designed to increase awareness, reduce stigma, and provide education about SUD prevention and treatment. It is displayed as six short learning modules that each take “just five” minutes to complete. The interactive lessons include:

• The Science of Addiction
• Are You at Risk?
• The Dangers of Opioids
• Signs, Symptoms and Treatment
• How You Can Help
• The Gift of Recovery

DDAP rolled out a version of Just Five to Pennsylvania commonwealth employees in May 2021 and an additional version of Just Five is available to all of Pennsylvania’s workforce. Since roll out, the statewide Just Five tool has had nearly 12,000 new users and users, with an average of 12 minutes of engagement per session.

Use of the Just Five website is completely confidential and voluntary, and no personal information regarding utilization of the program is shared. It can be accessed virtually from anywhere at any time with no registration required. The program is also available in English and Spanish and accessible for individuals with visual and/or hearing impairments.

DDAP operates the Get Help Now hotline at 1-800-662-HELP (4357). The hotline is a trusted resource for individuals and/or their loved ones if SUD treatment or resources are needed. The hotline is confidential, available 24 hours a day, 365 days a year and staffed by trained professionals who will connect callers to resources in their community. Callers can also be connected with funding if they need help paying for treatment.

To learn more about the Wolf Administration’s efforts in combating the addiction crisis, visit ddap.pa.gov.