From Becker’s Leadership and Management

President Donald Trump has signed an executive order creating the Make America Healthy Again Commission after Robert Kennedy Jr. was confirmed Feb. 13 as HHS secretary in a 52-48 Senate vote.

Mr. Kennedy will chair the commission, which is tasked with investigating “the root causes of America’s escalating health crisis,” with an initial focus on pediatric chronic disease, according to a Feb. 13 White House fact sheet on the executive order.

The commission will release its childhood chronic disease assessment in the next 100 days and will follow up with a strategy to improve children’s health within the next 180 days. The key priorities of the investigation include funding studies on what causes disease, promoting healthier food, expanding preventative treatment options and increasing health research transparency.

“The commission aims to restore trust in medical and scientific institutions and hold public hearings, meetings, roundtables and similar events to receive expert input from leaders in public health,” the release said.

The commission also has four policy directives to help reverse chronic disease:

• Ensure open access and transparency to federally funded health research data while preventing conflicts of interest.
• Focus federally funded health research on high-quality studies to help understand the cause of American illness.
• Work with U.S. farmers to ensure food in America is affordable, abundant and healthy.
• Provide flexible health coverage and expand treatment options to support lifestyle-based disease prevention.

The release pointed to information consistent with CDC data that found 6 in 10 adults in the U.S. live with at least one chronic illness, and 4 in 10 have two or more. It also touched on a spike in autism rates, childhood cancers and overmedication, with more than 3.4 million children in the U.S. on medication for attention-deficit disorder and attention-deficit/hyperactivity disorder, with diagnoses on the rise, according to Children and Adults with Attention-Deficit/Hyperactivity Disorder data.

It also pointed to information consistent with a 2023 Gallup poll that found only one-third of Americans have trust in the U.S. health system.

During his two confirmation hearings on Jan. 29-30, Mr. Kennedy frequently discussed his Make America Healthy Again agenda, which aims to cut chronic disease, tackle obesity and diabetes, and improve food policy, prevention-based care and environmental health.

In his new role, Mr. Kennedy’s portfolio will comprise HHS agency and program oversight, as well as a nearly $2 trillion budget. Among the agencies under his purview are CDC, CMS, FDA and the National Institutes of Health.

Elected by his fellow Appalachian state governors, Maryland Governor Wes Moore is now ARC’s 2025 States’ Co-Chair. He is the 72nd States’ Co-Chair in ARC’s history.

In his year-long position, Gov. Moore will work alongside ARC’s Federal Co-Chair and his fellow governors to continue investing in economic growth and innovation across the region. In fiscal year 2024, ARC invested nearly $365 million in 583 projects, which attracted an additional $5 billion in private investments across Appalachia.

Learn more about Gov. Moore and ARC’s leadership structure. And join us in thanking 2024 States’ Co-Chair Tennessee Governor Bill Lee for his leadership and contributions.

The Wright Center for Community Heath’s Clarks Summit and Mid Valley locations have learned national recognition from the National Committee for Quality Assurance for delivering top-quality, patient-centered care. Read more about the recognition.

Block grants, per Capita Medicaid funding, choices to expand Medicaid eligibility but receive less federal support, and Medicaid Work Requirements were hallmarks of the American Health Care Act which passed in the US House but failed in the US Senate in 2017. Per capita caps are fixed amounts of money per person enrolled in Medicaid that may or may not cover the cost of care. Block grants are a single lump sum to cover Medicaid expenses regardless of enrollment or cost of care. While some states have explored additional mechanisms to reduce the number of recipients by not expanding Medicaid to those in the coverage gap between 100% and 138% of the Federal Poverty Guidelines, more than 40 states have Medicaid Expansion, including Pennsylvania, with more almost 750,000 enrollees. Under the ACA, the federal government paid 100% of the cost of Medicaid expansion coverage from 2014 to 2016, with the federal share then dropping gradually to 90% for 2020 and each year thereafter, leaving states to cover the small remaining share. In 2014, Pennsylvania floated the idea of work requirements with gradual loss of coverage in year 2 if recipients were non-compliant, a mix of eligibility exemptions for special circumstances, and a 20-hour per week of work or 12 hours of job training. In 2018, analysts estimated work requirements would cost Pennsylvania Taxpayers 3.4 billion dollars over 6 years and would result in 85,000 consumers losing health coverage. With the current inflation rate, the cost would be over $4.2 billion and put more than 1.2 million at risk of losing coverage.  Pennsylvania has 2.9 million enrollees in Medicaid with 42% children and 33% representing people with disabilities, and pregnant women.

Consumer Affairs Journal of Consumer Research reports Pennsylvanians have the third most affordable healthcare costs in the United States. The state’s average combined annual costs for family coverage (premium plus deductible) are some of the lowest in the nation, and the state is the most affordable in other metrics like lower health insurance premiums and deductibles. According to recent polls from Kaiser Family Foundation, about half of US adults say it’s difficult to afford health care costs and 1 in 4 say they or a family member in their household had problems paying for health care in the past 12 months. Affordability is indicated as a barrier for many potential enrollees in coverage and the cause for disenrollment. Pennsylvania has taken steps to offer additional flexibility and afford options through Pennie, the state-based marketplace. Thousands have also benefited from Medicaid expansion for those falling between 100% and 138% of the Federal Poverty Limit. For more go to https://pennie.com/affordability/

Last week, Senators Tim Kaine (D-VA), Todd Young (R-IN), Jack Reed (D-RI), and Roger Marshall (R-KS) introduced bipartisan legislation to reauthorize the Dr. Lorna Breen Health Care Provider Protection Act, a law that had been successfully passed in 2022 to help prevent suicide, burnout, and mental and behavioral health conditions among healthcare professionals. Provisions of this law that made funding possible expired last year, and this new legislation would reauthorize grant programs for education on strategies to reduce burnout, peer-support programming, and mental and behavioral health treatments. Communities with a shortage of health care workers, rural communities, and those experiencing burnout due to administrative burdens will be prioritized. Read more about this bill.

Federal Poverty Level (FPL) guidelines are issued each year by the U.S. Department of Health and Human Services (HHS) based on information gathered by the Census Bureau. The Bureau uses that data to calculate the total cost of essential resources used by an average person in a year. FPLs are used to determine eligibility for certain programs and benefits, including savings on Marketplace Health Insurance, Medicaid, and CHIP coverage, as well as a basis for FQHC sliding fee scales. The 2025 guidelines establish $32,150 as the FPL for a family of four, a 2.9% increase from the previous FPL. View the full HHS chart.

Funding delays have pushed several community health centers nationwide to close or cut back on staff, citing issues accessing federal funding. The financial problems, the centers say, appear to stem from last week’s temporary domestic funding grant freeze and the implementation of new executive orders. Many grant programs, including Head Start and Title X, continue to experience financial shortfalls despite an injunction issued against the freeze. The community health center funding issues come as Elon Musk’s Department of Government Efficiency (DOGE) has targeted programs, grants and even entire agencies across the administration that it believes are not an efficient use of government funding. A White House spokesperson said the Department of Health and Human Services (HHS) and the administration are aware of the problem, and that it isn’t related to DOGE. The system is up and running now, but some users are experiencing lags because of high volume of requests, which HHS is working to resolve, the spokesperson said. Click here to learn more.

On Tuesday, February 4, Gov. Josh Shapiro delivered his annual budget address to the Pennsylvania General Assembly. Gov. Shapiro’s budget proposal serves as the initial step in a months-long budgeting process, but its most important purpose is a statement of the Shapiro administration’s priorities this year. Following are highlights of the governor’s address that may have notable impacts on Community Health Centers:

Addressing Rural Health Care Worker Shortages – Specific proposals include:

• $5 million to support workforce initiatives to educate, train, and recruit nursing professionals.

• Increase base funding by $20 million to counties to provide critical behavioral health services and address deepening workforce shortages. This is the third year of the administration’s three-year commitment to invest $60 million into the county behavioral health system.

• $15 million in new funding for the Primary Health Care Practitioner program. Of this $10 million to expand the Primary Care Loan Repayment Program, broadening the program’s geographic eligibility requirements and supporting behavioral health care workers in all regions of Pennsylvania. An additional $5 million would be used to expand programs to address workforce shortages specific in rural areas.

• Supporting full practice authority to nurse practitioners who work under a licensed physician for at least three years. This legislation has passed the State Senate in previous years but has not cleared the House of Representatives.

Investing in Apprenticeships and Other Paths to Success

Many CHCs in Pennsylvania are now offering apprenticeships and other forms of on-the-job training. The governor’s proposal includes:

• A dedicated $12.5 million Workforce and Economic Development Network appropriation, leveraging $10 million in existing funds and $2.5 million in new state funds to train additional workers.

• $2 million for the creation of the Career Connect program, a statewide program to build internships at Pennsylvania employers.

Addressing Structural Challenges at Rural Hospitals

The Governor convened a rural health care working group in 2023 (including several PACHC members and staff) to find a solution to this problem. Based on those conversations, the Governor’s proposed budget:

• Leverages a $10 million investment to draw down an additional $26 million in federal matching funds to provide immediate relief to Pennsylvania hospitals.

• Invests another $10 million in state funds to help meet rural hospitals’ needs.

• Adds $20 million for a new appropriation – ‘Patient Safety and Support for Hospitals’ – to “address barriers to care” at all hospitals.

Continuing to Make Mental Health Reforms

The Governor is calling on the General Assembly to send a bill to his desk that closes a loophole that allows insurance companies to deny coverage for mental health services provided to students inside the walls of a school, even though those same services would be covered in a mental health professional’s office across the street.

Transitions from Incarceration

The budget proposal also includes $4.8 million to provide Medical Assistance coverage for individuals transitioning from incarceration to the community. This is one of the federal 1115 waiver components (“Keystones to Health”) approved by CMS.

The 2025-2026 legislative session in Pennsylvania commenced on January 6, 2025. Once again, the state operates under a split legislature, with Republicans maintaining control of the Senate and Democrats hoping to retain their slim majority after the special election to fill one seat.

Legislative Activity and Key Bills

Lawmakers in Harrisburg have actively introduced and advanced numerous bills. In alignment with the 2025 Policy Agenda, PCOH has been monitoring several key pieces of legislation, including:

• SCO 108 – Restoring Dental Coverage for Medical Assistance Recipients.
• HCO 284 – Advisory Opinions from Licensing Boards.
• SB 81 & HCO 721 – Legislation authorizing Pennsylvania to join the Dentist and Dental Hygienist Compact and outlining its structure.
• HCO 1412 – American Association of Dental Boards Dental & Dental Hygiene Compact Legislation.
• HB 157 – Establishing grant awards for entities in rural counties and designated medically underserved areas to address practitioner education debt. As of 2/5/2025, this bill was unanimously amended by the House Health committee to include dentists and dental hygienists as eligible awardees and passed out of committee with unanimous support.

Governor’s Budget Address

On February 4, 2025, Governor Josh Shapiro delivered his third budget address. The Governor shared that “Pennsylvania is on the rise” as he proposed a budget with dedicated funding to address healthcare workforce issues and healthcare cost transparency. While it does not appear that funding to restore the comprehensive dental benefit is openly included in the DHS program budget, PCOH will continue to advocate for this need as the General Assembly prepares to commence budget hearings and negotiate budget priorities.

• Learn more about the Governor’s proposed 2025-26 budget here.

Federal Developments and Impact on Pennsylvania

With the beginning of President Trump’s second term, significant federal activity has raised concerns regarding dental care access in Pennsylvania. A recent executive order freezing federal funding caused temporary disruptions in state Medicaid portal access. Although a U.S. District judge has blocked this freeze, uncertainty remains about the future of federal funding for state-funded programs. Any reductions at the federal level could impact critical services for under-resourced communities
across Pennsylvania.

Additionally, hearings are underway to determine the composition of President Trump’s cabinet, including the Secretary of Health and Human Services. President Trump has nominated Robert F. Kennedy, Jr. for the role, a decision met with opposition from various public health and medical organizations due to his controversial stance on vaccines and community water fluoridation. The Senate Finance Committee approved his nomination in a narrow 14-13 vote, sending it to the Senate floor for final consideration.

PCOH will continue monitoring these legislative and policy developments to ensure Pennsylvanians maintain access to essential dental care services.