Federal Update
Despite starting the year with an audacious list of legislative goals, Congress will likely recess for the November election without having achieved much. The House and Senate’s government funding bills have not passed and there is expected to be a Continuing Resolution (a bill that extends government funding at the fiscal year 2018 level) for at least some government funding until after the November election.
The legislative session, which convenes after the election, is referred to as a “lame duck” session as many of the members will not be returning to Congress in January. Despite this, it is expected that opioid legislation will be finalized, along with government funding bills. The most controversial of the government funding bills is the Department of Homeland Security Appropriations Bill; the President has already threatened to veto this legislation if funding is not included for the Border Wall. Health Center discretionary funding for the 330 Grant Program is included in the Labor, Health and Human Services and Education Appropriations Bill, which is also likely to be completed during the lame duck session.
CaliforniaHealth+ Advocates will continue to monitor and engage on issues at the Federal level that impact community health centers and the patients they serve.
Title X
The United States Department of Health and Human Services (HHS) proposed changes to the Title X program that, if enacted, would make significant changes to medically-accurate, comprehensive family planning care.
Title X is the only federally-funded grant program dedicated to providing low-income patients with essential family planning and preventive health services and information. This program is vital to ensuring that more than four million people nationwide have access to critical care, including contraception and lifesaving cancer screenings. Health centers are important participants in the Title X program: nationwide roughly one-quarter of all Title X delivery sites are federally qualified health center sites.
The comment period for the rule closed on July 31, and almost 500,000 comments to the rule were received by HHS. HHS is required by law to respond to all comments, so it could take a number of months for the rule to be finalized.
Immigration Update: Public Charge
CaliforniaHealth+ Advocates is paying close attention to rumors regarding public charge. According to multiple reports, the Trump Administration is unfairly attempting to discourage utilization of public benefits by expanding the definition of what constitutes as a public charge. Public benefit programs, such as CHIP, WIC, and many others, may no longer be excluded from consideration in the public charge means test.
Advocates is concerned that changes to public charge unfairly targets groups of immigrants and increases their fear of deportation, which deters many from seeking health care services and other public benefits. Expanding the definition of public charge could also invalidate the state legislative work done in California to expand state-based public benefit services to all, regardless of immigration status.
In response, Advocates, along with its affiliate the California Primary Care Association (CPCA), have been working closely with immigrant-focused partners to create resources that assist health centers in advocating against changes that would negatively impact our immigrant patients and communities. To help health centers better understand the harm that could come from the proposed changes to the public charge rule, Advocates has taken a leadership role in helping to provide resources to other state health centers and PCAs in the hopes of increasing advocacy on the part of health centers on this issue
According to an analysis by CPCA, California health centers could see 132,000 to 397,000 patients disenroll from Medicaid, causing a financial loss of $74 million to $221 million in Medicaid funds annually. This analysis solely considers the financial loss in Medicaid reimbursements and does not take into account the loss of other reimbursement from county health insurance programs. The fiscal impact for health centers is likely to be much greater than the Medicaid losses estimated.
Impact of Changes to the Public Charge Rule
Health facilities may need to retrain staff, in particular enrollment staff, to ensure they can answer questions from immigrant patients who may qualify for Medicaid, the sliding fee scale, or other public benefit programs offered at the Federal, State or local level. If the proposed policy changes go into effect, it will no longer be possible to assure patients that using Medicaid or other health benefits won’t affect their immigration status. Each health center will need to decide how to talk to immigration patients about the possibility that receiving essential benefits could affect their ability to adjust their immigration status.
Community health centers, along with other safety-net providers, will likely experience an increase in uninsured patients. Since health centers and safety-net providers may no longer be able to enroll all their immigrant patients into public benefit programs, or possibly offer them the sliding fee scale, it could raise the cost of providing services to patients. This is of great concern for health centers in states with significant immigrant populations.
If we want our communities to thrive, all of the families in those communities must be able to get the care and services they need. At this time of rising national division, Advocates and health centers are proud to stand with our immigrant communities and re-affirm our commitment to valuing and protecting the health care rights of our immigrant patients.