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Budget/Appropriations
After Congress failed to reach an agreement on another stopgap spending measure to extend an expiring continuing resolution (CR), the Federal government shut down Friday January 19 at midnight.
AUCD network members should see the Health and Human Services (HHS) FY 2018 contingency plan for guidance. It says that about half of the HHS staff will be furloughed (sent on leave) and details which department-funded activities are expected to continue. Federal project officers will be unavailable during the shutdown. AUCD operations will continue uninterrupted.
Entitlement benefits that are permanently appropriated, such as Social Security, Medicare, and Medicaid, continue to be paid although services such as new enrollments or fixing benefit problems might cease.
The Anti-Deficiency Act of 1870 (31 U.S.C. 1341-42; 1511-1519) makes it strictly illegal for any government official to make payments or enter into contracts in excess of congressional appropriations.
On January 18, the House passed a 4-week Continuing Resolution (CR) through February 16 (it included a 6-year extension of CHIP & delayed several Affordable Care Act related taxes, but did not include extensions for the other expired health programs (e.g., community health centers) (see section-by-section summary). The Freedom Caucus voted for the CR since it was promised that defense spending caps would be raised - without raising caps on non-defense discretionary. The Senate, however, was unable to muster the 60 votes required for passage.
Senators voted on and approved (81-18) a CR today that would fund the government through February 8 with the promise from Leader Mitch McConnell (R-KY) to take up a bill to address border security and the DACA program next month. The measure includes a six-year funding extension for the Children's Health Insurance Program. The bill still needs approval from the House and then needs to be signed by the President.
Health Care
OIG Report
The Office of the Inspector General (OIG), Administration for Community Living, and Office of Civil Rights, released a report on the "Ensuring Beneficiary Health and Safety in Group Homes". The investigation was to determine if group homes complied with Federal and State requirements for reporting, recording, and detecting abuse and neglect in group homes and focused on three states: Connecticut, Massachusetts, & Maine. OIG "found serious lapses in basic health and safety practices in group homes". Their main recommendation was for these states to provide additional training, update policies and procedures, and provide access to Medicaid claims data. The report also offered "model practices" for State Incident Management and Investigation, Incident Management Audits, State Mortality Reviews, and State quality assurances. AUCD is still analyzing the report, but has concerns it could serve as validation for congregate settings and intentional communities. We have been working with the national DD Partners on talking points that make clear we support such improvements, we should not read this report as a reason to return to segregation. Furthermore, we should also not disregard that abuse and neglect was found, which supports the need for monitoring and reporting, the importance of P & A involvement, developing natural supports, and adequate funding for Home and Community Based Services. Also see letter from Seema Verma (CMS Administrator) to OIG.
Territories - Special Enrollment
The Centers for Medicare & Medicaid Services announced additional opportunities for individuals affected by the 2017 hurricanes in Puerto Rico and U.S. Virgin Islands to enroll in prescription drug plans and health coverage through the Federal Health Insurance Exchange through March 31. Find more information on special enrollment periods and Medicare. En español.
Territories - Funding
AUCD signed on to a letter addressed to Chairman Lamar Alexander and Ranking Member Patty Murray of the Senate Committee on Health, Education, Labor and Pensions, requesting hearings to address the ongoing education and health care crisis in Puerto Rico and The Virgin Islands. The letter emphasizes the need to begin hearings on these issues immediately so that the full range of needs can be met for every U.S. citizen, with and without disabilities, affected by hurricanes Irma and Maria. Link to previous letter.
Conscience and Religious Freedom Division
On January 18, the U.S. Department of Health and Human Services (HHS) announced the formation of the Conscience and Religious Freedom Division in the HHS Office for Civil Rights. HHS stated that this "division has been established to restore federal enforcement of our nation's laws that protect the fundamental and unalienable rights of conscience and religious freedom." AUCD is concerned that this new Civil Rights Division will potentially discriminate against certain individual's right to receive health care; including discrimination towards those who identify as LGBTQ, based on race or ethnicity, reproductive rights, end-of-life decision making, and people with disabilities.
Medicaid Work Requirements
On January 11, CMS issued a State Medicaid Director Letter providing new guidance for Section 1115 waiver proposals that would impose work requirements (referred to as community engagement) in Medicaid as a condition of eligibility. The guidance describes the potential scope of requirements that could be approved and presents the case for how these policies promote the objectives of the Medicaid program. Since this time, CMS has approved a work requirement waiver in Kentucky (see last week's In Brief); eight other states - AR, AZ, IN, KS, ME, NH, UT, and WI - have pending waiver requests that would require work as a condition of eligibility for expansion adults and/or traditional populations. While the guidance letter states that people with disabilities are excluded from the requirements, significant issues remain regarding how states may define disability. For more state specific information, please see Kaiser Family Foundation State Waiver Details and Key Issues. Also see Medicaid: What to Watch in 2018 from the Administration, Congress, and the States.
Bipartisan Insurance Stabilization
Sources indicate that a preliminary agreement was made between Senators McConnell and Collins to ensure the passage of the Collins-McConnell agreement ($5.5 billion in federal funding for 2018 - 2020 to help states set up a reinsurance or high-risk pool mechanism) and the Alexander-Murray legislation (authorizing federal cost-sharing reduction payments to insurers) by the end of 2018. The agreement was to ensure they are passed successfully through Congress and signed into law in advance of the deadline later this year by which time insurers must set their 2019 health insurance premium rates. However, given the ongoing budget tensions, there is little insight as to when these bills might actually be considered. Both proposals are designed to stabilize the insurance exchange marketplace created by the Affordable Care Act.
Resources
Center on Budget and Policy Priorities posted a series of four briefs that detail how cuts to Medicaid would impact children, seniors, persons with substance abuse disorders, and people in rural communities.
Education
ESSA
Secretary DeVos recently announced the approval of a number consolidated state plans under Every Student Succeeds Act: Minnesota and West Virginia (January 10 release) and Arkansas, Maryland, Missouri, New York, Ohio, Pennsylvania, South Dakota, Washington, Wisconsin, Wyoming, and Puerto Rico (January 16 release) were among the 34 states and Puerto Rico to submit their state plans by the final deadline of September 18, 2017.
Hearings
The Senate HELP Committee held a hearing on Reauthorizing the Higher Education Act: Financial Aid Simplification and Transparency, which took place January 18. (View archived recording and witnesses here.) The Committee will also hold two hearings on January 25, regarding the Higher Ed Act that will focus on access and innovation, and on the nomination of Frank Brogan to be Assistant Secretary for Elementary and Secondary Education.
Asset Development
Able National Resources Center provided a summary of some of the more significant changes that can be expect regarding ABLE in 2018. Summary includes information on annual contribution limit, saver's tax credit, and more.
Tuesdays with Liz: Disability Policy for All
This week, Liz interviewed Kara Ayers on the rights of parents with disabilities and discriminatory state laws that interfere with these rights, while also exploring why parents with disabilities face discrimination. Kara is the Associate Director at the UCEDD at the University of Cincinnati and Co-Founder of the Disabled Parenting Project. In case you missed last week, Liz interviewed Judy Heumann, a Senior Fellow at the Ford Foundation and a long-time disability advocate, about her early educational experiences as someone with a disability and the importance of the UN Convention on the Rights of Persons with Disabilities (which the US has yet to ratify).
Editor's Note: These episodes of Tuesdays with Liz have been pre-recorded. Liz Weintraub is currently on sabbatical working with the Senate Aging Committee. Tuesdays with Liz will return to a regular taping schedule and new episodes will air in the late Spring when Liz returns to AUCD.
For more from AUCD, follow @AUCDNews and like AUCD on Facebook
For updates from our Executive Director Andy Imparato, follow @AndyAUCD.
For more policy news, follow Kim on Twitter at @kmusheno
For definitions of terms used in In Brief, please see AUCD's Glossary of Legislative Terms
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