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Budget/Debt Ceiling/Appropriations
On June 3rd, President Biden signed The Fiscal Responsibility Act of 2023 (PL 118-5) The bill represents a bi-partisan compromise after months of negotiations regarding how to raise the debt ceiling. The bill suspends the debt ceiling through January 2025 in exchange for spending caps, new work requirements for TANF and food stamp recipients, rescinding unspent pandemic aid, and other changes. The bill has no impact on Medicaid.
The bill establishes budget caps for Fiscal Year (FY) 2024 and 2025 for both defense and non-defense discretionary (NDD) spending. For FY 2024, the bill would cap top-line discretionary spending at $1.58 trillion or approximately 6.7 percent less than FY 2023. For FY 2024, defense spending would be limited to $886.3 billion, approximately 3 percent more than FY 2023, and NDD would be limited to $703.6 billion, approximately 9 percent or $70 billion less than FY 2023. For FY 2025, the bill would allow for 1 percent growth over FY 2024, capping top-line discretionary spending at $1.606 trillion and limiting defense spending to $895.2 billion and non-defense spending to $710.7 billion.
There is also an incentive for Congress to act on all appropriations bills before January 1, 2024. If they do not, FY23 spending levels will be cut by an additional 1 percent until all bills are passed, this applies to both defense and non-defense spending.
The House of Representative’s Appropriations Committee has released their top line agreements for each of the 12 appropriations bills (known as 302(b) allocations). These represent how much money each of the Appropriations subcommittees can spend for FY 24. The total is $1.471 trillion or $119 billion less than the spending caps outlined in the Fiscal Responsibility Act. The Appropriations Committee is also looking to take back and reallocate $115 billion from previously enacted but still unspent funds to be used as offsets. For Labor-Health-Human Services- Education and Related Agencies bill, the 302b allocation is $147,096 million, or 29.3 percent less than Fiscal Year 2023. The House of Representatives has begun the process to mark up each of the 12 appropriations bills.
Plain Language
On June 3rd, President Biden signed The Fiscal Responsibility Act of 2023. This bipartisan (Democrat and Republican supported) raised the debt ceiling. The debt ceiling is the most amount of money that the federal government can spend, and this bill allows the federal government to spend more money.
The Fiscal Responsibility Act put a limit on the amount of money the federal government can spend in 2024 and 2025. There are some new work requirements for the Supplemental Nutrition Assistance Program (SNAP) for people below the age of 54. Work requirements are the number of hours a person has to work in order to receive SNAP. This bill has no impact on Medicaid. The House of Representatives has proposed to spend less money in Fiscal Year 2024 and has begun to decide how much money to spend on programs.
Action Steps
Call and educate your Members of Congress on the importance of funding for disability programs. You can reach your Members of Congress by calling the Capitol Switchboard at 202-224-3121.
Centers for Medicare and Medicaid Services Releases Two Notices of Proposed Rulemaking Around Medicaid and Managed Care
On April 27th, the Centers for Medicare and Medicaid Services CMS) released two notices of proposed rulemaking (NPRMs), Ensuring Access to Medicaid Services (Access NPRM) and Managed Care Access, Finance, and Quality (Managed Care NPRM). The rules will help eliminate barriers that people with disabilities face while trying to access quality health care through Medicaid and the Children's Health Insurance Program (CHIP). The rules will “strengthen access to and quality of care across Medicaid and the Children's Health Insurance Program (CHIP), the nation’s largest health coverage programs.”
If the proposed rules are adopted, they would establish national standards for access to health care, regardless of whether health care is provided through managed care plans or directly by states through fee-for-service as well as transparency for Medicaid payment rates to providers, including hourly rates and compensation for certain direct care workers. The rules would also establish other access standards for transparency and accountability and empower beneficiary choice. The rules would require that 80% of Medicaid payments for personal care and home health aides go directly toward compensation instead of administrative costs.
Plain Language
On April 27th, the Centers for Medicare and Medicaid Services released two new rules that would make it easier for people with disabilities to get health care if they are on Medicaid or CHIP. These rules will also improve wages for home healthcare workers who are giving care to people through home and community-based services.
Action Steps
Learn more about the rules. Submit comments by July 3, 2023. Read the Rule and Submit Comments for Medicaid Program; Ensuring Access to Medicaid Services. Read the Rule and Submit Comments for Medicaid Program; Medicaid and Children's Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality. Learn more about submitting comments from this toolkit from the Autism Society. Watch this webinar on submitting comments from the Autism Society and the National Association of Councils on Developmental Disabilities.
U.S. Department of Justice Announces New Guidance To Improve Interactions Between Law Enforcement and People with Disabilities
On May 25th, 2022 President Biden signed an Executive Order on Advancing Effective, Accountable Policing and Criminal Justice Practices aimed at improving law enforcement interactions with the communities they serve. The goal of the Executive Order was to “increase public trust and enhance public safety and security by encouraging equitable and community-oriented policing.” Section 14(a) of the Executive Order directed the Attorney General and the Secretary of Health and Human Services to consult with stakeholders and to issue guidance regarding best practices for State, Tribal, local, and territorial officials on responding to and interacting with persons with behavioral health or other disabilities.
On the one-year anniversary of this Executive Order, the U.S. Department of Justice released the report to implement that requirement. The report “outlines the application of federal disability rights laws as well as best practices for responding to crises experienced by people with disabilities.” The report also points out that while people with disabilities only make up 22 percent of the population, it is estimated that 30%-50% of all police use of force incidents involve a person with a disability. Some of the core principles in the report include:
- Use of person-centered approaches that avoid harm;
- Diverting to behavioral health services whenever it is appropriate;
- Use of peer support programs;
- Trauma-informed approaches and recovery;
- Round-the-clock resources for those experiencing mental health crisis;
- Encouraging coordination between law enforcement agencies; and
- Developing transparent data on the outcomes of interactions between law enforcement and people with disabilities.
Plain Language
On May 25th, 2022, President Biden signed an Executive Order that would help protect people with disabilities from violence from police officers. Executive Orders are rules that the President signs to tell federal agencies what they should or should not do. It has been one year since President Biden signed this Executive Order regarding policing, and the U.S. Department of Justice has just released new report to continue to protect people with disabilities from police violence.
Action Steps
Read the report.
Centers for Medicare and Medicaid Services Release Resources on Supporting Adults with Intellectual and Developmental Disabilities and Their Aging Caregivers
The Centers for Medicare and Medicaid Services (CMS) has released resources on supporting adults with intellectual and developmental disabilities (I/DD) and their aging caregivers. There are nearly one million households in the US that include adults with I/DD and an aging caregiver, who may soon need their own long-term care. CMS has issued the following resources so that adults with I/DD and their aging caregivers can prepare and plan for the future. The resources are state specific so people can find help at a local level.
Plain Language
The Centers for Medicare and Medicaid Services (CMS) put together a list of resources that will help adults with intellectual and developmental disabilities (I/DD) and their caregivers who are getting older. There are one million households in the US that have an adult with I/DD and an aging caregiver, and as caregivers age, they are not able to provide care. CMS has put links to state resources for people in this situation to use to plan for the future.
Action Steps
Read the resources.
U.S. Department of Health and Human Services Takes Action to Keep People Covered as States Resume Medicaid and Children’s Health Insurance Program Renewals
On June 12th, Secretary Becerra sent a letter to Governors to announce new flexibilities the U.S. Department of Health and Human Services is offering states to help people keep their health insurance as states resume Medicaid and Children’s Health Insurance Program (CHIP) renewals. The flexibilities include:
- Allowing managed care plans to assist people with Medicaid with completing their renewal forms.
- Allowing states to delay an administrative termination for one month while states conduct additional targeted outreach.
- Allowing pharmacies and community-based organizations to facilitate reinstatement of coverage for those who were recently disenrolled for procedural reasons.
Plain Language
On June 12th, the U.S. Department of Health and Human Services announced new rules so that people on Medicaid and the Children’s Health Insurance Plan (CHIP) can get help to make sure they do not lose coverage.
Action Steps
Read the letter.
Senator Menendez and Representative Titus Introduce the Disability Access to Transportation Act
On June 6th, Senator Menendez (D-NJ) and representative Titus (D-NV-1) introduced the Disability Access to Transportation Act (DATA) (H.R. 3845 / S. 1813). These bills will address numerous challenges faced by people with disabilities as they use public transportation. The bills will “establish a one-stop pilot program to help paratransit riders avoid excessive wait times between multiple trips, streamline the process for submitting accessibility complaints, and assist local communities with identifying gaps in transportation accessibility.” The bill is currently in the House Transportation and Infrastructure Committee and the Senate Commerce, Science, and Transportation Committee.
Plain Language
On June 6th, Senator Menendez (D-NJ) and Representative Titus (D-NV-1) introduced the Disability Access to Transportation Act (DATA) (H.R. 3845 / S. 1813) in the Senate and the House. The bill will help make public transportation, like trains, subways, and buses, more accessible for people with disabilities. The bills will provide money so that states and cities can also improve their paratransit systems. Paratransit systems help people with disabilities travel around a local area if they are unable to use the public transportation system.
Action Steps
Read the bill text. Read this announcement from Senator Menendez. Call your Members of Congress and educate them on the importance of accessible public transportation systems. You can reach your Members by calling the Capitol Switchboard at 202-224-3121.
Policy related “How To” materials can be found on our website here. Scroll to the bottom of the page to find the resources!
Tuesdays with Liz: Did you know that Liz has a YouTube Channel?
'Tuesdays with Liz' is a weekly video series highlighting current issues in disability policy. It is hosted by Liz Weintraub, a long-time disability advocate, and produced by AUCD.
You can help spread her message by:
- Subscribing to the Tuesdays with Liz YouTube Channel!
- Liking videos on the channel
- Making comments on the channel
 
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