Current Policy and Advocacy Efforts
Protect Medicaid (Medi-Cal)
Adequate Medicaid payments are essential to Health Centers’ viability and ability to innovate. Each health center’s unique, per-visit Medicaid payment is intended to cover the comprehensive set of services provided by the health center and covered by the Medicaid program. In addition to primary medical care, these services typically include dental, mental health, and pharmacy, and may also include services such as care management and health education.
FACTS | Read Issue Brief
Health Centers care for more than 1 in 6 Medicaid beneficiaries nationally
Health Centers provide care to 17% of all Medicaid beneficiaries, but Medicaid payments to health centers make up only 1.8% of total Medicaid spending
Health Centers’ Medicaid patient population is approximately double that of the general population
Health Centers save, on average, $2,371 (or 24%) per Medicaid patient when compared to other providers
Health Centers to have lower total spending per Medicaid patient compared to non-health centers within each of the states studied.
Health Centers save the Medicaid program $6 billion annually
Health Center patients with Medicaid have lower utilization of costly hospital and emergency department-related services compared to patients at other providers, even under managed care
Medicaid payments represent 43% of health centers’ total revenue, making it their largest revenue source.
Yet, despite serving increasing numbers of Medicaid patients, the amount of Medicaid revenue collected in 2016 only covered 80% of the cost associated with caring for that population, leading to a significant and unremitting uncompensated care gap for Health Center.
Read HCP's Op-Ed
The 340B Drug Discount Program is a US federal government program created in 1992 that requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices.
Health Centers reinvest these "savings" in underserved communities to expand services, add staff, and increase access to care for families.
Common examples include:
Extended hours of operation for Federally Qualified Health Centers;
HIV clinics offering a full range of medical and mental health services for patients;
Hepatitis C clinics that provide lifesaving, curative treatments for Medi-Cal patients;
Post-operative services including “meds to beds” programs that allow patients to be discharged from major operations, like cardiac surgeries and organ transplants, with critical medications needed for proper recovery, and to ensure patients receive necessary follow-up with pharmacists;
Specialized treatments at infusion clinics, like those provided to patients with congestive heart failure, hemophilia, multiple sclerosis and cancer;
Case workers for individuals experiencing homelessness and additional support staff to address patients’ complicated care needs;
Increased access to specialty care through expanded transportation services to patients without reliable transportation;
Expanded pharmacy access for Medi-Cal and uninsured patients; and, much, much more.
Title X and the GAG RULE
On Friday, June 1st, the anticipated Title X domestic gag rule was officially issued, thus beginning a 60-day comment period, ending July 31, 2018.
This gag rule would do three things:
- First, it imposes new rules designed to make it impossible for millions of patients to get birth control or preventive care from Planned Parenthood and other providers.
- Second, under this rule, doctors, nurses, hospitals, and community health centers across the country would no longer be able to refer their patients for safe, legal abortion.
- Third, it removes the guarantee that patients get full and accurate information about their health care from their doctor. For nearly two decades, Title X law has been clear: Health care providers cannot withhold information from you about your pregnancy options. This gag rule means they can.
This gag rule is an attempt to take away women’s basic rights. Period. The result of this gag rule is that people will not get the health care they need. They won’t get birth control, cancer screenings, STD testing and treatment, or even general women’s health exams.
This rule would make it illegal for doctors, nurses, hospitals, community health centers, and any other provider in the Title X program to tell patients how they can safely and legally access abortion. That’s the very definition of a gag rule.
About Title X
More than four million people rely on federal Title X funding to access contraception and other essential health care. Established in 1970, Title X provides affordable birth control and reproductive health care to people with low incomes, who couldn’t otherwise afford health care services on their own. Federal Title X funding helps ensure that every person — regardless of where they live, how much money they make, their background, or whether or not they have health insurance — has access to basic, preventive reproductive health care.
More than four million people rely on affordable birth control and reproductive health care services that are funded by Title X. Many of these people don’t even know Title X exists, but without it they wouldn’t be able to access this essential care.
The basic primary and preventive health care services provided by Title X include:
- Wellness exams
- Lifesaving cervical and breast cancer screenings
- Birth control
- Contraception education
- Testing and treatment for sexually transmitted diseases (STDs) and HIV testing
In 2016 alone, health centers used Title X funding to provide nearly 700,000 Pap tests, more than four million STD tests (including HIV tests), and nearly one million women with breast exams.
Governor Brown Has Signed the 2018-19 State Budget
Overview via CPCA
On June 27th, Governor Brown signed his final state budget of this term, and of his storied career in public service. Today’s budget reflects a far different fiscal reality than that which he inherited seven and a half years ago. The $27 billion budget deficit that marked the start of this third time is now replaced with continued growth. This final budget fills the state’s Rainy Day Fund and boosts education funding to an all-time high.
The enacted budget reaffirms the administration’s commitment to primary care workforce by moving forward with the second of three installments to increase funding to the Song-Brown Program that invest in primary care residency in underserved communities. One-time additional investments in emergency medicine, primary care, and psychiatry were also made
340B Drug Discount Program
We are excited to share that the enacted budget reflects no changes to the 340B program. We are grateful to the legislature for rejecting the Administration’s January proposal. Advocates continues to work with Department of Health Care Services (DHCS), plans, and covered entity partners to find a solution to the duplicate discount concerns and are hopeful to have resolution before the conclusion of this legislative session.
2018 STATE Supported Policies & Sponsored Legislation
Community Health Centers Response to Emergencies | AB 2576 by Assemblymember Cecilia Aguiar-Curry - SIGNED
In partnership with Redwood Community Health Coalition (RCHC), Advocates is co-sponsoring comprehensive legislation that builds on the lessons learned from the 2017 fire season. In particular, this bill aims to address payment for telephonic visits, payment for care provided at alternative locations, and pharmacy permitting issues.
Same Day Billing | SB 1125 by Senator Toni Atkins - VETOED
In partnership with the Steinberg Institute, Advocates has co-sponsored Same Day Billing legislation which would allow health centers to bill for both a medical and a behavioral health visit on the same day. With a raging opioid epidemic, a greater appreciation for the intersection of primary care and mental health services, and the need to increase access to behavioral health preventive and diagnostic services, Advocates is excited to be working with the Steinburg Institute on this important effort.
Consolidated Licensing | AB 2428 by Assemblymember Lorena Gonzalez Fletcher - SIGNED
This bill would allow health centers that elected to use a consolidated license the choice of using the same PPS rate for both sites or establishing new PPS rates.
Protect the savings of the 340B Program for Medi-Cal Fee For Service and Managed Care - ACCOMPLISHED in the Governor's Budget
The 340B prescription drug program enables Community Health Centers to stretch scarce federal resources to underserved patients and provide comprehensive services beyond the reach of the Medi-Cal program. It is a vital lifeline for safety-net providers across the state.
Influence the State Plan Amendment (SPA)
DHCS issued notice to implement changes to the current State Plan related to FQHC services and payment including MFTs as billable providers, Productivity Standards, Scope Changes, Four Walls, Executive Compensation Caps, Administrative Caps and other matters.
Partner Bills of Interest
• Assembly Bill 2204 (Gray) Clinics Licensure and Regulation Exemption - SIGNED
• Senate Bill 1004 (Wiener) Mental Health Services Act: prevention and early intervention - SIGNED
• Assembly Bill 180 (Wood) P4P Incentive Payments - VETOED
• Assembly Bill 2029 (Garcia) Federally Qualified Health Clinics: rural health clinics - Held in Appropriations Committee
2018 FEDERAL Supported Policies & Sponsored Legislation
Strong Medicaid Program
Preserve the FQHC Prospective Payment System (PPS) methodology within a strong Medicaid Program.
340B Drug Discount Pricing Program
Community Health Centers need continued, assured access to the 340B Program to sustain their essential model of care.
Integrated Behavioral Health and Substance Use Treatment (SUD)
Support Community Health Centers' ability to improve access to and delivery of high quality, cost effective behavioral health and SUD.
Support "CONNECT for Health Act of 2017" to allow FQHCs to be eligible for reimbursement in Medicare as both “distant and originating sites”, and to allow for reimbursement for remote patient monitoring.
Omnibus Bill for FY 2018 - March 2018
The bill signed into law builds upon Congress’ historic commitments to health centers by providing $1.626 billion in discretionary federal grant funding to support and expand primary care access in over 10,000 rural and urban communities in the U.S. Combined with last month’s extension of the mandatory Community Health Center Fund, this brings the total funding for community health centers in FY18 to $5.4 billion; an increase of more than $300 million to support the essential work of health centers across the country.
An increase in discretionary health center funding of $135 million to total $1.635 billion (added on to the $3.8 billion in mandatory funding for FY 2018)
Health and Human Services received a $10 billion increase over FY 2017.
$1 billion for a new state-based opioid grant program.
$200 million in mandatory funding for health centers to focus on opioid treatment to be distributed through grants.
$105 million increase for National Health Service Corps to support loan repayment for substance use disorder counselors.
The National Institutes of Health, instead of seeing its budget shrink by $5.8 billion, will get a $3 billion increase — which lawmakers say is the largest ever.
Funding for the health department's Title X grants program — called "America's family planning program" — remains stable despite Trump's proposal to eliminate it. (The administration is shifting the program's to emphasize so-called natural family planning rather than traditional contraception.)
The Trump administration's proposed 95 percent cut to the Office of National Drug Control Policy was rejected in the omnibus.
Congress keeps funding flat for the Office of the National Coordinator for Health IT office. President Trump had proposed to slice its budget from $60 million to $38 million.
Public Charge - September 2018
Joint Statement Opposing Public Charge
The proposed public charge regulation was published on the Federal Register and the comment period started on October 10 and will end on December 10, 2018
We ask that all Americans participate in the comment period and oppose the proposed regulation in order to ensure that health centers and the patients they serve are not put at risk. Take action to protect patients and families. SUBMIT YOUR PUBLIC COMMENT HERE
Public Charge is a term used in immigration law to describe an individual who is dependent on the government for financial and material support. The likelihood that a person will become a public charge is considered when the U.S. State Department Embassy or Consular officers abroad review visa applications for entrance or re-entrance into the United States, as well as when USCIS reviews applications for legal permanent resident (LPR) status in the US (i.e. applying for a green card). Public charge is NOT taken into consideration for people who have LPR status and are applying to become U.S. citizens.
When determining if a person is likely to become a public charge, the Immigration and Nationality Act (INA) requires the government to consider a variety of factors, including the person’s age, health, resources, family size, and education and skills.
The proposed rule would amend the definition of public charge and would expand the public benefit programs currently considered in the public charge determination. At the moment the only public benefit programs considered are cash assistance (like TANF) and institutionalized long term care on the government’s expense.
It is vital our patients and their families continue to access medical care and other social services without fear of adverse immigration consequences as healthy families are better able to assimilate and contribute to the U.S. economy
Fiscal Cliff - February 2018
$7.8 billion dollars in federal grant funding for the Community Health Center program was included in the bipartisan budget deal passed by Congress on February 8. 2018.
Congress recognized the growing value of health centers by including an additional $600 million dollars to further support health center operations and address unmet need in communities across the country, as well as $60 million dollars to assist health centers in areas impacted by recent natural disasters. We are also grateful for the funding extensions of the National Health Service Corps and the Teaching Health Centers Graduate Medical Education program, two vital resources that support the health center workforce.
WE STILL NEED YOUR VOICE - Stay Loud!
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