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America’s Voice for Community Health Care NACHC Mission: To promote the provision of high-quality, comprehensive and affordable health care that is coordinated,

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Presentation on theme: "America’s Voice for Community Health Care NACHC Mission: To promote the provision of high-quality, comprehensive and affordable health care that is coordinated,"— Presentation transcript:


2 America’s Voice for Community Health Care NACHC Mission: To promote the provision of high-quality, comprehensive and affordable health care that is coordinated, culturally and linguistically competent, and community directed for all medically underserved people.

3 NACHC Policy Update Presentation to New Mexico Primary Care Association Joe Gallegos, MBA National Association of Community Health Centers June, 2011

4 Last Year: Health Reform!

5 Health Reform: What Was it About? Expand coverage for 32 million low income Americans: –16 million estimated to acquire coverage through Medicaid expansion to 133% of FPL –Another 16 million estimated to acquire coverage through State Exchanges between 134% to 400% of FPL through subsidized premiums Expand Health Centers by $9.5 Billion to reach 40 million patients by 2015, PLUS $1.5 Billion for capital expansion

6 Health Reform: What Was It About? New and dedicated funding for the National Health Service Corps in a Trust Fund by $1.5 Billion over 5 years to place approximately 15,000 primary care providers in shortage areas Changes designed to revitalize Primary Care (Teaching Health Centers, Training of health professionals) Payment reform (PPS rates under Exchanges) Promote Integrated Care for Better Quality and Lower Costs

7 FY 2011 Appropriations- What Does it Mean? Continuing Resolution, H.R. 1473 reduced discretionary funding by $600 million for CHCs relative to the FY 2010-enacted level of $2.19 Billion H.R.1473 requires DHHS and other departments to provide a spending plan w/in 30 days of the legislation becoming law - Due May 15, 2011 HRSA/BPHC have just released their spending plan for the CHC program

8 FY 2011 Appropriations – What Does It Mean? Based on $600 million cut in discretionary funding together with $1.0 Billion in FY 2011 funding available through CHC Trust Fund--$400 million in funding is available for 2011 This limited funding will need to be dedicated to preserve existing operations FIRST: –Continue 127 NAP and IDS funding under ARRA ($250 million) –Replenish FTCA Malpractice Fund ($55 million) –0.2% Federal agency-wide rescission ($3-4 million) Leaving +/- $90 million available for NAPs, Service Expansion, Planning Grants, T/TA, Admin, etc.

9 FY 2012 Appropriations – Current Status HOUSE: Labor-HHS-Education Subcommittee accepting Member requests in support of programs funded through the subcommittee. Written requests due May 20, 2011 Subcommittee expected to begin consideration of Labor-HHS-Education proposals the week of July 26 th, with full Committee consideration the week of August 2 nd Subcommittee allocation is $18 billion BELOW FY11 level. SENATE: Has not released instructions for submission of programmatic requests or considered a Budget Resolution - Expect to hear shortly

10 FY 2012 Appropriations – NACHC’s Request $1.79 Billion in discretionary funding for FY 2012 will: –Would increase funding by $400 million over FY 2011 level –Extend cost-effective primary and preventive health care to over 3 million Americans –Bring a Health Center to approximately 200 new communities –Build on existing Health Center capacity through extended hours of operations, hire additional providers and availability of new medical, oral, behavioral, pharmacy and vision health services

11 FY 2012 Appropriations – What are we doing? HOUSE – Congressman Frank Pallone (D-NJ) and Congressman Gus Bilirakis (R-FL) began circulating a bipartisan sign-on letter indicating support for the Health Centers Program to the House Labor-HHS-Education Subcommittee on Appropriations No New Mexico House Members signed letter SENATE – Senator Debbie Stabenow (D-MI) and Senator John Boozman (R-AR) began circulating sign-on letter to the Senate- Labor-HHS-Education Subcommittee on Senate Appropriations –Enables members to publicly show their support for health centers –No funding amount included to ensure strong bipartisan response Senators Jeff Bingaman and Tom Udall signed the letter

12 The Outlook for Medicaid House-Approved Budget (Paul Ryan) Plan for FY 2012: (House Budget Committee Chairman) Dramatically restructure Medicaid by converting it to a state block grant and cutting funding sharply by capping federal government spending –$1 trillion cut to Medicaid over 10 years States would accept a block grant with broad authority and waivers to design their own state Medicaid program According to CBO, Ryan budget would reduce federal funding 35% by 2022 and 49% by 2030, compared to what the funding would be otherwise. (Center on Budget and Policy Priorities – May 3, 2011)

13 The Outlook for Medicaid Under current law, federal government pays a fixed percentage of a state’s Medicaid costs—Under a block grant, the federal government would pay only a fixed dollar amount each year States would be responsible for all costs that exceed the cap Ryan plan would convert Medicaid from an entitlement program to a block grant starting in 2013 States would receive a fixed allotment of federal funding that would be increased annually based only on population growth and inflation as measured by Consumer Price Index (CPI) No provision for increases due to recession, epidemics, natural disasters

14 The Outlook for Medicaid Beneficiaries SENIORS: An overwhelming majority of Medicare beneficiaries who live in nursing homes rely on Medicaid for their nursing home coverage Deep cuts in federal Medicaid funding, would result in less coverage for nursing home residents and shift more of the cost of nursing home care to elderly beneficiaries and their families – unless States made up the difference (highly unlikely) Reduction in the quality of nursing home care would be virtually inevitable

15 The Outlook for Medicaid Beneficiaries PEOPLE WITH DISABILITIES: Constitute15% of Medicaid beneficiaries Account for 40% of all Medicaid expenditures, mostly due to their extensive health and long term care needs Cuts in federal Medicaid $$ would place significant financial pressure on states to scale back eligibility and coverage for high cost population Would be unable to obtain coverage because of their medical conditions

16 The Outlook for Medicaid Beneficiaries CHILDREN: Current law requires states to provide children with health care services and treatment they need for healthy development (EPSDT) which provides regular preventive care, follow-up, diagnostic and treatment services A Block grant program would likely permit states to drop EPSDT coverage, meaning that children particularly those with special health care needs would not be able to access some care that they need and their parents will be unable to afford that care on their own

17 The Outlook for Medicaid Beneficiaries WORKING PARENTS AND PREGNANT WOMEN: State Medicaid programs already have extremely restrictive eligibility requirements for parents Typical state, working parents are ineligible for Medicaid if income exceeds 64% of the poverty line ($14,304/year for family of 4). Unemployed parents are ineligible if their income exceeds 37% of the poverty line ($8,270/year for family of 4) States do the same for low-income pregnant women who rely on Medicaid for their prenatal care resulting in foregoing services that are critical to ensuring a health pregnancy.

18 Outlook for Medicaid on Health Centers Medicaid is single most important source of health care coverage for low-income and disabled Americans (CHCs serve 1 in 7 Medicaid beneficiaries) 37% of health center patients are covered by Medicaid—single largest revenue source for CHCs Adequate and fair Medicaid Payment is essential to health centers’ solvency—especially when by law and by mission, cannot limit the number of Medicaid or uninsured patients they serve

19 Outlook for Medicaid on Health Centers If states eliminate PPS rates for FQHCs—severe limits in revenue flowing to health centers, threatening their ability to care for uninsured and even their solvency is at risk If states limit eligibility, many patients who are covered by Medicaid would lose coverage, increasing the number of uninsured patients –CHCs would see dramatic increases in uninsured patients presenting for care Because health centers provide high quality services, care coordination that is integral to keeping patients out of ERs and drive savings throughout the health care system -- this savings would not be realized

20 Other NACHC Policy Priorities Medicaid Health Information Technology Incentive Payments: The FIX-HIT Act (H.R. 1187, S. 643) –Automatic reassignment of ARRA Medicaid HIT Incentive Payments directly to health centers rather than CHC provider Family Health Care Accessibility Act of 2011 – (H.R. 1629 sponsored by Representative Tim Murphy (R-PA) and Gene Green (D-TX) and S. 1059 sponsored by Senator John Thune (R-SD) and Senator Bob Casey (D-PA) would extend Federal Tort Claims Act (FTCA) medical malpractice coverage to health professionals who wish to volunteer their clinical skills at 330-funded health centers.

21 The Takeaway Preserve the great gains we have made over the years Ensure that, in Federal and State Budgets, the burden does not fall disproportionately on those who can least afford it; but rather use a balanced approach Ensure that our health centers, which deliver hard results on national priorities (such as Access, Quality and Cost), remain a key part of any solution going forward Ensure that health centers serve as leaders in transforming the nation’s health care system

22 The Takeaway The View from Capitol Hill is turbulent, with the parties taking dramatically different approaches on many big issues, especially the budget A major assault on Programs for Low and Moderate Income People We must protect the Medicaid program from a block grant We can’t afford to be spectators, but we must be active participants in this battle Our message must be loud and clear!!! Be active and engaged health center advocates!!!

23 What Can I Do? No later than end of June, NACHC will unveil a new “Save America’s Health Centers” campaign on its website and will add some of the following materials: –Action Plan Outline –Issue Briefs (1-4 items) –Sample CHC Board Letter/Resolution –Key Local Endorsements to Secure –Cause/Impact Scenarios (CHC and State Level) –Frequently Asked Questions – and CHC answers –Key Talking Points –Sample CHC Patient Letter/Petition/Email –Request for Support to Members of Congress

24 Where Can You Get More Information? Visit our improved, expanded web site… – for more information on all issues, – for the latest on federal and state policy developments, including health reform, –for the schedule of webcasts and trainings on key health center management topics –Latest research and data on health centers Read the Washington Update each week… All Are available at

25 Thank You! Any Questions?

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