March 12, 2008 Grassley Amendment to Budget Bill Threatens Possible Moratoria on CMS Regulations

By Hansine Fisher

Multiple amendments to the budget are rumored at this point that may impact children’s access to care under Medicaid and SCHIP.  Attached are a couple of documents that may be of help in our efforts to defeat them.  As background, the budget already includes a reserve fund for SCHIP reauthorization, as well as a reserve fund to extend moratoria to damaging Medicaid regulations.  See http://budget.senate.gov/democratic/documents/BudRes09CHAIRMAN’SMARK030508FINAL.pdf <http://budget.senate.gov/democratic/documents/BudRes09CHAIRMAN’SMARK030508FINAL.pdf> and scroll to page 28.

1) Grassley Amendment – please call your senators and urge them to OPPOSE the Grassley amendment.
 
 **    The Grassley amendment to the budget resolution’s Medicaid regs reserve fund places new restrictive conditions on the use of the reserve fund.  The underlying reserve allows the Congress to address the concerns related to the regulations listed in the reserve fund in a number of ways.
**    Under Grassley’s approach, however, the reserve fund would only be available for legislation that amends underlying Medicaid law to clarify “…allowable uses of federal funds paid to public providers, the appropriate methodologies states can use to bill the federal government for graduate medical education, the appropriate use of rehabilitation services by states, and the appropriate billing methodologies for school-based administration, school-based transportation, and case-management services.”   This effectively means the reserve fund would not give the Finance committee any flexibility.  Instead, the Committee’s hands would be tied and it would not have the time it needs to consider the underlying policies. It would require legislative changes be made concurrent with delaying the offending regulations.
**    Nothing in the existing reserve fund in the budget resolution stops the Congress from modifying Medicaid policy to address these issues.  If Congress can agree to change the law that’s fine, but if it cannot reach bipartisan agreement this year, it should still be able to block the Administration’s proposed policy changes to protect beneficiaries and the states. Grassley’s approach means the administration’s regulations stand until and unless the Congress can agree on specific revisions to Medicaid law dealing with these complex issues.
**    The amendment needs to be soundly rejected to help protect states and Medicaid beneficiaries from the harmful impact of the Medicaid regs we’ve all been working on this year.

2) Other Rumored SCHIP Amendments
 
Rumors about SCHIP amendments to the Senate budget resolution have also been swirling.  Amendments could be along the lines of budget amendments offered last year:
·      proposing restrictions on adult/parent coverage (like last year’s Chambliss No. 536.  A YEA vote would have limited state flexibility to cover parents and childless adults and create an option to cover mental and dental health for children. (The option to provide mental and dental health coverage already exists under current law.) This amendment was defeated 44-55.
·      restricting coverage in SCHIP over 200% (like last year?s Cornyn No. 511.  A YEA vote would limit states’ flexibility to cover children above 200% FPL and parents. This amendment was defeated 38-59).

Attached is a chart that CCF did to summarize last year’s budget amendments (see last page for brief descriptions) – the Chambliss and Cornyn amendments seem most likely to be repeated in some form, another Bunning EPSDT amendment would obviously be bad too.
 
Please let folks know on Capitol Hill that these amendments should not be supported and thanks so much for your advocacy on behalf of children