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Volume 1, No. 32, October 1, 2019

Medicaid Expansion May Be Back on the Table in North Carolina
 
Last edition, the ADEA Advocate reported about the uncertain future of Medicaid expansion in North Carolina following a surprise vote to override Gov. Roy Cooper’s (D) budget veto in the state’s House of Representatives. The Governor had vetoed the budget because it did not include provisions to expand Medicaid and, following the override, it appeared he may have lost leverage to force the issue. This week, in another surprise move, it appears Medicaid expansion may be back on the table [ [link removed] ] —although not on the Governor’s desired terms.
 
A compromise bill [ [link removed] ] offered by Republicans in the state’s General Assembly passed a committee vote on Sept. 18 and would allow the state to expand Medicaid to individuals who earn up to 133% of the federal poverty level. The compromise legislation, however, includes two provisions opposed by Democrats in the legislature: a work requirement and a monthly premium that is equal to 2% of a recipient’s income.
 
The Republican-backed bill would also create the North Carolina Rural Access to Healthcare Grant Fund. The grant program would provide funds to qualified applicants to engage in health care provider recruitment, loan forgiveness for health care providers, provider retention incentive programs, telehealth and other methods of delivering health care to rural areas specified in the bill. The state’s Office of Rural Health would be required to develop criteria for determining qualified applicants.

Tennessee Unveils Medicaid Block Grant Proposal
 
On
Sept. 17, Tennessee Gov. Bill Lee (R) unveiled a proposal [ [link removed] ] to formally request the state’s federal Medicaid funds be distributed in the form of a block grant. Block grants are funding mechanisms used by the federal government to provide a fixed amount of funds that can be used for a state-run program. Currently, Medicaid uses
a shared-funding [ [link removed] ] arrangement with no pre-set limit whereby the federal government provides funds using a formula based on a state’s per capita income. The shared-funding arrangement requires states to adhere to conditions established by the federal government, but under a block grant system, there would be fewer conditions to which states must adhere. Proponents
of block grants argue that with fewer strings attached to funding, states could use Medicaid more efficiently. But opponents have voiced concerns that the fixed amount of funding could result in reductions in or denial of Medicaid coverage for recipients.
 
The Governor’s proposal calls for a modified version of a traditional block grant. Under the proposal, the state would be awarded a fixed amount of funds annually. During times of growth in the state’s Medicaid population, the federal government would add additional funds that would range from $500 to $1,600 per person. If Tennessee can save funds and not spend the entire block grant, the difference between the amount spent and the fixed block grant would be shared between the state and the federal government.
 
The state will not submit the proposal until after a 30-day public comment [ [link removed] ] period, and will also hold three hearings throughout the state on the measure.

FDA Announces Upcoming Ban on Flavored e-Cigarettes
 
On Sept. 11, President Trump announced he would ban flavored e-cigarettes due to the current outbreak of unexplained lung disease that has sickened hundreds and killed at least six people. The common thread between these cases has been the patients’ use of e-cigarettes.
 
Currently, the U.S. Food and Drug Administration (FDA) is finalizing its rule that would remove from the market all non-tobacco flavors of e-cigarettes, including mint and menthol. Once the rule is released, retailers will have 30 days to comply with the rule.
 
The illnesses are fueled by what some are calling an “epidemic” in teen use of e-cigarettes. Last year, 3.05 million high schoolers in the United States reported using e-cigarettes. The Centers for Disease Control and Prevention released data showing that between 2017 and 2018, there was a 78% rise in the number of high schoolers using e-cigarettes in the past the 30 days, increasing from 11.7% to 20.8%.
 
However, a bipartisan group of U.S. senators wants the FDA to go even further and not only ban the use of flavored e-cigarettes, but also to increase regulation of the vaping device itself [ [link removed] ] . This would likely require some type of restrictive access to the device.

Kaiser Family Foundation Releases Report on Improving Dental Coverage for Medicare Recipients
 
The Kaiser Family Foundation released a report [ [link removed] ] detailing policy options for improving dental coverage for people on Medicare. Two-thirds of the Medicare population—approximately 37 million beneficiaries—lack dental coverage. The report notes that costs and lack of coverage impact beneficiaries’ access to dental care. The report includes a review of dental coverage currently permitted under Medicare law and recommends policy options that can increase coverage, and thereby improve oral health in older adults. The five options are:
 
1) Add a dental benefit to Medicare Part B,
2) Create a voluntary dental benefit under a new part of Medicare,
3) Permit greater access to medically necessary dental services under Medicare,
4) Test models for dental coverage and
5) Offer dental discount cards.

Senate Committee Releases Labor, Health and Human Services and Education Appropriations Bill
 
The U.S. Senate Appropriations Committee released its version of the Fiscal Year (FY) 2020 Labor, Health and Human Services, Education and Related Agencies bill [ [link removed] ] on Sept. 18, with programs important to dental education doing relatively well regarding funding. Below is a summary of some of those programs:
 • The bill includes $40.6 million for the Oral Health Training Program (the full amount the dental community asked for), which includes $12 million each for General and Pediatric Dentistry residencies. These amounts are the same as in the bill passed in the House of Representatives.
 • The bill includes $486.8 million for the National Institute of Dental and Craniofacial Research—$2 million more than the House and $25 million more than the FY19 budget. It is below the dental community’s request, but still a substantial increase over the current fiscal year.
 • For the Dental Reimbursement Program in Part F of the Ryan White Act, the Senate allotted $13.2 million.

The only disappointment so far is the Senate provided no funding for the Health Careers Opportunity Program. The House included $20 million for the program, so this will likely be a conference item between the two Houses. U.S. Rep. Rosa DeLauro (D-CT), Chair of the House Subcommittee on Labor, Health and Human Services, Education and Related Agencies, is a strong supporter of continued funding for the program.

Congress Clears Way to Keep Government Open Past Sept. 30
 
The U.S. Senate followed the U.S. House of Representatives’ lead in clearing a short-term spending bill (H.R. 4378 [ [link removed] ] ) that would fund the government through Nov. 21, and give lawmakers more time to pass the 12 full-year appropriations bills for fiscal year 2020 that starts Oct. 1. The vote was 82-15. President Trump signed the bill into law over the last weekend.
 
Under its provisions, agencies and programs would continue to operate as they have in the current fiscal year through Nov. 21. In addition, the bill also extends funding for expiring health programs at their current levels through Nov. 21, including earmarking $44.2 million for the National Health Service Corps [ [link removed] ] and $18 million for the Teaching Health Center Graduate Medical Education Program [ [link removed] ] .
 
Finally, it would boost funding for the U.S. Census Bureau to carry out various activities and operations for the 2020 census as well as increase funding for the U.S. Secret Service to support hiring additional personnel and conducting protective activities during the 2020 presidential campaign.

ADEA State Calendar [ [link removed] ]

ADEA Washington Calendar [ [link removed] ]

ADEA U.S. Interactive Legislative and Regulatory Tracking Map [ [link removed] ]

Key Federal Issues [ [link removed] ]

Key State Issues [ [link removed] ]

The ADEA Advocate [ [link removed] ] is published weekly. Its purpose is to keep ADEA members abreast of federal and state issues and events of interest to the academic dentistry and the dental and research communities.
 
©2019
American Dental Education Association
655 K Street, NW, Suite 800
Washington, DC 20001
202-289-7201, adea.org [ [link removed] ]

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B. Timothy Leeth, CPA
ADEA Chief Advocacy Officer
 
Bridgette DeHart, J.D.
ADEA Director of Federal Relations
 
Phillip Mauller, M.P.S.
ADEA Director of State Relations and Advocacy
 
Brian Robinson
ADEA Program Manager for Advocacy and Government Relations
 
Ambika R. Srivastava, M.P.H.
ADEA/Sunstar Americas, Inc./Jack Bresch Legislative Intern
 
[email protected] [ mailto:[email protected]?subject=State%20Update%3A%20 ]

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