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American Dental Education Association
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Volume 1, No. 23, July 16, 2019
Medicaid Work Requirements Rolling Out Slowly in Indiana, Delayed in New Hampshire
Indiana has begun enforcing its new Medicaid work requirements, potentially impacting tens of thousands of Indiana citizens who rely on Medicaid for health coverage. The new program, known as Gateway to Work [ [link removed] ] , has stirred controversy with some who fear that low-income people may lose health coverage. They point to the example of Arkansas [ [link removed] ] where thousands lost coverage when the state instituted a similar program. It is estimated that 72,000 people in Indiana will be required to report hours worked and other qualifying activity to the state to maintain benefits. The new requirements will be implemented slowly [ [link removed] ] , beginning with 20 hours worked per month and then increasing to 80 hours per month by next summer.
New
Hampshire Gov. Chris Sununu (R) announced on July 8 that new penalties for being out of compliance with the state’s Medicaid work requirements will be delayed by 120 days/not instituted until September. This development was due to the discovery that—despite the educational efforts taken by the state that included radio ads, direct mail, information booths and 50,000 phone calls and text messages—almost 17,000 recipients [ [link removed]
] have not yet complied with their work requirements. Educational efforts will be supplemented further [ [link removed] ] by a door-to-door canvassing to inform more recipients about the rules. Gov. Sununu also signed into law a measure
designed to loosen some of the requirements.
Alaska to Eliminate Dental Benefits for Adult Medicaid Patients
On June 28, Alaska Gov. Mike Dunleavy (R) vetoed nearly $50 million [ [link removed] ] from the state’s Medicaid budget. Included in that veto were $27 million allocated to provide dental care for adults under the state’s Medicaid program. While the federal government requires states to provide dental benefits for children, dental benefits for adults are optional. The level of adult benefits varies from state to state [ [link removed] ] , as some states provide benefits only in the case of emergency, while other states provide reimbursement for a comprehensive range of procedures. If the veto is upheld, Alaska will only provide adult dental benefits in cases of emergency.
Appropriations Bills Stall in U.S. Senate
Early last week, U.S. Senate Majority Leader Mitch McConnell (R-KY) said that the Senate would await a final overall budget agreement between the Senate, the U.S. House of Representatives and the White House before moving ahead with its 12 appropriations bills. U.S. Sen. Richard Shelby (R-AL), Chairman of the Senate Committee on Appropriations, had hoped the Senate would follow the House’s lead and adopt a “deeming” resolution, setting an overall budget spending target for fiscal year 2020 (FY20) so that the Senate would allow his Committee to begin work on its version of the bills—as the House had done. U.S. Sen. Shelby has reluctantly agreed with the Majority Leader that his Committee will have to await an overall deal before moving forward. The hope is for such a deal to arrive by the end of July, but it could be delayed until the fall.
Discussions to reach an overall agreement are ongoing. U.S. Rep. Nancy Pelosi (D-CA), the Speaker of the House, has met again with the U.S. Secretary of the Treasury Steven Mnuchin concerning a package that would include the top-line numbers for the budget and an extension of the debt limit, which also must be done this fall. FY20 begins Oct. 1.
U.S. Rep. Pelosi is hopeful that those discussions can be concluded by the end of this month, before Congress takes its annual recess for the month of August. Time will tell, but a budget agreement would represent evidence of greater bipartisan cooperation in Congress as well as between the legislative and executive branches than we have seen so far this year.
ADEA Advocacy and Government Relations (AGR) will keep you informed about how these discussions progress and their potential impact on funding for oral health programs and/or whether there will be another government shutdown.
Committee Holds Hearing on Trump Administration and the Affordable Care Act
On July 10, the U.S. House of Representatives’ Committee on Oversight and Reform held a hearing titled “The Trump Administration’s Attack on the ACA: Reversal in Court Case Threatens Health Care for Millions of Americans [ [link removed] ] ,” to examine the Trump Administration’s decision to reverse its position in Texas v. United States, and the impact this reversal could have on millions of Americans.
Plaintiffs
in Texas v. United States [ [link removed] ] , led by Texas Attorney General Ken Paxton (R), have challenged the constitutionality of the Affordable Care Act (ACA) on the grounds that the U.S. Congress rendered the law unconstitutional when it removed the individual mandate penalty. In a 2012 earlier ruling, the U.S. Supreme Court upheld the ACA on the grounds that the penalty was a tax
and because the law charged a tax, it fell under Congress’ constitutional authority to levy taxes. In December, a federal judge ruled in favor of the plaintiffs and found the entire ACA unconstitutional. The case is now under review by a U.S. Court of Appeals. On March 25, the U.S. Department of Justice announced in a letter filed with the U.S. Court of Appeals that it would no longer defend any part of the ACA in the Texas v. United States litigation.
The House hearing panel consisted of seven witness, six of whom defended the ACA. Each witness provided his or her respective statement and then answered questions from the Committee.
After a couple of hours of debate, the Democrats’ takeaways from the hearing testimony include:
• There will be “catastrophic” implications for millions of Americans and the United States healthcare system if ACA is found unconstitutional.
• There is no replacement plan for the ACA.
• Choosing not to defend ACA directly undermines many of the Administration’s own policy goals, including tackling the opioid epidemic.
The Republicans stated multiple “failures” of the ACA and felt there was an unfair lack of representation of witnesses on the panel who spoke about shortcomings of the ACA.
ADEA AGR will monitor developments with the court case and inform you of any developments.
California to Pay $10.5 Million in Dental School Debt
On July 11, the California Department of Health Care Services announced [ [link removed] ] it was paying off $10.5 million [ [link removed] ] in student loan debt for dentists. The CalHealthCares program provides dentists with up to $300,000 in student loan repayment for maintaining a case load that consists of at least 30% Medicaid patients for five years. The program was created to increase the number of providers willing to serve Medicaid populations, as low rates of Medicaid reimbursement often make it difficult for providers to treat Medicaid patients while also attempting to pay off student debt.
Please refer to ADEA’s overview of State and Federal Loan Forgiveness Programs [ [link removed] ] to learn about student loan repayment programs for dental professionals in other states.
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
Phillip Mauller, M.P.S.
ADEA Senior Manager for Advocacy and Government Relations
Ambika R. Srivastava, M.P.H.
ADEA/Sunstar Americas, Inc./Jack Bresch Legislative Intern
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