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Health - 10/9/02 Letter  to Senators Daschle & Lott re: NCSL FY 2003 Health Priorities. Click here for a printer-friendly version of this letter (letterhead format) (Adobe Acrobat Reader Required)

October 9, 2002

Dear Senator Daschle and Senator Lott:

On behalf of the National Conference of State Legislatures (NCSL) I would like to take this opportunity to call to your attention NCSL health care priorities as the end of the second session of the 107^th Congress draws to a close. Most states began their 2003 fiscal year on July 1^st and are finding it to be a difficult year. Given the slow national economic recovery, we are anticipating an even more challenging FY 2004. Your continued support for priority issues for the states is crucial to preserving states' ability to meet the needs of our shared constituents during these challenging economic times. The proposals below will provide critical assistance to states as we work as partners with you to support our mutual constituents.

Medicaid

• Hold harmless those states that would otherwise have their federal matching payments (FMAP) under Medicaid reduced, combined with a temporary FMAP increase for every state. This proposal ameliorates the lag between the scheduled FMAP updates, based on per capita income, and the recent economic downturn. The holdharmless proposal is critically important to stabilize the Medicaid program during these challenging times. States scheduled to receive an increased FMAP would still receive it.
• Temporary Increase in Federal Matching Payments (FMAP). NCSL supports a temporary increase in federal Medicaid matching payments for all states. We do not support the provision in the previously enacted version (S. 812) that imposes a maintenance of effort (MOE) requirement on program eligibility. This is a fundamental change in the Medicaid program. Under current law, a set of mandatory eligibility categories and benefits is established. States are then given the option to expand their programs beyond those mandated by law. All states have done so. The MOE provision, which would require states to maintain whatever eligibility provisions were in place as of January 1, 2002, would make all of those categories mandatory for purposes of obtaining relief under this provision. In these difficult economic times, states must be given the maximum flexibility to establish what mix of eligibility, benefit and reimbursement changes should occur, if such changes are necessary, to best meet the needs of its citizens.
• Medicaid Disproportionate Share Hospital (DSH) Payments. Under current law, reductions in Medicaid DSH payments are scheduled to occur in FY 2003. NCSL urges you to repeal the scheduled reductions.
• Extension of Temporary Medical Assistance (TMA) - Under current law, the program sunsets September 30, 2002. NCSL supports a three-year extension of the program.

• Extension of the Availability of Expiring SCHIP Funds and Provision of Additional Flexibility to States - Under current law, more than $3 billion in SCHIP funds will revert back to the federal treasury at the end of FY 2002. The President recommends that the funds be made available to states through FY 2006. NCSL urges you to approve legislation that will: (1) keep all the SCHIP funds in the states; (2) assist states that have expended all of their SCHIP allotments; (3) assist and provide additional flexibility to states that have not expended all of their SCHIP funds, by providing additional program flexibility and additional time to spend the funds; and (4) authorize states to extend SCHIP eligibility to pregnant women over age 19 and to legal immigrant children and their families.

• Repeal the 15% payment reduction for Medicare home health services.
• Enact a Medicare Prescription Drug Program - Seniors need the financial and medical protection of a benefit that is fixed and uniform across the states. The prescription drug benefit should have no requirement relating to the use of state funds now used for existing state programs and should be: (1) Comprehensive; (2) Universal; (3) Affordable, the beneficiary share of the premiums should be set low enough so that individuals are not forced into the Medicaid program; and (4) Voluntary. If additional low-income individuals are made eligible for the Medicare program through program reforms, including the establishment of a prescription drug benefit, the additional program costs should be 100 percent federally funded.
• Equalize Medicare Hospital Payments Between Urban and Rural Hospitals.

Health Care Access/Health Care for the Uninsured - Below are some ideas of how the federal and state governments can partner to bolster the health care safety net for American workers and their families.

• Establish a temporary, fully federally funded, medical assistance program. A block grant to states to provide temporary medical assistance is an attractive option that would authorize states to buy in to existing health care programs (e.g. state or local employee health plans or community health centers) or to provide coverage through other innovative approaches. The advantage to this approach is that coverage that is less expensive than COBRA may be identified which would permit the funds to cover more individuals and families. Many affected workers or their dependents will be eligible for COBRA continuation coverage. Unfortunately, this coverage is expensive. Without substantial assistance, either through direct subsidies or through tax credits, many individuals and families will be unable to afford the premiums. As a result, substantial funds will be needed to provide premium assistance sufficient to enable low and moderate-income people to receive assistance. The grant program could be a companion piece to provide coverage to low and moderate income individuals and families that are ineligible for COBRA continuation coverage or that cannot afford COBRA premiums even with assistance.

Other Legislative Priorities

• Reauthorize the National Health Services Corps and Community Health Centers (S. 1533, H.R. 3450). The programs authorized under this legislation provide critical support to low income individuals who live in underserved areas, both urban and rural. We urge you to work towards a compromise on the House and Senate versions of this important legislation.
• Enact Legislation to the Improve Access to Physicians in Medically Underserved Areas (H.R. 4858). NCSL urges you to support legislation enacted by the House to allow states to continue to utilize foreign physicians in underserved areas across the country.
• Enact Legislation Providing Additional Resources to Assist State and Local Governments Responding to the West Nile Virus (S. 2935, H.R. 4793). NCSL urges you to enact S. 2935 providing additional resources to local governments to respond to the West Nile Virus.
• Provide Funding for the Nurse Investment Act (P.L. 107-205). NCSL urges you to provide funding in FY 2003 for implementation of the provisions of the Nurse Investment Act.

Thank you for your consideration of NCSL's concerns. If you need additional information, please have your staff contact Joy Johnson Wilson (202-624-8689) or Ellen Mee (202-624-3578) in NCSL's state-federal relations office in Washington, D.C.

Sincerely,

Angela Monson
Oklahoma State Senate
President, NCSL

cc: Members, United States Senate