THIS WEEK’S DOSE

• Upcoming FY 2024 Funding Deadlines: Congress returns for the second session of the 118th Congress next week, as deadlines to advance FY 2024 spending bills quickly approach. Four of the 12 annual appropriations bills are currently funded through January 19, and the remaining eight through February 2.
• Medicaid Unwinding Enrollment Data: The US Department of Health and Human Services (HHS) released new data on Medicaid and Children’s Health Insurance Program (CHIP) enrollment changes among children and youth as Medicaid unwinding continues. Secretary Becerra sent letters to nine states with the highest child disenrollment rates, urging them to adopt additional federal strategies and flexibilities to help prevent children and their families from losing coverage.
• OMB FAQ Document on FY 2024 Discretionary Spending Limits: The Office of Management and Budget (OMB) released a frequently asked questions (FAQ) document about the discretionary spending limits imposed by the Fiscal Responsibility Act (FRA) and their impact on federal agencies.

CONGRESS

Congress Returns Next Week to Face Imminent Funding Deadlines. The Senate will return to session on January 8, and the House will return on January 9. Lawmakers face an immediate time crunch on FY 2024 appropriations, as the current stopgap continuing resolution (CR) is set to expire on January 19 for four of the 12 annual funding bills, and on February 2 for the remaining eight. The first CR may also include temporary extensions of expiring health programs, including funding for community health centers, the National Health Service Corps and the Special Diabetes Programs and preventing cuts to the Medicaid disproportionate share hospital program.

These fast-approaching deadlines may provide an opportunity for Congress to advance additional health policy priorities, such as efforts to address Medicare physician payment cuts, the continuation of the Medicare alternative payment model bonus, transparency provisions and pharmacy benefit manager reforms. Once the parameters of a funding agreement are reached, it is expected that lawmakers will work to add such health policy provisions to the package. Details are expected to become clearer in the coming days, and we will provide updates as developments occur.

ADMINISTRATION

Administration Releases Medicaid and CHIP Renewal Data. HHS released new data on state Medicaid and CHIP enrollment changes among children and youth since full eligibility renewals for these programs restarted in 2023. According to the data, states that have taken up more of the federal strategies provided by the Centers for Medicare & Medicaid Services (CMS) and that prioritized auto-renewals have helped more eligible children renew Medicaid and CHIP coverage. Many of CMS’s flexibilities make it easier for states to renew eligible children’s coverage by using data the state already has available. More than 88 million people, including almost 40 million children and youth, were enrolled in Medicaid and CHIP coverage as of September 2023. Before the pandemic, in February 2020, about 71 million people were enrolled in Medicaid and CHIP, including about 35 million children.

In light of this data, CMS released new comprehensive guidance to states on strategies to protect Medicaid and CHIP coverage for children during this return to regular Medicaid and CHIP renewals. The guidance also announced an extension of these federal strategies for states through the end of 2024.

On a related note, Secretary Becerra sent letters to the governors of nine states with the highest child disenrollment rates by number and percentage, urging them to adopt additional federal strategies and flexibilities to help prevent children and their families from losing coverage. Those states include Arkansas, Florida, Georgia, Idaho, Montana, New Hampshire, Ohio, South Dakota and Texas. These nine states account for about 60% of the decline in children’s Medicaid and CHIP enrollment from March through September 2023, as indicated in the data release.

OMB Releases FAQ Document on FY 2024 Discretionary Spending Limits. The December 22, 2023, document discusses the provisions of the FRA—the debt limit agreement reached by Congress in June 2023 that suspends the limit on federal debt through January 1, 2025, and makes several changes that affect discretionary spending limits for FY 2024. The FAQ seeks to provide additional clarity as Congress continues to work toward an agreement on FY 2024 appropriations bills.

The FRA included discretionary spending limits that would be relevant with the passage of full-year appropriations bills (section 101) and interim discretionary spending limits that would be enforced after April 30, 2024, if full-year appropriations bills are not signed into law (section 102).

OMB also notes that it will take no action on January 1, 2024, and no additional action should be taken by agencies to reduce impacted discretionary funding, even though a short-term CR will be in effect at that time. Under the FRA, spending limits would not be enforced until full-year appropriations are enacted, or April 30, whichever comes first. The document includes 14 FAQs about the discretionary spending limits imposed by the FRA and their impact on agencies.

In related news, the Congressional Budget Office (CBO) sent a letter to the House Budget Committee providing information about implementation of the caps on most discretionary funding for FY 2024 as established by the FRA. The letter provides CBO’s assessment of the effects of the caps on discretionary funding in FY 2024 and notes that those effects will depend on the nature and timing of appropriation legislation and on decisions by OMB.

QUICK HITS

• CMS Releases Enrollment Figures for Medicare, Medicaid & CHIP. As of September 2023, more than 66.4 million people were enrolled in Medicare and more than 88.4 million people were enrolled in Medicaid & CHIP. View the data here.
• Administration Announces Guidance to Expand Naloxone Access. HHS and the General Services Administration announced new guidance recommending that all federal facilities include overdose reversal medications in their safety stations onsite. The recommendation will make life-saving medications such as naloxone more readily available in case of emergency.
• GAO Releases Report on Medical Device Cybersecurity. The US Government Accountability Office (GAO) found that available data on cybersecurity incidents in hospitals does not show that medical device vulnerabilities have been common exploits. GAO notes that the US Food and Drug Administration (FDA) is responsible for ensuring that medical devices sold in the United States provide reasonable assurance of safety and effectiveness.
• GAO Announces MACPAC Commissioner Nominations. Nominations for new Medicaid and CHIP Payment and Access Commission (MACPAC) commissioners will be accepted through January 25. Appointments to MACPAC based on these nominations will be effective in May.
• AHRQ Announces Nominations for US Preventive Services Task Force. Nominations must be received electronically by March 15 to be considered for appointment in January of the following year. Responses can be submitted electronically here.
• FDA Authorizes Florida’s Drug Importation Program. FDA authorized Florida’s Agency for Health Care Administration’s drug importation program under section 804 of the Federal Food, Drug, and Cosmetic Act. Through this pathway, FDA may authorize section 804 importation program (SIP) proposals from states or Indian tribes to import certain prescription drugs from Canada if the SIP will significantly reduce the cost to the American consumer without imposing additional risk to public health and safety. Read FDA’s press release here.

NEXT WEEK’S DIAGNOSIS

The House and Senate are scheduled to return to session next week. Congress will be tasked with advancing FY 2024 spending bills, or another short-term stopgap, as the current CR deadlines of January 19 and February 2 quickly approach.