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Government funding deal brings wins for children, families

February 1, 2023

After weeks of negotiation, Congress passed a sweeping $1.7 trillion federal government funding package, which was signed into law by President Joe Biden. The deal, which funds the federal government for this fiscal year, includes several important advocacy wins for children and families.

As congressional leaders ironed out the details of the agreement, the Academy and its members pursued extensive advocacy efforts to urge lawmakers to prioritize the needs of children and families in their federal spending decisions. As is typical for the end of the congressional calendar, especially during a lame duck session, it was a race to the finish line to advance key policies before the start of a new session this year.

Following is a look at some of the notable AAP-championed priorities included in the comprehensive package and what they mean for children, families and pediatricians.

Funding for home visiting programs

Without action from Congress, the law that authorized the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program was set to expire. Home visiting programs, long supported by the Academy, connect new parents with specially trained home visitors who can offer support, expertise and guidance.

The spending deal extended the MIECHV program and will double its funding over the next five years. Additionally, it doubles the program’s funding to serve more American Indian and Alaska Native families and continues to allow families the option of virtual home visits while retaining the program’s rigorous quality standards. The Academy had been calling for Congress to take these steps to strengthen the program, which reaches fewer than 5% of eligible families.

In the weeks leading up to the deal’s passage, hundreds of AAP members called on their lawmakers to extend and expand funding for MIECHV. In addition, Committee on Federal Government Affairs members met with their legislative offices on the issue, and an op-ed by AAP Immediate Past President Moira A. Szilagyi, M.D., Ph.D., FAAP, was published in The Hill.

“It is time we make sure that all eligible families can receive the lifelong benefits that home visiting can offer,” Dr. Szilagyi wrote.

Access to health care coverage

The agreement included several critical provisions aimed at improving access to health care coverage for children and families.

Notably, the deal provides children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) in every state with a full year of eligibility, regardless of changes in family circumstances. The new continuous coverage requirement will take effect in 2024. This long sought-after AAP priority will help ensure children do not experience disruptions in coverage or face administrative barriers to remain enrolled.

Further, Congress de-linked the Medicaid continuous coverage requirement from the public health emergency. The continuous eligibility requirement — which kept individuals enrolled in Medicaid during the emergency — has been in place since the passage of COVID-19 relief legislation in 2020.

Now, states have long-anticipated clarity that the continuous coverage requirement will end March 31, regardless of when the federal public health emergency declaration ends. That means, starting on April 1 states will begin what is known as the 14-month “unwinding process” to redetermine Medicaid eligibility for its enrollees, equipped with guidance from the Centers for Medicare & Medicaid Services on how to navigate the process.

Congress also included several guardrails for states to follow throughout this process and ways to hold them accountable, such as monthly public reporting and requirements for outreach to families. The Academy is following this undertaking and will continue to provide chapters with support and resources.

Additionally, the spending agreement extended CHIP funding for two years, made permanent the state option to extend postpartum coverage in Medicaid and CHIP from 60 days to 12 months, and provided Medicaid funding for Puerto Rico and other territories.

AAP-championed child health bills  

Sweeping year-end spending legislation also provides a timely vehicle for smaller bills to advance. This year’s spending agreement included several AAP-championed bills, sending them on for passage into law:

Stop Tip-overs of Unstable, Risky Dressers on Youth (STURDY) Act: This legislation requires the Consumer Product Safety Commission to set mandatory safety standards for dressers and similar furniture products made in the United States, which will help protect children from furniture tip-overs and save lives.

Providing Urgent Maternal Protections (PUMP) for Nursing Mothers Act: This legislation expands workplace protections for nursing workers for time and space for pumping, reaching an additional 9 million women.

Pregnant Workers Fairness Act: This bill ensures workplace accommodation protections for pregnant and postpartum workers that allow them to stay healthy and financially secure, such as a private space for lactation needs.

Sober Truth on Preventing (STOP) Underage Drinking Act: The spending agreement reauthorized this legislation for five years, including a first-ever $3 million annual authorization for the AAP-supported grant program to train pediatric providers in screening, brief intervention and referral to treatment (SBIRT) for alcohol use.

Other AAP policy priorities received funding, including but not limited to gun violence prevention research, pediatric subspecialty loan repayment and global health.

Looking ahead

The expanded child tax credit and reauthorization of the Child Abuse Prevention and Treatment Act were among the AAP’s priorities that were not included in the year-end agreement.

With a new Congress in Washington, D.C., the Academy will continue to advocate for these policies and many others that are most supportive of children, families and pediatricians. Importantly, the AAP will build on the progress made for children’s health to ensure the policies that did become law are addressing children’s needs effectively as they are implemented.

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