February 2008

President's Budget for FY 2009 Released
The President's Budget for FY 2009 was released February 4, and it contains several notable cuts for programs important to local public health.

Public health emergency preparedness programs for local and state capacity building received $609 million, an 18 percent cut from FY2008. The Preventive Health and Health Services Block Grant, which provides flexible funding for disease prevention programs at the state and local level, was eliminated in the budget again this year. The Section 317 Immunization program, which funds immunizations for low income populations, received a small cut of $899,000 from FY 2008.

The Maternal and Child Health Block Grant (Title V) received no change in funding from FY 2008, or $666 million. The President's Budget would also increase funding for the Ryan White Care Act to $2.143 billion, only $1 million over FY 2008.

Despite these drastic cuts, it is unlikely that these proposed funding levels will be enacted by Congress. As the FY 2009 appropriations process moves forward, we will keep you informed of key decision points where your input to your Senators and Representatives is crucial.

For details on the President's Budget proposal for all Health and Human Services programs, go to http://www.hhs.gov/budget/09budget/2009BudgetInBrief.pdf

Action alerts, sample letters and talking points and contact information for your Members of Congress can be found at NACCHO's Legislative Action Center. http://capwiz.com/naccho/home/

Medicaid Rule Cuts Reimbursement for Targeted Case Management
In a proposed rule that goes into effect March 3, the Centers for Medicare and Medicaid Services would require a single case manager for the provision of targeted case management, which helps people with multiple social service needs to navigate the system to get the assistance they need. Local health departments in many states are involved in the provision of these services and would be adversely impacted by this rule and vulnerable people would be at risk of losing access to important services. Local health departments that offer direct clinical service focus on prevention through the provision of such services as prenatal care, preventive health care for children, and participation in the Women, Infants and Children (WIC) nutrition program. Their contact with persons at high risk for multiple health problems puts them in an ideal position to assume the case management role, assuring linkage to the constellation of community services needed to keep vulnerable people as healthy as possible. The new rule seriously threatens the ability of health departments engaged in case management for Medicaid-eligible persons to serve them effectively. (For NACCHO's comments opposing the rule, go to http://www.naccho.org/advocacy/action/letterstotheadmin.cfm)

The comment period on the rule has closed, but Members of Congress have moved to take action to block the rule. Representative Ellison (D-MN) and Senator Coleman (R-MN) have introduced legislation to delay the rule taking effect. On February 14, the Senate agreed by voice vote to attach an amendment to the Indian Health Care Reauthorization bill that would block the implementation of the targeted case management rule. The full Senate has not yet acted on this bill. If your local health department would be affected by this rule and you would like to receive updates on this issue as it moves forward, please contact Eli Briggs, NACCHO Government Affairs Specialist at ebriggs@naccho.org.