JANUARY POLICY AND ADVOCACY WEBINAR The Latest Developments for Health Centers on the Hill: Challenges, Opportunities, Priorities, Asks, Messaging

JANUARY POLICY AND ADVOCACY WEBINAR The Latest Developments for Health Centers on the Hill: Challenges, Opportunities, Priorities, Asks, Messaging

IN THIS BRIEFING, WE LL COVER: Congressional Update: Challenges and Opportunities for Health Centers in 2017 Priority Issues and Strategy: The Two Pillars: CHC Funding and Medicaid, plus: 340B! Advocacy Update: Key action steps to take today and the resources to help you take them

MAJOR DEVELOPMENTS SINCE OUR LAST WEBINAR House and Senate take first steps toward ACA repeal Repeal and Delay is out, repeal and replace back in as Governors, providers, skeptical Senators weigh in President-elect has given some more indication of health care plans insurance for everybody NACHC held in-person SLC meeting and targeted fly-in New materials! (and recording of last webinar) at www.saveourchcs.org/makethecase.cfm

THE FUTURE OF THE AFFORDABLE CARE ACT Congress has begun the process of repealing and replacing the Affordable Care Act, but that is easier said than done. Big Questions remain unanswered: What s on and off the table in a potential repeal? How long will implementation of repeal be delayed? What happens in the meantime? What does a replacement plan look like? What role is there for Health Centers? What has (or doesn t have) the votes to pass Congress?

POTENTIAL TIMELINE FOR REPEAL AND REPLACE PASSED 51-48 PASSED 227-198 Senate Budget Resolution Vote (January 12) House Repeal Bill Vote (early late Feb?) Repeal Bill Signed Into Law (unclear) House Budget Resolution Vote (January 13) Senate Repeal Bill Vote (Late Feb March?) Replace Plan Enacted (simultaneous) Repeal Bill Introduced in Committee (begins ASAP) Conference Committee/ House Vote Budget Resolution includes instructions to repeal parts of ACA through reconciliation Budget Resolution will not make any immediate changes to ACA once voted on by House and Senate; it merely sets up Congress for the next step in the process Repeal bill will begin in the House to comply with budget-related constraints of reconciliation Still not clear when, and in what form, we will see Congress s plan for replace

REPEAL AND REPLACE WHAT WE KNOW NOW Repeal already underway. Congress passed resolution unlocking Budget Reconciliation - only needs 51 votes but can only do certain things Repeal bill would likely undo big pillars of ACA: Medicaid Expansion, Subsidies for Exchange Individual/Employer Mandates, taxes Likely repeal plan would keep some pieces of ACA pre-existing conditions, coverage to 26, CHC/NHSC funding mechanism, THCGME, Medicare PPS Unclear what replace elements will go with repeal Replace will be much more complicated, many parts require 60 votes in Senate, i.e. bipartisan Several major plans, including Ryan A Better Way, but little consensus on a path forward All are coverage/insurance focused, and contain: Medicaid block grants or other reforms High-risk pools for sicker, poorer individuals Tax credits to purchase private coverage President-elect Trump: It will be repeal and replace.could be the same hour.

WHERE DO HEALTH CENTERS FIT? MESSAGING: Everyone needs a place to go for care. Health Centers are a local solution to the national challenge of access to primary care. Health Centers are innovators consumer-driven and patient-centered. Health Centers deliver value and impact for the health system and taxpayer: Access: 25 million patients, nearly 10,000 locations Integrated Care: Medical, Dental, Behavioral, all under one roof Cost-Savings: 24% lower TOTAL Medicaid costs Economic Impact: 188,852 employees, $39 billion in economic activity Health Centers are on the front lines of the most challenging health crises: veterans access, the opioid epidemic, public health issues like Zika, etc. Health Center stability rests on two key pillars: targeted federal investments and a strong Medicaid program. These elements must be protected and strengthened.

NACHC LEGISLATIVE PRIORITY AREAS IN 2017 MEDICAID CHC GRANTS WORKFORCE 340B 49% of Patients Largest Revenue Source for FQHCs We serve 1 in 6 of all beneficiaries Unique FQHC Payment System Foundation of CHC model Vital to care for un, under-insured Mechanism for growth in Sites, Services Vital to achieving mission 54% of NHSC in FQHCs THCGME Program If fully staffed, could serve 2m+ Key for stretching federal dollar Ensures access to prescription drugs for our patients All FQHCs are Covered Entities

MEDICAID CHC GRANTS WORKFORCE 340B HIGHEST PRIORITY Foundational to entire system the two pillars that hold up every community health center Unique policy to CHCs NACHC is central player We ll do a recap/update today HIGH PRIORITY Enormously important to CHCs viability, sustainability Debate will happen within or alongside other debates NACHC leads coalition efforts We ll talk 340B today

OUTLOOK & UPDATE MEDICAID OUR ASK FAQ & KEY MESSAGING

OUTLOOK & THREATS IN 2017 Big changes to Medicaid are ON THE TABLE in 2017. 3 major ones being discussed: Repeal of ACA Medicaid Expansion Block Grants or Per-Capita Allotments Increased Flexibility for State Programs

OUR ASK Support a strong Medicaid Program that works for Health Centers and our patients Don t put patients coverage at risk. We are concerned about repeal/changes without a plan for continuity of meaningful coverage AND access to care.

ZOOMING IN: MAKING THE CASE FOR FQHC PPS With everyone pushing State Flexibility, how do we defend a federal payment protection for Health Centers? 1. The Health Center PPS was specifically designed to make Health Centers more accessible to Medicaid patients, who already have a hard enough time accessing care. 2. The PPS was also designed to protect the federal grant investment paying health centers a fair rate so that grants wouldn t be diverted to cover underpayments by Medicaid. 3. Changes to the Medicaid program should prioritize things that deliver value PPS delivers value. Health centers serve 15% of all Medicaid patients for less than 2% of total Medicaid spending, and save 24% on total costs compared to other providers. 4. There is already flexibility built in to our payment system. If the CHC and the State agree, they can use an alternative payment methodology. More than 20 states are doing this, with success.

FAQ:? WHAT DO YOU THINK ABOUT CHANGING MEDICAID TO A BLOCK GRANT OR A PER- CAPITA CAP? I can t speak to the details of a proposal without having seen specifics, but I can tell you Medicaid is vital for our patients and our Health Center s viability. That said, based on what I know, we have real concerns with these ideas, given the clear potential for cuts to benefits, eligibility, provider payments, especially if expansion is repealed. We want to work with you to be sure any changes maintain meaningful coverage for our patients, and protect key elements, like the Health Center PPS, so we don t put patients at risk.

ADVOCACY TIP Fill out the Medicaid Impact Statement Find a few stories to go along with the numbers you present in the impact statement

KEY FACTS & BACKGROUND OUTLOOK & UPDATE CHC GRANTS OUR ASK F.A.Q. & KEY MESSAGING

KEY FACTS & BACKGROUND The Health Centers Funding Cliff 6 5 4 3 2 1 0 Community Health Center Operational Funding: FY 2011 FY 2018 1 1.2 1.5 2.2 3.6 3.6 3.6 1.6 1.6 1.5 1.5 1.5 1.5 1.5 1.5 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 Base Discretionary Appropriation ACA Health Centers Fund H.R. 2/MACRA? No action = 70% cut to 330 funds Would affect every CHC, not just newly funded/expanded NHSC, THCGME also at risk HRSA s Own Impact analysis: 2,800 sites closed 9+ million patients lost 50,000+ jobs lost Would quickly reverse more than 2 decades of bipartisan investment

OUTLOOK & THREATS IN 2017 Cliff WILL happen if Congress does not act by September 30 th. Limited vehicles, and all will be controversial. Other Key Programs (CHIP being the largest) have the same expiration date. Must be coordinated. CHCs are bipartisan. But debate over our funding will happen in tandem with other highly divisive debates.

OUR ASK Sustain Health Center Funding on a long-term basis by fixing the cliff Build in targeted new investments to address increased demand and to ensure stability for patients

FAQ:? WE VE PUT A LOT OF MONEY TOWARD HEALTH CENTERS THESE LAST FEW YEARS. WHAT DO YOU HAVE TO SHOW FOR IT? We deeply appreciate your support and take our responsibility as stewards of federal funds seriously. Examples: NAPs, Service Expansions (especially Behavioral Health, Opioid), Quality Improvement, Capital/Construction) Advice: Don t wait for this question. Lead your conversations with Members with a story about recent investments and what they ve meant in terms of access to care for patients.

Community Health Centers: New Expenditures by Category, FY11 - FY16 Base Grant Adjustments BGA Service Expansions (e.g. Dental, BH, SA) BGA SA NAP IDS New Access Points Quality, Outreach, Health IT, Networking Capital Investment Sustaining ARRA Investments HIV BH BH OH PG QI BGA ES ES QI CA NAP NAP NAP NAP NAP DSHII OE Capital Capital HCCN O&E QI HIIP O&E PC MH HIIP FY11 FY12 FY13 FY14 FY15 FY16

Community Health Centers: New Expenditures by Category, FY11 - FY16 New Access Points (ARRA) $78m 126 CHCs Increased Demand (ARRA) $170m 1,100 CHCs Planning Grants $8m 129 CHCs Cooperative Agreements $8m New Access Points $28.8m 67 CHCs PG Capital Improvement $727m 143 CHCs NAP IDS CA P NA Quality Improvement $44m 810 CHCs New Access Points $128m 219 CHCs Base Grant Adjustments Service Expansions (e.g. Dental, BH, SA) New Access Points Quality, Outreach, Health IT, Networking Capital Investment Sustaining ARRA Investments QI NAP Capital Improvement $728m 398 CHCs Base Grant Adjustment $48m 1,159 CHCs New Access Points $19m 32 CHCs HC-Controlled Networks $18m 37 awards Outreach & Enrollment $150m 1,159 CHCs BGA NAP HCCN O&E Base Grant Adjustment $110m 1,20 CHCs HIV Service Integration $9.9m 22 CHCs Behavioral Health Exp. $54.6m 221 CHCs Expanded Services $295m 1,195 CHCs New Access Points $150m 236 CHCs Outreach & Enrollment $58m 1,157 CHCs PCMH Facility Exp. $35m 147 CHCs HIV BH NAP O&E PC MH BGA ES Base Grant Adjustment $165m 1,280 CHCs Behavioral Health Exp. $51.3m 210 CHCs Expanded Services $350m 1,184 CHCs New Access Points $270m 430 CHCs Quality Improvement $99.6m 1,153 CHCs Health Infrastructure $150m 160 CHCs BGA BH ES NAP QI HIIP Substance Abuse/Opioid $94m 271 CHCs Oral Health Expansion $156m 420 CHCs Quality Improvement $100m 1,304 CHCs Delivery System/HIT $90m 1,300 CHCs O&E to NAPs $7m 93 CHCs Health Infrastructure $260m 290 CHCs SA OH QI DSHII OE HIIP FY11 FY12 FY13 FY14 FY15 FY16

ADVOCACY TIP Fill out the Cliff Impact Estimator Think about the impact of a potential 70% cut beyond just the numbers tell a story of what would happen to your health center

KEY FACTS & BACKGROUND 340B OUTLOOK & THREATS IN 2017 OUR ASK & ARGUMENTS

KEY FACTS & BACKGROUND FQHCs are the type of safety net provider that the 340B program was intended to support FQHC participation in 340B has bipartisan support in Congress Providing access to pharmacy services and affordable medications is a key component to FQHCs comprehensive care model FQHCs, by statute, are required to reinvest 340B savings to advance their charitable mission

OUTLOOK & THREATS IN 2017 Previous Attempts to Amend the Program: 21 st Century Cures E&C Draft in 2015 pulled after stakeholder concerns HRSA Proposed Mega-Guidance not likely to be released given the change in Administration Continued scrutiny of the program: Outside oversight groups including HHS OIG & MedPAC Drug manufacturers continue to stress the need for legislative changes to address their concerns around the growth of the 340B program in recent years While Health Centers are not the focus of recent scrutiny, any potential legislative changes could unintentionally impact Health Centers

OUR ASK Preserve health centers ability to stretch scarce federal resources through continued access to the 340b program If changes to the 340b program are being considered, take into account the unique role of Health Centers and other grantees

OUR ARGUMENTS 1. 340B ALLOWS HEALTH CENTERS TO STRETCH FEDERAL DOLLARS KEY TO PROVIDING MORE COMPREHENSIVE PRIMARY AND PREVENTATIVE CARE FOR OUR PATIENTS 2. ESSENTIAL TO AFFORDABILITY OF PRESCRIPTIONS FOR OUR PATIENTS 340B PROVIDES ACCESS TO PHARMACY SERVICES AND AFFORDABLE MEDICATIONS 3. 340B PROGRAM ALLOWS FQHCS TO SUSTAIN ONGOING OPERATIONS AS CONGRESS CONSIDERS CHANGES TO THE HEALTH SYSTEM, FQHCS WILL CONTINUE TO RELY ON 340B, AND IT IS CRITICAL FOR STABILITY.

ADVOCACY TIP Be prepared with at least one good example of how 340B supports your center. For example, in addition to passing along savings to your patient, perhaps your health center: Has a full-time pharmacist Stays open an extra hour Created a wellness program

SO, WHAT S THE BOTTOM LINE MESSAGE TODAY? Health Centers are one of the few things in health care both parties agree on. As Congress debates the future of our health system, we need to be part of the solution. CHC Grants AND a strong Medicaid program are the 2 pillars of Health Centers success, delivering access to care to patients and cost savings to taxpayers. Will you support fixing the cliff and ensure that Medicaid works for our patients? We are concerned about repealing the ACA without a clear plan to replace it. Please work with us to minimize uncertainty and enact solutions that work for our patients.

Advocacy Update

MAKING THE CASE WITH ADVOCACY: 3 STEPS TO TAKE NOW #1: Commit to staying informed and engaged #2: Complete a health center data analysis #3: Prioritize building advocacy capacity

#1: COMMIT TO STAYING INFORMED AND ENGAGED If you re not signed up already, make sure you go to www.saveourchcs.org NOW and click Join the Campaign You can also text HCADVOCATE to 52886 Mark your calendars for monthly policy and advocacy briefs (recordings will be available on saveourchcs.org): 3:30 PM Eastern Feb. 22 and Mar. 21 Register for February s webinar at bit.ly/feb22chcwebinar Commit to taking action

#2: COMPLETE A HEALTH CENTER DATA ANALYSIS Good data leads to stronger advocacy tell a clear story How would a 70% cut to your grant funding affect your health center operations? Your patients? The services you provide? The community at large? How much of your health center revenue derives from Medicaid? How many of your patients are being served in each FPL bracket or eligibility group under Medicaid? What is the financial impact of Medicaid cuts/changes to your health center in the context of operations, services, and patients? Prepare to show in numbers the importance of grant funding and the Medicaid program to your health center, staff, and patients Now Available: - Updated cliff impact estimator - Template Medicaid impact statement **Both Available on CFAHC website**

#3: PRIORITIZE BUILDING ADVOCACY CAPACITY Being prepared to advocate at ALL levels local, state, and federal is critically important Participate in NACHC s Advocacy Center of Excellence (ACE) Program Follow clearly outlined steps for building an advocacy program Receive national recognition upon completion Learn more: www.saveourchcs.org/ace.cfm

COMING SOON: NEW KEY RESOURCE FOR ADVOCATES A new Health Center Advocacy Network website will launch in march www.hcadvocacy.org Expect a new look and feel as well as easier access Save the Date: March 15 th at 3PM for a webinar launch of the Health Center Advocacy Network website

RESOURCES FOR ADVOCATES PREVIOUSLY RECORDED WEBINARS AND LINK TO REGISTER FOR FEBRUARY S WEBINAR TALKING POINTS ONE PAGE POLICY PAPER MEDICAID SAVINGS STUDY FUNDING CLIFF EXPLAINER ONE PAGERS ON PPS, MEDICAID S IMPORTANCE CLIFF AND MEDICAID IMPACT ESTIMATORS Everything can be found at: www.saveourchcs.org/makethecase.cfm Didn t find what you need? Email: federalaffairs@nachc.org or grassroots@nachc.org.

Questions?