Michigan Council for Maternal and Child Health Friday Notes

March 27, 2015

In this issue

State Budget Update

MIECHV Reauthorization Passes House

Legislation Would Regulate Human Milk Banks

Immunization Record Posting Bills to be Introduced

State Budget Update

House and Senate appropriations subcommittees began reporting their recommendations for the 2015-16 budget this week--showing their differences with Governor Snyder's proposal.

DCH Budget
The House and Senate Appropriations Community Health subcommittees reported their versions of the budget Tuesday, and both rejected the Governor's call to increase the tax on all health insurance claims, known as the Health Insurance Claims Assessment, from 0.75 percent to 1.3 percent and lift the cap on what the HICA can collect.

While both included some reductions to the department that the governor did not propose, most of the $180.1 million cost to the General Fund of not increasing HICA will be borne by other areas of the budget.

Besides the difference on HICA, legislative resistance clearly has developed against Governor Snyder's proposal to remove Medicaid pharmacy coverage from the Medicaid health plans and put the state in charge of the program with one state-established formulary. Both subcommittees rejected the proposal, but required the health plans to find at least the $16.8 million in savings the governor said his change would produce (the House subcommittee budget calls for $18.8 million in savings). In addition, both versions also call for the department and the health plans to work together to develop a single, consensus prescription drug formulary-- a response to messages from the provider community (including MCMCH) that the current system needs to be improved.

Both the House and Senate subcommittees restored $11 million that Governor Snyder recommended cutting to hospitals that qualify for special rural hospital payments based on the amount of obstetrical care and newborn care provided. Both versions suggest cuts proposed to the aid for rural hospitals be restored.

Where the House and Senate split was on the governor's proposal to discontinue funding for Graduate Medical Education out of the General Fund. Snyder proposed increasing the tax on hospitals to replace $56 million in General Fund that had paid for the program. The House agreed to the change, but the Senate rejected it.

House DCH Subcommittee Budget
There is a smattering of cuts the House subcommittee budget contains that the governor did not recommend, and one of the most notable is $2.2 million General Fund in administrative savings from merging DCH with the Department of Human Services.

Other General Fund actions:
- Establishing a $100 placeholder to keep discussion open on the $2 million for the child and adolescent health center "hub" pilot currently underway in three communities despite its lack of inclusion in the executive budget;
- Delaying a 12-bed psychiatric residential treatment facility and a children's behavioral action team to save $1 million;
- Replacement of Gov. Snyder's call for $1.5 million in new funding for a drug policy initiative with a $100 placeholder;
- Cut $531,400 from the children's waiver home care program, wiping out all but a $100 placeholder from what had been a $1.5 million Health Innovation Grants program; and
- Replacement of the $1.5 million Gov. Snyder had recommended for the Pay for Success Maternal and Child Health Pilot Program with a $100 placeholder.
The House also pulled $37.5 million from the Merit Award Trust Fund to replace General Fund money for long-term care services.

And the House budget, in an unconventional move, also would include $361.1 million in supplemental federal funding for the current 2014-15 fiscal year to pay for the higher than expected sign-ups for the Healthy Michigan program that expanded Medicaid eligibility to those with incomes at 133 percent of the poverty level. Usually a supplemental expenditure would be done in a separate bill.

One surprise is that the budget, unlike many of the others that won subcommittee approval Tuesday, does assume a fee increase, specifically one involving liquor fees. Gov. Snyder's budget, if the fee increases pass, would allocate $913,200 to support programming to combat fetal alcohol syndrome disorder. The budget reported by the Senate Appropriations Licensing and Regulatory Affairs Subcommittee on Wednesday does not include the fee increase. The fetal alcohol syndrome program funding in the DCH budget cannot be realized without this increase.

The budget, approved on a unanimous vote, is $127.85 million General Fund above Mr. Snyder's recommendation, but $39 million less in all funds.

Senate DCH Subcommittee Budget
Overall, the Senate budget proposal for DCH is a little more than $135 million General Fund above Gov. Snyder's recommendation.

There's also some savings from various programs being delayed - among them, the expansion of Healthy Kids Dental to Kent, Oakland and Wayne counties. Per the Senate proposal, that initiative is delayed until July 1, 2016, saving about $5.6 million General Fund, but then the Senate expands the program to all children (instead of those 0 through 8 as the governor proposed) in those counties on July 1, 2016 at a cost of about $3.7 million, for a net savings of $1.9 million.

The Senate also proposed an increase of about $208 million gross ($72,284,100 GF) in the Medicaid adult dental reimbursement portion of the budget, a reduction from the roughly $223.3 million ($77,567,400 GF) Gov. Snyder had proposed. The difference comes by assuming the delay of this program to September 1, 2016.

And the Senate also rejects the governor's use of Quality Assurance Assessment Program fund to replace General Fund money for Graduate Medical Education funding and rural/sole hospital funding. Instead, they are continuing the use of GF funding.

Other key items in the Senate subcommittee budget include:

- Delaying a 12-bed psychiatric residential treatment facility and a children's behavioral action team until July 1, 2016 to save $1 million
- Does not assume passage of liquor fee increases (no funding for fetal alcohol syndrome);
- Remove $1.5 million funding for new drug policy initiatives program
$100 placeholder on the $2 million for the child and adolescent health center "hub" pilot (see above);
- Questions on the executive proposal to continue the $2.25 million invested in rural home visiting initiatives resulted in it also only receiving a $100 placeholder.
- Proposing to move several lines in the Health and Wellness Initiatives to consideration by the Michigan Health Endowment Fund.

K-12 Budget
MCMCH also monitors a couple key issues in the state School Aid or K-12 Budget. Budgets reported this week from the House Appropriations School Aid Subcommittee and the Senate Appropropriations K-12 School Aid Subcommittee had some significant differences.

The House budget (HB 4089) cuts the governor's proposed $18.4 million ($2 million GF) for third grade reading but the Senate (SB 130) retained the program.

The Senate subcommittee retained the $35 million the governor had proposed for early literacy, (which includes $5 million for home visiting programs), but doubled the amount for additional kindergarten instruction to $20 million, striking funds for a best practices clearinghouse and for an elementary reading assessment.

Both the House and Senate retained the current funding for the operations line of the child and adolescent (school-based) health centers.

The budget process will continue; although much work happened this week we are still very early in the overall process. Keep reading Friday Notes for additional opportunities for advocacy on maternal and child health issues.

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MIECHV Reauthorization Passes House

Reauthorization of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program took a giant step forward Thursday, as the House approved a two-year extension of the program tucked inside the large, bipartisan bill to fix Medicare provider payments (the "doc fix"). Funding will remain at $400 million a year. The bill also extended another important children's program for two years, the Children's Health Insurance Program (CHIP), set to expire this September.

Thank you to those who have helped step up our advocacy on this issue! Your voices make a difference! On the whole, the outlook for Senate passage seems positive, although the Senate did not vote before adjourning for a spring recess. Senate Majority Leader Mitch McConnell told reporters early this morning that the chamber would take up the House-passed SGR repeal package "very quickly when we get back" from recess. Senators concluded their marathon budget session shortly before 3:30 a.m. Friday.

Even as we celebrate home visiting and CHIP, the House has passed and the Senate is considering budget plans that envision major cuts and changes for programs important to children's well-being. Restructuring and funding cuts would be directed at Medicaid and the Supplemental Nutrition Assistance Program. The budgets also propose additional cuts, on top of those already in place as part of the sequester process, to the discretionary side that funds programs such as Head Start/Early Head Start, part of child care, and early intervention. Both budget plans also would repeal the Affordable Care Act. Budget resolutions do not carry the force of law, but must be implemented through other legislation. We will keep you updated as the budget process moves forward.

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Legislation Would Regulate Human Milk Banks

Rep. Erika Geiss (D-Taylor) and Sen. David Knezek (D-Dearborn Heights) have introduced legislation that would set standards for milk banks to ensure women are not exploited and a proper pasteurization process is used.

Hospitals prefer to use donated and pasteurized human breast milk for babies who cannot receive their own mother's milk, but as for-profit companies have begun paying mothers for breast milk in the state, regulations are needed, the legislators said.

HB 4206 sits in the House Health Policy Committee and will likely see a hearing in April. SB 143, is currently in the Senate Health Policy Committee. The committee process is anticipated to start in the House.

"Multiple studies show that feeding breast milk to premature infants, whether from their mother or another source, has significant short- and long-term benefits," Rep. Geiss said at a Thursday press conference. "Many mothers are unaware that donated breast milk is an option. I introduced this bill to help premature babies recover and also raise awareness of this critical issue."

Geiss also noted the infant mortality rate is among the highest in the nation, at 7.1 deaths per 1,000 live births. In urban areas such as Detroit and Saginaw, infant mortality rates are as high as 15.3 per 1,000 live births, she said.

One of the top causes of infant death is necrotizing enterocolitis, which occurs more frequently in premature infants. Using human milk, as opposed to formula, reduces the incidence of necrotizing enterocolitis, and results in lower hospital readmissions and fewer long-term health issues, she said.

Beth McClellan, a lactation consultant with Sparrow Hospital, said the hospitals in the state get pasteurized breast milk from a Human Milk Banking Association, which has a location in Kalamazoo.

But she said other places have been cropping up in the state, and they do not have guidelines and are taking milk that would have been donated to the nonprofit, causing shortages.

"Our first choice by far is the mother's own milk, and we work hard to get as much of that for their babies that we can," she said. "But there are times when we need to supplement with something else. And it has become the theory that it's species specific. They can get pre-term formula, but it's made with cow's milk and there are certain things in cow's milk you just can't take out."

Jayne Jackson, with Black Mothers' Breastfeeding Association, said it is very common for mothers in Detroit to be a single parent and want to sell her extra breast milk to help pay the bills.

"But when you take a look at her situation, she may, instead of providing that milk and nourishment to her baby, she may take that risk to keep the lights on and get paid," Jackson said. "The bill states that we want to wait 180 days so that that baby has had a nice time period and the mom has built a nice milk supply."

The bills also provide for education to the mothers; screening mothers; collecting, processing and providing human milk; and directing the donated milk to premature and critically ill infants where it is needed most.

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Immunization Record Posting Bills to be Introduced

On Thursday Sen. Curtis Hertel, Jr. (D-East Lansing) announced plans to introduce Senate Bills 259-261, which would require schools and day care centers to post their immunizations rates either online or in their building.

Providing this information will be a major weapon to helping parents protect their children, especially those too young for vaccines or those with weakened immune systems due to chemotherapy or autoimmune disorders, Hertel noted on his social media page.

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Contributors to this Issue
Gongwer News Service
HealthDay
Zero to Three
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Quick Links . . .

DD Council Seeks Feedback
Are you a person with a developmental disability, a family member of a person with a developmental disability, or an advocate for persons with disabilities?
The Michigan Developmental Disabilities Council is gathering information for its next 5-year state plan. This is your chance to tell us what's important to you and what you want the DD Council to do about it. Join us to share your story, explore the challenges that effect your life and talk about the issues that are important to you.

Community Conversations will be held around the state, beginning in Detroit on April 10. Learn more here.

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Webinar: Prevent Cancer Through HPV Vaccination

Registration is now open for the webinar titled, "Prevent Cancer through HPV Vaccination: Update for Health Care Personnel." Please join the Michigan Department of Community Health, the Physician Peer Education Project on Immunization, and P. Ann Ryan, DO, PhD, from Michigan State University on Wednesday, April 29 from 12-1 p.m. (EST).
1.0 CME credit for physicians and nurses will be available and you must register to receive CME credit.
Register online here.
The goals of the webinar are to:
· Define the importance of HPV vaccination for cancer prevention and the rationale for vaccinating at ages 11 or 12
· List the indications for HPV vaccine for girls and boys
· Provide useful and compelling information about HPV vaccine to aid parents in making the decision to vaccinate
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Frontline Vaccine Documentary Re-broadcast, Updated

With measles, mumps and whooping cough making a comeback, FRONTLINE will broadcast a newly updated version of their 2010 documentary The Vaccine Wart on PBS stations.
Here's a link where you can check to see when the documentary airs on your local PBS station:
http://www.pbs.org/wgbh/pages/frontline/local-schedule/
Building on years of research, the documentary explores both the roots of the vaccine debate, and the latest chapter in the heated controversy, including the debate over exemptions and whether children should be allowed to attend public schools if they are not vaccinated.

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Director Lyon Writes Blog Post Promoting Oral Health

This guest blog post was written by Nick Lyon, Director of the Michigan Department of Community Health. The Department participated in a blog carnival to promote the oral health safety net that Medicaid and CHIP provide to children. The Centers for Medicare & Medicaid Services offer a variety of handouts and posters to help oral health advocates educate parents and pregnant women.

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Job Posting: Reproductive Health Unit/Family Planning Nurse Consultant
Application Deadline: April 14, 2015
This position provides statewide family planning, reproductive and maternal/women's health clinical expertise to the Michigan Family Planning program, the division and department. This position assesses related health care and service trends and developments, using this knowledge to develop family planning, women's and men's reproductive health clinical services, standards, policies and protocols. This senior level nursing professional provides clinical expert consultation and technical assistance to state and local providers, and arranges for training, orientation, monitoring and evaluation of clinical services. This nurse also develops clinical protocols/guidelines in compliance with national standard, and federal and state regulations.
This position requires a Michigan Registered Nurse License, and at least three years post-master's experience. Please see the full job description for additional requirements and to apply via the State of Michigan NeoGov system.