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The 2020 Federal Budget: Funding Risks for Key Public Health Programs

Congressional Arguing Over Funding for Key Public Health Programs Puts Them at Risk

With Congress at a political impasse in finalizing a federal budget, a potential government shutdown means critical health programs are at risk.

Women's Health Policy

By Allison Ivie

As the end of the year quickly approaches, so too does the annual Congressional budget deadline for the coming year, placing in jeopardy a number of important public health programs that impact American lives.

Here are just a few key women's health programs currently under funding consideration.

Violence Against Women Act

Passed in 1994, the Violence Against Women Act (VAWA) not only created comprehensive programs and supports for individuals affected by domestic violence, sexual assault, dating violence, and stalking, it also established domestic violence and sexual assault as crimes punishable under law.

Since its passage, VAWA has awarded more than $6 billion to communities nationwide and must be reauthorized every five years. Each reauthorization provides the opportunity for the law to be improved and adjusted to take into consideration the differing needs of communities across the nation based on the latest research and best practices for addressing gender-based violence.

In 2005, for example, VAWA reauthorization created new support systems for American Indian and Alaska Native women, who disproportionately experience violence, and addressed immigrant victims and survivors. Meanwhile, the 2013 reauthorization required college campuses to create action plans to prevent violence and educate survivors on their rights and resources. Additionally, that reauthorization also expanded housing protections to individuals in all federally subsidized housing programs to prevent discrimination against unjust evictions.

This April, the House of Representatives passed the bipartisan Violence Against Women Reauthorization Act of 2019 (H.R. 1585) and advanced the legislation to the Senate for consideration. This reauthorization contains provisions to address the #MeToo movement, improve campus health centers response to sexual assault, and ensures survivors can maintain housing in the event of a breakup with a spouse.

Certified Community Behavioral Health Clinic Demonstration Program

Certified Community Behavioral Health Clinics (CCBHC) provide a range of mental health and substance use disorder services to individuals and communities in need. In return, CCBHCs receive a Medicaid reimbursement rate based on their anticipated costs of expanding services. In order to be eligible, CCBHCs are required to provide 24-hour crisis care, evidence-based practices, care coordination, and nine types of services including:

  • Crisis mental health services
  • Screening, assessment and diagnosis
  • Patient-centered treatment planning
  • Outpatient mental health and substance use disorder services
  • Primary care screening
  • Targeted case management
  • Psychiatric rehabilitation services
  • Peer and family supports
  • Intensive community-based mental health care for members of the armed forces and veterans

The CCBHC began as a demonstration program, piloting the clinics in select states to gather data on the effectiveness and feasibility of expanding the model to more locations. Since then, the program has expanded to 113 CCHBCs across 21 states. However, the latest iteration of eight participating demonstration states, including Oregon, Oklahoma, Minnesota, Missouri, Nevada, New Jersey, New York, and Pennsylvania saw their federal funding expire in September. Today, their funding is sustained only through Congressional stopgap funding bills.

If Congress allows the CCHBC demonstration program to end the results would have devastating effects across the nation including:

  • 77% of CCBHCs will have to reestablish wait lists for services
  • 81% of CCBHCs be forced to close programs or eliminate services
  • 55% of CCBHCs will have to turn patients away from care

Title X Family Planning Program

Created in 1970, the Title X Family Planning Program is a federal grant program that provides contraception counseling, breast and cervical cancer screenings; testing and treatment for sexually transmitted infections (STIs); and pregnancy diagnosis and counseling. The program provides grant monies to more than 3,500 clinical sites, including public health departments and non-profit health centers across the country. In 2016, Title X providers served more than 4 million individuals and their families through approximately 6.7 million family planning encounters.

In March, the U.S. Department of Health and Human Services finalized new regulations that made major changes to the program, including a prohibition from any sites that receive grant monies from providing abortion referrals and mandate referrals to prenatal services for all pregnant patients.

Given this regulatory change, 23 percent of Title X sites have withdrawn from the program, calling the rule unethical and a violation of the patient and provider relationship. Clinics that will no longer utilize Title X funding must rely instead on state funds to provide services, resulting in fewer programs/services, less available of costly contraceptives and a decline in outreach and education efforts.

To mitigate these effects, Senators have attempted to rescind the federal government regulation within the Labor, Health and Human Services and Education FY2020 appropriations bill; however, these negotiations have not been successful. If a solution can is not reached, the current regulations will remain in effect and access to care will continue to be curtailed.

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