This Week on the Hill
The House and Senate are not in session until after the elections, returning on November 13.
Administration Takes Several Actions on Opioids
Last week the administration took several actions to address the opioids crisis, from signing legislation to awarding grants. First, on Tuesday the Secretary of Health and Human Services announced a new demonstration program for treating pregnant women and women with young children who struggle with opioid addiction. The Center for Medicare and Medicaid Innovation will execute up to 12 cooperative agreements with states, whose Medicaid agencies will implement the model with one or more “care-delivery” partners. Next, on Wednesday President Trump signed H.R. 6, a bipartisan bill that includes provisions aimed at stopping fentanyl from coming through the mail, expanding the types of health care professionals who can prescribe medication-assisted treatment, and loosening restrictions on inpatient treatment coverage of Medicaid recipients. Finally, on Thursday Attorney General Jeff Sessions announced the availability of almost $70 million in grant funding to help control the manufacturing and distribution of certain illegal substances and support programs for children affected by the opioid epidemic. Grant recipients for the Office of Victims of Crime funding can be found here, while recipients for the Anti-Methamphetamine Program can be found here and the Anti-Heroin Program can be found here.
Homeland Security Updates REAL ID Compliance Timelines
The Department of Homeland Security recently updated the REAL ID compliance extensions, indicating that as of October 10, 37 states, territories and the District of Columbia have been determined to be compliant with all REAL ID requirements. The remaining 19 jurisdictions have been granted a temporary extension from enforcement, with the extensions granted for only the amount of time that states or territories need to both begin issuing REAL IDs and to complete the department’s compliance review. Additional information on REAL ID can be found here.
Administration Proposes Expansion of Health Reimbursement Arrangements
The Departments of Labor, Health and Human Services, and the Treasury proposed a regulation that would expand the use of health reimbursement arrangements (HRAs). HRAs allow employers to reimburse their employees for medical expenses in a tax-favorable way and this proposed regulation would create a new tax-preferred option for employers of any size to use when funding employee health coverage. The proposed regulation would allow employers offering traditional employer-sponsored coverage to offer an HRA of up to $1,800 per year, indexed annually for inflation, to reimburse an employee for certain qualified medical expenses, including premiums for short-term, limited-duration insurance plans. Comments on the proposed regulation are due by December 28, 2018. The regulation would be effective for plan years beginning on and after January 1, 2020.
OJJDP Awards $172 Million to Support Juvenile Justice
Last week the Department of Justice Office of Juvenile Justice and Delinquency Prevention (OJJDP) announced awards of more than $172 million in grant funding to support state and local juvenile justice systems. The funds were distributed across seven broad categories: mentoring programs and services ($83.12 million); assistance to states ($50.4 million); drug courts and the opioid crisis ($23.3 million); reentry services for youth and families ($13.1 million); law enforcement and youth field-initiated research and evaluation program ($999,396); gang prevention, intervention and education ($800,000); and juvenile justice emergency planning demonstration program ($415,822). Grants were awarded through the assistance to states category to help states improve their juvenile justice systems, train court personnel, and assist nongovernmental organizations in providing juvenile services, with $42.8 million allocated through the Formula Grants Program under Title II of the Juvenile Justice and Delinquency Prevention Act.
CMS Releases New Flexibilities for State Insurance Markets
The Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of the Treasury announced new state flexibilities for state insurance markets under revised guidance for Section 1332 waivers of the Affordable Care Act, which were previously known as State Innovation Waivers and will be known as State Relief and Empowerment Waivers. Specifically, the guidance provides information about the requirements that must be met for the approval of these waivers, including the calculation of pass-through funding, certain analytical requirements, and operational considerations. According to the CMS guidance, state waivers should aim to provide increased access to affordable private market coverage, encourage sustainable spending growth, foster state innovation, support and empower those in need, and promote consumer-driven healthcare. This guidance expands the definition of coverage to include access to more forms of coverage, including short-term plans. CMS intends to release waiver concepts in the near future to give examples of how states can take advantage of these waivers.
Labor Unveils Association Retirement Savings Plan Proposed Rule
The Department of Labor recently announced a notice of proposed rulemaking that would make it easier for small businesses to offer retirement savings plans to their workers through Association Retirement Plans, allowing small businesses to join together to offer 401(k) plans to their employees. According to the press release, approximately 38 million private-sector employees do not have access to a retirement savings plan through their employer. Under the proposed rule, Association Retirement Plans could be offered by associations of employers in a city, county, state or a multi-state metropolitan area, or in a particular industry nationwide. Comments on the proposed rule are due by December 24.
Recently Released Reports
Stability in Overall Pension Plan Funding Masks a Growing Divide
Center for State and Local Government Excellence
The 2018 State CIO Survey
National Association of State Chief Information Officers
Approaches to State Workforce Development Systems
Education Commission of the States
Public High Schools with More Students in Poverty and Smaller Schools Provide Fewer Academic Offerings to Prepare for College
U.S. Government Accountability Office
Kaiser Family Foundation
Medicaid Enrollment and Spending Growth: FY2018 and 2019
States Focus on Quality and Outcomes Amid Waiver Changes: 50-State Medicaid Budget Survey Results
Economic News
GDP Increased 3.5 Percent in the Third Quarter
Last week the U.S. Department of Commerce Bureau of Economic Analysis released data on the gross domestic product (GDP) for the third quarter of 2018 (advance estimate), showing an increase at an annual rate of 3.5 percent. In the second quarter, real GDP increased 4.2 percent. Real gross domestic product is the value of goods and services produced by the nation’s economy less the value of the goods and services used up in production, adjusted for price changes. The increase in real GDP in the third quarter reflected positive contributions from personal consumption expenditures, private inventory investment, state and local government spending, federal government spending, and nonresidential fixed investment that were partly offset by negative contributions from exports and residential fixed investment. The deceleration in real GDP growth in the third quarter reflected a downturn in exports and a deceleration in nonresidential fixed investment. The “second” estimate for the third quarter, based on more complete data, will be released on November 28.
Unemployment Rates Lower in 9 States in September
New data from the Bureau of Labor Statistics shows that many state unemployment rates saw little change in September; 37 states and the District of Columbia had stable unemployment rates, 4 states had higher rates and 9 states had lower rates. Compared to one year earlier, 34 states and the District of Columbia had little or no change, while 16 states had unemployment rate decreases. The national jobless rate declined by 0.2 percentage point from August to 3.7 percent and was 0.5 point lower than in September 2017. Nonfarm payroll employment decreased in 3 states in September, increased in 1 state and was essentially unchanged in 46 states and the District of Columbia. Over the year, 37 states added nonfarm payroll jobs and 13 states and the District of Columbia were essentially unchanged.