Dec. 18 Federal Update: Child Tax Credit on the Docket for Year-End Tax Deal

House and Senate members are actively involved in last-ditch negotiations on a year-end tax deal that would address key issues for both Democrats and Republicans. Ahead of the 2024 election, Democrats are pushing for a strengthened Child Tax Credit (CTC) to address rising childhood poverty after a refundable CTC expired in 2021. Republicans are hoping to reinstate full deductibility for research and development investments, a provision that lapsed in 2022. Senate Finance Committee Chairman Ron Wyden (D-Ore.) and House Ways and Means Chairman Jason Smith (R-Mo.) are collaborating on a potential package, with an estimated cost of around $100 billion.

If a deal cannot be made by the end of the year, both sides of the aisle are eyeing passage of the bill in January. This is good news considering a similar deal was attempted and failed last December, and talks did not continue into the new year. Nevertheless, the $100 billion tax deal is expected to encounter numerous challenges, such as determining the appropriate legislative vehicle to pass the deal as well as Congress needing to reach consensus on essential appropriations bills.

Special Committee on Aging Holds Hearing on Substance Use Trends Among Older Adults

On Dec. 14, the Senate Special Committee on Aging convened its 11th hearing of the 118th Congress to address substance use disorder in older adults. Chairman Bob Casey (D-Penn.) and Ranking Member Mike Braun (R-Ind.) introduced the hearing by providing context. The National Survey of Drug Use and Health reported that nearly 4 million older adults had a substance use disorder in 2022. The committee is also addressing the overlooked issue of synthetic drugs, like fentanyl, with overdose death rates increasing by 53% among older Americans. According to the senators, the hearing aimed to shed light on the challenges faced by older adults with substance use disorders, emphasizing gaps in data, stigma, and barriers to accessing treatment, while also addressing the broader fentanyl crisis affecting different demographic groups and regions of the country.

The first witness, Keith Humphreys of Stanford Medical School and a former White House drug policy advisor, emphasized the need for urgent policy actions, pointing to factors such as the growing number of pharmaceutical products, changes in drug tolerance with aging, generational substance use patterns, and the expansion of synthetic drugs contributing to the crisis. The second speaker, James W. Carroll, former director of the White House Office of National Drug Control Policy, advocated for tailored treatment for older adults, accountability in treatment centers, supply-side interventions to counter the influx of synthetic drugs, and comprehensive prevention efforts, including education, naloxone availability, and safe disposal of medications.

The next witness, Deborah Steinberg, representing the Legal Action Center, highlighted the organization’s Medicare Addiction Parity Project, which has found that financial barriers in Medicare persist. She recommended addressing remaining gaps, including discriminatory standards, barriers in Medicare Advantage plans, and the need to expand coverage for community-based and residential substance use disorder treatment. The final speaker, William Stauffer of the Pennsylvania Recovery Organization Alliance, highlighted the prevalence of negative attitudes and stigma surrounding addiction in society, especially affecting older adults due to ageism, leading to underreporting and insufficient support. The speaker proposed initiatives such as a Master Plan for Older Adults, investment in the substance use disorders workforce, and the establishment of an Older Adult Recovery Community Corps to utilize the strengths of older adults in recovery.

HHS Announces New Guidelines for HCBS Worker Registries

The U.S. Department of Health and Human Services (HHS) has rolled out directives via the Centers for Medicare & Medicaid Services (CMS) to enhance accessibility to home- and community-based services (HCBS). The central focus revolves around the establishment and management of worker registries, advanced platforms that identify health workers delivering Medicaid-covered HCBS to specific groups, like those grappling with disabilities and the elderly. The guidelines underscore the availability of substantial federal funding, courtesy of the American Rescue Plan (ARP), which earmarked aid to states for these registries. In a statement, HHS Secretary Xavier Becerra said, “The Biden-Harris Administration has distributed $37 billion from the American Rescue Plan across all 50 states for home- and community-based services. Additionally, we are delivering new guidance to states about how direct worker registries can help ensure more individuals receiving Medicaid-covered services can receive care in a setting of their choice.”

The guidelines are geared toward helping Medicaid recipients stay in their homes and neighborhoods, rather than utilizing nursing homes. Additionally, CMS highlights how ARP funds have been strategically injected to strengthen HCBS workers registries, allowing states to access a verified list of professional home care workers. This initiative dovetails with overarching endeavors in support of quality HCBS, which include increased funding, proposed rule adjustments around access and quality, and collaborative ventures with government partners to refine workforce data, all in sync with President Biden’s executive mandate amplifying access to top-notch care and supporting caregivers.

Biden Administration Urges All-of-Government Approach to Naloxone Access

The U.S. Department of Housing and Urban Development (HUD), the White House Office of National Drug Control Policy (ONDCP), and the U.S. Department of Health and Human Services (HHS) have jointly issued a letter urging collaboration between public health departments, health care providers, housing providers and agencies, and community-based organizations. The objective is to enhance access to naloxone and other overdose reversal medications, particularly in public housing facilities, multifamily housing and housing counseling programs, and programs for individuals experiencing homelessness. The joint effort aims to address overdoses happening within homes and encourage housing providers to ensure access to effective medications that can reverse an overdose. The guidance stresses the importance of making overdose reversal medications readily available in all public spaces, such as schools, libraries, and community institutions.

The guidance aligns with President Biden’s Unity Agenda, which calls for a collective response to the nation’s overdose epidemic, de-stigmatization of substance use disorders, and emphasis on recovery. “Naloxone and other overdose reversal medications save lives and should be as available in public housing as smoke detectors and fire extinguishers,” said to Richard Monocchio, HUD’s Principal Deputy Assistant Secretary for Public and Indian Housing. The letter underscores the federal government’s commitment to a flexible and collective response to the evolving overdose epidemic, working together at federal, state, and local levels. It also aligns with President Biden’s National Drug Control Strategy and the investments made in the State Opioid Response (SOR) grant program, which has already helped states acquire nearly 9 million naloxone kits and reverse over 500,000 overdoses.

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