Public Health Funding Archives - Page 16 of 29

The Draft House Farm Bill Will Harm Nation’s Most Vulnerable

Washington, D.C., April 12, 2018 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH) on release of “Farm Bill” draft legislation (the Agriculture and Nutrition Act of 2018 (H.R. 2)) to reauthorize key federal agricultural and nutrition programs.

“The Trust for America’s Health is seriously concerned about the draft Farm Bill legislation released today by the House Agriculture Committee, noting that many proposals could weaken or eliminate coverage and benefits under the Supplemental Nutrition Assistance Program (SNAP).

While immediate savings may seem beneficial now, they will evaporate quickly when the nation gets the bill for poor health and nutrition. In addition, when children are hungry they do more poorly in schools and, when adults are under-nourished, they are less productive in their jobs. As such, SNAP and other nutrition assistance programs can help curb healthcare costs in the future while providing immediate economic benefits to communities.

Increasingly, states, cities and other partners are piloting and scaling programs and policies that help SNAP recipients access healthier food options. Proposals that would roll back eligibility and otherwise shrink enrollment will create new health risks for a population of Americans that are already at greater risk of malnutrition. And, without nutrition supplemental programs like SNAP there may actually be increases in obesity because families will be forced to buy the least expensive food, which are often filled with excess calories and have low nutritional value.

According to State of Obesity, obesity remains a significant public health crisis and a national security issue—being overweight or obese is the leading cause of medical disqualifications for military service, with nearly one-quarter of applicants being rejected for exceeding the weight or body fat standards.

Quite simply, while this legislation will directly harm our nation’s most valuable and vulnerable, everyone will shoulder the pain—from lack of education attainment to lack of economic development to lack of national security.

TFAH looks forward to working with Congress and partners to help develop a Farm Bill that will benefit, not harm, Americans’ health.”

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

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New Report: Funding for Public Health Has Declined Significantly since the Great Recession

Core Federal Emergency Preparedness Funding has been cut by More than One-Third Since FY 2002

Washington, D.C., March 1, 2018 – A new Trust for America’s Health (TFAH) analysis—A Funding Crisis for Public Health and Safety: State-by-State and Federal Public Health Funding Facts and Recommendations—finds spending on public health is insufficient.

“A healthy United States is a strong United States. A prepared nation is a safe nation. But persistent underfunding of the country’s public health system has left the nation vulnerable,” said John Auerbach, president and CEO, of TFAH. “The country needs a long-term commitment to rebuild the nation’s public health capabilities – not just to plug some of the more dangerous gaps but to make sure each community will be prepared, responsive and resilient when the unexpected occurs.”

Flat Federal Funding

In Fiscal Year (FY) 2017, the U.S. Centers for Disease Control and Prevention’s (CDC) budget was $7.1504 billion ($21.95 per person). Adjusting for inflation, CDC’s core budget—not including the Prevention and Public Health Fund—has been essentially flat for the last decade.

Because much of CDC’s budget is distributed to states and localities, the impact of budget cuts is experienced directly at the state and local level. Of the roughly 75 percent of CDC funds that go to states and local communities, support ranges from a low of $5.74 per person in Missouri to a high of $114.38 per person in Alaska.

In addition, 12 percent of CDC’s budget consists of the Prevention and Public Health Fund, with about $625 million a year of that directed to state and local efforts. From FY 2013 through FY 2027, the Prevention Fund will receive nearly $12 billion less than the law intended.

Within CDC, the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Program is the only federal program that supports the work of state and local health departments to prepare for and respond to emergencies. Except for one- time, short-term funding to contain the Ebola and Zika viruses, core emergency preparedness funding has been cut by more than one-third (from $940 million in FY 2002 to $667 million in FY 2017) since the program was established.

State Public Health Funding Declining

Spending for public health by states has been declining. Based on a TFAH analysis (adjusted for inflation), 31 states made cuts to their public health budgets from FY 2015-2016 to FY 2016-2017. Only 19 states and Washington, D.C. maintained or increased their budgets, making it hard for states to compensate for reduced federal funding.

According to the report, state public health spending is actually lower in 2016-2017 than it was in 2008-2009, as some of the funding cuts that occurred during the Great Recession have not been fully restored—and federal funding has been essentially flat (almost half of state public health spending comes from federal funds).

Local Public Health Funding Decreasing

Since 2008, local health departments (LHDs) have lost 55,590 staff due to layoffs or attrition. In addition, about 25 percent of LHDs reported a lower FY 2016 budget than the previous year, with fewer LHDs reporting an increase in their budget for the current year as compared to the previous.

Recommendations

“Each year, we issue this report to examine the amount of public health funding each state receives and provide an independent analysis of how communities protect the public’s health. With life expectancy declining in the U.S. for the second year in a row—something unheard of in recent memory—policymakers must take the public’s health seriously and allocate the funds needed to improve well-being and prevent illness and injury,” said Auerbach.

The report includes eight key recommendations:

Increase Funding for Public Health – at the Federal, State and Local Levels
Preserve the Prevention and Public Health Fund
Prepare for Public Health Emergencies and Pandemics
Establish a Standing Public Health Emergency Response Fund
Build a National Resilience Strategy to Combat Deaths of Despair
Prevent and Reduce Chronic Disease
Support Better Health and Top Local Priorities in Every Community
Expand the Use of Evidence-Based, High-Impact Strategies to Improve Health in Every Community

The brief was supported by a grant from the Robert Wood Johnson Foundation (RWJF).

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A Funding Crisis for Public Health and Safety

TFAH Statement on the House Appropriations Committee’s Proposed Plan to Use the Prevention and Public Health Fund To Fund a Continuing Resolution: Would Cut CDC Funding by $2.85 Billion Over the Next Decade

February 6, 2018

Washington, D.C., February 6, 2018– The below is a statement from John Auerbach, president and CEO, Trust for America’s Health (TFAH).

“It is absolutely critical to extend funding for community health centers and other health safety net programs.

But, the House Appropriations Committee’s proposed long-term funding cuts to the U.S. Centers for Disease Control and Prevention (CDC) would be a staggering blow to the world’s premier public health agency and would cut health-related funding to states and local communities by billions of dollars.

While this Continuing Resolution (CR) would temporarily restore the near-term cuts made to CDC in the last short-term CR, the cumulative cut would amount to $2.85 billion over the next decade.

Plainly, the CR would drastically hamper our nation’s ability to control outbreaks, address the opioid epidemic, and keep the nation healthy and secure.

This severe flu season illustrates how critical public health infrastructure is to protecting all Americans. CDC has been working with state and local public health to track the outbreak, measure the effectiveness of vaccines and antivirals, and communicate the best ways to stay healthy. And it provides state and local public health organizations with grants that give them the resources to protect their residents of their communities. These are basic protections we depend on, but they would be threatened by cutting CDC’s core budget.

This legislation furthers our national trend of conflating treatment for disease with the critical efforts to prevent it. Public health keeps people healthy and out of the hospital, while community health centers provide the clinical care communities depend on.

We need to invest in the continuum of chronic and infectious disease prevention, detection and mitigation—the very programs supported by the Prevention and Public Health Fund—alongside the critical safety-net treatment provided in community health centers.

Since FY 2010, CDC’s budget authority has actually decreased by 11.4 percent (adjusted for inflation). This cut has occurred in spite of the growing burden of largely preventable health threats such as the opioid epidemic and emerging infectious disease outbreaks such as Zika.

Instead of pitting CDC funding against other important health priorities, Congress should significantly increase its investment in CDC to ensure we have the resources required to address the many health challenges facing the nation.”

Impact of Proposal from the House Appropriations Committee Regarding Prevention and Public Health Fund (PPHF) Allocations Fiscal Year 2018 – 2028

Current Law	Proposed House PPHF Budget for Latest CR	Net Impact of Proposed House Budget	Cumulative Impact of Proposed House Budget
FY18 ($900M)	$900M	0	0
FY19 ($800M)	$900M	+$100M	+$100M
FY20 ($800M)	$1B	+$200M	+$300M
FY21 ($800M)	$1B	+$200M	+$500M
FY22 ($1.25B)	$1.1B	-$150M	+$350M
FY23 ($1B)	$1.1B	+$100M	+$450M
FY24 ($1.7B)	$1.1B	-$600M	-$150M
FY25 ($2B)	$1.1B	-$900M	-$1.15B
FY26 ($2B)	$1.1B	-$900M	-$1.95B
FY27 ($2B)	$1.1B	-$900M	-$2.85B

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Public Health Funding

The COVID-19 pandemic is a stark illustration of what can happen when the public health system is not adequately funded but infectious disease is just one of the public health challenges the country faces. More than half of all Americans live with at least one chronic disease. Deaths of despair, those associated with alcohol, drugs or suicide, are also continuing to increase. In addition, the threat from droughts, floods, wildfires and other weather-related events is also on the rise.

Despite these threats, federal funding for public health is less today than it was a decade ago. This persistent underfunding of the country’s public health system has led to serious gaps in our readiness to respond to disease outbreaks, natural disasters and other health emergencies.

Prevention and Public Health Fund Detailed Information

Leading Public Health Groups: Using the Prevention Fund to help fund CHIP: A Serious Mistake

Statement from Trust for America’s Health, American Public Health Association, National Association of County and City Health Officials, Prevention Institute, and Public Health Institute

December 22, 2017

Washington, D.C., December 22, 2017 –It is a serious mistake to cut $750 million from the Prevention and Public Health Fund to provide very short-term funding for the Children’s Health Insurance Program (CHIP) and community health centers. The below is a statement from the American Public Health Association, National Association of County and City Health Officials, Prevention Institute, Public Health Institute, and Trust for America’s Health:

“The Prevention Fund supports critical public health activities—including lead poisoning surveillance, vaccination initiatives and other programs—in every state and community across the country. Cutting this significant funding source would leave communities without the vital resources needed to keep children and families happy, healthy and safe.

It is even more alarming and contradictory that this cut will be used to provide very short-term funding for CHIP and community health centers. Our organizations are united in support of CHIP and community health centers, which are vital to improving children’s health. But losing the Prevention Fund would just create another hole in the public health support children need.

The Prevention Fund is supported strongly by national, state and local groups alike—indeed to-date 1,142 have joined the Prevention Fund supporter’s list. They know the value of the $630 million annually that goes directly to states and communities to prevent illness and disease.

A strong public health system makes the difference between health and illness, safety and injury, life and death.

We urge Congress to oppose any and all future cuts to the Prevention Fund and to begin the long-overdue process of increasing support to CHIP, community health centers, CDC and other public health agencies so today’s children can be our healthiest and happiest generation.”

John Auerbach, President & CEO, Trust for America’s Health

Georges C. Benjamin, MD, Executive Director, American Public Health Association

Larry Cohen, Executive Director, Prevention Institute

Laura Hanen, MPP, Interim Executive Director and Chief of Government Affairs, National Association of County and City Health Officials

Mary A. Pittman, President & CEO, Public Health Institute

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The American Public Health Association champions the health of all people and all communities. We strengthen the public health profession. We speak out for public health issues and policies backed by science. We are the only organization that combines a 145-year perspective, a broad-based member community and the ability to influence federal policy to improve the public’s health. Visit us at www.apha.org.

The National Association of County and City Health Officials (NACCHO) represents the nation’s nearly 3,000 local governmental health departments. These city, county, metropolitan, district, and tribal departments work every day to protect and promote health and well-being for all people in their communities. For more information about NACCHO, please visit www.naccho.org.

The Public Health Institute, an independent nonprofit organization, is dedicated to promoting health, well-being and quality of life for people throughout California, across the nation and around the world.

Prevention Institute is an Oakland, California-based nonprofit research, policy, and action center that works nationally to promote prevention, health, and equity by fostering community and policy change so that all people live in healthy, safe environments.

Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism

Ready or Not? 2017

«state» Achieved «score_num» of 10 Indicators in Report on Health Emergency Preparedness

«state»’s Flu Vaccination Rate is «fvr_num» Percent, «flu_rank_upper»

Washington, D.C., December 19, 2017 – In Ready or Not? Protecting the Public’s Health from Diseases, Disasters and Bioterrorism, «state» achieved «score_lower» of 10 key indicators of public health preparedness.

In total, 25 states scored a 5 or lower—Alaska scored lowest at 2 out of 10, and Massachusetts and Rhode Island scored the highest at 9 out of 10.

The report, issued today by the Trust for America’s Health (TFAH), found the country does not invest enough to maintain strong, basic core capabilities for health security readiness and, instead, is in a continued state of inefficiently reacting with federal emergency supplemental funding packages each time a disaster strikes.

According to Ready or Not?, federal funding to support the base level of preparedness has been cut by more than half since 2002, which has eroded advancements and reduced the country’s capabilities.

“While we’ve seen great public health preparedness advances, often at the state and community level, progress is continually stilted, halted and uneven,” said John Auerbach, president and CEO of TFAH. “As a nation, we—year after year—fail to fully support public health and preparedness. If we don’t improve our baseline funding and capabilities, we’ll continue to be caught completely off-guard when hurricanes, wildfires and infectious disease outbreaks hit.”

No.	Indicator	«state»	Number of States Receiving Points
A “Y” means the state received a point for that indicator
1	Public Health Funding Commitment: State increased or maintained funding for public health from FY 2015 to FY 2016 and FY 2016 to FY 2017.	«phfc»	19 + D.C.
2	National Health Security Preparedness Index: State increased their overall preparedness scores based on the National Health Security Preparedness Index™ between 2015 and 2016.	«nhspi»	33
3	Public Health Accreditation: The state public health department is accredited.	«pha»	30 + D.C.
4	Antibiotic Stewardship Program for Hospitals: State has 70 percent or more of hospitals reporting meeting Antibiotic Stewardship Program core elements in 2016.	«asp»	20 + D.C.
5	Flu Vaccination Rate: State vaccinated at least half of their population (ages 6 months and older) for the seasonal flu from Fall 2016 to Spring 2017.*	«fvr»	20
6	Enhanced Nurse Licensure Compact (eNLC): State participates in an eNLC.	«enlc»	26
7	United States Climate Alliance: State has joined the U.S. Climate Alliance to reduce greenhouse gas emissions consistent with the goals of the Paris Agreement.	«usca»	14
8	Public Health Laboratories: State laboratory provided biosafety training and/or provided information about biosafety training courses (July 1, 2016 to June 30, 2017).	«lab_safety»	47 + D.C.
9	Public Health Laboratories: State laboratory has a Biosafety Professional (July 1, 2016 to June 30, 2017).	«phl_staff»	47 + D.C.
10	Paid Sick Leave: State has paid sick leave law.	«sick_leave»	8 + D.C.
Total		«score_num»

Ready or Not? features six expert commentaries from public health officials who share perspectives on and experiences from the historic hurricanes, wildfires and other events of 2017, including from California, Florida, Louisiana and Texas.

The report also examines the nation’s ability to respond to public health emergencies, tracks progress and vulnerabilities, and includes a review of state and federal public health preparedness policies. Some key findings include:

Just 19 states and Washington, D.C. increased or maintained funding for public health from Fiscal Year (FY) 2015-2016 to FY 2016-2017.
The primary source for state and local preparedness for health emergencies has been cut by about one-third (from $940 million in FY 2002 to $667 million in FY 2017) and hospital emergency preparedness funds have been cut in half ($514 million in FY 2003 to $254 million in FY 2017).
In 20 states and Washington, D.C. 70 percent or more of hospitals reported meeting Antibiotic Stewardship Program core elements in 2016.
Just 20 states vaccinated at least half of their population (ages 6 months and older) for the seasonal flu from Fall 2016 to Spring 2017—and no state was above 56 percent.
47 state labs and Washington, D.C. provided biosafety training and/or provided information about biosafety training courses (July 1, 2016 to June 30, 2017).

The Ready or Not? report provides a series of recommendations that address many of the major gaps in emergency health preparedness, including:

Communities should maintain a key set of foundational capabilities and focus on performance outcomes in exchange for increased flexibility and reduced bureaucracy.
Ensuring stable, sufficient health emergency preparedness funding to maintain a standing set of core capabilities so they are ready when needed. In addition, a complementary Public Health Emergency Fund is needed to provide immediate surge funding for specific action for major emerging threats.
Strengthening and maintaining consistent support for global health security as an effective strategy for preventing and controlling health crises. Germs know no borders.
Innovating and modernizing infrastructure needs – including a more focused investment strategy to support science and technology upgrades that leverage recent breakthroughs and hold the promise of transforming the nation’s ability to promptly detect and contain disease outbreaks and respond to other health emergencies.
Recruiting and training a next generation public health workforce with expert scientific abilities to harness and use technological advances along with critical thinking and management skills to serve as Chief Health Strategist for a community.
Reconsidering health system preparedness for new threats and mass outbreaks. Develop stronger coalitions and partnerships among providers, hospitals and healthcare facilities, insurance providers, pharmaceutical and health equipment businesses, emergency management and public health agencies.
Preventing the negative health consequences of climate change and weather-related threats. It is essential to build the capacity to anticipate, plan for and respond to climate-related events.
Prioritizing efforts to address one of the most serious threats to human health by expanding efforts to stop superbugs and antibiotic resistance.
Improving rates of vaccinations for children and adults – which are one of the most effective public health tools against many infectious diseases.
Supporting a culture of resilience so all communities are better prepared to cope with and recover from emergencies, particularly focusing on those who are most vulnerable. Sometimes the aftermath of an emergency situation may be more harmful than the initial event. This must also include support for local organizations and small businesses to prepare for and to respond to emergencies.

The report was supported by a grant from the Robert Wood Johnson Foundation (RWJF) and is available on TFAH’s website at www.healthyamericans.org.

Score Summary:

A full list of all of the indicators and scores and the full report are available on TFAH’s website. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. The data for the indicators are from publicly available sources or were provided from public officials.

9 out of 10: Massachusetts and Rhode Island
8 out of 10: Delaware, North Carolina and Virginia
7 out of 10: Arizona, Colorado, Connecticut, Hawaii, Minnesota, New York, Oregon and Washington
6 out of 10: California, District of Columbia, Florida, Illinois, Maryland, Nebraska, New Jersey, North Dakota, South Carolina, South Dakota, Utah, Vermont and West Virginia
5 out of 10: Georgia, Idaho, Maine, Mississippi, Montana and Tennessee
4 out of 10: Alabama, Arkansas, Iowa, Louisiana, Missouri, New Hampshire, Oklahoma and Pennsylvania
3 out of 10: Indiana, Kansas, Kentucky, Michigan, Nevada, New Mexico, Ohio, Texas, Wisconsin and Wyoming
2 out of 10: Alaska

Rhode Island’s Efforts to Prevent and Respond to Childhood Lead Exposure

Background

In June 2016, the Rhode Island General Assembly passed the Lead and Copper Drinking Water Protection Act, requiring schools, day care facilities, public playgrounds, shelters and foster homes with children under six, and other state facilities to certify that drinking water conduits are lead-safe. It also directs state inspectors to conduct an annual lead and copper test at these facilities. In conjunction with the law, which will be implemented once regulations are promulgated, the state created a commission to study lead in the water system.

Documentation of Lead-Safe Remodeler/Renovator License Required to Receive a Building Permit to Complete Housing Renovations

In 2011, the City of Providence began requiring applicants for building permits at pre-1978 homes to provide proof of training and licensing in lead-safe work practices. The state of Rhode Island requires all construction contractors working in homes and child care facilities built before 1978 to hold a Lead-Safe Remodeler/Renovator License or a higher level of lead hazard control certification. The lead-safe remodeler/renovator program has been overseen by the state since 2001. It is authorized by the U.S. Environmental Protection Agency to administer the federal Renovation, Repair, and Painting rule in Rhode Island. To increase compliance with the state remodeler/renovator law, the City of Providence will issue permits for construction work at properties covered by the law only if proof of licensure is provided. In January 2015, the City of Pawtucket put in place a similar requirement: contractors must document their training and licensure to receive a building permit for renovations.

Use of Local Housing Officials to Enforce Lead Hazard Mitigation Law

The state of Rhode Island passed the Lead Hazard Mitigation Act in 2002 and implemented regulations in 2004. Under the law, rental property owners are required to attend a training on unsafe lead conditions, inspect/repair any lead hazards at their properties, make residents aware of their findings and actions, address residents’ lead-hazard concerns, use lead-safe work practices during maintenance, and verify each unit’s compliance through a lead inspector. Typically, the owner must have the property inspected every two years and prove its safety for children by showing a Certificate of Conformance (COC) or a Lead-Safe or Lead-Free Certificate. Owners of two- and three-dwelling properties who live onsite are exempt from the law.

Since the law’s enactment the state has been challenged by compliance. In 2014, when the Providence Plan completed an evaluation of the Lead Hazard Mitigation Law, it found that only 20 percent of the covered properties had complied with the regulations within the first five years of implementation. Several cities have taken steps to improve enforcement. Providence, for example, created a separate division of Housing Court to address lead violations.

The Inspection and Standards division reported that of 537 lead violation cases filed over the first four years, 484 resulted in corrective action. An analysis conducted by the Rhode Island Department of Health discovered that between 2012 and 2013, there was a significant decline in children with elevated blood lead levels in Providence. Notably, the declines coincided with the implementation of the building permitting requirements and the lead docket.

Medicaid Reimbursement for Lead Follow-Up Services and Lead Centers and Reimbursement

Rhode Island Medicaid, which covers nearly 40 percent of children in the state and roughly half of children below six with elevated blood lead levels, provides reimbursement for lead follow-up services under its 1115 demonstration waiver (known as the Rhode Island Comprehensive Demonstration). The waiver gives Rhode Island the flexibility to “redesign the state’s Medicaid program to provide cost-effective services that will ensure beneficiaries receive the appropriate services in the least restrictive and most appropriate setting.”

Lead follow-up services eligible for reimbursement in Rhode Island are provided through four “lead centers” certified through the state health department. Because the services are offered under specifications of the contract with Rhode Island Medicaid, the centers have the flexibility to hire a range of personnel to deliver in-home lead services. These include community health workers, nurses, and certified lead inspectors.

Medicaid reimbursement is currently available to the lead centers for follow-up services provided to Medicaid-enrolled children up to age six who are identified to have elevated blood lead levels. The lead centers bill by the “Current Procedural Terminology” billing code for each service provided to Medicaid recipients. Medicaid reimburses them for an initial visit, a follow-up visit, or to close the case. The lead centers are reimbursed by the state for services provided to non-Medicaid-enrolled children.

Follow-Up Services: Education, Case Management, Assessment, and Inspection

Written Rhode Island Medicaid standards require the lead centers to contact associated healthcare providers when providing lead follow-up services. For each child or family, the lead center identifies a specific case manager who handles all communication and coordination with the child’s primary care provider or treating physician, all treatment providers and community support agencies, and the child’s health plan, when appropriate. When necessary, the lead center case manager also works with the Rhode Island Department of Human Services and Department of Health, serving as the point of contact for the child, family, and all providers and agencies.

Along with case management, other Medicaid-reimbursable follow-up services provided to children under age six with elevated blood lead levels by Rhode Island lead center staff include:

Visual assessment of the primary residence
Nutrition counseling
Lead education
Interim controls to limit exposure to lead hazards
Information on safe cleaning techniques
In-home education

For children with blood lead levels elevated above the designated threshold (as set by the U.S. Centers for Disease Control and Prevention), Medicaid also reimburses for a Comprehensive Environmental Lead Inspection of the home by a Rhode Island Department of Health lead inspector. After the inspection, lead center staff review the results with the family to help them understand sources of lead in their home.

The lead centers provide some education and other services to children with blood lead levels that are high but do not exceed the designated threshold. However, these services are funded by a Rhode Island Department of Health contract, not by Medicaid. The services include an educational home visit to discuss lead poisoning, nutrition, and cleaning practices that can protect children from additional lead risks; a Visual Environmental Lead Assessment by a trained community health worker, which provides education and preventative next steps; and the provision of soil and dust wipes for the home. The Rhode Island Department of Health is also piloting a limited environmental investigation (soil testing only) in partnership with the lead centers for children with lower blood lead elevations that do not meet the designated threshold.

Additional Services: Structural Remediation

While Rhode Island Medicaid can provide some reimbursement for window replacement and spot repair of conditions found to pose a lead-related threat to children with elevated blood lead levels, this structural remediation benefit has been used rarely. The primary reasons include: (1) the current reimbursement rate for window replacements is less than the typical replacement cost and (2) the mechanisms by which lead centers receive this reimbursement are cumbersome. In an effort to increase use, the Rhode Island Department of Health is exploring ways to improve the window replacement program. One possibility may be a revolving loan fund since lead centers must pay for replacement first and seek Medicaid reimbursement later.

In addition, when a lead violation is found and a notice of violation issued, property owners and families are automatically referred to local Housing and Urban Development-funded lead hazard control grant programs that may pay for structural remediation. Access to these grant programs depend on income, the property’s age (pre-1978), and the presence of a child under age six living in or frequently visiting the home or unit. The Rhode Island Department of Health is currently assessing how often cited owners use these grant programs and whether or not there are enrollment barriers.

Use of Medicaid Reimbursement for Lead Follow-Up Services

This table from the Rhode Island Executive Office of Health and Human Services shows the total number of Medicaid-enrolled children who received lead follow-up services from the Rhode Island lead centers and the corresponding amount of total Medicaid reimbursement for selected years between 2006 and 2014.

Rhode Island’s current Medicaid 1115 demonstration waiver is in place through 2018, and there has been consistent support for the continuation of the lead follow-up service reimbursement program in the state. Stakeholders attribute this enthusiasm to the relatively low total cost of the lead program within Rhode Island’s overall Medicaid budget, along with the well-known dangers of lead poisoning.

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In August, 2017, the Health Impact Project, a collaboration between the Robert Wood Johnson Foundation (RWJF) and Pew Charitable Trusts released: Ten Policies to Prevent and Respond to Childhood Lead Exposure. The Trust for America’s Health (TFAH), National Center for Healthy Housing (NCHH), Urban Institute, Altarum Institute, Child Trends and many researchers and partners contributed to the report. TFAH and NCHH worked with Pew, RWJF and local advocates and officials to put together the above case study about lead poisoning and prevention initiatives.

The case study does not attempt to capture everything a location is doing on lead, but aims to highlight some of the important work.

Graham-Cassidy is Legislative Malpractice – It Would Greatly Harm the Nation’s Health

Joint Statement from American Public Health Association, Prevention Institute, Public Health Institute, and Trust for America’s Health

Washington, D.C., September 25, 2017 – Below is a statement from American Public Health Association, Prevention Institute, Public Health Institute, and Trust for America’s Health on Graham-Cassidy, which would cause millions to lose healthcare coverage, decrease access to clinical preventive services, and eliminate the Prevention and Public Health Fund.

“Graham-Cassidy would do untold damage to the nation’s health, unraveling the progress we’ve made to expand access to quality, affordable healthcare, reorient our healthcare system to value prevention and equity, and invest in a healthier future for all Americans.

Graham-Cassidy upends efforts to improve the nation’s health in the future by threatening to strip people of access to preventive care and zeroing out the Prevention and Public Health Fund. Over the next five years alone, states and communities stand to lose more than $3 billion in funding to prevent chronic disease, stop the spread of infectious diseases, and invest in resources that support health and equity. The Prevention and Public Health Fund also provides 12 percent of the Centers for Disease Control and Prevention’s annual budget. Losing this much funding—about $900 million a year—would irreparably damage our public health infrastructure, including our ability to respond to disasters and emerging epidemics. These short-term cuts will lead to more chronic conditions and exact a heavy burden of preventable illness and death – as well as higher healthcare expenditures for worse health outcomes – down the line.

Investing in public health makes the difference between health and illness, safety and injury, and life and death. The deep cuts this bill proposes – to Medicaid, to public health and prevention – would touch every community, especially those communities that are struggling most with longstanding inequities in health and safety.

Passing Graham-Cassidy is tantamount to legislative malpractice. The undersigned groups find this approach unacceptable and strongly urge Congress to work in a bipartisan manner to improve the nation’s public health and healthcare systems.”