2021 Federal Budget – Hopeful News for Non-Emergency Medical Transport

Through its coalition work with the Medical Transportation Access Coalition (MTAC), ANCOR has been advocating for Congress to intervene in the Centers for Medicare and Medicaid Services’ (CMS) proposal to make non-emergency medical transportation (NEMT) optional in Medicaid services. While Congress asked CMS to halt this proposal last year until it did a study on the effects this change would have, CMS has reiterated its commitment to scaling back NEMT in its unified spring agenda, to Congress’ dismay.

As the House lays out its budget appropriations proposal for 2021 in advance of negotiations with the Senate, it has included language that would block CMS from moving forward (see section 246, page 124). While this language would still have to make it through the Senate, this is a promising step for an essential service for people with disabilities, who rely on NEMT to go to doctor’s appointments, among other uses. The House budget will be subject to close scrutiny in the Senate due to the inclusion of contentious provisions such as funding for family planning and gun control research.

The bigger budget picture: The House Appropriations Committee wrapped up mark-ups (hearings dedicated to working through the funding bills) land sent the funding package to the floor on Friday. The House expects to hold floor votes on its budget by the end of the month. It is already proceeding with a small omnibus bill to fund four departments – Agriculture, State, Interior and Veterans Affairs, plus the EPA, FDA and military construction projects. The Labor-HHS package that funds Medicaid will be later in the queue. In contrast, Politico Pro reports that “Senate appropriators have yet to begin their process amid disagreements over coronavirus cash and other issues. Congress is likely hurtling toward a stopgap spending bill that will stretch out current funding levels past Election Day.”

The specifics on the House’s health and disability funding legislation: Below are key provisions relevant to ANCOR members.

• Department of Health and Human Services (HHS), which includes Medicaid: $96.4 billion, an increase of $1.5 billion above the FY 2020 enacted level and $11.1 billion above the President’s budget request. (Markup video here, summary here, report here).
• Administration for Community Living (ACL): $2.3 billion, an increase of $56 million above the FY 2020 enacted level and $171 million above the President’s budget request.
• Public Health and Social Services Emergency Fund (PHSSEF): The bill provides $2.8 billion for PHSSEF, an increase of $90 million above the FY 2020 level and $186 million above the President’s budget request.
• INCLUDE Down syndrome research initiative: $65 million for, an increase of $5 million above the FY 2020 enacted level.
• Additional disability policy clauses:
  • Continuing Disability Reviews—The bill includes a new provision prohibiting the Social Security Administration from finalizing or implementing a new rule that would significantly increase the number and frequency of CDRs, cutting benefits to Social Security and SSI disabled beneficiaries.    
• Administrative Law Judges—The bill includes a new provision prohibiting the Social Security Administration from finalizing or implementing a proposed rule that would replace an individual’s right to appeal their denied application for Social Security or SSI benefits before an independent Administrative Law Judges at a hearing, with an appeal before an SSA staff attorney.