Title X

Government Shutdown: Impact on Title X Network

Since Congress was unable to agree on a final appropriations bill for fiscal year (FY) 2014, the federal government shut down effective 12:01 a.m. on Tuesday, October 1, 2013. The House of Representatives passed several continuing resolutions (CR) that would fund certain government programs such as the Special Supplemental Nutrition Program (SNAP) for Women, Infants, and Children (WIC)  and provide back pay for federal employees furloughed by the shutdown. Both the Senate and the Obama administration rejected this piecemeal approach, instead advocating for a clean CR that would level-fund all programs for FY 2014. 

As the shutdown over discretionary funding continues, the October 17 deadline for Congress to raise the debt limit, allowing the government to continue to borrow money, draws closer. House Speaker John Boehner (R-OH) has now indicated the House will likely not increase the limit without concessions from Senate Democrats and President Obama, particularly on implementation of the Affordable Care Act (ACA). Senate Majority Leader Harry Reid (D-NV) is expected to introduce legislation this week on a clean increase to the debt limit, forcing the House to address the issue directly. House Democrats have indicated they would vote to support a clean CR, even at sequestration levels, and have urged their Republican colleagues to join them - it remains to be seen whether Speaker Boehner will reach across the aisle to pass final legislation. 

Below are possible scenarios of what could happen based on the previous government shutdowns in 1995 and 1996 as well as guidance provided by the Office of Population Affairs (OPA) and the Department of Health and Human Services (HHS).

Will the government shutdown affect Title X? 
Should the government shutdown, HHS’s Office of the Assistant Secretary for Health (OASH) staff, including OPA, will not be available to provide routine administrative support services. However, OPA has issued guidance to grantees on Title X program operations under a shutdown scenario. Payment Management System will remain in an “operational status” to continue processing grant drawdown requests, and payments will continue. For awards received prior to the shutdown, grantees may be able to continue to draw funds from those awards, unless the notice of grant award had restrictive terms and conditions. However, if the drawdown request triggers one of the Payment Management System edit checks and/or drawdown limit controls, the grantee will not be able to drawdown funds. 

Additionally, OPA advises that if an entity is considering submitting an application for additional HHS federal assistance funding, the Grants.gov system will continue to accept applications, and HHS will take action on those applications for fully funded and excepted programs. For those programs which are non-excepted, the applications will be stored and reviewed upon the government resuming normal operation. OPA encourages grantees to visit www.hhs.gov for regular updates. 

Will the government shutdown affect Medicaid reimbursements? 
Medicaid reimbursements to providers would not likely be affected by a short-term shutdown, as states are responsible for paying providers. In a days-not-weeks shutdown, most providers would not see any impact to their reimbursements. The real questions for both providers and the states will be how long will the shutdown last and how bad are particular states' current budget crises? 

A federal government shutdown would likely cause a delay in federal Medicaid payments to the states which, along with lapses in other federal payments, will strain state coffers. The longer the shutdown lasts, the harder it will be for cash-strapped states to keep up with the costs, which in turn could impact a state’s ability to pay providers. 

Will the government shutdown impact Medicaid enrollment? 
Since states are responsible for processing Medicaid applications and making eligibility determinations, a shutdown of the federal government should not have any direct impact on Medicaid enrollment. However, if the federal shutdown lasts for weeks instead of days, states could become concerned about cash flow from the federal government and decide to limit or delay new Medicaid enrollments. 

Will the government shutdown impact ACA implementation, including the October 1 enrollment period opening? 
Because a significant portion of funding surrounding the ACA is mandatory, not the annual discretionary funds up for negotiation, a government shutdown is not expected to impact open enrollment and other implementation efforts at this time.

NFPRHA will continue to closely monitor the negotiations and update the membership accordingly. If you have questions, please contact Annie Walden-Newman at awaldennewman@nfprha.org or (202) 293-3114 ext. 207.