Insights on Federal Budget Reconciliation and House Revolt Updates - CalAIM Statewide Dementia Collaborative

CalAIM Statewide Dementia Care Learning Collaborative April 2, 2025 California Health Policy Strategies, LLC

Agenda Welcome and Introductions Federal Budget and Administration Update D-SNP Policy Guide Follow-up Discussion Announcements and Upcoming Meetings California Health Policy Strategies, LLC 1

Programs Serving Older Adults & Persons with Disabilities: HHS Cuts & Federal Budget Updates CalAIM Statewide Dementia Learning Collaborative April 2, 2025 Presented By Cathy Senderling-McDonald, Catbird Strategies

Presentation Overview Latest on Federal Budget Reconciliation Senate Current Policy Baseline Gambit House Floor Revolt U.S. Health and Human Services (HHS)Department Cuts Program and Staffing Reductions Elimination of Administration for Community Living (ACL) What Can You Do at a Time Like This?

Budget Reconciliation Updates Reminder of current BR status House, Senate passed bills that are very different Can t move forward until key elements of bills reconciled and in agreement Senate may attempt to pass updated BR bill this week Parliamentarian meeting canceled yesterday (Tuesday 4/1) Unclear how Senate can move forward without parliamentarian ruling Senate wants to use current policy baseline approach Basically pretending that $4.7 trillion in expiring tax cuts are free to extend Senate also wants to increase debt ceiling in its BR bill $5 trillion debt ceiling increase to pave way for tax cut extension

House Revolt No Votes This Week House waiting for Senate to make its move on reconciliation Revolt among GOP members resulted in gridlock for this week Related to bipartisan, female member led proxy vote bill Speaker Johnson opposes bill, tried to make end run around sponsors 9 GOP members broke ranks to support Dems in voting against rules bill Without rules, House can t act, so adjourned for remainder of week Link to article: https://www.npr.org/2025/04/01/nx-s1-5347921/congress- proxy-voting-new-parents Politico article yesterday indicated that House Speaker intends to muscle through the Senate version of BR before April recess A number of House Freedom Caucus members are unhappy with approach House leaders will say that the House plan is embedded in Senate plan

Details of HHS Restructuring: Make America Healthy Again Combination of job cuts, consolidation and centralization Reducing from 82,000 full-time employees to 62,000 Consolidating 28 divisions down to 15 Consulting 10 regional offices into 5 Centralizing HR, IT, Procurement, Policy, & External Affairs functions Stated purposes Compliance with Executive Order re: Workforce Optimization Save money Become more efficient and more responsive to Americans needs Implement changes to end the chronic disease epidemic

Potential Service Impacts for Older Adults, Persons with Disabilities Elimination of Administration for Community Living (ACL) Established in 2012 to coordinate multiple departments Connects and funds more than 2,500 organizations nationwide Combined the Administration on Aging, Office on Disability, and Administration on Developmental Disabilities ACL duties will be broken up across three offices Centers for Medicare and Medicaid Services (CMS), Administration for Children and Families (ACF), Assistant Secretary for Planning and Evaluation (ASPE) But ASPE also being merged with another department into Office of Strategy, so their role is unclear

Older Americans Act Programs OAA programs are housed within ACL, so could be impacted OAA is a federal law that establishes multiple programs within the Act. Congress authorizes funding for the programs in the annual budget process. Full-year Continuing Resolution enacted in March extends funding for these programs at the prior-year level through September 30, 2025 The Impoundments Control Act would apply to these programs if President Trump were to attempt to defund them or defer payments to states HHS has not provided details on where OAA programs will be moved to following elimination of ACL

Layoffs Began on April 1 Many offices across multiple HHS agencies appear to have been eliminated or significantly scaled back. RIFs Reduction in Force notices 60 days administrative leave Haphazard approach that appears to have eliminated all access to email, workstreams, buildings to those receiving notices Unclear how this work will be picked up/transitioned elsewhere

Administration for Community Living 40 percent of staff at ACL were laid off on Tuesday, 4/1 per NPR ACL Center for Policy and Evaluation staff were all let go Subject matter expertise in Older Americans Act programs Data collection on how OAA funds are spent and how many are served Full article: https://www.motherjones.com/politics/2025/04/rfk- hhs-acl-disability-center-layoffs/ Per former ACL Director Alison Barkoff on LinkedIn: Communications team was eliminated Budget and Management team was eliminated Regional office administrators and staff were laid off

Effects Elsewhere in HHS Many cuts at National Institutes for Health Epidemiologists and other researchers Communications teams Equity officers and similar job titles ACF Division of Energy Assistance was eliminated Affects about 20 workers who ran Low-Income Home Energy Assistance Program - LIHEAP serves 5.9 million low- income households Full article: https://www.npr.org/sections/shots-health- news/2025/04/01/g-s1-57716/hhs-layoffs-seniors- disabled-liheap-acl

What Can You Do? Contact your Congressperson and encourage others to do so also Ask them to seek congressional hearings on the impacts of these cuts Document and share the impacts Write an op ed for the local paper or online media service Share stories with reporters, congressional offices, local lawmakers Connect with advocacy groups locally, or state groups like Justice in Aging Take some time for self care This is all really new - we don t know what is going to happen It s ok to take a news break and/or to take some time sit with the grief, anxiety or anger you might be feeling when you learn about these things happening

Resource Links Justice In Aging Statement: https://justiceinaging.org/statement-on- the-elimination-of-the-administration-for-community-living-acl/ Update from AutisticAdvocacy.org including information on April 5 nationwide demonstration: https://autisticadvocacy.org/2025/03/hhs- restructuring-harms-people-with-disabilities/ Update from MedicareRights.org: https://www.medicarerights.org/medicare-watch/2025/03/27/hhs- announces-sweeping-cuts-that-threaten-access-to-critical-services Kaiser Family Foundation Compendium of Articles: https://kffhealthnews.org/morning-breakout/hhs-workers-begin- getting-pink-slips/

Questions? Questions? Cathy Senderling-McDonald csm@catbirdstrategies.com

D-SNP Policy Guide Discussion 1. What should be our primary concerns about implementing the 2026 policy guide? 2. How should we be thinking about marketing materials for the dementia population? 3. What add-ons might make D-SNPs attractive to dementia patients and families? 4. What kind of network should we envision to support dementia patients and families? Gerontology? respite services? CBAS? IHSS? 5. What types of CHWs or CBOs in general will be used to support dementia care? 6. Could a D-SNP like model work for dementia care patients? 7. How should we consider the overall issue of decision making and consent for dementia patients signing up for a D-SNP? California Health Policy Strategies, LLC 15

Announcements and Upcoming Meetings Next Learning Collaborative Meeting: Wednesday, May 14th at 12:00 PM Topic of Focus: Additional Upcoming Meetings Meeting #19: Wednesday, June 11th, 12:00 PM Topic: In-Home Supportive Services Update No meeting in July ECM Managers/Directors Ad-Hoc Meeting: Wednesday, May 7th, 1:00 PM California Health Policy Strategies, LLC 16