CHA's End of Year Priorities

In a letter to Congress, Children’s Hospital Association (CHA) identified our end-of-year priorities. It is critical Congress take action before the end of the year to sustain children's hospitals' ability to provide high-quality, timely, and appropriate care to our nation's children.

The letter asks Congress to:

• Pass the bipartisan Accelerating Kids Access to Care Act (H.R. 4758/S.2372).
• Prevent Medicaid Disproportionate Share Hospital (DSH) cuts.
• Secure $758 million for the Children's Hospitals Graduate Medical Education (CHGME) program.
• Stop harmful policies that negatively impact access to care for children, like site neutrality and attacks on 340B.
• Ensure children's hospitals can participate in the Hospital at Home program.

Pass the bipartisan Accelerating Kids’ Access to Care Act

Today, children on Medicaid who need care outside their home states often experience delays because some state Medicaid programs require out-of-state providers to be enrolled into their program, even if the provider is already enrolled and in good standing with their home state’s Medicaid program.

This is particularly true for children with medically complex conditions, like cancer or other rare diseases, who must travel long distances and across state lines to receive care at a children’s hospital where the specific expertise is available. The process for providers to enroll in multiple Medicaid programs consumes valuable time and resources, increases program costs, and delays children’s access to care.

Passing this legislation would:

• Ensure timely access to care for children, regardless of where they live.
• Reduce administrative burdens on Medicaid providers to enroll in multiple state Medicaid programs.

The Accelerating Kids’ Access to Care Act has strong bipartisan support and passed the House of Representatives in September 2024.

Prevent Medicaid Disproportionate Share Hospital (DSH) cuts

Hospitals are facing $8 billion in annual payment cuts to the Medicaid Disproportionate Share Hospital program. These cuts would reduce children’s hospitals’ ability to provide care for children on Medicaid.

We urge Congress to act immediately to stop these cuts. Continued investment in Medicaid is critical to children’s health and our nation’s future.

Support the Children’s Hospital Graduate Medical Education (CHGME) program

CHGME is the only federal program focused exclusively on training pediatricians and pediatric specialists. The program ensures children and their families have access to the routine and specialized care they need.

The $758 million in funding is vital so children’s hospitals can train the next generation of pediatric doctors and specialists. We are hopeful Congress can maintain this support without any policy riders as they seek to complete their work for fiscal year 2025.

Stop harmful proposals that jeopardize care for children

CHA calls on Congress to consider the unique and harmful impact certain policies can have on children’s access to care.

Policies like site neutrality and facility fees can create barriers for children’s hospitals to sustain, expand, and open outpatient facilities in service areas, like rural and underserved communities. This directly impacts children’s access to care and community-based care.

These proposals jeopardize care for:

• Children with medical complexities who receive care more often in ambulatory outpatient settings. These children need coordinated care that continues outside the hospital, closer to home.
• Rural communities with outpatient facilities that a hospital can no longer afford to keep open.

Additionally, changes to the 340B program could impact the ability of our hospitals to serve low-income, uninsured, and underinsured pediatric patients. The program helps children’s hospitals invest in care for more children, improve access to care, and provide more comprehensive services. Some organizations have used the savings to help subsidize the cost of behavioral health services, annual flu shots, affordable prescription drugs, or hemophilia treatment centers. The critical resource helps offset low Medicaid reimbursement rates and enables children’s hospitals to further support initiatives that provide essential care to children and their families.

Ensure children’s hospitals can participate in hospital at home

Implementation of the Hospital at Home program under Medicare has been challenging for children’s hospitals. Children’s hospitals pursue similar initiatives with their state Medicaid program since Medicaid is the main insurer for America’s children.

More states are requiring hospitals to enroll in the Medicare Hospital at Home program in order to participate in the Medicaid version. The Centers for Medicare and Medicaid Services (CMS) determined that freestanding children’s hospitals, which are exempt from the Inpatient Prospective Payment System, are not able to participate in the Medicare program.

We ask Congress to ensure that children’s hospitals can participate in the Hospital at Home program so children with complex conditions can get the care they need in the best setting for them.

Children need our help now. This year and always, we stand ready to promote children’s health and enact policies that improve the health and well-being of America’s children.