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StateView

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​​StateView compiles up-to-date information on state policy trends and resources for chapter advocacy efforts and focuses on important state-level child health advocacy issues, and summarizes valuable resources from the AAP and other public and private sector sources.​​​​​​​​​​​

December 3, 2019: Chapter Advocacy | Looking Back, Planning Ahead
This year, AAP chapter advocacy efforts led to tremendous advances in children’s health and well-being across the country, including removal of nonmedical exemptions to immunizations, prevention of youth e-cigarette use, and protection of children from gun violence. For more information on all that’s happened in states in 2019, we are pleased to announce the release of the 2019 AAP State Advocacy Wrap Up. This new resource highlights the successes chapters achieved on the priorities they outlined in their 2019 advocacy blueprints and agendas.

To help advance these priorities, 33 AAP chapters, AAP District II (New York), and AAP District IX (California) held productive advocacy days in their state capitals. These well-attended events strengthen chapter relationships with legislators and other policymakers and raise awareness about child health needs. To better assist chapters in developing and implementing advocacy days in 2020, the AAP Chapter Advocacy Day Planning Guide is now available.

The 2020 state legislative elections are quickly approaching and there is still work to be done. Your chapter’s advocacy efforts in 2019 provide a springboard to determining your advocacy needs in 2020. To support chapters in determining these advocacy priorities, the AAP developed the 2020 Chapter Blueprint for Children template, as well as the AAP Chapter Advocacy Agenda Planning Toolkit. The blueprint template is fully customizable to meet your chapter’s needs. State advocacy planning tools, sample chapter advocacy agendas, and issue resources are included in the toolkit.

StateView will be taking a break for the holidays. We wish you a happy holiday season and a new year filled with peace and happiness, and thank you for all you do to advocate for children. We’ll see you in 2020!

December 2, 2019: States Act to Reform the Juvenile Justice System

The health impacts of youth involvement in the juvenile justice system are well known, and, as with many other issues related to child health and wellness, prevention is key. State lawmakers across the country are taking important steps to limit youth detention and provide alternatives that not only limit risks to youth that have run afoul of the law, but that also better protect communities and save money. The Pew Charitable Trust recently asked state officials in Kansas, South Dakota, and Hawaii about juvenile justice reforms in their state, and how they have benefitted juvenile offenders and communities. A summary of recent state level actions on juvenile justice reform is available from the National Conference of State Legislatures. 

For more information about care of youth in the juvenile justice system, see the AAP policy statement from the Committee on Adolescence. Also visit stopsolitaryforkids.org, a juvenile justice reform organization which the AAP supports.

November 26, 2019: AAP District IV Vice Chairperson Joins KY Cabinet of Health and Family Services

Congratulations to AAP Kentucky Chapter Past President and AAP District IV Vice Chairperson Patricia Purcell, MD, MBA, FAAP, who was recently named medical director of Office of Children with Special Health Care Needs within the Kentucky Cabinet for Health and Family Services. In this role, Dr Purcell will provide medical guidance and oversight of programs and services designed to improve the health and well-being of children with special health care needs, including the state’s newborn hearing screening program (EHDI), medically complex foster care program, and medical, therapy, and support services.

November 25, 2019: Push for Stronger Immunization Laws in Florida

Sharing her message in a recent op-ed, AAP Florida Chapter Vice President Dr Lisa Gwinn called for reforms of the state’s immunization laws. Citing the 2019 actions of the New York legislature (thanks to the effort and leadership of New York District II) to eliminate nonmedical exemptions to school entry immunization requirements, Dr Gwinn notes the important role strong laws can play in preventing outbreaks of measles and other infectious diseases that have been seen in recent years. The Florida Senate has prefiled legislation that replicate New York’s successful effort for the legislatures’ consideration next year.

As we near the 2020 legislative sessions, contact the AAP state advocacy team with any questions you may have on this issue, and be sure to see our State AdvocayFOCUS resource, our interactive infographic, and our immunization campaign materials.

November 21, 2019: US and the High Price of Child Care: An Examination of a Broken System

Child care is inherently expensive. In 43 states, full time center based child care for an infant costs more than 10% of a married couple’s annual median income. For a 4 year old, cost for center based care is more than 7% in all but 2 states. For those families living in poverty, the costs are even more. A new report from Child Care Aware of America, The US and The High Price of Child Care: An Examination of a Broken System, examines the issue of access to child care by looking at a number of factors, including child care type, child care population, and parent and family demographics.

You can learn more about how the cost of child care in your state by taking a closer look at the report’s interactive map.

For more on early childhood from the AAP, visit the AAP Council on Early Childhood and the AAP Initiative Healthy Child Care America.

November 19, 2019: Addressing Hunger Through Public-Private Partnerships

States and local governments have long served as incubators of innovative policies to address a wide range of public policy issues, including food insecurity. State partnerships with private organizations can strengthen the development and implementation of public programs and services. Bringing Legislators to the Table, a new report from the National Conference of State Legislators (NCSL), examines how such partnerships have led to improvements in food insecurity programs related to the Supplemental Nutrition Assistance Program (SNAP), child nutrition partnerships, healthy food access partnerships, food distribution partnerships, and bilingual and multicultural partnerships.   

For more from the AAP, see Addressing Food Insecurity: A Toolkit for Pediatricians and our policy statement Promoting Food Security for All Children.

November 18, 2019: A Look at Healthy School Policies

School districts across the country develop and implement plans to deliver preventive care, provide behavioral and mental health services, and manage chronic conditions for children. Schools also help create healthy lifelong habits through physical and health education and school nutritional programs. The current landscape of school district and charter policies that support healthy schools,  a new report from Child Trends and the University of Illinois at Chicago’s Institute for Health Research and Policy, examines state and school district policies in 20 states (AK, CA, CO, FL, ID, IN, MI, MS, MO, NE, NJ, NM, NY, ND, OR, RI, SC, TX, and WA) that address the Centers for Disease Control and Prevention’s Whole School, Whole Community, While Child (WSCC) initiative. The study determined that most states do not universally cover the WSCC domains, but the greatest policy coverage currently in place addresses community involvement and the physical environment.

For more from the AAP, see our School Physical Education and Activity State AdvocacyFOCUS resource and visit the AAP Council on School Health.

November 14, 2019: States Identify Costly Drugs, Including Those with Unsupported Price Increases

As states continue to pass new laws in order to address increasing drug prices, efforts to identify costly drugs also move forward. The National Academy for State Health Policy (NASHP) recently highlighted an Institute for Clinical and Economic Review (ICER) report, Unsupported Price Increase Assessment, which identifies drugs with unfounded price increases. California, Maine, Oregon, and Vermont all have transparency laws which require them to report data from public and private payers regarding drug spending. The drugs identified by the ICER report also appear on the 4 state lists of their most costly drugs or drugs that cause the most cost growth.

With states implementing more drug pricing transparency laws, and ICER planning to publish its pricing report every year, there will be additional ways to guide effective state policy in lowering drug prices.

AAP chapters advocating on issues related to lowering drug costs are encouraged to contact the AAP at stgov@aap.org for consultation and technical assistance.

November 12, 2019: Medicaid Expansion Saves Lives

Research continues to show the positive effects Medicaid expansion has on access to care, coverage, utilization and treatment, family financial security, state budgets and state economies. Medicaid expansion to adults also has a positive impact on children's coverage and even children's use of preventive services. A new landmark study by the National Bureau of Economic Research (NBER) adds to this considerable record by demonstrating that Medicaid expansion has also saved over 19,000 lives between 2014-2017. Researchers looked at mortality rates of 55-64-year-olds in expansion and nonexpansion states and found deaths from treatable conditions among low-income adults dropped considerably after states expanded Medicaid. Conversely, nonexpansion states lost 15,600 lives of older adults by not expanding Medicaid. Had all states expanded the program, the number of lives saved just among older adults in 2017 would nearly equal that of lives saved from seatbelts in the entire US population.

For consultation and technical assistance on Medicaid expansion advocacy, contact the AAP state advocacy team.

November 11, 2019: New State Fact Sheets on Infant-Toddler Nutrition

Across the US, 17.4% of children younger than 18 live in a household experiencing food insecurity and 23.7% of children ages 0-3 live in families experiencing poverty. A lack of proper nutrition puts young children at greater risk of health problems, developmental issues, and poor educational outcomes. New fact sheets from the Food Research & Action Center (FRAC) and Think Babies provide state specific data and analysis of hunger and poverty experienced by infants and toddlers.

For more from the AAP, see Addressing Food Insecurity: A Toolkit for Pediatricians and our policy statement Promoting Food Security for All Children.

November 7, 2019: 2019 State Elections—Key Highlights

Election Day 2019 is now in the books. Mississippi, New Jersey, and Virginia held their legislative elections on November 5th, and Kentucky and Mississippi held gubernatorial elections, as well. There were changes in partisan control in the Kentucky governor’s race, where the incumbent governor was defeated, and in the Virginia House and Senate, where control of both chambers of the legislature will flip when the General Assembly reconvenes in 2020. Voters also let their voices be heard on a number of ballot measures addressing tax and funding priorities, education, and other fiscal issues relevant to children. 

In the municipal elections in Rockville, MD, AAP Committee on State Government Affairs (COSGA) member Dr David Myles won his bid for a seat in the city council. In Virginia, AAP member Dr Mark Downey came up short of the votes needed to win House of Delegates District 96 seat.

The AAP is looking ahead to the 2020 elections and is developing resources for pediatrician engagement in this important process.

November 5, 2019: State Systems Using National Standards for CYSHCN

The National Standards of Systems of Care for Children and Youth with Special Health Care Needs (Version 2.0) provides stakeholders—including state programs, health systems, private and public insurers, physicians, and families—a core set of standards for children and youth with special health care needs (CYSHCN) in 8 important domains. Developed with input from the AAP, these standards can be used to help build and ensure robust systems of care for CYSHCN.

How States Use the National Standards for CYSHCN in their Health Care Systems, a new National Academy for State Health Policy (NASHP) resource, details how state Medicaid programs and Title V agencies are using these national standards. Examples include program and system improvement, managed care contracting, quality measurement, strategic planning, and stakeholder engagement. For consultation and technical assistance with state advocacy efforts for CYSCHN, contact the AAP state advocacy team

November 4, 2019: Local Government Supports for Immigrant Children and Families

Due to the current policy climate, immigrant children and their families face greater challenges and are at an increased risk of mental health trauma according to Addressing Health and Social Needs of Immigrant Families: Lessons from Local Communities. The Kaiser Family Foundation report examines efforts in California communities to coordinate and integrate services for immigrant children and families, including expanding mental health services and maintaining access to the state’s MediCal (Medicaid) program.

Pediatricians play a special role in supporting the health and well-being of immigrant children. By recognizing the unique challenges and strengths that many immigrants experience; pediatricians can identify effective practice strategies and relevant resources that support health within the community. For ways your chapter can support immigrants and their families, visit the AAP Immig​rant Child Health Toolkit​​​.

October 31, 2019: 2019 State Elections

While considerable public attention is focused on the 2020 election cycle, it will soon be Election Day 2019 in several states. Mississippi, New Jersey, and Virginia will hold legislative elections on November 4th, with Louisiana doing the same on the 16th. Voters in Kentucky, Mississippi, and Louisiana will select governors this year, too. The Kentucky governor’s race has been projected to be close in the relative few polls that have been made public, and control of one or both chambers of the legislature may be in play in Virginia, as both bodies are currently governed by a one-seat majority. Numerous municipal elections along with 24 ballot issues certified in 8 states (focusing primarily on tax and funding priorities, including education) will be decided by voters this year as well.

Contact the AAP state advocacy team with any questions and see chapter seven of the AAP Advocacy Guide for guidance on pediatrician engagement in campaigns and elections.

October 29, 2019: National Prescription Opiate Litigation

In the late 1990s, pharmaceutical companies began to market opioids as pain medicine with low risk of addiction and physicians began to prescribe them at greater rates. Since then, hundreds of thousands of people in the US have died from opioid overdoses and even more have battle opioid misuse disorder.

Your Guide to the Massive (And Massively Complex) Opioid Litigation, a report from National Public Radio, examines the National Prescription Opiate Litigation which consolidates over 2000 individual lawsuits brought forth against large multinational opioid manufacturers and distributors, among other defendants. As litigation progresses, the AAP will work with chapters and other stakeholders to help ensure that any funds that may be allocated to local and/or state governments are used for prevention and treatment and include the pediatric population. For more from the AAP, please see American Academy of Pediatrics Resources to Address the Opioid Epidemic

October 28, 2019: California Medical Board Engages on Immunization Exemptions

Earlier this month, we detailed California’s recently enacted law to deter the misuse of medical exemptions used to opt students out of school entry immunization requirements. Because of the new law, authored and championed by Senator Richard Pan, MD, FAAP, the Medical Board of California has initiated disciplinary actions against physicians granting inappropriate medical exemptions to school entry immunization requirements. As more states consider reforms of nonmedical exemptions, California actions serve as an important roadmap to ensure that children entering school are fully protected from vaccine preventable diseases.

For additional guidance from the AAP, see our State AdvocayFOCUS resource, our interactive infographic, and our immunization campaign materials on this topic.

October 24, 2019: California Sets Later School Start Times for Teens

Sleep is critical to healthy child development. Adolescents who sleep 8 hours or more a night are more likely to have better academic performance and have better health outcomes in areas like weight, mental health, and safety practices. The AAP recommends that schools serving adolescents start no earlier than 8:30 am to optimize student sleep.

California recently became the first state to mandate later school start times for public middle schools (8:00 am or later) and public high schools (8:30 am or later). School districts in the state will  be required to implement the new requirements by 2022. 

For more from the AAP on school start times, see our policy statement School Start Times for Adolescents

October 22, 2019: Vaping | State Policy Update

With more than 1,400 probable and confirmed lung injuries and at least 33 deaths associated with vaping products, states are acting to address this public health concern. Governors in Michigan, Montana, New York, and Rhode Island have banned flavored nicotine vaping products via executive action, while governors Oregon and Washington banned flavored nicotine and THC products. Massachusetts Governor Charlie Baker went a step further and ordered removal of all flavored and unflavored nicotine and THC products from the market. These emergency measures are time limited and will likely be followed-up with legislative action in 2020 to ensure the products do not return to the market. 

In addition, the governors of Connecticut, New Jersey, New York, and Pennsylvania are considering creating a regional standard for vaping products, including nicotine and CBD products. Among other regulations, the states would ban all flavored vaping products, standardize labeling for all vape products, and increase enforcement for selling to those under 21.

For more from the AAP, see our E-Cigarettes and Raising the Tobacco Purchase Age to 21 AdvocacyFOCUS resources and visit the AAP Julius B Richmond Center of Excellence. 

October 21, 2019: State Policies Can Affect Access to Child Care for Latino Families

More than 80% of Latino children in families with low incomes reside in 13 states, AZ, CA, CO, FL, GA, IL, NJ, NM, NY, NC, PA, TX, and WA, and compose about 35% of children who are eligible for Child Care Development Fund (CCDF) subsidies. Although 35% are eligible, it is estimated that only 20% are being served by CCDF subsidies. How State Policies Might Affect Hispanic Families’ Access To and Use of Child Care and Development Fund Subsidies, a report from the National Research Center on Hispanic Children & Families explores how state policies and application processes affect access to this critical child care program. AAP chapters can utilize this data to advocate for simplifying your state’s CCDF subsidy application process to better ensure access for low income children. 

For consultation on child care and early education advocacy activities in your state, contact the AAP State Advocacy team

October 17, 2019: New Report on How States Measure Poverty Among Students

States have traditionally relied on the number of children receiving free and reduced-price lunches (FRPL) to help determine poverty rates among students, and subsequently, how to distribute funding to schools in low income areas. The introduction of the Community Eligibility Provision (CEP), which provides no cost lunches to all students in a school or district with at least 40% of the student population living in poverty, has made using the FRPL less reliable. Measuring Student Poverty: Dishing Up Alternatives to Free and Reduced-Price Lunch, a new report from the Urban Institute,provides an interactive state-by-state look at how states are measuring student poverty. AAP Chapters can utilize this data to support advocacy efforts on food insecurity, nutrition, and poverty.

For more from the AAP on this issue, check out the AAP and Food Action Research Center (FRAC) Addressing Food Insecurity: A Toolkit for Pediatricians.

October 15, 2019: Representative Yadira Caraveo, MD, FAAP Named 2019 AAP Child Health Advocate Award

Colorado State Representative Yadira Caraveo, MD, FAAP (D-31) received the 2019 AAP Child Health Advocate Award in recognition of her work for children and families as a member of the state legislature. Representative Caraveo was elected to the legislature in 2018, joining a record number of women winning state legislative offices across the country. In her first term, she succeeded in getting 6 of her 7 bills enacted into law. One of the new laws makes possible an assessment of the potential impact of bills on economic, employment, health, education, or public safety outcomes when comparing the state population as a whole and population subsets based on race, ethnicity, sex, sexual orientation, gender identity, disability, and geography. Another of Dr Caraveo’s successful bills provides grants to local governments, schools districts, and nonprofits to support efforts to ensure an accurate 2020 Census count.

The AAP Colorado Chapter, in conjunction with the Colorado House of Representatives Majority Leaders Office, hosted an award ceremony at the State Capitol for Representative Caraveo to present her with the AAP award. After the ceremony, in a note to her fellow pediatricians, she thanked them for supporting her work in the legislature and trusting her to be a voice for Colorado’s children and families.

October 14, 2019: State Borders and Medicaid Disparities

To date, 36 states and the District of Columbia (DC) have expanded their Medicaid programs for low-income adults earning up to 138% of the federal poverty level (FPL) as permitted under the Affordable Care Act (ACA). The Deep Divide: State Borders Create Medicaid Haves and Have-Nots, a feature by Kaiser Health News, examines how policy decisions like these can result in health care disparities between states.

Since Medicaid expansion began, extensive research demonstrates the links between increased coverage, improved access to care, reduced mortality rates, financial security for beneficiaries, and even economic benefits for states and practitioners.

AAP chapters advocating for Medicaid expansion are encouraged to contact the AAP at stgov@aap.org for consultation and technical assistance.

October 10, 2019: AAP Tennessee Chapter Fights Medicaid Block Grant Proposal

Recently, Tennessee proposed a Medicaid waiver which would fundamentally alter how the program is funded and managed by converting TennCare into a block grant.

The AAP Tennessee Chapter (TNAAP) recently opposed the waiver at a public hearing, noting the threat posed to children’s access to care by the proposal. TNAAP emphasized the importance of ensuring that the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit remain intact, that funding remain sufficient to provide services for children with special health care needs, and that kids maintain access to medically necessary prescription drugs. TNAAP and the AAP will advocate to children’s health care needs are not at risk as review of the proposed waiver continues.

For more from the AAP, please see our Principles on Waivers resource. AAP Chapters working to address state Medicaid waivers may contact the stgov@aap.org for consultation and technical assistance.

October 8, 2019: Implementing the Family First Prevention Services Act | New Resource

The Family First Prevention Services Act provides an opportunity for states to initiate landmark reforms within their child welfare systems to benefit children and families, namely by allowing states to put Title IV-E funds towards prevention services to keep children from out of home placement and with their families. To better assist states and stakeholders with implementation of Family First, The Children’s Defense Fund, in partnership with the AAP and other stakeholders, recently released Implementing the Family First Prevention Services Act: A Technical Guide for Agencies, Policymakers, and Other Stakeholders. This easy to use guide provides an in depth look at implementing the federal law in and can be utilized by AAP chapters in their work with state policymakers.

For more from the AAP, see our Family First Advocacy Toolkit and our Family First State Legislation Tracker.

Questions? Contact the AAP advocacy team at stgov@aap.org or kids1st@aap.org.

October 7, 2019: West Virginia Kids’ Health Roundtable Series

The AAP West Virginia Chapter, in partnership with West Virginians for Affordable Healthcare, recently held their 3rd Kids' Health Roundtable Series to discuss issues facing the state’s children and families. Issues included the opioid epidemic, adverse childhood experiences (ACEs), foster care, and the importance of wrap-around services for children. Representing the chapter were President Traci Acklin, MD, FAAP and Vice President and AAP Committee on State Government Affairs (COSGA) member Lisa Costello, MD, FAAP­.

A report outlining these discussions will developed and delivered to the state legislature prior to the convening of the 2020 legislative session.

October 3, 2019: 2019 State of Obesity Report

Trust for America’s Health recently released its 2019 State of Obesity report outlining current state obesity rates and highlighting successful public policy strategies that state and local governments can implement to reduce obesity. The report notes that though adult obesity rates continue to rise across the country, there has been success reducing obesity rates among young children. Of note, the rate of obesity for children enrolled in the WIC program decreased from 15.9% in 2010 to 13.9% in 2016. This decrease corresponds with an update to WIC food packages to more closely meet recommended national dietary guidelines including the addition of more fruits, vegetables and whole grains and reduced fat levels in milk and infant formula.

In addition, the report notes that taxes on sugary drinks are showing promise in reducing consumption, citing studies of taxes in Philadelphia and Berkeley California that show these taxes significantly reduce consumption of sugary drinks. An additional 29 promising obesity prevention policy strategies are highlighted in the report.

For more from the AAP, see our Advocacy Infographic Sugary Drinks: State and Local Policy Options and State AdvocacyFOCUS resources Sugary Drink Taxes and School Physical Education and Activity.

October 1, 2019: California Enacts Important Reforms to Medical Exemption Policy

After an entire summer of hearings and negotiations, California Governor Gavin Newsom recently signed legislation to deter the misuse of medical exemptions used to opt students out of school entry immunization requirements. The legislation, sponsored by California Senator Richard Pan, MD, FAAP will create a system of review for medical exemptions by state health department officials.

This new law comes in response to a rising number of medical exemptions granted after elimination of nonmedical exemptions in California, as  reported in a November 2018 study published in Pediatrics. This legislation will prevent economic incentives to the small but growing number of pediatric practices that had begun providing questionable medical exemptions for an out-of-pocket fee.

Congratulations to Dr Pan, a national policy leader on this issue. His work has helped to support other states and AAP chapters in efforts to strengthen immunization laws and practices.

For more from the AAP, see our Childhood Immunizations State AdvocacyFOCUS resource and our interactive infographic Child Vaccination Across America.

September 30, 2019: Number of Children Without Insurance Increased in 2018

The United States Census Bureau recently released its Current Population Survey which, in part, looks at data related to health insurance status. The Census Bureau subsequently sent out a separate report, Uninsured Rate for Children Up 5.5 Percent in 2018, which focused on insurance coverage for children, which showed that there were 4.3 million, children under the age of 19 were uninsured that year.  This is an increase of 425,000 children, or 0.6 percentage points from the previous year. 

The report concludes this increase is largely due to a decline in Medicaid and Children’s Health Insurance Program (CHIP) coverage. The percentage of kids with private health insurance did not statistically change, but the number of those with either Medicaid or CHIP fell by 1.3 percentage points. 

For more on child enrollment in Medicaid and CHIP, please see the AAP's 2019 State Medicaid and CHIP Snapshots. AAP chapters advocating on issues related to enrollment and children's coverage are encouraged to contact the AAP at stgov@aap.org for consultation and technical assistance. 

September 26, 2019: States Act to Address Vaping Public Health Crisis

The CDC recently released data showing 805 confirmed and probable patient cases of lung injury and 12 deaths associated with e-cigarette/vaping product use in 46 states and the US Virgin Islands. Governors in California, Massachusetts, and Rhode Island joined their counterparts in Michigan and New York by addressing this public health concern via executive order. California Governor Gavin Newsom, noting a lack of direct authority to ban vaping devices,  pledged stronger enforcement efforts on counterfeit vaping devices and set aside $20 million dollars to fund public education.

Massachusetts Governor Charlie Baker issued an emergency public health ruling ordering a 4-month ban on sales of vaping products including favored and unflavored e-cigarettes that contain nicotine and THC vaping products. Following action in Massachusetts, Rhode Island Governor Gina Raimondo issued an executive order banning flavored e-cigarettes. 

For more from the AAP, see our E-Cigarettes and  Raising the Tobacco Purchase Age to 21 State AdvocacyFOCUS resources and visit the AAP Julius B Richmond Center of Excellence.

September 24, 2019: AAP Members Making a Difference in Their States| WIAAP Advocates for Gun Safety

AAP Wisconsin Chapter (WIAAP) President Mala Mathur, MD, FAAP spoke at a press conference Governor Tony Evers and bill sponsor, Representative Melissa Sargent, announcing Extreme Risk Protection Order legislation in the state, emphasizing the importance of removing guns from the environment of a person at risk of hurting themselves or others. WIAAP identified gun safety as a priority for 2019 and focused its February advocacy day on advancing the issue.

Currently, 17 states and Washington DC have Extreme Risk Protection Orders or “Red Flag” Laws, which allow for the removal of firearms from the environment of a person at risk of hurting themselves or someone else. If your state is working on this issue and would like a customized Chapter Advocacy Infographic on Preventing Youth Suicide or Extreme Risk Protection Orders, please contact the State Advocacy Team.

For more from the AAP on Extreme Risk Protection Orders or “Red Flag” laws, see our State AdvocacyFOCUS resources on Extreme Risk Protection Orders (ERPO) or “Red Flag” Laws, Safe Storage of Firearms, Waiting Periods, Universal Background Checks for Gun Purchases, and Assault Weapon Bans.
                            

September 23, 2019: AAP Members Making a Difference | 2019 Louisiana Elections

Louisiana is 1 of the 4 states holding state elections this November (Kentucky, Mississippi, New Jersey are the others) and the AAP Louisiana Chapter is working hard to ensure that children are included in priorities set forth by candidates for state office. Roberta Vicari, MD, FAAP, AAP Louisiana Chapter President, recently authored Pediatrics leader: Make children a priority in Louisiana elections, highlighting the need to invest in and increase access to early education and care in the state.

For more from the AAP on ways to make your voice heard, get all of the tools that you need from our State Advocacy page and from the state advocacy team staff.

September 19, 2019: Addressing the Maternal and Infant Mortality Crisis

Michael Warren, MD, FAAP, Associate Director of the Maternal and Child Health Bureau, recently joined state legislators to discuss how states are addressing infant and maternal mortality. After decades of improvement, the maternal mortality rate in the US has been on the rise since the 1990s. Every year, between 700-900 women die from pregnancy-related causes during or within 1 year of pregnancy. In 2017, the infant mortality rate for black infants reached the same rate as for white infants in 1980, a near 40-year lag. Black women are more than 3 times as likely to die from pregnancy-related complications than white women.

Earlier this year, NCSL launched the inaugural class of its Maternal and Child Health Fellows, a program designed to support legislators who are experienced or emerging leaders in maternal and child health related issues. Check to see if a legislator from your state is participating and connect with them to offer your chapter’s expertise and support.

Questions? Contact the AAP State Advocacy Team.

September 17, 2019: Protecting Immigrant Families | Public Charge State Policy Toolkit

October 15 is the anticipated effective date of the public charge rule opposed by the AAP and other advocates. While we are engaged in litigation seeking to stop implementation of the rule, there are actions that states, localities, and service providers can take to support immigrant access to health, nutrition, and housing programs.

Our partners at Protecting Immigrant Families have released a state policy toolkit that includes actions for state and local government officials seeking to minimize harms of the public charge rule. This resource can be utilized to support AAP chapter advocacy and outreach efforts with these policymakers. 

The AAP continues to speak up for immigrant children through rapid response advocacy and the work of the new Council on Immigrant Child and Family Health. Contact us at stgov@aap.org for help with related advocacy work. 

September 16, 2019: Michigan and New York Ban Flavored E-Cigarettes

The governors of Michigan and New York both recently issued emergency rules affecting the sale of flavored e-cigarettes. New York’s rule exempts mint and menthol e-cigarettes, but the Michigan ban includes all flavors. While Michigan and New York are the first 2 states to restrict or ban these products by executive action, at least 9 other states (California, Connecticut, Hawaii, Illinois, Massachusetts, Montana, New Mexico, North Dakota, and Washington) proposed legislation this year to ban flavored e-cigarettes and/or tobacco.

AAP Michigan Chapter President Sharon Swindell, MD, FAAP, testified in favor of the state’s emergency rule.

For more from the AAP, see our E-Cigarette and Raising the Tobacco Purchase Age to 21 State AdvocacyFOCUS resources and visit the AAP Julius B Richmond Center of Excellence. 

September 12, 2019: States Pass Record Number of Laws to Control Drug Prices

States continue to pass new laws to address escalating drug prices. So far this year, 33 states have enacted 51 laws to tackle the issue. Legislation covers a broad scope of policies, including the importation of prescription drugs, screening drug companies for excessive price increases, governing pharmacy benefit managers (PBM), and establishing drug cost oversight boards.

AAP chapters advocating on issues related to lowering drug costs are encouraged to contact the AAP at stgov@aap.org for consultation and technical assistance.

September 10, 2019: Delaware Governor Signs Healthy Drink Bill

Recently, Delaware Governor John Carney signed HB 79 , which requires restaurants to include a healthy drink option as the default option for children’s meals. The AAP Delaware Chapter wrote an influential letter to the bill’s sponsor, helping the legislation move along. AAP Delaware Chapter President Laura Lawler, MD, FAAP and AAP Delaware Chapter Executive Director Angela Warren attended the bill signing.

For more information on sugary drinks and children’s health, check out our Sugary Drink Taxes State AdvocacyFOCUS and Sugary Drinks Advocacy Infographic, which can be customized for your state.

September 9, 2019: Modest Medicaid Payment Increase Can Ease Access Disparities

A recent study from the National Bureau of Economic Research provides further evidence that increased Medicaid payment can increase access to care. Because 79% of all children living in or near poverty are insured by Medicaid, payment policy has a significant effect on their health. The report estimates that an average Medicaid payment increase of $26 could eliminate access disparity between children insured by Medicaid and those covered by private insurance.

An earlier study in Pediatrics also showed that pediatricians increased their participation in the program, thereby expanding access, during the time of Affordable Care Act payment increase. 

If your chapter is advocating for increased Medicaid payment, please contact the AAP at stgov@aap.org for consultation and technical assistance.

September 5, 2019: Mental Health Services for LGBTQ Adolescents in US Public Schools

LGBTQ youth face an increased risk of mental health problems, including suicide. Half of females who identify as lesbian or bisexual seriously considering suicide within the past 12 months. Similarly, 42.5% of males who identify as bisexual and 30.3% of males who identify as gay report considering suicide within the past 12 months as well

According to a new report from Child Trends, most public schools in 29 states and DC facilitate connections for LGBTQ youth to experienced mental health service providers. Massachusetts sets the high mark, with almost 80% of public schools facilitating this access, while Kansas is the lowest with only around 36% of public schools assisting LGBTQ youth in locating mental health services from LGBTQ experienced providers. 

For more from the AAP on LGBTQ health and well-being, visit the AAP Section on Lesbian, Gay Bisexual, and Transgender Health and Wellness.

July 23, 2019: When Life Gives You Lemons

Most state legislatures have adjourned their 2019 regular sessions and we thank you for your amazingly successful advocacy work this year, despite some lemons coming your way. Speaking of lemons, laws, and summer, did you know children's lemonade stands are technically prohibited in 34 states? True. But thankfully, several state legislatures are considering proposals to change that.

As we enter midsummer, StateView will be taking a brief recess. We’ll be back right after Labor Day to guide you through your fall state advocacy activities and help you to plan for the 2020 state legislative sessions.

Until then stay cool and contact us at stgov@aap.org if we can be of help to you and your chapter advocacy efforts.

July 22, 2019: Virginia Special Session on Gun Violence Prevention Meets Abrupt End

In the wake of the mass shooting event in Virginia Beach, Governor Ralph Northam, a pediatric neurologist, called the legislature back into session to consider a package of bills addressing gun violence prevention, with proposals to: implement universal background checks; ban assault weapons, bump stocks and high-capacity magazines; reinstate a law permitting only one handgun purchase a month; enact an Extreme Risk Protection Order law; require lost or stolen guns to be reported to law enforcement within 24 hours; and prohibit the state from preempting local laws on firearms that may be more restrictive than state law.

Within 90 minutes, every gun violence prevention bill was tabled by legislative majority leaders, cutting off debate, and the special session was adjourned. Governor Northam expressed his disappointment with the legislature’s inaction on the issue. 2019 is an election year, and with a razor-thin majority currently separating partisan control of both chambers, voters will ultimately decide the direction of this issue in the Commonwealth of Virginia.

For more from the AAP on state gun violence prevention efforts, see our State AdvocacyFOCUS resources on Safe Storage of Firearms, Extreme Risk Protection Orders (ERPO) or “Red Flag” Laws, Waiting PeriodsUniversal Background Checks for Gun Purchases, and Assault Weapon Bans.

July 18, 2019: State Reforms of Nonmedical Exemptions—A Midyear Look

The 2019 state legislative sessions have been productive in reforming nonmedical exemptions to immunization requirements. Fight over vaccine exemptions hits state legislatures, published in The Hill, offers an overview of recent state level actions as well as the tactics employed by opponents of related policy changes. Similar opposition efforts have been chronicled in the Boston Globe, New York Times, Washington Post, CNN, and the Hartford Courant this year as well.

Todd Wolynn, MD, FAAP, shared his experiences about being the target of opposition this year on an episode of the ZDoggMD Podcast, and describes how it ultimately provided a rich dataset for research into vaccine hesitancy.

Contact stgov@aap.org for consultation and technical assistance if you’re working on reforming nonmedical exemption policies in your state and see our State AdvocacyFOCUS resource, our interactive infographic, and our immunization campaign materials for more on this topic. 

July 16, 2019: AAP Illinois Chapter Advocacy Success Leads to CHIP Vaccine Change

Three years of advocacy by the AAP Illinois Chapter paid off this month when the Illinois Department of Public Health announced that it will be changing state vaccine supply policy for children enrolled in Children’s Health Insurance Program (CHIP). Issues with vaccines for children in Illinois CHIP began in 2016, when the state abruptly began requiring physicians to buy vaccines from the private market and to be paid back by the program at a later date. Worried about the inability of practices to sustain this financial burden in the midst of a state budget crisis, the Illinois Chapter sprang into action and has sustained its advocacy ever since. The new policy will allow the state’s CHIP program to purchase vaccine for children in the program on the CDC contract and be distributed to physician practices through Vaccines for Children (VFC) distribution channels. The state has released guidance for practices in the state about how to obtain vaccine this way, and is hosting webinars to spread information about the policy change. 

Working on vaccine issues in your state? Contact the state advocacy team for consultation and resources.

July 15, 2019: Immigrant Children and California Insurance Coverage

California just became the first state to expand Medicaid coverage to adults who are undocumented immigrants, however, unauthorized immigrant children through age 18 have been eligible for the state’s program since 2016. (Illinois, Massachusetts, New York, Oregon, Washington, and the District of Columbia also offer health coverage for children who are undocumented immigrants.) Child enrollment peaked in 2017 with more than 134,000 children receiving coverage. However, as of February 2019 enrollment dropped by 5% from that peak. The decline is similar to the national trend for all children insured by Medicaid and the Children’s Health Insurance Program (CHIP). Researchers say however, that different factors are at play in the decline for immigrant children.   

While a shift in migration patterns for some children and families is attributing to a decline, a rising fear among families in response to anti-immigration policy proposals is likely to be having an effect. Additionally, the proposed “public charge” rule, which would consider immigrants’ use of public benefit programs as a reason to deny lawful permanent residency, is also having a chilling effect on seeking coverage.

For more from the AAP, please see our policy statement, Providing Care for Immigrant, Migrant, and Border Children.

July 11, 2019: San Francisco Bans E-Cigarettes

The city of San Francisco has passed a sweeping ordinance prohibiting the sale of e-cigarettes within its borders; just 50 miles away, the city of Livermore acted to do the same. In the beginning of June, Beverly Hills became the first US city to ban the retail sale of e-cigarette and tobacco products in nearly all instances. Local actions around the country on flavored tobacco products have been another successful tactic to limit exposure to tobacco products intended to be appealing to youth. In response, the tobacco and e-cigarette industry is redoubling its efforts to resist similar actions from expanding to additional cities around and beyond the state of California, and advocates should brace for pushback accordingly.

For more from the AAP, see our Raising the Tobacco Purchase Age to 21 and Electronic Nicotine Device Systems (ENDS) State AdvocacyFOCUS resources and visit the AAP Julius B Richmond Center of Excellence.

July 9, 2019: Improving Access and Quality in Primary Care

Access to care is critically important but can be particularly challenging for families in lower income brackets. The Commonwealth Fund held focus groups with more than 100 low-income patients and 30 primary care physicians (PCPs) to ask about barriers they face that hinder access and ability to provide needed care. Listening to Low-Income Patients and Their Physicians: Solutions for Improving Access and Quality in Primary Care examines related obstacles, such as financial barriers, poor access to specialty care, and unnecessary red tape, and provides potential policy solutions to address these issues.

Policies regarding telehealth, increased Medicaid payment for physicians, and more flexibility from Medicaid managed care organizations on preauthorization and referrals are also explored.

For more from the AAP, please see our resources on poverty and child health, our Telehealth Care Advocacy Action Guide and our Medicaid Payment State AdvocacyFOCUS.   

July 8, 2019: Addressing the School Breakfast Gap
Children who have access to a healthy breakfast to start the day are more likely to earn higher test scores, have more regular school attendance, and higher graduation rates. Yet, while more than 22 million children participate in the National School Lunch Program, only 11 million participate in the School Breakfast Program, according to a new report from The Network for Public Health Law. With 3 of 4 teachers saying they see children coming to school hungry, the school breakfast program presents an opportunity to help alleviate that hunger burden.

For more from the AAP, see Addressing Food Insecurity: A Toolkit for Pediatricians and our policy statement Promoting Food Insecurity for All Children.

July 2, 2019: New York Eliminates Nonmedical Exemptions

AAP chapter advocacy continues to have an impact on reforms to the nation’s laws addressing childhood immunizations. In a remarkable turn of events, the state of New York enacted a new law eliminating nonmedical exemptions for school and childcare entry. The bill was passed out of the Assembly Health Committee, where the bill had been pending for several weeks, by a margin of 1 vote—after the motion initially led to a tie, and a committee member had a change of heart and recast his vote in the affirmative. The bill was then ushered to the Assembly floor, the Senate floor, and was signed by the governor, all within hours on the same day. This successful advocacy win was part of a monumental effort led by AAP New York District II and their coalition consisting of over 30 medical organizations and the Medical Society of the State of New York. Read NY District II’s statement on the legislation on the front page of their Web site.

As AAP chapters continue to work to implement the recommendations of AAP policy on this and many other issues, the AAP state advocacy team thanks our chapters for their tireless advocacy for children. 

For more from the AAP, see our Childhood Immunizations State AdvocacyFOCUS resource and our interactive infographic Child Vaccination Across America.

July 1, 2019: Medicaid and CHIP Strategies to Optimize Social and Emotional Health

With nearly half of US children younger than 3 receiving coverage through Medicaid or the Children’s Health Insurance Program (CHIP), the programs play a critical role children’s social and emotional health. AAP/Bright Futures recommended well-baby and -child visits, and the distinct bond between pediatricians and families, establish the pediatric medical home as a unique opportunity to strengthen social and emotional development.

Fostering Social and Emotional Health through Pediatric Primary Care: A Blueprint for Leveraging Medicaid and CHIP to Finance Change—a new report from the Center for the Study of Social Policy and Manatt—provide a series of concrete strategies Medicaid and CHIP programs can take to support children’s social and emotional development in the pediatric primary care setting. Focusing on coverage and benefits, quality improvement, new payment models, team-based care, and unique ways to finance CHIP, the blueprint features state innovations and provides AAP chapters and other stakeholders with advocacy tips.

June 27, 2019: AAP Maine Member Appointed State's Chief Pediatrician

At a recent meeting of the Maine Children’s Cabinet, AAP Maine Chapter board member Amy Belisle, MD, FAAP was named as the state’s first Chief Pediatrician. In this role, Dr Belisle will oversee the efforts of the Children’s Cabinet to ensure that children receive the full range of state programs and services available. Dr Belisle has spearheaded efforts to increase development screening and immunization rates in the state; helped create the Maine Child Health Improvement Partnership; and leads the chapter’s efforts on developmental screening, the medical home, and quality improvement.

Dr Belisle joins a growing list of pediatricians leading state health efforts, including Arkansas Chief Medical Officer Gary Wheeler, MD, MPS, FAAP; California Surgeon General Nadine Burke Harris, MD, MPH, FAAP, and Pennsylvania Physician General Rachel Levine, MD, FAAP.

June 25, 2019: California Immunization Bill Gains Governor’s Support

AAP member and California State Senator, Richard Pan, MD, MPH, FAAP has sponsored a bill this year to curb the inappropriate use of medical exemptions to school entry immunization requirements. The legislation, which requires review of medical exemptions by the California Department of Health, was amended in committee to gain Governor Gavin Newsom’s support, after initially expressing criticism of the proposed law. This legislation comes in response to a rising number of medical exemptions issued after enactment of reforms in 2015 that eliminated nonmedical exemptions in California, as was reported in a November 2018 study published in Pediatrics, and later drawn attention to in editorials as details emerged about some pediatric practices that had begun essentially selling medical exemptions in the state. Dr Pan’s leadership on this issue serves as an important model for other states as they work to eliminate nonmedical exemptions, as was enacted this year in Maine and New York, and as recommended in AAP policy.

For more from the AAP, see our Childhood Immunizations State AdvocacyFOCUS resource and our interactive infographic Child Vaccination Across America.

June 24, 2019: 2019 KIDS COUNT Data Now Available

The 2019 KIDS COUNT Data Book, an annual report from The Annie E. Casey Foundation, examines state level child health, education, and well-being data. The 2019 report finds that the overall child poverty rate declined to 18% in 2017 from 22% in 2010, but the poverty rate for African American and Native American children remains extremely high at 33%. Additionally, the report finds that 2017 was the first year since 2010 that the number of uninsured children increased and the number of infants born with a low birth weight reached 8.3%, matching a 4 decade high.

State and topic specific data are easily searchable through the KIDS COUNT Data Center. This customizable resource is an excellent tool to lend support to a wide variety of AAP chapter advocacy initiatives.

June 20, 2019: Louisiana Extends Foster Care

Earlier this month, Louisiana Governor John Bel Edwards signed Senate Bill 109, which extends the state’s foster care program for youth up to age 21. To be eligible for extended foster care up to age 21, Louisiana youth must meet educational and/or vocational criteria. Louisiana’s extension is being funded by a blend of federal and state funding. In 2018, Governor Bel Edwards signed a similar but services were only available to youth enrolled and seeking a high school diploma and was contingent on state funding.

With this new law, Louisiana joins 41 other states that have extended foster care to age 21. Two additional states, Massachusetts and Texas, offer extended foster care up to age 22 depending on circumstances. To learn more about what states provided extended foster and the requirements for extended foster care in your state, visit the our resource, Covering Extended Foster Care

For more on foster care from the AAP, visit Healthy Foster Care America 

June 18, 2019: Supporting Rural Health

Rural communities in many states continue to face issues related to access to care, workforce shortages, and the financial instability of hospitals. Supporting Rural Health: Practical Solutions for State Policymakers, a new resource from the Milbank Memorial Fund, examines rural and urban health disparities and shares successful models for addressing them.

Key themes in the report include the importance of health care delivery models that promote community health investment, supporting health workforce development, leveraging technology and telehealth care options, and the need for ongoing rural health research and policy development.

Working on rural health issues in your state? Contact the State Advocacy Team for consultation.

June 17, 2019: AAP Members Making a Difference in Their States
Members of the AAP New Jersey Chapter (NJAAP) recently joined Advocates for Children in NJ and more than 150 young children and their families to participate in the Strolling Thunder campaign in the state capitol. NJAAP was 1 of 6 AAP chapters to receive a grant from Zero to Three and the AAP to partner with their state Think Babies coalitions to advocate for key policies and programs that prioritize babies and their families. Below, residents from the NJ AAP Chapter (left to right: Alycia Foti, MD; Meagan Ford, MD; Peter Wu, MD; Stefanie Cheang, MD) enjoy a stroll around the capitol with other advocates.

June 13, 2019: California to Offer Coverage to Undocumented Young Adults

A budget agreement announced this week in California would extend state-financed Medicaid coverage to young adults ages 19-25 regardless of immigration status. First-in-the-nation coverage for such young adults, actively supported by the AAP California District, will begin on January 1, 2020 and 138,000 residents are expected to enroll. California already offers Medicaid coverage to undocumented immigrant children younger than 19, as does the District of Columbia, Illinois, Massachusetts, New York, Oregon, and Washington.

The state budget agreement also takes several steps to shore up and extend Affordable Care Act (ACA) protections by creating a state-level individual mandate, which will require California residents to have insurance or pay a state penalty. Revenue from the penalty will be used to expand and extend state health insurance marketplace subsidies for middle-class families to 600% of the federal poverty level (FPL). Working on Medicaid or other acces issues in your state? Please contact the state advocacy team for consultation and technical assistance.

June 11, 2019: AAP Advocates in Action | Wisconsin Helping Tennessee
The National Conference of State Legislatures (NCSL) recently held a day long series of briefings on adverse childhood experiences (ACEs), early literacy, and other early childhood policies with the Tennessee Senate Education Committee, Tennessee House of Representatives Education Committee, and the new Tennessee Early Learning Caucus. As part of the briefings, AAP Wisconsin Chapter Vice President and AAP Council on Early Childhood executive committee member, Dipesh Navsaria, MD, MPH, MSLIS, FAAP, briefed legislators on early brain and child development (EBCD) and shared how his experience utilizing Reach Out and Read has played a role in increasing early literacy and development among patients and families. Dr Navsaria’s visit and presentation boosted the AAP Tennessee Chapter’s efforts on related issues.

June 10, 2019: What States Mean By “Public Option”

Last month, Washington became the first state to pass a law implementing a “public option” health care plan. In recent years, other states have also debated public option health care alternatives. But exactly what “public option” means varies among states and policymakers. In general, a public option plan is one that would be run by states (the way Medicare is managed by the federal government) or run by a private entity but overseen by state government.

The goal of these plans is to offer consumers a more affordable health insurance option. For example, Washington’s plan will set a cap on physician payment rates of 160% of Medicare for hospital-based services and 135% of Medicare payment for primary care. The plan includes requirements on administrative costs and purchasing that do not apply to other payers.

AAP chapters working on public option or other insurance related issues are encouraged to contact the AAP state advocacy team for consultation and technical assistance. 

June 6, 2019: State Immunization Laws Webinar
Measles Outbreak: Public Health Authority, NYC’s Mandate, and the Current Legislative Landscape, a webinar from the Network for Public Health Law examines state laws addressing school entry immunization requirements and 2019 advocacy efforts to reform them, including legislation enacted in Maine this year to wholly eliminate personal and religious exemptions. The webinar provides an insightful overview of case law addressing childhood immunizations and what may be on legislative agendas in 2020. Visit NPHL to download the slide materials or view the Webinar in its entirety.  

For more from the AAP, see our Childhood Immunizations State AdvocacyFOCUS resource and our Child Vaccination Across America interactive infographic. Contact the AAP State Advocacy Team for additional support and technical assistance.

June 4, 2019: Significant Drop in Medicaid/CHIP Enrollment in 2018

Child enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) experienced a net decline of 828,000 children (or 2.2%) in 2018. A new analysis from the Georgetown Center for Children and Families (CCF) indicates that this significant decline occurred in 38 states, with only 13 states experiencing enrollment growth last year. Enrollment declines were concentrated in 7 states (California, Florida, Illinois, Missouri, Ohio, Tennessee, and Texas), which account for 70% of the overall drop in Medicaid/CHIP coverage.

While the improved economy may have played a small role in this enrollment decline, other factors, including repeal of the ACA individual mandate penalty, significant cuts to outreach, state eligibility/enrollment practices, and the chilling effect of immigration policies are also cited as contributing factors. The CCF report highlights several policy options—such as 12 months of continuous eligibility and automated renewals—that can be adopted to help maintain Medicaid and CHIP coverage. 

Working on strengthening eligibility and enrollment in your state? Contact the AAP state advocacy team for consultation and technical assistance.

June 3, 2019: AAP Members Making a Difference in Their States

Pediatricians are natural advocates. AAP member Yadira Caraveo, MD, a member of the Colorado House of Representatives, has had an immediate impact on the children and families in her state during her first legislative session. Five of the bills she sponsored bills have been signed into law, including HB 19-1133, which creates the Colorado Child Abuse Response and Evaluation Network (CARENetwork). The network will provide medical exams and behavioral health assessments to children who have experienced abuse or neglect.

Representative Caraveo joined Colorado Governor Jared Polis as he signed the CARENetwork measure and 2 of her other bills: HB 19-1239, which provides grants to local governments, school districts, and nonprofits to support efforts to ensure an accurate 2020 Census count and HB 19-1184, which enables legislators to request an assessment of the potential impact of bills on economic, employment, health, education, or public safety outcomes when comparing the state population as a whole and population subsets based on race, ethnicity, sex, sexual orientation, gender identity, disability, and geography.

May 30, 2019: National Governors Association | Opioid Epidemic and Sexually Transmitted Infections
The National Governors Association (NGA) convened a “learning lab” of state level cross-disciplinary leaders in 2018 to examine successful strategies initially developed in Kentucky to slow the spread of sexually transmitted infections related to IV drug use, specifically, HIV and Hepatitis C—the latter of which had 350% increase in reported cases from 2010-2016, primarily in young adults. The findings of that inquiry, conducted in partnership with the Centers for Disease Control and Prevention (CDC) and ChangeLab Solutions, have just been released. Among the key strategies highlighted for replication include sterile syringe programs and leveraging federal opioid response funds to enhance public health surveillance of HIV and Hepatitis C.

To see a map of states and communities most at risk of HIV or Hepatitis C outbreaks, see page 3 of the NGA report.
May 28, 2019: Maine Eliminates Nonmedical Exemptions

Maine Governor Janet Mills has signed legislation eliminating nonmedical exemptions to her state’s school entry immunization requirements. The new law, which gained final passage in the Maine Senate last Thursday, will require students to be fully immunized as a condition of school entry effective in 90 days, and existing students with nonmedical exemptions will need to be in compliance by the 2021 school year. Medical exemptions for children with contraindications to routine childhood immunizations will still be permitted, as certified by a physician, nurse practitioner, or physician’s assistant. The Maine Chapter of the AAP made passage of the bill one of their key legislative priorities for 2019, and worked in concert with the Maine Immunization Coalition, Maine Families for Vaccines, and the Maine Medical Association to achieve this important advocacy milestone.

For more from the AAP, see our Childhood Immunizations State AdvocacyFOCUS resource and our Child Vaccination Across America interactive infographic. Contact the AAP State Advocacy Team for additional support and technical assistance.

May 23, 2019: Chapter Advocacy in Action | What’s Happening in State Capitals

Members of the 4 California AAP chapters recently visited Sacramento to advocate for their AAP District IX Advocacy Priorities. Newly appointed California Surgeon General (and AAP California Chapter 1 member) Nadine Burke Harris, MD, MPH, FAAP spoke with attendees about the important work being done in the state on adverse childhood experiences and developmental screening. Later members visited with legislators to discuss these efforts along with advocating to strengthen the process for immunization exemptions and to enact a sugary drinks tax

May 21, 2019: AAP Opposes Interference in Medical Practice by State Legislatures

The American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians, American College of Obstetricians and Gynecologists, American Osteopathic Association, and American Psychiatric Association, (collectively known as America’s Frontline Physicians: The Group of Six) have joined in issuing a statement opposing inappropriate interference with evidence-based medicine and criminalization of safe, legal, and necessary medical care. Recent actions in state legislatures to restrict access to health services—some of which would create criminal sanctions for physicians providing treatment—are an inappropriate intrusion into the provision of the full range of health care, and our shared membership of 560,000 physicians and medical students stand united to protect the physician-patient relationship.

Visit the Group of Six Web site for previous statements from frontline physicians joined in support of the evidence-based practice of medicine.

May 20, 2019: Chapter Advocacy in Action | What’s Happening in State Capitals
Members of the AAP North Carolina Chapter recently visited the state capital during White Coat Wednesday and met with legislators to discuss their 2019 Policy Agenda. Participants emphasized the value of Medicaid for children, pediatric workforce improvements, prevention of youth suicide and firearm-related injuries and fatalities, and tobacco use prevention and cessation.

Chapter members also visited with Governor Pat McCrory and Secretary of the North Carolina Department of Health and Human Services, Mandy Cohen, MD, to discuss making children a top priority for the state.

May 16, 2019: State Payment Rates for Infant Child Care

Quality early education and child care is a key component of a child’s development. When care is consistent, developmentally appropriate, and emotionally supportive, and the environment is healthy and safe, there is a positive effect on children and their families. Yet a new report, Still Shortchanging Our Young Children: State Payment Rates for Infant Care in 2018, from the National Women’s Law Center, shows that states aren’t keeping up with adequate payment rates for infant child care. Just 6 states (Arkansas, California, Indiana, New Mexico, North Carolina, and South Carolina) had payment rates for infants in center based child care that were at or above 75% of the current market rates, which is the federally recommended level. In family-based center care arrangements,12 states (Arkansas, California, Connecticut, Illinois, Maine, Michigan, Montana, New York, North Carolina, South Carolina, Washington, and West Virginia) had payment rates for infants that were at or above the federally recommended level. Without adequate payment rates from states, child care providers have difficulty attracting and retaining quality staff, keeping staff to child ratios low, maintaining facilities, and obtaining proper supplies.

For more information on the AAP on child care issues, visit Healthy Child Care.

May 14, 2019: Chapter Advocacy in Action | What’s Happening in State Capitals

The AAP Delaware Chapter recently hosted its annual “White Coats in the Hall” advocacy day. Chapter members from around the state visited the capital to promote the 2019 Delaware Blueprint for Children and discuss their priorities with the governor, lieutenant governor, and legislators. These priorities include the creation of a childhood lead poisoning screening advisory committee, increasing healthy beverage options for children, and banning assault weapons. Below, chapter members present Governor John Carney with the chapter mascots, #MAMADellNMonty.

The Pennsylvania Chapter of the AAP Legislative Advocacy Day was held recently as well. Chapter members participated in interactive training sessions, networked with colleagues from across the state, and met with legislators to advocate for stronger immunization laws to protect kids and prevent disease outbreaks. Pennsylvania Secretary of Health Rachel Levine, MD, FAAP, a member of the chapter, spoke to attendees about working to help spread the message about the importance of immunizations and about vaccine safety and effectiveness.

May 13, 2019: State Action on Firearms Policy

Last week, Florida Governor Ron DeSantis signed a bill allowing school districts to set policies that allow teachers to carry guns in school. However, the 25 largest school districts in the state--covering over 2.4 of 2.6 million Florida K-12 students--have indicated that that will not likely implement the policy.

Montana Governor Steve Bullock vetoed a bill that would have established a “school marshall” program, allowing trained armed guards in state schools and Washington Governor Jay Inslee signed a package of gun bills tightening mental health restrictions, updating restrictions for gun owners served with restraining orders, and prohibiting “ghost guns” that have no serial numbers or are made of plastic.

For more from the AAP on state gun violence prevention efforts, see our State AdvocacyFOCUS resources on Safe Storage of Firearms, Extreme Risk Protection Orders (ERPO) or “Red Flag” Laws, Waiting Periods Universal Background Checks for Gun Purchases, and Assault Weapon Bans.

May 9, 2019: State Action on Short-Term, Limited Duration (STLD) Plans
Last year, federal rules promoted the use of Short-Term, Limited Duration (STLD) plans and Association Health Plans (AHPs) that offer less coverage and do not adhere to critical ACA protections. The AAP actively opposed both final rules and lawsuits were filed over each; the AAP submitted an amicus brief in the STLD case. While the legality of these plans is under review, states have a several options to protect consumers. They range from banning the sale of STLD products to limits on who can form an AHP and compliance with consumer protection laws.

A new report on STLD plans finds that 9 states and the District of Columbia took a variety of protective actions. State STLD plan actions complement state efforts on AHPs, which will be directly affected by a federal district court ruling in late March that found the AHP final rule unlawful. The US Department of Labor is appealing this ruling, and while the matter is under review, AHP coverage will continue until the end of the plan year. 

For more from the AAP, please see our AHP and STLD Advocacy Action Guide and contact the AAP for consultation and technical assistance.

May 7, 2019: AAP Sugary Drink Statement | New AAP State Advocacy Resources

Last month, the AAP released Public Policies to Reduce Sugary Drink Consumption in Children and Adolescents, a joint policy statement with the American Heart Association (AHA), outlining public policy strategies to reduce sugary beverage consumption by children. One strategy highlighted in the statement that has been shown to reduce consumption is raising the price of sugary beverages through an excise tax.

To aid AAP chapter advocacy efforts to enact taxes or surcharges on sugary beverages at the state or local level, 3 new resources are available: State AdvocacyFOCUS Resource | Sugary Drink Taxes, Sugary Drinks Advocacy Infographic, and the Sugary Drinks Chapter Advocacy Infographic. The Chapter Advocacy Infographic can be customized with state specific data and your chapter logo—please contact us for additional information.

For more from the AAP on sugary beverages, see HealthyChildren.org.

May 6, 2019: New AAP/Georgetown CCF State Medicaid & CHIP Snapshots Now Available

To support AAP chapters in your ongoing advocacy to increase and improve coverage and care in Medicaid and the Children’s Health Insurance Program (CHIP), the AAP is pleased to release new state-by-state 2019 Medicaid and CHIP Snapshots.

Produced with our partners at the Georgetown Center for Children and Families (CCF), these snapshots provide updated state-specific data on Medicaid and CHIP enrollment and the greater coverage landscape of your state; also presented are facts on how Medicaid and CHIP help children succeed and bring economic activity to the state. These easy to read snapshots can be used as a leave-behind or other helpful resource when advocating with lawmakers or state Medicaid/CHIP officials, and may be particularly useful as there are warning signs that enrollment in these programs is declining

As always, AAP chapters working on Medicaid, CHIP, and other access and coverage issues are encouraged to contact the AAP for targeted consultation.

May 2, 2019: Oregon Immunization Bill Nears Key Vote

This year, in the face of the biggest measles outbreak in a generation, state legislators across the country have introduced bills related to childhood immunizations. Ten states have legislation aimed at eliminating nonmedical exemptions and others seeking ways to curtail or restrict their use. Oregon’s bill to permit only medical exemptions to school entry immunization requirements has passed a key house committee and will be eligible for a vote on the House floor as early as Monday. Editorial boards for newspapers in Bend and communities in Douglas County have recently come out in support of the legislation. Public voices of support are critical to the effort to stop vaccine preventable diseases.

For more from the AAP, see our Childhood Immunizations State AdvocacyFOCUS resource, our interactive infographic Child Vaccination Across America, and our Immunization Initiatives pages.

April 30, 2019: 2018 Decline in Child Enrollment in Medicaid and CHIP

The Centers for Medicare and Medicaid Services (CMS) just released updated 2018 Medicaid and Children’s Health Insurance Program (CHIP) enrollment data and an analysis from the Georgetown Center for Children and Families (CCF) shows 840,000 fewer children enrolled in Medicaid and CHIP in 2018. While it is likely that some of these children have moved to other sources of coverage, this data remains troubling. There is evidence of a small increase in the number of employers offering employee health insurance, however employer sponsored insurance can still be unaffordable to many low-income families. There is also no indication that children leaving the programs are moving to marketplace coverage as federal data shows the number of children under 18 enrolling in marketplace plans has declined.

State specific reasons, from eligibility system changes to more frequent edibility reviews, may be contributing to coverage losses in those states with the most significant declines. AAP chapters in these states continue to work with their Medicaid programs and policy makers to rectify these issues.

If your chapter is advocating on Medicaid enrollment or other access issues, please contact the AAP at stgov@aap.org for consultation and technical assistance.

April 29, 2019: Family First Starts in Kansas

Earlier this month, legislators in Kansas enacted HB 2103, which will allow the state to meet requirements of the Family First Prevention Services Act (FFPSA) and be eligible for increased federal funding for prevention services for children and families involved in the child welfare system. The new law defines what a “qualified residential treatment program (QRTP)” is and provides the requirements for placement in such a program and requires a placement hearing being held for a child in a QRTP within 60 days of placement to determine if the QRTP provides the most appropriate level of care.

State implementation of the FFPSA is a key component of the AAP Kansas Chapter’s Kansas Blueprint for Children, and the chapter was instrumental in getting HB 2103 enacted. The chapter, as part of its advocacy day, held a briefing to educate legislators on the FFPSA. Governor Laura Kelly, a staunch advocate for the FFPSA, joined the chapter during the briefing and has proposed almost $7 million in state funding  for prevention services to match the increased federal funding available as part of the FFPSA.

Join AAP chapters and pediatricians across the country tomorrow for the AAP’s FFPSA Day of Action tomorrow May 1. The AAP FFPSA Toolkit will provide you with everything you need to participate in tomorrow’s day of action.

April 25, 2019: National Infant Immunization Week
As part of our ongoing commitment to childhood immunizations, each year the AAP participates in National Infant Immunization Week (NIIW) to highlight the importance of protecting infants from vaccine-preventable diseases. This year, during the week of April 27-May 4, 2019, sharing positive messages about the value of immunizations is vitally important. Our NIIW campaign site includes social media messages, videos, HealthyChildren.org links, and other tools you and your chapters can use to educate others about this child health priority. Given the current measles outbreak and the widespread and important advocacy taking place in state legislatures about immunizations, it is a critical time to remind the public at large that vaccines are safe, vaccines are effective, and vaccines save lives.

For more from the AAP, see our Childhood Immunizations State AdvocacyFOCUS resource and our interactive infographic Child Vaccination Across America.

April 23, 2019: State-based ACA Marketplace Enrollment Remains Stable

Starting in 2017, after a previous 3-year period of steady growth, enrollment on the Affordable Care Act’s (ACA) marketplaces began to decline—a trend that continues. Several factors contributed to this such as reduced federal funding for enrollment assistance, elimination of the federal individual mandate, and new federal rules that increased the availability of non-ACA compliant plans.

However, there were differences in enrollment trends between states that utilize the federally run marketplace and states that have their own state-based marketplaces. While there was a 4% decline in plan selections on the federally facilitated marketplace for 2019, plan selections in state-based marketplaces overall held steady. This may be due to state specific policies such as investing additional funds for advertising and enrollment assistance, expanded sign-up periods, and other policies, such as a state individual mandate. States that maintained or increased the number of plan selections due to state policy decisions demonstrate the continued need for comprehensive insurance coverage.

States continue to play a significant role in ensuring children and families get and stay covered. If your AAP chapter is working on access to care issues, please contact us at stgov@aap.org for consultation and technical assistance. 

April 22, 2019: Medicaid Expansion Helps Community Health Centers

As millions of people gained health insurance coverage via the Affordable Care Act (ACA), the demand for services provided by community health centers increased. A recent study from the Commonwealth Fund shows that community health centers in Medicaid-expansion states were more likely to report improvement in their financial security, are better able to address patients’ behavioral health needs and provide social services, and are more likely to participate in value-based payment arrangements. The study demonstrates that increased Medicaid revenue may help community health centers improve the way they deliver care. Community health centers in expansion states are also more likely to be recognized as patient-centered medical homes, which would result in improved outcomes and serve to reduce existing disparities in health care for low-income populations.

One remaining challenge reported by centers in the study is difficulty with filling mental and behavioral health staff positions, which could still result in limited access to such services.

If your chapter is advocating to expand Medicaid, please contact the AAP at stgov@aap.org for consultation and technical assistance.

April 18, 2019: Chapter Advocacy in Action | Making a Difference in NH, IL, and WA

Medical students Ashley Hamel and Emily Georges recently had their op/ed published in the Valley News (NH/VT) in support of New Hampshire Senate Bill 1. In it, Hamel and Georges, both set to begin residencies in pediatrics in the coming months, stress the importance of paid family and medical leave in health outcomes for children—with their own personal clinical encounters fresh in mind—and to promote economic and gender equality. Paid family leave was a focus of the AAP New Hampshire Chapter advocacy day earlier this year.

In the Midwest, AAP Committee on State Government Affairs liaison Dr Jennifer Kusma wrote to the Chicago Tribune emphasizing the importance of combatting vaccine misinformation on the Internet and calling on the state to enact policy changes to stop the spread of vaccine preventable diseases.

In the Pacific Northwest, AAP Washington Chapter President Dr Rupin Thakkar wrote in Seattle’s Crosscut about the need to connect children and adolescents with mental health services and the state legislature’s critical role in improving Medicaid payment rates for mental health services.  

All around the country, pediatricians are using their voices to raise awareness, spur action, and create policy change. For more from the AAP on ways to speak up for kids in your states see the tools and resources on our State Advocacy page and reach out to the state advocacy team.

April 16, 2019: Chapter Advocacy in Action | What’s Happening in State Capitals

Last week, more than 100 pediatricians, pediatric residents, and medical students from the AAP Missouri Chapter spent the day at the state capital advocating for the chapter’s Blueprint for Children. Members met with legislators to advocate for strengthening immunization policy, advancing trauma-informed care, and increasing child safety.

April 15, 2019: Medicaid Payment Reform for Children

As payment and delivery systems move away from volume toward value-based payment, ensuring that the needs of children are reflected in such reforms remains paramount. Medicaid payment reform efforts can have an outsized effect on children as they make up a large percentage of enrollees.

Two new United Hospital Fund reports provide insights from such payment reform activity. Drawing on the experiences of New York and other states, Achieving Payment Reform for Children Through Medicaid and Stakeholder Collaboration examines steps Medicaid programs might go through as they make the case for—and begin a conversation on—moving toward value-based payment with children foremost in mind. A companion document speaks to the importance of stakeholder collaboration as these efforts move forward. These resources are drawn from early state experiences and can be helpful to AAP chapters working on value-based payment or seeking to begin conversations around this important subject. AAP chapters working on payment or other Medicaid-related issues are encouraged to contact the AAP state advocacy team for consultation and technical assistance. 

April 11, 2019: Strong Gun Laws are Hampered by Local Enforcement Challenges in Some States

A recently enacted law in New Mexico aims to close the private sale loophole and require background checks for all firearm purchases. However, 29 out of 32 county sheriffs in New Mexico signed a letter stating their opposition to the new law. As a result, New Mexico Attorney General Hector Balderas has issued a statement warning local law enforcement that they must  enforce the new law or risk liability for damages incurred by illegal gun sales. 

The actions by New Mexico county sheriffs are part of a growing trend at the state level, with more than 200 counties in the United States declaring themselves “sanctuary” counties for gun owners. Counties in 9 states (Colorado, Illinois, Maryland, North Carolina, Nevada, New Mexico, New York, Oregon, and Washington) have passed ordinances or resolutions opposing enforcement of certain state gun laws.

Working closely with legal advocates, state attorneys general, and other legal community stakeholders will be important to ongoing advocacy on this issue and to address related challenges. 

For more from the AAP on state gun violence prevention efforts, see our State AdvocacyFOCUS resources on Extreme Risk Protection Orders (ERPO) or “Red Flag” Laws, Safe Storage of Firearms, Waiting Periods, Universal Background Checks for Gun Purchases, and Assault Weapon Bans.

April 9, 2019: Chapter Advocacy in Action | What’s Happening in State Capitals

The AAP Illinois Chapter recently held its annual Lobby Day in the state capital. Medical students, residents, and fellows met with legislators to discuss the importance of Medicaid, immunizations, school physical education, and ensuring that all children and their families are counted in the 2020 Census.

April 8, 2019: States Respond Differently to Rulings Medicaid Work Requirements

On March 27, 2019 a federal judge struck down Medicaid work requirement waivers in Kentucky and Arkansas. The court decisions effectively ended Arkansas’ program, which has resulted in more than 18,000 people losing coverage, and delays implementation of the program in Kentucky. However, states have responded differently to the rulings.

While the court decisions were narrow and only impact Kentucky and Arkansas, states are approaching this issue in different ways. In Iowa and Idaho legislatures have either stalled consideration of or altered their work requirement proposals. However, states with approved Medicaid work requirement waivers, such as Indiana and New Hampshire, are still planning to move forward. And state leaders in other states have indicated the court rulings will not derail their efforts to develop such a policy.   

For more from the AAP on this issue, please see our Principles on Waivers. AAP chapters working on waiver-related issues may contact us at stgov@aap.org for consultation and technical assistance. We’re here to help!

April 4, 2019: AAP Members Making a Difference in Their States

Pediatricians are natural advocates. AAP members in Minnesota and New Mexico have been speaking up for children in powerful ways.

AAP Minnesota Chapter Early Childhood Champion Dr Nathan Chomilo was invited by Governor Tim Walz to his state of the state address. Governor Walz honored Dr Chomilo, highlighting his efforts to prepare young children to thrive.

In New Mexico, chapter member Anjali Subbaswamy, MD, FAAP, a pediatric intensive care physician, wrote about the vital role pediatric advocacy plays in furthering the health and well-being of children. Dr Subbaswamy highlights ways that pediatricians can affect change on the individual, local, state, and federal levels. Dr Lance Chilton, also a AAP New Mexico chapter member, and chairperson of the AAP Council on Community Pediatrics, joined Dr Subbaswamy, noting “Children don’t get to vote, so we have to advocate on their behalf. I specifically go (to the capitol) to give a child-centered and physician-specific perspective to analysis and summary of some of the 1,300+ bills the legislators deal with during 60 action-packed days and nights of the legislative session.”

For more from the AAP on ways to speak up for kids in your states, visit our State Advocacy page and reach out to the state advocacy team for consultation and technical assistance.

April 2, 2019: Chapter Advocacy in Action What’s Happening in State Capitals

Recently, more than 140 pediatricians, residents, and medical students gathered in Albany, the state capitol, to advocate for the New York State AAP (District II) 2019 Legislative Priorities and 2019 Budget, Policy, and Practical Issues. Attendees educated lawmakers about raising the tobacco purchase age to 21 and protecting immunizations, among other priorities.

The AAP Tennessee Chapter recently hosted a day in the capital to advocate for their 2019 child health priorities, which include raising the tobacco purchase age to 21 and adoption of a Katie Beckett Waiver, which would allow Medicaid to cover at-home care for children with complex medical needs if they would otherwise be eligible for institutional care.

April 1, 2019: AAP Member Named Florida Surgeon General

This morning, Florida Governor Ron DeSantis announced the appointment of Scott A. Rivkees, MD, FAAP, as Florida Surgeon General and Secretary of the Florida Department of Health. Dr Rivkees, a pediatric endocrinologist, is the AAP Florida Chapter Treasurer, the Association of Medical School Pediatric Department Chairs (AMSPDC) liaison to the AAP Committee on Federal Government Affairs, chair of the Department of Pediatrics at the University of Florida College of Medicine, and physician-in-chief at the University of Florida Shands Children’s Hospital.

With the appointment of Dr Rivkees, pediatricians have been appointed as Surgeon General or Physician General in 3 of the 4 states (California–Nadine Burke Harris, MD, MPH, FAAP; Florida–Scott Rivkees, MD, FAAP; and Pennsylvania–Rachel Levine, MD, FAAP) that hold these cabinet level positions. The 4th state cabinet level position, which is in Arkansas, was previously held by a pediatrician, Joseph Thompson, MD, MPH, FAAP, who served as the state’s surgeon general from 2005-2015.

March 28, 2019: AAP Members Making a Difference for Children

Bird Gilmartin, MD, FAAP is 1 of just 51 pediatricians in Wyoming and 1 of 2 in the southwestern part of the state. She has worked tirelessly as a general child abuse pediatrician (Gen CAP) in her community across Wyoming. Dr Gilmartin effectively overhauled a system of care and response for child abuse at the hospital in Rock Springs, creating an improved medical response and multidisciplinary system in the community.  Now, in Evanston, she is working to accomplish the same goals. As a result of her work, Dr Gilmartin saw a gap in how children at risk for abuse, specifically siblings-at-risk, lacked protection and support because there was no process that allowed siblings-at-risk to undergo evaluation.  

Thanks to Dr Gilmartin’s skillful advocacy work, the Wyoming legislature passed—and Governor Mark Gordon recently signed—a new law that establishes a legal mechanism to evaluate siblings-at-risk. Dr Gilmartin, an early career pediatrician, AAP Wyoming Chapter member, and member of the AAP Council on Child Abuse and Neglect executive committee, reflects the power pediatricians have to create change in their communities, states, and across the country. Congratulations, Dr Gilmartin!

March 19, 2019: New AAP Drowning Prevention Statement and Advocacy Resources

Drowning is the leading cause of injury death among children ages 1-4 and the 4th most common cause of injury death to children ages 1-20. To address this important issue, the AAP has released the updated policy statement Prevention of Drowning with new data and recommendations to parents and policymakers to reduce drowning deaths and injuries.  

To aid related chapter/state advocacy efforts, the AAP has developed 3 new resources—Residential Pool Fencing and Life Jackets and a state advocacy infographic Drowning Prevention | Advocating for State and Local Action. This infographic can be customized with state specific data and your chapter logo—please contact us at stgov@aap.org for additional information. For more from the AAP on drowning prevention, please see the AAP Drowning Prevention Web page.

March 18, 2019: States Making Progress on Tobacco21 | Customizable State Advocacy Infographic Available

Last month, Virginia became the 7th state to raise the minimum purchase age of tobacco products and e-cigarettes to 21. The Illinois legislature has also passed a Tobacco 21 law and Governor JB Pritzker is expected to sign the bill later this month. In addition, 26 states have introduced bills to raise the minimum age of purchase for tobacco products and e-cigarettes.

The AAP has developed an infographic, Advocating for Tobacco21 in Your State, to support chapters working on these bills. If your chapter is interested in a customizing this infographic with state-specific information and your chapter logo, please contact us at stgov@aap.org.  

For more from the AAP, see our Raising the Tobacco Purchase Age to 21 and Electronic Nicotine Device Systems (ENDS) State AdvocacyFOCUS resources and visit the AAP Julius B Richmond Center of Excellence.

March 14, 2019: The State of Babies Yearbook 2019

The State of Babies Yearbook 2019, a report from Zero to Three, examines national and state data on the well-being of infants and toddlers, and provides advocates and policymakers with information to help advance policies that will improve the lives of babies and families. The report found that more than 8% of infants and toddlers have experienced 2 or more adverse childhood experiences (ACEs), 16.5% of babies don’t have access to healthy food, and only 30% of infants and toddlers received a developmental screening in the last year.

You can learn more about how your state’s infants and toddlers are faring by taking a closer look at these state profiles.

For more on early childhood from the AAP, visit the AAP Council on Early Childhood.

March 12, 2019: Chapter Advocacy in Action | What’s Happening in State Capitals

More than 140 members of the AAP Minnesota Chapter recently participated in a Day at the Capitol. Keynote speaker State Representative Matt Klein, MD, a hospitalist, rallied pediatricians' in their advocacy work on a range of issues including firearm safety, access to care, and immunization policy. More than 50 meetings were held with legislators to discuss the chapter’s 2019 legislative priorities.

The AAP South Carolina Chapter recently held its Legislative Advocacy Day where members worked to educate lawmakers about protecting children from gun injuries and violence as well as the health risks of e-cigarettes.

March 11, 2019: The Economic Cost of Vaccine Refusal

The Centers for Disease Control and Prevention recently reported on a 2017 case of tetanus in a 6 year old unvaccinated Oregon child. The boy, who was injured while playing outdoors on a farm, was the first case of tetanus reported in over 30 years in the state, and ultimately required 57 days of inpatient acute care. The economic costs related to his direct treatment (excluding medevac transportation, inpatient rehabilitation, and follow-up treatment) exceeded $800,000. While the child has now thankfully recovered, his parents refused a second dose of DTaP and any other recommended vaccines.

The costs of vaccine refusal and its role in vaccine preventable diseases are well known and significant. The total cost of containing just one case of measles in Iowa in 2004 is estimated at over $142,000 (almost $193,000 in CPI inflation adjusted dollars; see:
 
https://pediatrics.aappublications.org/content/pediatrics/116/1/e1.full.pdf). Through reforms of state laws addressing vaccine refusal, states can help to prevent these diseases and their attendant economic costs.

For more from the AAP, see our Childhood Immunizations State AdvocacyFOCUS resource and our Child Vaccination Across America interactive infographic. Contact the AAP State Advocacy Team for additional support and technical assistance.

March 7, 2019: Children’s Medicaid and CHIP Enrollment Drops by 600K in 2018

Newly released data from the Centers for Medicare and Medicaid Services (CMS) show that enrollment in Medicaid and Children’s Health Insurance Program (CHIP) dropped by nearly 600,000 children in the first 11 months of 2018. While some point to a strong economy and low unemployment as reasons for this drop, such an enrollment decline is unusual and raises concerns, particularly as the uninsured rate for children has also recently reversed its decline.  

The Georgetown Center for Children and Families (CCF) provides state-by-state data from the CMS report, charting the change in children’s Medicaid and CHIP coverage from 2016-2017 and again from 2017-2018 across states. Enrollment declines in 2018 were experienced in 36 states, with declines of more than 4% in 5 states. While the strong economy might have played a role in this decline, other policies may have also been a factor, including the recent public charge proposed rule, the 2017-2018 delay in federal CHIP funding reauthorization, cuts to navigators, and the elimination of a federal penalty for not having insurance, among others. Whether this is an anomaly or a trend will become clearer as more data on children’s coverage is released in 2019. 

States play a role in ensuring children obtain coverage and remain covered. AAP chapters working on enrollment issues such as presumptive eligibility, 12-months continuous eligibility, streamlined renewal practices or other coverage concerns are encouraged to contact the AAP at stgov@aap.org for consultation and technical assistance. 

March 5, 2019: Chapter Advocacy in Action | What’s Happening in State Capitals

AAP Kentucky Chapter President Pat Purcell, MD, FAAP (left) joins pediatric residents during the 15th Annual Children’s Advocacy Day at the Capitol. Chapter members advocated for the Blueprint for Kentucky’s Children, a statewide coalition of nonprofit, public, and private organizations that speaks with a common voice to create brighter futures for Kentucky kids.

Members of the AAP Mississippi Chapter are introduced on the floor of the Mississippi State Senate, which passed a resolution honoring the life and work of Blair Batson, MD, FAAPconsidered the “Father of Organized Pediatrics” in the state–during the chapter’s annual advocacy day. In addition, chapter members met with legislators to discuss the chapter’s 2019 Mississippi Advocacy Agenda, with a major focus of the day being on school bus safety.

Members of the AAP Oregon Chapter gather at the steps leading to the Oregon State Senate before heading to meet with legislators to discuss the chapter's endorsements of the statewide 2019 Children's Agenda. The chapter also had the opportunity to attend the first hearing of legislation to repeal the state's nonmedical vaccination exemptions, with chapter member Dawn Nolt, MD, MPH, FAAP testifying in support of removing the exemptions.

Attendees at the AAP Texas Chapter's 7th Annual Resident/Fellow & Medical Student Advocacy Day prepare to head off to the legislature to discuss the chapter's 2019 Legislative Priorities, with the focus being on access to Medicaid. Groups of pediatric trainees and chapter members made 40 legislative visits throughout the day.

Holding its 2nd Annual Pediatric Advocacy Day, members of the AAP Wisconsin Chapter join Dr Moo on the steps of the capitol. After a morning of preparation which included presentations by a state representative who is sponsoring an extreme risk protection order (ERPO) law in the state as well as the WI attorney general who supports the measure, chapter members visited legislators to discuss the importance of such a law and to roll out the chapter’s 2019 Wisconsin Blueprint for Children.
 

March 4, 2019: Who’s Speaking Up for Kids? | AAP State Advocacy Resource

State of the state and inaugural addresses offer a quick look at governors' top line priorities and are a great way for your chapter to identify shared interests, make a connection, and offer your expertise. 

The AAP State Advocacy team has been listening in to what governors are saying, and we’re keeping track of some things you’ll want to know in our Who’s speaking up for children? resource. The National Academy for State Health Policy (NASHP) has also issued a report that offers an in depth examination of key themes governors are discussing. Used together, these tools can help you identify policy priorities or issues of concern for your chapter. Utilize that information to reach out to your governor’s office, to discuss common interests, share your experience and expertise, and build or strengthen your advocacy relationship.

February 28, 2019:New York Enacts Extreme Risk Protection Order | New State Advocacy Infographics Available

New York became the 14th state to enact an Extreme Risk Protection Order (ERPO) law that would allow police officers, family or household members, or school personnel to petition a court to remove a gun from the environment of a person deemed at risk of hurting themselves or someone else.

More than 20 other states are considering similar legislation in 2019. The AAP has developed 2 new infographics Extreme Risk Protection Orders and Preventing Youth Suicide | Extreme Risk Protection Ordersto support chapters working on these bills. If your chapter is interested in a customizing these infographics with state-specific information, please contact us at stgov@aap.org.

For more from the AAP on state gun violence prevention efforts, see our State AdvocacyFOCUS resources on Extreme Risk Protection Orders (ERPO) or “Red Flag” Laws, Safe Storage of Firearms, Waiting Periods, Universal Background Checks for Gun Purchases, and Assault Weapon Bans.

February 26, 2019: Chapter Advocacy in Action | What’s Happening in State Capitals
At its recent Day at the Statehouse, members of the AAP Indiana Chapter joined forces with other stakeholders to advocate for a $2.00 increase in the state’s tobacco tax as part of the Raise It For Health campaign to make the state tobacco free.


The
AAP Maryland Chapter’s Resident Advocacy Day in the state capital was an opportunity for pediatric trainees to advocate for legislation to provide adolescents with pre-exposure prophylaxis (PrEP) to help prevent HIV.


Members of the
AAP Washington Chapter braved snowy weather to visit Olympia for the chapter’s annual advocacy day. AAP President and chapter member Kyle Yasuda, MD, FAAP addressed the attendees and chapter members met with legislators to advocate for the chapter’s 2019 Legislative Priorities.

The AAP West Virginia Chapter held its second “Tiny Hearts Day” to advocate for the chapter’s
West Virginia Blueprint for Children. In recognition of the chapter’s dedicated advocacy to children and families, the West Virginia Senate adopted Senate Resolution 43, which honors the state’s pediatricians, the AAP WV Chapter, and their advocacy work.

February 25, 2019: AAP Members Making a Difference in Their States
AAP chapters know that advocacy for children is at their core. Two AAP members have recently spoken out to make a difference for kids in their states, demonstrating the power of the pediatrician's voice on key issues. 

In California, Dr Richard Pan, a pediatrician, member of the California Senate, and coauthor of the 2015 law to eliminate nonmedical exemptions to school entry immunization requirements in the state, called on the US Surgeon General to take action on vaccine refusal and to make the issue of vaccine hesitancy a top priority. In Michigan, Dr Mona Hanna-Attisha, the leading voice for children in the wake of the Flint Water Crisis, voiced her support for Governor Gretchen Whitmer’s plan to restructure the state’s Department of Environmental Quality in order to better protect public drinking water. Governor Whitmer has since issued an executive order to do so, despite an earlier attempt by the legislature to block the plan.  

For more from the AAP on ways to speak up for kids in your states, see the tools and resources on our State Advocacy page and reach out to the state advocacy team

February 21, 2019: State Adoption and Implementation of Newborn Screening for CCHD

A new CDC study, coauthored by AAP Utah Chapter and AAP Section on Cardiology and Cardiac Surgery member Nelangi Pinto, MD, FAAP and the AAP state advocacy team’s Jeff Hudson, found that, as of 2018, all 50 states and Washington, DC have newborn screening programs that test for critical congenital heart defects (CCHD). According to the CDC, newborn screening for critical congenital heart defects could save the lives of at least 120 babies each year nationwide. All US newborns now have the opportunity to be screened for critical congenital heart defects, which can prevent early death. Key findings are available from the CDC. 

For more information from the AAP on newborn screening for CCHD, please visit the Program to Enhance the Health & Development of Infants and Children (PEHDIC).

February 19, 2019: Chapter Advocacy in Action | What’s Happening in State Capitals

The AAP Arizona Chapter recently held its annual Pediatricians Day at the Capitol. As part of the day, the chapter unveiled its Arizona Blueprint for Children. Pediatric residents in attendance met with their legislators, utilizing the blueprint to advocate for the chapter’s priorities.

Pediatric trainees from the AAP Georgia Chapter visited the state capitol to hone their advocacy skills and meet with their legislators. The residents discussed several issues with legislators, including pediatric workforce, prohibiting smoking in cars when a child is present, and protecting LGBTQ youth from conversion therapy. 

The AAP Kansas Chapter held its recent meeting in the state capitol. As part of its 2019 advocacy day, the Chapter, in partnership with national AAP and Casey Family Programs, held briefings for legislators and staff about the Family First Prevention Services Act (FFPSA), a key priority of the Kansas Blueprint for Children. Kansas Governor Laura Kelly (center, red jacket), a champion of improving the state's child welfare system, joined the event to support FFPSA efforts. 

Members of the New Hampshire Pediatric Society/AAP New Hampshire Chapter visited the state capitol for the chapter's first ever advocacy day to speak with lawmakers about paid family leave, home visiting, gun violence protection, regulation of marijuana, and behavioral health. Prior to meeting with legislators, participants learned about key issues and honing their advocacy skills from advocacy partners at New Futures, the AAP advocacy team, and the New Hampshire Medical Society (NHMS). Pediatrician Tessa Lafortune-Greenberg, MD, FAAP, is the current president of NHMS.

February 14, 2019: Pediatrician Sworn in as First Surgeon General of California
Nadine Burke Harris, MD, MPH, FAAP, California’s first surgeon general, was officially sworn in on February 11th. Dr Burke Harris, pictured below with California Governor Gavin Newsom, enters office ready to take on the numerous challenges facing the health of California’s children, and has highlighted toxic stress as one of her top priorities.

February 12, 2019: Measles Outbreak Continues, Prompting Action by State Legislators
Outbreaks of measles in the Pacific Northwest and other regions of the country have prompted public calls for state policy reforms on school entry immunization requirements—and state lawmakers are listening. In Oregon, legislation may soon be filed to eliminate nonmedical exemptions to school entry immunization requirements. In neighboring Washington, a house bill aimed at eliminating the philosophical (but not religious) exemption for measles, mumps, and rubella specifically, will be heard in committee this week. A more expansive measure introduced in the Washington Senate would eliminate the philosophical (but again, not religious) exemption for all school entry immunization requirements. New York, with more than 130 measles cases reported since October of 2018, is also considering legislation to eliminate nonmedical exemptions. The AAP policy statement “Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance calls on states to end nonmedical exemptions outright, as California successfully did in 2015, under the leadership of state legislator Richard Pan, MD, MPH, FAAP.

For more from the AAP, see our Childhood Immunizations State AdvocacyFOCUS resource and our Child Vaccination Across America interactive infographic. Contact the AAP State Advocacy Team for additional support and technical assistance. 

February 11, 2019: State Gun Violence Prevention Advocacy in 2019
Building off success 2018, with 26 states enacting 67 new guns safety laws, 2019 promises to be another big year for new gun violence prevention laws across states.  Extreme Risk Protection Orders (ERPO)—also known as “red flag laws”, which allow for the removal of firearms from the environment of a person at risk of harming themselves or someone else, are expected to be the legislation with the most bipartisan support, along with the removal of weapons from the homes of domestic violence perpetrators.

Some state lawmakers have made this issue a top priority. Just 4 days into his tenure, Illinois Governor JB Pritzker signed legislation to require state licensure of gun dealers doing business in the state, in order to reduce illegal sales of firearms commonly used in acts of gun violence. In addition, the New York legislature has already passed a bill that includes an ERPO provision as well as a ban on bump stocks, an extended waiting periods for gun purchases, and a prohibition on teachers carrying guns in schools. Governor Andrew Cuomo is expected to sign the bill.

For more from the AAP on state gun violence prevention efforts, see our State AdvocacyFOCUS resources on Safe Storage of Firearms, Extreme Risk Protection Orders (ERPO) or “Red Flag” Laws, Waiting PeriodsUniversal Background Checks for Gun Purchases, and Assault Weapon Bans.

February 7, 2018: Short-Term Plans Lacking ACA Protections Being Marketed to Consumers
Many consumers search for affordable health care coverage online. A recent study, The Marketing of Short-Term Health Plans, shows that these consumers (during the recent Affordable Care Act (ACA) open enrollment period that ended on December 15, 2018) were most often directed to websites that promoted individual health insurance plans that do not include the protections provided for in the ACA, such preexisting condition coverage.

State insurance commissioners indicated that tracking the marketing and sales of short-term plans can be challenging and some expressed concerns that the marketing tactics could result in consumers choosing plans that ultimately do not meet their needs. The study also includes early evidence that after recent federal regulatory changes that some insurers are aggressively marketing short-term plans as a replacement for traditional health plans, while not informing consumers of the limited coverage.

As efforts to weaken ACA insurance standards continue, states play a critical role in regulating health insurance. For more from the AAP on these efforts, please see our Advocacy Action Guide for AAP Chapters, New Rules Advance Insurance Plans Without ACA Protections

February 5, 2019: The State of Tobacco Control

Following the US Surgeon General’s advisory declaring teen vaping a youth epidemic and the release of the AAP policy statement E-Cigarettes and Similar Devices, the American Lung Association has released its annual State of Tobacco Control Report. The new resource evaluates current state and federal policies addressing tobacco and e-cigarette use and prevention and outlines the policy strategies that should be taken to reduce the deadly impact of tobacco and e-cigarette use.


Among the needed state strategies are increased tobacco and e-cigarette taxes, raising the purchase age of all tobacco and e-cigarette products to 21, improving access to tobacco cessation treatment, prohibiting the use of all tobacco and e-cigarette products in public places, and banning the sale of all flavored tobacco and e-cigarette products—including menthol.

 

For more from the AAP, see our Raising the Tobacco Purchase Age to 21 and Electronic Nicotine Device Systems (ENDS) State AdvocacyFOCUS resources and visit the AAP Julius B Richmond Center of Excellence


February 4, 2019: Pediatricians and State Health Departments Sound Alarm on Measles

Measles outbreaks in the Pacific Northwest, New York, and 6 other states are putting individual children and entire populations in peril of a preventable and dangerous disease, and the outbreak is placing unvaccinated children at particular risk. In response, pediatricians and other advocates for children are calling for states to tighten state level policies that ensure that children are vaccinated prior to school entry, and make it more difficult for parents to opt out of immunization requirements. Fearing a loss of community immunity amid rising opt-out rates, Maine has also filed legislation to reform its immunization policies, and other states where vaccine refusal outpaces national rates may soon follow suit. 

AAP state chapters advocating for stronger state level immunization policies have found that parents of young children are some of the most effective volunteer advocates on these issues, and Voices For Vaccines and Vaccinate Your Family are ideal partners in these efforts. For more from the AAP, see our policy statement Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance, our State AdvocacyFOCUS resource on Childhood Immunizations, and our Child Vaccination Across America interactive infographic. The AAP State Advocacy Team is here to help you with this important work.

January 31, 2019: Pediatrician Named California Surgeon General

California Governor Gavin Newsom recently appointed Nadine Burke Harris, MD, MPH, FAAP as the state’s first surgeon general. Dr Burke Harris is a national leader on adverse childhood experiences and founding CEO of the Center for Youth Wellness. With her appointment, California becomes the 5th state to create a surgeon general position. Arkansas and Florida currently have a surgeon general, while Pennsylvania has a similar position, physician general. Michigan previously had a surgeon general, but the position was eliminated in 2010.

Dr Burke Harris is now the second pediatrician, joining Pennsylvania’s Physician General Rachel Levine, MD, FAAP, serving as a chief state health officer. From 2005-2015 Joe Thompson, MD, FAAP, served as Arkansas Surgeon General for the administrations of Governor Mike Huckabee and Governor Mike Beebe.

January 29, 2019: Virginia Pediatric General Assembly Day
Earlier this month, 70 members of the AAP Virginia Chapter visited the state capitol to meet with legislators and advocate for the chapter’s top 2019 child health priorities. Chapter members spoke up on the importance of improving access to mental healthcare, ensuring coverage of essential health benefits in new insurance plans, gun violence prevention and reducing food insecurity and poor nutrition.

We’re here to help you with your chapter advocacy days and related events! Contact the AAP State Advocacy team at stgov@aap.org or 800.433.9016, extension 6240.

January 28, 2019: AAP Chapter Advocacy Action Guides | CHIP Funding & Insufficient Insurance Plan Coverage

The AAP is releasing new resources to help chapters and advocates work to advance the needs of children among state policymakers. CHIP Funding: Opportunities for State Advocacy advocates for states to fully fund their share of CHIP and provides guidance on other aspects of recently enacted CHIP funding legislation. An updated Association Health Plans (AHPs), Short Term, Limited Duration (STLD) Plans, and Section 1332 Waivers Advocacy Action Guide provides new information on opportunities for states to regulate AHPs and STLD plans, which, by their nature, offer limited coverage. The resource also provides updated information on Centers for Medicare and Medicaid Services (CMS) Section 1332 waiver guidance, which will allow states to direct premium subsidies toward such plans. Both action guides can be helpful as chapters and pediatrician advocates work to ensure children have access to affordable, robust health insurance coverage.

Working on these or other access issues in your state? Please contact the AAP state advocacy team at stgov@aap.org for consultation and technical assistance.

January 24, 2019: Rural Hospitals in Greater Jeopardy Where States Do Not Expand Medicaid
Since 2010, nearly 100 rural hospitals across the US have closed and another 600 or more are currently at risk of closing. Most of these hospitals are in states that have not expanded the Medicaid program to adults earning up to 138% of the federal poverty level (FPL) as permitted by the Affordable Care Act (ACA). By not expanding Medicaid, hospitals in the 14 states (AL, FL, GA, KS, MO, MS, NC, OK, SC, SD, TN, TX, WI, and WY) that have not done so continue to experience high levels of uncompensated care costs, as the uninsured continue to go to hospitals where care will not be denied due to inability to pay.

While expanding Medicaid alone may not resolve all rural hospital funding issues, it can serve to ease the burden. A 2018 Health Affairs study demonstrated that expansion of Medicaid resulted in improved financial performance and substantially decreased the likelihood of closure.

If your chapter is advocating to expand Medicaid, please contact the AAP at stgov@aap.org for consultation and technical assistance. 

January 22, 2019: Illinois Enacts Licensing Law for Gun Dealers

Just 4 days into his tenure, Illinois Governor JB Pritzker signed legislation to require state licensure of gun dealers doing business in the state, in order to reduce illegal sales of firearms commonly used in acts of gun violence. The new law will require gun shop owners to demonstrate that they have already received a federal license from the Bureau of Alcohol, Tobacco, Firearms, and Explosives (ATF), and require them to install surveillance equipment and electronic record keeping systems that can be used to detect straw purchases of guns intended to divert firearms to the illegal market. A similar bill was passed by both chambers of the legislature last year, but was vetoed by then-Governor Bruce Rauner. 

For more from the AAP, see our Safe Storage of FirearmsUniversal Background Checks for Gun Purchases, and Assault Weapon Bans State AdvocacyFOCUS resources. For information on state-level gun violence research and data collection options, also see our State Advocacy Engagement on Firearm Data Collection resource.

January 21, 2019: States Join to Further Limit Carbon Emissions

Ten years into a multistate partnership focused on reducing power plant carbon emissions, 9 of those states have now joined forces to address the second largest source of greenhouse gas—the tailpipes of our cars, trucks, and mass transportation. Connecticut, Delaware, Maryland, Massachusetts, New Jersey, Pennsylvania, Rhode Island, Vermont, and Virginia, along with Washington, DC, have committed to adding transportation emissions to their ongoing efforts to limit greenhouse gas as part of the Regional Greenhouse Gas Initiative.

States and municipalities face region-specific threats from climate change, ranging from longer wildfire seasons to rising sea levels, and can also play a significant leadership role in the national and international effort to reduce carbon emissions. AAP chapters can be essential partners in the effort to effort to combat climate change by giving voice to its threat to child health. For more from the AAP, see our Climate Change resources from the Council on Environmental Health.

January 17, 2019: States Strained by Federal Shutdown

State governments are being pressed to fill the void and provide support to recipients of federal benefits and federal employees during the ongoing federal shutdown. While the current state budgetary environment is largely stable across the country, states may begin looking at using rainy day funds in absence of payments from Washington. The National Governors Association has called on the federal government to end the shutdown, citing the impacts on both state economies and working families.

January 15, 2019: Few States Test for Lead in School Water
The Flint Water Crisis helped to draw much-needed public attention to the hazards posed by lead contamination of drinking water, but in the years following the crisis, many regulatory gaps in water monitoring remain, particularly in our nation’s schools. Only 7 states and the District of Columbia currently require testing of school drinking water sources for lead, as outlined in a new report published by the Harvard TH Chan School of Public Health.

Pediatric advocacy on this issue can have a dramatic impact in making children’s drinking water safe from lead hazards; last year, the Florida chapter outlined this issue in the winter edition of their monthly journal, the Florida Pediatrician, and since that time, legislation has been prefiled in the Florida Senate to mandate lead testing of school drinking water.

For more from the AAP, see our policy statement, Prevention of Childhood Lead Toxicityand visit the AAP Council on Environmental Health Web page. Guidance on lead exposure in children is also available from HealthyChildren.org.

January 14, 2019: HRSA Extends Pediatric Mental Health Access Program Funding Opportunity
In September 2018, the Health Resources and Services Administration (HRSA) awarded 18 states (AL, AK, CO, DE, IA, MI, MS, MO, MT, NE, NV, NH, NJ, NC, ND, RI, VA, and WI) a total of $7.9 million through the Pediatric Mental Health Care Access Program with the goal of integrating behavioral health into pediatric primary care using telehealth care. HRSA has now opened this grant opportunity to 3 additional states. A total of $1.3 million per year for 4 years is available.

Although not eligible as grantees, we encourage AAP chapters to reach out to relevant state agencies to encourage them to apply. As experts in pediatric health, these grants can provide opportunities for you to work to improve access to mental health services for children and families while maintaining the medical home.

Learn more about this opportunity.

January 10, 2019: Standing Orders for Newborn Care in NY
Advocacy by New York District II and New York members of the Section on Administration and Practice Management (SOAPM) has led to important reforms of nursery care of newborns. New York’s new law, which will take effect in April, will permit births of healthy newborns to be subject to hospital-approved standing orders, eliminating the need to contact the attending physician for approval of routine care. The statute enables the prompt institution of routine newborn care orders, thereby improving the timeliness of care and positively impacts physician wellness.

Working on this issue in your state? Contact the AAP state advocacy team at stgov@aap.org for consultation and technical assistance.

January 8, 2019: State Legislative Sessions Underway | Chapter Blueprints for Children
Happy New Year! All 50 states will hold regular sessions this year and are expected to introduce and consider more than 175,000 bills. A majority of state legislatures will convene their 2019 sessions this month and AAP chapters are preparing to be the voice for children in every state capital across the country.

To support your state advocacy efforts, our 2019 Chapter Blueprint for Children template and accompanying toolkit, released during the November Chapter Chat, is a fully customizable resource that includes your state name, chapter logo, and chapter contact information and is designed to include your 2019 advocacy agenda. Development of a blueprint or agenda is a proactive way to share your pediatric advocacy priorities with your members, lawmakers, and other stakeholders. Posting it to your chapter website and sharing on your social media platforms, sharing it with members, policymakers, and other stakeholders is a great way to promote your advocacy agenda and to strengthen the alignment of the agenda for children across the country.

When your 2019 chapter blueprint or advocacy agenda is complete, please share it with us so we can post them on the Chapter and District Collaboration Site.

Remember, we’re here to help you with your state advocacy work throughout the year! Please contact the AAP State Advocacy team at stgov@aap.org or 800.433.9016, extension 6240.

January 7, 2019: New Medicaid Expansions Proceeding
Despite the uncertainty created by the December 14 US District Court ruling overturning the Affordable Care Act (ACA), states are continuing to move forward with plans to implement the laws Medicaid expansion provision. Idaho, Nebraska, and Utah all expanded Medicaid to the ACA uninsured adult population via ballot initiative in the November 2018 election, bringing the total number of states with an expansion policy to 36 plus the District of Columbia. While Montana voters failed to extend its Medicaid expansion, the legislature is beginning debate now on the program’s future. Meanwhile, on January 1, Medicaid coverage for the ACA expansion population also went into effect in Virginia, and the newly elected governor of Maine used her first executive order to implement Medicaid expansion in that state, over a year after voters had approved the expansion there. Advocacy has also begun anew in other states where lawmakers more favorable to expansion are assuming their offices this year.

Working on Medicaid expansion or other Medicaid issues in your state? Please contact the AAP state advocacy team at stgov@aap.org for consultation and technical assistance.

January 3, 2019: State Lawmakers Race to Keep Up With Electric Scooters
Since the end of 2017, 39 of the 100 largest US cities have been introduced to electric scooters, also known as e-scooters, which look like regular scooters, but travel up to 15 MPH. E-scooter rental services allow users to download an app, find an electric scooter nearby, unlock it, and ride. Because e-scooters are relatively new, regulation is catching up. Often users can operate them on sidewalks and bike paths without helmets, leading to injuries for both users and pedestrians. State lawmakers in at least 15 states plan to consider legislation to regulate the e-scooter industry in 2019.

Currently, 10 states (California, Delaware, Massachusetts, Minnesota, New Jersey, Oregon, Texas, Virginia, Utah, and Washington) have laws addressing electronic scooters. Of these states, Massachusetts, New Jersey, and Oregon require helmets for all electronic scooter riders and California, Delaware, and Minnesota require helmets only for those younger than 18. Virginia’s law authorizes localities to establish helmet laws for electronic scooters but does require such provisions.

For safety information on related products see Bicycle Helmets: What Every Parent Should Know and Skateboarding and In-Line Skating.

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E-mail your comments and suggestions to the AAP State Advocacy team. Please contact us at 630/626-6240 if you require additional assistance or information.​​​
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