The 446^th Legislative Session convened on January 10, 2024 with ambitious goals and tough budget decisions ahead. The main legislative priorities from both chambers and the Governor focused on affordable housing, infrastructure, transportation, military families, and public safety. From the moment the Governor released his $63 billion budget in January to the very final hours of the legislative session, fiscal responsibility and restraint remained the top focal point.

During the 90-day session, over 2,700 bills were introduced and 1,053 bills were ultimately passed by both chambers. In addition to budget advocacy, Children’s National Government Affairs spent the session advocating for legislation that supports both the policy priorities of the hospital as well as the Community Health Needs Assessment (CHNA) and its corresponding Community Health Improvement Plan (CHIP).

Focusing our advocacy on the four priority areas identified by the CHNA (Early Childhood Education, Healthy Food, Health Insurance Coverage, and Employment Rate), we identified 17 bills that we testified in support of. Our advocacy was most successful in the healthy food and health insurance coverage space this session. Highlights from both priority areas are detailed below.

Healthy Food (Increase Access to Healthy Food Options)

Over the last several years, it’s been reported that heavy metals have been found in a variety of baby food products. While the FDA and Congress are working to remove these toxic metals from infant and toddler foods, states are beginning to take action. In Maryland, Delegate Deni Taveras (D-Prince George’s) drafted and introduced HB 97/SB 723 – Baby Food – Toxic Heavy Metals – Testing and Labeling (Rudy’s Law). This bill requires manufacturers of baby food to test a representative sample of each production aggregate of the manufacturer’s final baby food product for certain toxic heavy metals and to make certain information related to the testing and a link to certain guidance available on the manufacturer’s website.

Unfortunately, exposure to toxic heavy metals from baby food is something that pediatricians see in our clinics. Children’s National provided written testimony in support of this bill, including a recent example of a Maryland patient who had very high lead levels in her blood (4x higher than what is considered normal or acceptable for her age) as a result of a food product that she regularly consumed. We know that there is no safe level of exposure to heavy metals for children and legislation such as Rudy’s Law are essential in protecting this vulnerable age group.

HB 97/SB 723 passed the General Assembly on April 6, 2024 and is awaiting the Governor’s signature. Maryland is leading the way with this legislation, second only to California which was the first state to pass a law requiring testing of baby food that recently went into effect on January 1, 2024.

An honorable mention in the healthy foods space this session is SB 579 – Primary and Secondary Education – Breakfast and Lunch Programs – Universal Expansion Report.  When we initially testified in support of the bill, it was simply a universal school meals expansion bill. However, the majority of the bill text was struck and the final version of the bill ended up requiring the State Department of Education to report to the General Assembly on a cost estimate for providing free breakfast and lunch to all students in public schools in the State on or before December 1, 2024. While this ultimately was not the outcome we would have preferred, it is an important incremental step towards universal meal expansion in the State. SB 579 passed the General Assembly on April 6, 2024 and is awaiting the Governor’s signature.

Health Insurance Coverage (Improve Access to Health Care and Health Insurance Coverage)

For the second year in a row, the Maryland General Assembly introduced a bill to increase access to health insurance for the State’s undocumented population. HB 728/SB705 – Health Insurance – Qualified Resident Enrollment Program (Access to Care Act) requires the Maryland Health Benefit Exchange to establish and implement the Qualified Resident Enrollment Program to facilitate the enrollment of qualified residents in qualified plans. In other words, this bill allows individuals, regardless of immigration status, to purchase health insurance on the exchange and allows for access to its navigators for assistance in selecting an appropriate plan. It is important to note that individuals would be paying unsubsidized premiums on the exchange and the implementation of this legislation is dependent on the Maryland Health Benefit Exchange applying for a State Innovation Waiver that the federal government must approve.

Many view HB 728/SB 705 as a first step towards greater access to health insurance coverage and health care for all Marylanders. For those who can afford to do so, purchasing insurance on the health benefit exchange provides security and improved access to quality health care. Insurance coverage is an integral component of hospitals being able to deliver quality of care. The bill is seen as a win-win for patients and hospitals alike. Those without health insurance are less likely to receive necessary preventative care, oftentimes ending up in Hospital Emergency Departments when they are far better suited to be treated in a preventive care environment. This legislation will contribute to more individuals getting access to health insurance and receiving essential, routine preventative care. The Access to Care Act was passed by the General Assembly on April 4, 2024 and is awaiting the Governor’s signature.

Another bill of note in the access to health insurance space this session is HB 1074/SB 684 – Health Insurance – Mental Health and Substance Use Disorder Benefits – Sunset Repeal and Modification of Reporting Requirements. This bill alters certain reporting requirements on health insurance carriers relating to compliance with the federal Mental Health Parity and Addiction Equity Act and establishes certain remedies the Commissioner may use to enforce compliance with the Mental Health Parity and Addiction Equity Act.

While state and federal parity laws provide Marylanders the right to non-discriminatory health insurance coverage for substance use and mental health care, the Maryland Insurance Administration (MIA) recently released a report that concluded no carrier in the state has complied with these laws. This bill gives the MIA the authority and oversight needed to enforce state and federal parity laws and ultimately increase access to care and health insurance for Marylanders. HB 1074/SB 684 passed the General Assembly on April 4, 2024 as an emergency bill and thus takes effect from the date it is enacted.

While not every bill that we testify in support of will make it across the finish line, or will pass in the posture that we prefer, it’s important to utilize the pediatric expertise that Children’s National has in order to educate and influence policy makers to help kids grow up stronger.