Category: CMS News

Alternative Headline: $350K Ad Targets Rep. Gonzales

[MM Curator Summary]: A $350K ad campaign is targeting Rep. Tony Gonzales for voting to cut Medicaid in the “One Big Beautiful Bill.”

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News: Liberal outside group Unrig Our Economy is launching a $350,000 ad buy targeting Rep. Tony Gonzales (R-Texas) over his vote to back the One Big Beautiful Bill.

“Rep. Tony Gonzales just voted to cut Medicaid and health care coverage…all to fund tax breaks for billionaires,” the ad’s narrator says, before urging voters to tell Gonzales “to stop cutting health care.”

The latest ad buy comes on the heels of a larger $2 million effort from Unrig Our Economy that slams Texas GOP Reps. Lance Gooden, Monica De La Cruz, Beth Van Duyne and Dan Crenshaw for supporting the reconciliation package.

Unrig Our Economy is trying to squeeze GOP incumbents who may see their districts shift if state lawmakers pass new House maps.

But based on our reporting, the proposed Texas gerrymander may leave the state’s incumbents in fairly safe red seats.

Gonzales represents a west Texas seat that encompasses large swathes of the U.S.-Mexico border. Gonzales won reelection by 24 points last November.

https://punchbowl.news/article/campaigns/unrig-hits-gonzales/

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Alternative Headline: Medicaid Cuts Threaten Rural OK Hospitals

[MM Curator Summary]: Massive Medicaid cuts from the “One Big, Beautiful Bill” threaten over half of Oklahoma’s rural hospitals and could devastate already limited health care access.

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• The passage of the "One Big, Beautiful Bill" will result in nearly $1 trillion in Medicaid cuts and an estimated $6.3 billion in cuts in Oklahoma alone.
• Over half of Oklahoma’s rural hospitals are at risk of closing, despite the fact that nearly half of Oklahomans live in rural areas.
• Rural hospitals will need to redefine their mission as a result, as they will not be able to operate as they do now with limited funding.

Nearly half of Oklahoma’s four million residents live in rural areas. And now, over half of Oklahoma’s rural hospitals are at risk of closing. 

The passage of the "One Big, Beautiful Bill" will result in nearly $1 trillion in cuts to Medicaid, and an estimated $6.3 billion in cuts in just Oklahoma, according to state health care leaders. Over a quarter of the population of Oklahoma is enrolled in the state’s Medicaid program, SoonerCare, and more than half of those enrollees are children.1

Oklahoma’s situation highlights the barriers rural residents across the country will face in the wake of Medicaid cuts.

Oklahoma Will Be Hit Hard

Medicaid helps fund many rural hospitals and other health facilities in the U.S., among other things.

Over 700 rural hospitals across the country are at risk of closure, with 300 considered to be at “immediate risk” of closure.2 Oklahoma is one of the top three states likely to bear the brunt of these shutdowns, according to the Center for Healthcare Quality and Payment Reform. The fate of 47 of its 90 rural hospitals now hangs in the balance.3

Rich Rasmussen, the president and CEO of the Oklahoma Hospital Association, says rural hospitals will have to “redefine what their mission is” when the law is fully phased in, as they won’t have the funding to operate as they are currently.

“What are small communities supposed to do?” Rasmussen said.

Cuts to Medicaid will likely impact Oklahoma’s 39 critical access hospitals (CAHs), Rasmussen said. These hospitals are designated by Centers for Medicare & Medicaid Services to give basic health care access to rural communities and transfer patients with complex needs to larger facilities. They have limited beds and are typically located at least 35 miles from another hospital.

Nursing homes, emergency rooms, clinics, and other health care facilities that serve rural communities will also be disproportionately impacted by these cuts because they rely more on Medicaid reimbursements to operate than urban hospitals do, according to health care think tank KFF.4

Specific health sectors could also struggle. Oklahoma has one of the largest maternity deserts in the country, and obstetrics care could be severely depleted in the 15 most northwestern counties in the state.5 This could force patients to drive further for routine care, and 80 miles or more for specialty care. 

Cuts Are Already Happening

Cuts to care in Oklahoma facilities were already underway before the bill passed.

Endocrinology, rheumatology, pediatrics, wound care, and primary care clinics all ceased operations in July due to cuts made by a regional health system based in Norman, Okla.6 Although many of these shuttered clinics aren’t in rural areas, they served patients throughout the state, and more are expected to close down the pipeline due to Medicaid cuts.

The state already ranks 47th nationally in overall health performance, and continued cuts will only make things worse, according to Rasmussen.7

“It will no longer be safe for many people to live in rural communities if they don’t have ready access to health care,” Rasmussen said. “As a result, people are going to rethink where they live and where they retire.”

https://www.investopedia.com/this-state-could-lose-over-half-its-rural-hospitals-11784908

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Alternative Headline: CT Expands Sickle Cell Gene Therapy

[MM Curator Summary]: Connecticut will provide Medicaid patients with access to multimillion-dollar gene therapies for sickle cell disease through a new federal outcomes-based payment program that ties cost to how well the drugs work in patients. 

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Connecticut is now participating in a new federal program aimed at expanding treatment access for patients with sickle cell disease who are insured through Medicaid.

Through the Cell and Gene Therapy Access Model established by the Centers for Medicare and Medicaid Services (CMS), costs of cell and gene therapies for sickle cell disease will be tied to how well the drugs work in patients. If the treatments don’t work to their full potential, states participating in the program will receive discounts and rebates from the drug manufacturers.

The U.S. Food and Drug Administration approved two gene therapies for sickle cell disease—exagamglogene autotemcel (Casgevy™) and lovotibeglogene autotemcel (Lyfgenia™)—that while potentially curative are costly, priced at $2.2 million and $3.1 million per patient, respectively. The model is intended to make it easier for participating states to pay for these gene therapies.

Lakshmanan Krishnamurti, MD, professor of pediatrics (hematology /oncology) at Yale School of Medicine and chief of pediatric hematology, oncology, and bone marrow transplant at Yale New Haven Children’s Hospital, worked with Yale Cancer Center, Yale New Haven Hospital (YNHH), and the state of Connecticut to bring this program to the state. Both gene therapies are offered at YNHH.

“This important program will enable patients to have access to this life-changing new therapy for sickle cell disease,” says Clifford Bogue, MD, Waldemar Von Zedtwitz Professor of Pediatrics, chair of the Department of Pediatrics at Yale School of Medicine, and chief of pediatrics at Yale New Haven Health. “We are excited that Connecticut is one of the participating states.”

The Cell and Gene Therapy Access Model is the first of its kind in the United States. Connecticut is among 33 states currently participating along with Washington, D.C. and Puerto Rico, which together represent 84% of Medicaid beneficiaries with sickle cell disease. CMS says other conditions may be added to the model in the future.

New treatments for sickle cell disease

In people with sickle cell disease, red blood cells that are typically smooth, round, and flexible are instead hard, crescent-shaped, and brittle. These malformed cells break down faster and can scratch and block blood vessels, leading to severe pain, inflammation, organ damage, infection, and even stroke. Sickle cell disease affects an estimated 100,000 Americans.

Prior to gene therapy, the only potential cure for patients was a bone marrow transplant, an option available to only around 25% of patients. For the other 75%, lifelong management includes medications to reduce blood cell sickling, pain treatment, and blood transfusions.

Both approved gene therapies for sickle cell disease are intended to be one-time treatments. Each takes a different approach, but both ultimately reprogram the body’s blood stem cells, leading them to produce healthy red blood cells in amounts that dilute the sickle cells.

Gene therapies have the potential to be transformative for patients with sickle cell disease. Freed from disabling pain, patients have the possibility of normalcy for the first time in their lives.

In clinical trials, 93.5% of patients receiving Casgevy and 88% of those receiving Lyfgenia experienced no vaso-occlusion events—in which sickle cells block blood vessels, causing severe pain and, over time, organ damage—in the months following treatment.

“Gene therapies have the potential to be transformative for patients with sickle cell disease,” says Krishnamurti. “Freed from disabling pain, patients have the possibility of normalcy for the first time in their lives.

“CMS has taken a major step forward to make these treatments available at a reasonable cost and to implement these programs in a way that improves access to these complex treatments. The Cell and Gene Therapy Access Model for sickle cell is likely be a forerunner for similar treatments for many diseases in the future.”

https://medicine.yale.edu/news-article/expanding-access-to-sickle-cell-gene-therapies-for-patients-with-medicaid/

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Alternative Headline: Rural Maternity Care Crisis Deepens

[MM Curator Summary]: Medicaid cuts and declining birth rates are accelerating maternity ward closures, leaving rural communities with dangerous gaps in obstetrics care — especially in states with abortion bans. 

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When there’s a maternal health emergency, Jessica Wheat springs into action.

Alongside a group of specialized health providers at Research Medical Center in Kansas City, Wheat works fast to make sure patients are able to have their babies delivered safely or their children given critical treatment at the Level III neonatal intensive care unit on site.

“We have just an abundance of resources, and people that know what they’re doing,” the labor and delivery nurse said.

That abundance is coming to an end. Last month, HCA Midwest Health, which owns Research Medical Center, announced it was closing its obstetrics program and NICU. The umbrella company that runs HCA Midwest Health, which oversees multiple hospitals and related sites of care in nearly two dozen states, cited declining births at the hospital as part of its reasons for the closure.

Wheat is worried about the implications for local patients who often struggle to find transportation even across Kansas City. But she’s also concerned about the rural patients outside of the metro area.

“We tend to get smaller hospitals that will Life Flight bleeding moms or moms who are breech or moms who are having a hypertensive crisis,” she said. “We can do the emergency C-section — a lot of smaller hospitals do not have those capabilities. The farther they have to go, the more at risk they’re going to be for complications, even death.”

The availability of obstetrics care in America has been dwindling for years. That could accelerate now, as hospital leaders across the country warn that President Donald Trump’s massive cuts to Medicaid, the federal-state health insurance program for low-income Americans, could leave pregnant people in rural communities with vanishingly few options for medical care. 

Obstetrics is one of the most expensive services provided by hospitals, especially in rural areas, which often see a larger portion of Medicaid patients. Nationwide, the program pays forabout 40 percent of all births. With financial hits looming, hospitals are primed to close maternity wards first, and rural areas are particularly vulnerable.

“This is going to have an enormous impact,” said Dr. John Cullen, a family physician in Valdez, Alaska, a remote city of about 4,000 people. “Already we’re seeing OB deserts that are increasing in size, and after the passage of this bill those are going to be markedly worse — where people are going to have to drive hundreds of miles before they can get prenatal care, much less delivery.”

For years, hospitals facing financial pressure have shuttered maternity wards. Between 2010 and 2022, more than 500 hospitals across the country dropped obstetrics, per a recent study that also shows more than half of rural counties now have no hospital-based obstetric services. A report from the advocacy group March of Dimes found that 1 in 3 U.S. counties had no OBGYN at all.

Empty infant beds sit gathered in a corner in a shuttered maternity ward at rural Madera Community Hospital which closed in January 2023, in Madera, California. (Melina Mara/The Washington Post/Getty Images)

There are numerous reasons for the recent closures, ranging from declining births to difficulties hiring local providers. But the biggest issue is financial: Hospitals typically don’t earn enough from labor and delivery to cover the cost. Now, cuts to Medicaid — which will further cut hospital revenues and increase their share of uncompensated care — threaten to strain finances further.

“I do have a lot of concern that we’ll continue to see labor and delivery units close in rural hospitals and potentially even at an accelerated rate, as hospitals feel greater strain due to cuts in the bill,” said Carrie Cochran-McClain, chief policy officer with the National Rural Health Association.

The National Rural Health Association and Manatt Health, a consulting firm, estimated in June that the proposed Medicaid cuts over 10 years could reach almost $70 billion just for rural hospitals. Nearly half of all children and 1 in 5 adults in rural communities are enrolled in Medicaid or the related Children’s Health Insurance Program. The health insurance plan also pays hospitals less for the same services than private insurance does.

“When rural hospitals say, ‘We have these big Medicaid cuts, how do we deal with that shortfall?’ the OB units are going to be first on the chopping block,” said Jamie Daw, an associate professor of health policy at Columbia University.

One analysis from the National Partnership for Women and Families, a nonpartisan organization that supports policies such as equal pay and access to health care, suggests that the new cuts to Medicaid put almost 150 rural hospitals with maternity services at risk of serious downsizing or closing altogether.

The changes to Medicaid — including cumbersome new paperwork requirements for people insured through the program, and cuts to some of the taxes used to finance state Medicaid programs — largely won’t take effect until after the 2026 midterm elections. But already, hospitals are preparing for huge reductions in services, and pointing to labor and delivery as one of their most vulnerable offerings.

Michigan-based Trinity Health operates five hospitals that include maternity services. Hospital leaders are deeply concerned about service cuts that would make it harder for pregnant patients to get appropriate medical care, said Dr. Sharon O’Leary, an OBGYN and the organization’s chief data analytics and chief equity officer.

When patients have to travel further for prenatal care, they are more likely to cut the number of doctors’ visits or to receive no prenatal care at all. Studies over the past several years have shown that obstetrics unit closures — and increased travel time for pregnant patients — result in higher rates of pregnancy-related complications, including premature birth and low birth weight. 

“Our biggest fear is that as women lose coverage that they will not seek prenatal care,” O’Leary said.

The consequences are likely to be heightened in areas that are already underserved, and where birth outcomes are worse: rural parts of the country, and, in particular, large swaths of the South. 

“While we are concerned about the impact the bill will have on all hospital services, we are particularly concerned about its impact on labor and delivery services,” said Richard Roberson, president and CEO of the Mississippi Hospital Association.

Already, rural areas have seen access to reproductive care dwindling, particularly in the past three years, since the fall of Roe v. Wade allowed states to outlaw abortion. Preliminary data shows that medical residents for OBGYN are applying in smaller numbers to states with abortion bans and a recent study in the medical journal JAMA, the first to assess the relationship between abortion bans and provider availability, found that in Idaho, the number of OBGYNs fell by 35 percent between August 2022 — when the state implemented its near-total ban — and December 2024.

Abortion ban states, which are largely in the South, also have higher rural populations, worse birth outcomes and larger shares of hospitals at risk of closure. 

“It’s an additional trend — on top of this piece of the general financial pressure  — that’s going to also affect predominantly rural Southern communities,” Daw said. “It seems like a perfect storm of these concurrent trends really really affecting access to care.”

If hospitals reduce their pregnancy-related offerings, few alternatives will be able to fill in the gap. Earlier this year, the Trump administration began withholding millions of dollars in family planning grants through Title X, the federal program that supports family planning services for low-income people. Planned Parenthood, a major provider of services that include cancer screenings, testing for sexually transmitted diseases and contraception, is also one of the largest Title X providers. Most Planned Parenthood clinics are in rural or otherwise medically underserved areas. The federal budget and tax law also includes a provision that would cut federal Medicaid funding from Planned Parenthood, though that policy has since been blocked by a federal court ruling. In recent weeks, several clinics have announced their plans to close. 

“You have to think of them as related,” Daw said. “It’s definitely not helpful to have all of these changes happening at the same time and really undermining the safety net for reproductive-aged women.”

Cochran-McClain said when a provider with a background in obstetrics care leaves a rural town or city, that impacts health services more broadly: Often, that provider was also providing contraception, general gynecological care and routine screenings.

“It’s so interconnected. While we’re talking specifically about labor, delivery and pregnancy, it can have an impact more broadly on access to women’s health in rural communities,” she said. “It’s been a rough couple of years before all of this, so it just feels like it’s a worsening trend in terms of overall access.”

The closure at Research Medical Center in Kansas City — where its obstetrics program is scheduled to close down in early September — also shows that even when a person in a rural area is forced to travel greater distances into a city setting for specialized care, those services aren’t guaranteed.

Wheat and other affected nurses at Research Medical Center, where they are represented by National Nurses United, said HCA Midwest Health has not provided enough information about the logistics of winding down services. Will the rest of the hospital, including its ICU unit, take emergency patients who need labor and delivery services? Or will the remaining staff in other areas of the hospital get specialized training?

HCA Midwest Health, which did not immediately respond to a request for comment from The 19th, said in a statement to a media outlet that it is working with area health providers to ensure patients have other delivery options.

Wheat has lined up another nursing job in labor and delivery with a different hospital system. In her text group chats with other impacted staff, there is a sense of sadness. She believes the obstetrics-related health providers will find other work, even if it means even more gas mileage to get to a new job. But Wheat keeps thinking about what’s to come for the patients.

“I’m emotionally exhausted. It is hard,” she said. “We’re just grieving for the community at this point, because we know they’re going to have a lot of issues after we’re gone.”

https://19thnews.org/2025/08/pregnancy-rural-america-maternity-ward-closures-medicaid/

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Alternative Headline: Mfume Warns of Medicaid, Immigration Crisis

[MM Curator Summary]: Rep. Mfume hosted a Baltimore town hall warning of severe Medicaid and immigration consequences under Trump’s policies.

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U.S. Rep. Kweisi Mfume, D-District 7, hosted a community town hall Wednesday at the Bilingual Christian Church in Southeast Baltimore.

"We are going through a difficult time in our society," Mfume said. "Over 40,000 constituents will lose health insurance, (majority) will be Medicaid. Maryland hospitals will face $362 million in unreimbursed care costs, and they risk closures as a result of that. One in five seniors will lose access to nursing home care."

Mfume listed out a number of statistics regarding Medicaid cuts from the Trump administration and spoke about actions from President Donald Trump when it comes to immigration.

Immigration attorney Adonia Simpson, who is also a Baltimore City resident, was in attendance to address any questions or concerns constituents may have had.

"There are things like temporary protected status, we have a large number of Central Americans who have TPS. The administration is actively ending these programs, and there is also litigation challenging the termination of these programs," Simpson said. "This means thousands of individuals in our community could go back to being undocumented."

Simpson also said the future of the Deferred Action for Childhood Arrivals remains uncertain under the Trump administration.

11 News reached out to Baltimore County Sen. Johnny Ray Salling, R-District 6, for comment regarding both immigration and Medicaid. He said he believes the administration is working responsibly:

"I think (the Trump administration is) being responsible because there’s a lot of people that abuse those privileges here in our country," said Salling. "We have this type of Medicare and Medicaid to help people. The previous administration has literally bent over backwards to (help) people that don’t belong here. That’s just one of the main problems that’s there, and they need to really fix that, and I believe that’s what the Trump administration is doing now."

In response to the recent ICE raids happening throughout the nation, Salling said:

"(The) previous administration has literally opened the borders to anybody and everybody, not just in Central America, but around the world, and criminals and people that came in. That’s why we have problems with a lot of crime in our country," said Salling. 

https://www.wbaltv.com/article/kweisi-mfume-town-hall-baltimore-medicaid-immigration/65557223

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Alternative Headline: Medicaid Cuts Threaten Caregivers

[MM Curator Summary]: Millions of unpaid caregivers face growing burdens as Medicaid cuts threaten vital support programs, especially within the Latino community. 

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For a decade, Alma Valencia has taken on the task of caring for her mother, Arminda, who suffers from dementia.

"I’ve had to take on that role of being a nurse — a person that does everything for my mom — dressing her, bathing her, feeding her. And it’s like having another child but that’s an adult, you know?" Valencia said. "It’s very, very tough, emotional, very, very draining."

Valencia is one of the approximately 63 million people in the U.S. — about a quarter of the entire U.S. population over the age of 18 — who have taken on the role of caring for a loved one who needs additional attention due to issues such as aging, disabilities or illness, according to a new report from AARP and the National Alliance for Caregiving.

Most of them do it without getting paid, and 6 in 10 are employed apart from the caregiving work they do at home. “It’s an invisible workforce that strengthens our families and our communities,” the report notes. In the Hispanic community, over one-third of all caregivers and almost half of caregivers are also in households where they’re taking care of children under 18.

Now there are worries among caregivers like Valencia over how Trump’s "big, beautiful bill" that recently passed the Republican-led Congress will cut Medicaid funding and implement tougher Medicaid eligibility requirements. Some caregivers get financial help through programs funded by Medicaid, and some rely on Medicaid for their own medical care.

Among the programs at risk due to funding cuts to Medicaid is the Home and Community-Based Health Services (HCBS) program, which in some states offers a stipend to those who care for their loved ones at home to help cover things like medications or day care centers.

Alma Valencia and her mother Arminda.Courtesy Alma Valencia

Valencia says this type of program is a much-needed relief, as she estimates her family already spends about $20,000 a year on out-of-pocket expenses for things like home improvements, such as installing ramps.

Half of caregivers have taken a financial hit, according to the report, and almost a quarter exhausted their short-term savings and are taking on debt, according to the report. Among Latinos like Valencia, almost a third (31%) reported being in debt and depleting their short-term savings. Latinos make up about 16% of caregivers in the U.S.

Now Valencia, who lives in California, worries the situation could become more severe. Even before any Medicaid cuts go into effect, Valencia said she’s seen changes in what’s accessible to her.

At the day care program where she takes her mom, "they were able to drop off Mom, pick her up. So they were able to support me with transportation. Now I’ve had to step in, and so that was removed. It’s little, little changes like that that I’m seeing," she said.

Approximately 8 million family caregivers rely on Medicaid for their own medical care, and 11 million receive HCBS-like stipends through the program, according to Jason Resendez, president and CEO of the National Alliance for Caregiving.

“It is very likely that those pathways will start to diminish because of tough choices that states will have to make in terms of what to fund with less federal Medicaid dollars,” Resendez said at an event presenting the AARP report. “Historically research has shown that when states have less money and are forced to make decisions Home and Community Benefits are the first optional benefits to get cut.”

The planned Medicaid cuts and changes include an increase in the number of minimum hours needed to work in order to receive benefits.

Resendez said this will affect caregivers, who often can only work part-time jobs so they can care for their loved ones and won’t be able to work additional hours as may be required under new Medicaid rules.

The increase in family members acting as unskilled caregivers could become more pronounced in the coming years not only because of budget cuts, but also due to the Trump administration’s immigration actions, according to experts. This is because many immigrants work as nurses for the elderly or the disabled.

Many immigrants from countries like Venezuela and Haiti who had work permits for jobs, including nursing, have now had their temporary legal status revoked by the Trump administration, who ended programs like TPS and humanitarian parole.

If more families lose that formal support, they may have to take on the role of caregivers directly.

Valencia lives near the San Diego area, where Republican Rep. Darrell Issa, who voted for the bill, defended the proposed changes to Medicaid spending and eligibility.

"Republicans in Congress are saving Medicaid by ending waste, eliminating fraud, and ensuring it will be there for the American people who need it," Jonathan Wilcox, deputy chief of staff and communications director for Issa, said via email to Noticias Telemundo.

Ahead of the planned Medicaid and budget cuts, Resendez said public policies must not lose sight of the caregiving population, whether through potential financial assistance, such as tax credits, and more programs that provide medical training and payment to caregivers.

Meanwhile, social media has enabled caregivers to share their experiences and knowledge.

“This way, we can see how each other is doing and share resources and valuable information,” said Valencia, who posts her experiences as a caregiver on Instagram under the Caregiver Comadre account.

"I really wish in the Latino community that we shared more of what we’re experiencing," she said, noting many people tend to be very private. "The more that we share, the more we normalize the experience, and we open up the opportunity of helping each other out."

An earlier version of this story was first published in Noticias Telemundo.

https://www.nbcnews.com/news/latino/family-caregivers-worry-planned-medicaid-cuts-impact-rcna221915

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Alternative Headline: Medicaid Reform Effort Falters

[MM Curator Summary]: Congress’s latest Medicaid reform plan, OBBBA, focuses on cuts and work requirements but fails to address structural flaws. 

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Every decade since the 1970s, Congress has tried and failed to reform Medicaid, the health entitlement for the poor. Republican lawmakers’ latest effort — as part of the One Big Beautiful Bill Act — appears to be no different. Instead of addressing the program’s core deficiencies, the party instead fixated on shrinking it. The likely result? Needless disruption and little in the way of serious savings or reform.

All told, the bill seeks to cut about $1 trillion from federal Medicaid spending over a decade. This savings largely would be achieved through a series of technical changes that nonetheless would be costly and difficult to implement, and thus may not fully materialize.

The most substantial amount in theory would come from adding “work requirements” for beneficiaries. Starting next December, Medicaid recipients under age 65 will need to work, seek employment, go to school or volunteer 80 hours a month, with exemptions for pregnant women, parents with children under 14, the “medically frail” and others. The goal is to save money by shrinking the pool of enrollees — without cutting benefits for those still eligible or dramatically increasing the uninsured rate.

Accomplishing such a delicate task is, you might say, aspirational. States will need to update creaky IT systems and retrain staff. They’ll have to coordinate with the managed-care companies that administer Medicaid plans and communicate changes to a population that’s known to move and change jobs frequently. To show they’re working in good faith and not simply snatching benefits from the poor, officials ought to establish pathways to vocational and other programs that put recipients in compliance with the new rules. They likewise should work with local employers to help those who’ve lost coverage find alternatives.

Preparation of this sort is improbable, and not just because it’s laborious.

Thanks to Medicaid’s funding model, most states have little incentive to strictly comply with work requirements. Since its inception in 1965, Medicaid has offered a federal “match” for state spending on public aid, without a cap. For each dollar a state spends, it gets $1 to $9 from the federal government. By enforcing work rules — and thus lowering their Medicaid spending — states stand to cut off their biggest source of funding, at the risk of yanking away their residents’ health care. Far better to create workarounds.

For these reasons, work requirements are unlikely to generate hoped-for savings. They’ll also hassle the poor while failing to address the perverse incentives of the open-ended federal match that has made Medicaid one of the fastest-growing federal programs, with expenditures soaring to more than $800 billion from about $40 billion in 1985.

Proposals that seek to eliminate the open-ended match have long been debated but remain unpopular. So-called block grants, for example, would allocate a fixed amount of money to states each year. Although that would curb runaway spending, it would be perilously inflexible in times of need — say, when enrollment rises during recessions, disease outbreaks or natural disasters.

One idea that deserves more attention is something of a hybrid. It involves maintaining the uncapped federal match for mandatory benefits and eligibility categories — that is, the core services and populations required by federal law — while setting limits on matching for states’ optional expansions. A split along these lines would make states, rather than federal taxpayers, responsible for spending they choose to incur.

The good news is that the One Big Beautiful Bill has started a long-overdue conversation on Medicaid reform. The bad news is that, as things stand, the cuts the law has imposed are likely to result in disruptive yet ineffective change. Congress still has a chance to do the right thing.

This editorial was published by the Bloomberg and distributed by Tribune Content Agency.

https://www.koreatimes.co.kr/amp/opinion/20250728/republicans-missed-a-shot-at-serious-medicaid-reform

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Alternative Headline: NY Medicaid Tax Faces Threat

[MM Curator Summary]: A federal proposal may eliminate New York’s $1.8 billion Medicaid MCO tax, threatening key healthcare funding.

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A federal proposal could pull the plug on a key Medicaid funding mechanism in New York, deepening the state’s health care budget troubles and putting hospitals, nursing homes and clinics at risk.

New York is counting on a tax it imposed on Medicaid health plans – called managed care organizations – to help pay for its health care system this year. The state expects to collect $1.8 billion this year from the tax, which is meant to fund Medicaid and support hospitals, nursing homes and community clinics, according to Budget Director Blake Washington.

https://www.crainsnewyork.com/health-pulse/proposed-rule-would-eliminate-nys-mco-tax

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Alternative Headline: Federal Cuts Threaten Durham Aid

[MM Curator Summary]: Federal cuts to Medicaid and SNAP are threatening food, health, and economic stability for more than 17,000 in Durham County.

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More than 1.5 million North Carolinians could lose food and medical assistance when new limits on SNAP and Medicaid go into effect. That’s why Durham County’s leadership wanted an update Monday on the scope of the issue at the county level.

A representative with Durham County’s Department of Social Services said more than 17,000 people in the county who could lose access to health insurance.

North Carolina’s expansion of Medicaid in 2023 was contingent on the federal government paying 90% or more of the cost to add the working poor — those in low-wage jobs that don’t offer benefits. But the recently passed "big, beautiful bill" would reverse that federal funding. Unless North Carolina law is changed, those people will lose their Medicaid.

Durham’s Innovative Nutrition Education (DINE), which educates the public, including children, about nutrition and provides services, expects to cut 13 positions, most of them dietitians.

Durham County DSS Director Maggie Clapp said the change in the law means "more than 500,000 children no longer automatically qualifying for school meals because of SNAP."

She also brought up that reducing SNAP benefits means less money for businesses. She said the food assistance money "goes right to our supermarkets. It goes right to our mom and pop grocery stores. So, that money goes directly to them, so that is a huge loss for the economy."

Republican lawmakers have defended the cuts as means to reduce wasteful spending. North Carolina Republican Sen. Ted Budd said the 600,000 people added to Medicaid after the 2023 expansion aren’t who the program was originally intended to help in the 1960s, and removing their coverage will lower government spending a substantial amount while reserving those benefits for the people who need it most.

Regardless, the concern for the people charged with providing these services say its the most-vulnerable who will feel the impact.

Some agencies discussed ways they can get creative to bridge a shortfall in financial support from the federal government. This includes finding new partnerships and finding potential revenue-making ability within their current means.

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https://www.wral.com/news/local/durham-county-medicaid-snap-cuts-august-2025/

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Alternative Headline: AMA Opposes Estate Recovery

[MM Curator Summary]: The AMA formally opposed Medicaid estate recovery and endorsed tracking GLP-1 drug side effects, while delaying Medicare opt-out guidance.

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CHICAGO — The American Medical Association (AMA) House of Delegates  voted Wednesday to oppose federal or state efforts to try to recover long-term care costs from Medicaid beneficiaries’ estates.

"The government taking a house from a grieving family, for pennies in return, is not healthcare. That is state-sanctioned exploitation," said Dayna Isaacs, MD, MPH, speaking for the Resident and Fellow Section. "A grave should not come with a bill."

Sarah Mae Smith, MD, PhD, who was also speaking for the Resident and Fellow Section, said states that do recover costs from estates recoup small fractions of the amounts owed.

"The highest-income patients to whom estate recovery  would putatively apply are also best able to evade recovery efforts by leveraging legal mechanisms, leaving poorer families and families of color to bear the brunt of these misguided policies," she said.

"Medicaid and estate recovery in the same phrase is an oxymoron," said Niva Lubin-Johnson, MD, speaking for the Illinois State Medical Society.

Gregory Pinto, MD, speaking for the New York delegation, expressed an opposing view. "Our AMA should not be trying to prohibit federal estate efforts to recoup these funds. In fact, several states are able to do so successfully."

The recommendation to oppose estate recovery came in the form of an amendment to an 8-page report from the AMA’s Council on Medical Service that detailed the pros and cons of estate recovery. As proposed, the report had recommended that the AMA support making Medicaid estate recovery optional, instead of mandatory, for states.

"At this time right now, Medicaid needs every dollar that it can get to help care for patients" due to looming and widespread federal cuts to Medicaid, said Patrice Burgess, MD, a member of the council that compiled the report. "It is important to allow states that option," so more patients can get covered care.

However, so many delegates were against that, an amendment was introduced to oppose estate recovery efforts outright.

The report noted that just five states — Massachusetts, New York, Pennsylvania, Ohio, and Wisconsin — recouped nearly half of all Medicaid Long Term Services and Supports (LTSS) collections in the U.S., and that overall, "recovered dollars represent a small slice of what Medicaid spends on LTSS." Plus, the administrative costs of going after such assets "can be substantial," the report noted.

Medicare Opt-Out Advice?

The AMA had trouble gathering consensus about whether it should develop educational guidance for physicians to opt out of Medicare, since payment to physicians treating seniors and the disabled has fallen far short of keeping pace with inflation, even as administrative burdens have risen.

The idea was that the AMA should develop on its website a prominently featured page with a step-by-step guide on how to opt out; an overview of legal, financial, and ethical considerations; information on alternative payment models and strategies to ensure continuity of care; and an FAQ section to address concerns or special scenarios doctors might face.

The resolution, introduced by seven state delegations, noted that participating in the Medicare program imposes "increasing administrative burdens and financial strain due to payment rates that fail to keep pace with inflation and rising practice costs." Many physicians, the proponents said, "are unaware of the process and implications of opting out of Medicare" or their ability to explore alternative payment models.

But would actively helping doctors drop out be a good service for its members? Or would it perhaps subject the AMA to criticism that it was, in effect, acting to reduce the supply of doctors available to treat the nation’s seniors and disabled?

Delegates tried to soften the language by deleting one paragraph that might appear to be overly promotional for doctors to opt out. Before deletion, the paragraph would have allowed the AMA to "promote awareness of this resource among its members and provide additional support for physicians exploring alternative practice models."

Gregory Fuller, MD, speaking for the Texas Medical Association, said he understands "the optics don’t look good" and pointed to negative press reports about the effort.

But he insisted that it’s important "to have all options available so when people go to the website and look, they can see that option to opt out, but they can also see how to not participate or maybe they need to know how to get into Medicare. We want the optics to look good."

Ultimately, the resolution was referred to the Board of Trustees to make a decision.

GLP-1 Side Effects Registry

Another item prompting vigorous discussion was a proposal for the AMA to support a registry of patients’ side effectsfrom GIP and GLP-1 drugs and their impacts on pregnancy.

The resolution notes that besides their use in people with diabetes, there are limited studies on the potential side effects, such as muscle loss and bone density loss, especially in adults ages 65 and older.

It was approved with overwhelming support from the delegates.

"These are now given to a completely different population of people, [than they were originally intended] and a lot of people are taking these recreationally … that we would describe as otherwise healthy individuals," said Alan Klitzke, MD, a delegate of the American College of Nuclear Medicine, who spoke for himself. "Some of them have obesity and some of them don’t. And they’re prescribed to a whole population of people that don’t understand what the side effects may be."

"We’ve seen the commercials: that you learn how to dance or sing or play the guitar if you take one of these medications," Klitzke said.

Nita Shumaker, MD, an alternate delegate for the Organized Medical Staff Section that proposed the resolution, said she could find nothing on the FDA’s website about "the newest side effect I’ve seen, which is non-arteritic anterior ischemic optic neuropathy."

As an obesity medicine specialist, she added, "when I prescribe these medications for my patients, I want to know every potential side effect and everything that is known in the literature, which is not easily accessible at this time."

Jonathan Leffert, MD, of the American Association of Clinical Endocrinology, speaking on behalf of the Endocrine Section Council, argued strongly against the registry, noting that the side effects "are well known."

"These drugs have revolutionized the care of patients with type 2 diabetes because of their effect on both blood sugar and weight loss," he said. "Several hundred papers have been written about these medications and their side effects, including in pregnancies, with many ongoing."

Pinto, of the New York delegation, supported the move. "These medications indeed are not new, but the marketing is new. A bigger advertisement requires a bigger warning label, and that’s what this registry does."

https://www.medpagetoday.com/meetingcoverage/ama/116057

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