Alternative Headline: CMS Expands School Medicaid Guidance

[MM Curator Summary]:  CMS issued new FAQs clarifying Medicaid reimbursement and support for school-based health services amid upcoming federal Medicaid cuts.

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As a follow-up to requirements under the 2022 Bipartisan Safer Communities Act that required the Centers for Medicare & Medicaid Services (CMS) to set up a technical assistance center and provide guidance to support the delivery of services to students covered by Medicaid and CHIP in school-based settings, CMS recently added 30 additional questions to its list of frequently asked questions on issues related to school-based health services (SBS). This additional information adds on to CMS’ 2023 guidance and previous FAQs from for local education agencies (LEAs) and state Medicaid agencies that work to provide health services to those enrolled in Medicaid. The new FAQs cover a wide range of topics, such as administrative claiming, billing/funding, provision of Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), managed care programs, and student transportation, among others. Specifically, CMS cleared up some of the confusion surrounding Medicaid reimbursement for preventive services delivered in a school setting. The FAQ clarifies that states are able to assume medical necessity for a population of Medicaid-enrolled students for preventive care, instead of requiring documentation for each individual. Additionally, the FAQ states that children enrolled in Medicaid can receive a “broad range of the EPSDT services … even if the services are not otherwise available under the State Medicaid Plan.”

Under this critical pediatric benefit, states are required to cover preventive health care and provide screenings to all children enrolled in the program. Additionally, states must provide medically necessary services identified to correct or ameliorate any diagnosed health conditions, regardless of whether or not those services are included in the Medicaid state plan. School is a common location for the provision of preventive services, such as immunizations, regular check-ups, mental health assessments and vision, hearing and dental screenings. In many cases, especially for schools in states that have expanded their Medicaid programs, schools may bill Medicaid for such services.

These services are essential to supporting the health and long-term wellbeing of students. For example, as chronic absenteeism is at an all-time high, supporting student’s mental health and reducing barriers to access is key to ensuring student success. A recent study showed that attendance immediately improved for students who visited a school-based health center for any reason, and those that visited for a mental health condition were five times more likely to improve their attendance.

Not only are children still reeling from the educational and health-related consequences of the pandemic, states will be facingmajor budget pressures over the coming months and years as states grapple with the fall out of the hundreds in billions of cuts to federal Medicaid under the recently passed reconciliation bill. School districts, and many others, will likely have to compete for more limited funds, which could cause reduced access to services for students. As states move into the implementation phase of this new law, state advocates will play an important role in educating stakeholders about the key role of Medicaid and school-based health services as well as documenting and working to try and mitigate the damage created by these cuts.

https://ccf.georgetown.edu/2025/07/14/new-faqs-from-cms-on-school-based-health-services/

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Alternative Headline: Medicaid Cuts Delayed but Deep

[MM Curator Summary]: Trump’s health bill cuts nearly $1 trillion from Medicaid, but delays major impacts until after the 2026 elections, complicating political accountability.

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President Trump’s tax and spending bill sets in motion nearly $1 trillion in cuts to Medicaid and other health policy changes that could loom over the midterm elections.

• But the real effects likely won’t be felt until well after the ballots are cast.

Why it matters: Despite negative polls and headlines, bill supporters could be insulated from political blame by a slow drip of policy changes that will play out over the next decade — a contrast to when the GOP tried to repeal Obamacare in 2017.

• "Republicans backloaded a lot of the Medicaid and ACA cuts," said Larry Levitt, executive vice president at KFF. "There will be few tangible effects in health care from this bill before the midterms."
• That creates a messaging challenge for Democrats, he added. "There’s not going to be a day where everyone wakes up and all of a sudden … more people are uninsured."

What’s inside: Medicaid work requirements, which account for many of the nearly 12 million people projected to lose coverage under the bill, generally won’t kick in until 2027, and some states could get extensions.

• Though beneficiaries will get warnings ahead of time, able-bodied recipients ages 19 to 64 wouldn’t actually be dropped from program rolls for failure to meet or properly report the required 80 hours a month until after November 2026.
• The bill also increases the frequency of Medicaid eligibility checks to every six months, starting on Dec. 31, 2026. People in the Medicaid expansion population who retain coverage under the new system could have to pay up to $35 in cost-sharing per service starting in October 2028.

The phasedown of Medicaid provider taxes and state-directed payments, which states use to help fund their share of program costs and which hospitals in particular have come to rely on for funding, only begins in 2028.

• The legislation’s $930 billion cut to federal Medicaid funding will likely force states to make corresponding cuts to their programs or pick up a greater share of obligations, but those wouldn’t take effect right away, either.

Yes, but: People covered through the Affordable Care Act exchanges will see changes more swiftly. The bill does not extend the Biden-era enhanced premium subsidies, which are set to expire on Jan. 1, 2026. The GOP-led Congress still can do so, but has shown little appetite so far.

• Obamacare premiums would increase by more than 75% on average for enrollees next year without the enhanced subsidies.
• That would give Democrats "a very potent talking point going into the midterms," Levitt noted.
• Medicaid funding of Planned Parenthood will also be cut off for next year under the bill — a change the family planning organization said could result in the closure of nearly 200 clinics.
• Restrictions on which lawfully residing immigrants can access Medicaid will go into effect on Oct. 1, 2026, just before the primaries.

Reality check: Hospitals and clinics have to plan ahead and already are making contingencies for the Medicaid cuts and coverage losses. That could translate into facility closures or the elimination of some services.

Case in point: Community Hospital in McCook, Nebraska, announced last week that it’s closing as a result of uncertainty over the upcoming Medicaid cuts, per Nebraska Public Media.

What to watch: Patient advocates and provider groups will likely press Congress to further delay the provisions, or stop them from taking effect.

• Sen. Josh Hawley (R-Mo.), who argued against the steep health insurance cuts before voting for the package, said he would "do everything in his power" to reverse the future Medicaid cuts.
• "The fact that this all plays out over a period of time creates an opportunity for opponents to try to delay and overturn," Levitt said.
• Democrats, meanwhile, plan to launch the first fusillade of ads about the cuts in swing states this week, and want to turn the August recess into a referendum on the bill at town halls and through mobilization efforts.
• "House Democrats will spend every day of the next 16 months making sure moms, dads, seniors, and veterans know that Republicans took away their health care, raised their energy bills, and hiked their grocery costs," Democratic Whip Katherine Clark of Massachusetts said in a statement.

The bottom line: If nothing changes, it will take nine years for the effects of the bill to fully play out.

• To put that in perspective: Former President Barack Obama was still in office nine years ago.

https://www.axios.com/2025/07/07/medicaid-impacts-tax-bill-delayed

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Alternative Headline: CMS Boosts Medtronic Outlook

[MM Curator Summary]: CMS’s proposed coverage for renal denervation significantly boosts Medtronic’s market potential and stock outlook.

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Medtronic’s stock is rising after the Centers for Medicare & Medicaid Services proposed coverage for renal denervation, a procedure to treat uncontrolled hypertension. The coverage would be granted under a Coverage with Evidence Development framework, requiring treatment within CMS-approved studies. Analysts view this development positively, noting the potential for tens of billions of dollars in revenue for Medtronic. A final decision from CMS is expected later this year.

Medtronic plc’s stock has seen a significant increase following the Centers for Medicare & Medicaid Services (CMS) proposal for coverage of renal denervation (RDN) procedures. The proposal, which includes a Coverage with Evidence Development (CED) framework, aims to treat uncontrolled hypertension by covering the procedure for eligible patients under specific criteria. The stock has gained momentum as analysts project substantial revenue growth for Medtronic.

The CMS proposal, released on July 10, 2025, sets an ambulatory blood pressure threshold of 140 mmHg for patient eligibility. This aligns with Medtronic’s clinical trial parameters and market strategy [2]. The proposal requires patients to have persistently elevated blood pressure above 140/90 mmHg despite management with three antihypertensive therapies of different classes. A final decision is expected around October 8, 2025 [1].

Medtronic’s Symplicity Spyral™ renal denervation (RDN) system, approved by the U.S. Food and Drug Administration (FDA) in November 2023, is the focus of this proposal. The system delivers radiofrequency energy to nerves near the kidneys, contributing to high blood pressure. Clinical studies have shown significant long-term reductions in blood pressure without the need for additional medication [3].

Analysts view this development positively, noting the potential for tens of billions of dollars in revenue for Medtronic. William Blair maintains a Market Perform rating, JPMorgan reiterates a Neutral rating, and BofA Securities holds a Buy rating, projecting annual revenue growth of $100-150 million from RDN therapy [2].

Medtronic is preparing for market entry by expanding commercial operations and training physicians. The proposed coverage could also benefit Boston Scientific (NYSE:BSX), which plans to launch its own RDN device.

A final decision from CMS is expected later this year, which would formalize reimbursement for the procedure and potentially drive broader market adoption for Medtronic’s Symplicity Spyral device.

References:

[1] https://news.medtronic.com/Medtronic-issues-statement-on-the-U-S-Centers-for-Medicare-Medicaid-Services-proposed-National-Coverage-Determination-for-Symplicity-Spyral-TM-renal-denervation-RDN-system

[2] https://www.investing.com/news/analyst-ratings/medtronic-stock-gains-as-cms-proposes-renal-denervation-coverage-93CH-4132109

[3] https://www.investing.com/news/analyst-ratings/medtronic-stock-gains-as-cms-proposes-coverage-for-renal-denervation-93CH-4132451

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https://www.ainvest.com/news/medtronic-stock-rises-cms-proposes-coverage-renal-denervation-technology-2507/

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Alternative Headline: States Push for Doula Coverage

[MM Curator Summary]: States are increasingly passing bipartisan laws to expand Medicaid coverage for doula services to improve maternal and infant health outcomes.

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As a postpartum doula, Dawn Oliver does her best work in the middle of the night.

During a typical shift, she shows up at her clients’ home at 10 p.m. She answers questions they may have about basic infant care and keeps an eye out for signs of postpartum depression.

After bedtime, she may feed the baby a bottle or wake the mother to breastfeed. She soothes the infant back to sleep. Sometimes, she prepares meals for the family in a Crock-Pot or empties the dishwasher.

She leaves the following morning and returns, often nightly, for two or three weeks in a row.

“I’m certified to do all of it,” said Oliver, of Hardeeville, South Carolina, who runs Compassionate Care Doula Services. It takes a village to raise a child, as the adage goes, but “the village is not what it used to be,” Oliver said.

Doulas are trained to offer critical support for families — before delivery, during childbirth, and in those daunting early days when parents are desperate for sleep and infants still wake up around the clock. While doulas typically don’t hold a medical or nursing degree, research shows they can improve health outcomes and reduce racial health disparities.

Yet their services remain out of reach for many families. Oliver charges $45 an hour overnight, and health insurance plans often don’t cover her fees. That’s partly why business “ebbs and flows,” Oliver said. Sometimes, she’s fully booked for months. Other times, she goes several weeks without a client.

That may soon change.

Two bipartisan bills, introduced in separate chambers of the South Carolina General Assembly, would require both Medicaid, which pays for more than half of all births in the state, and private insurers to cover the cost of doula services for patients who choose to use one.

South Carolina isn’t an outlier. Even as states brace for significant reductions in federal Medicaid funding over the next decade, legislatures across the country continue to pass laws that grant doula access to Medicaid beneficiaries. Some state laws already require private health insurers to do the same. Since the start of 2025, Vermont lawmakers, alongside Republican-controlled legislatures in Arkansas, Utah, Louisiana, and Montana, have passed laws to facilitate Medicaid coverage of doula services.

All told, more than 30 states are reimbursing doulas through Medicaid or are implementing laws to do so.

Florida began covering doula services for Medicaid recipients in 2019. This coverage is part of an optional benefit expansion within Medicaid managed care plans, meaning it’s not a statewide mandate but rather offered by individual managed care plans. Reimbursement is determined by each managed care plan.

Notably, these coverage requirements align with one of the goals of Project 2025, whose “Mandate for Leadership” report, published in 2023 by the conservative Heritage Foundation, offered a blueprint for President Donald Trump’s second term. The document calls for increasing access to doulas “for all women whether they are giving birth in a traditional hospital, through midwifery, or at home,” citing concerns about maternal mortality and postpartum depression, which may be “worsened by poor birth experiences.” The report also recommends that federal money not be used to train doctors, nurses, or doulas to perform abortions.

The Heritage Foundation did not respond to an interview request.

Meanwhile, the idea that doulas can benefit babies, parents, and state Medicaid budgets by reducing costly cesarean sections and preterm birth complications is supported by a growing body of research and is gaining traction among conservatives.

A study published last year in the American Journal of Public Health found that women enrolled in Medicaid who used a doula faced a 47% lower risk of delivering by C-section and a 29% lower risk of preterm birth. They were also 46% more likely to attend a postpartum checkup.

“Why wouldn’t you want somebody to avail themselves of that type of care?” said Republican state Rep. Tommy Pope, who co-sponsored the doula reimbursement bill in the South Carolina House of Representatives. “I don’t see any reason we shouldn’t be doing that.”

Pope said his daughter-in-law gave birth with the assistance of a doula. “It opened my eyes to the positive aspects,” he said.

Amy Chen, a senior attorney with the National Health Law Program, which tracks doula reimbursement legislation around the country as part of its Doula Medicaid Project, said lawmakers tend to support these efforts when they have a personal connection to the issue.

“It’s something that a lot of people resonate with,” Chen said, “even if they, themselves, have never been pregnant.”

Conservative lawmakers who endorse state-level abortion bans, she said, often vote in favor of measures that support pregnancy, motherhood and infant health, all of which these doula reimbursement bills are intended to do.

Some Republicans feel as if “they have to come out in favor of that,” Chen said.

Health care research also suggests that Black patients, who experience significantly higher maternal and infant mortality rates than white patients, may particularly benefit from doula care. In 2022, Black infants in South Carolina were more than twice as likely to die from all causes before their 1st birthday as white infants.

That holds true for women in rural parts of the country, where labor and delivery services have either closed or never existed.

That’s why Montana lawmakers passed a doula reimbursement bill this year — to narrow health care gaps for rural and Indigenous communities. To that end, in 2023, the state enacted a bill that requires Medicaid to reimburse midwives for home births.

Montana state Sen. Mike Yakawich, a Republican who backed the Democratic-sponsored doula reimbursement bill, said pregnant women should have someone to call outside of a hospital, where health care services can be costly and intimidating.

“What help can we provide for moms who are expecting? My feeling is, it’s never enough,” Yakawich said.

Britney WolfVoice lives on the Northern Cheyenne Indian Reservation in southeastern Montana, about two hours from the closest birthing hospital. In early July, she was seven months pregnant with her fourth child, a son, and said she planned to have a doula by her side for the second time in the delivery room.

During WolfVoice’s previous pregnancy, an Indigenous doula named Misty Pipe brought cedar oil and spray into the delivery room, rubbed WolfVoice’s back through contractions, and helped ensure WolfVoice’s husband was the first person their daughter saw.

“Being in a hospital, I felt heard for the very first time,” WolfVoice said. “I just can’t explain it any better than I felt at home. She was my safe place.”

Pipe said hospitals are still associated with the government forcibly removing children from Native American homes as a consequence of colonization. Her goal is to help give people a voice during their pregnancy and delivery.

Most of her clients can’t afford to pay for doula services out-of-pocket, Pipe said, so she doesn’t charge anything for her birth services, balancing her role as a doula with her day job at a post office.

“If a mom is vulnerable, she could miss a prenatal appointment or go alone, or I can take time off of work and take her myself,” Pipe said. “No mom should have to birth in fear.”

The new state law will allow her to get paid for her work as a doula for the first time.

In some states that have enacted such laws, initial participation by doulas was low because Medicaid reimbursement rates weren’t high enough. Nationally, doula reimbursement rates are improving, Chen said.

For example, in Minnesota, where in 2013 lawmakers passed one of the first doula reimbursement bills, Medicaid initially paid only $411 per client for their services. Ten years later, the state had raised the reimbursement rate to a maximum of $3,200 a client.

In Florida, doula reimbursement rates through Medicaid managed care plans range from $450 to $1,110, according to the National Health Law Program. Last year, Florida lifted the requirement for doulas to bill through a supervising medical provider.

But Chen said it is unclear how federal Medicaid cuts might affect the fate of these state laws.

Some states that haven’t passed doula reimbursement bills, including South Carolina, might be hesitant to do so in this environment, she said. “It’s just a really uncertain time.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling, and journalism. Learn more about KFF.

https://www.wusf.org/health-news-florida/2025-07-11/doulas-once-luxury-increasingly-covered-medicaid-even-gop-states-florida

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Alternative Headline: Rural Hospital Fund Faces Scrutiny

[MM Curator Summary]: A $50B rural hospital fund may be undermined by Medicaid cuts and vague eligibility rules, risking care access in vulnerable areas.

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Michael Abrams, M.A., managing partner at Numerof & Associates, warned that without clear eligibility rules, the new $50 billion rural hospital relief fund could end up helping the wrong providers instead of the rural hospitals most in need.

In the days leading up to the Senate’s July 1 vote, Michael Abrams, M.A., managing partner at Numerof & Associates, spoke with Managed Healthcare Executive about the potential ripple effects of Medicaid cuts included in the broader legislative package—particularly for hospitals and patients in rural America.

The conversation took on added weight just days later.

On July 4, President Trump signed into law his nearly 900-page “Big Beautiful Bill” of tax breaks and spending cuts, affecting millions of Medicaid recipients while growing the Immigration and Customs Enforcement agency by thousands of workers.

The Senate passed the bill earlier in the week, while the Republican-controlled House voted 218 to 214 in favor on Thursday evening, with all Democrats and two Republicans opposed. The $50 billion rural hospital relief fund is part of that package.

Abrams was candid about the double impact that Medicaid changes could have.

“It is a double whammy for provider organizations,” he said. “Because they are going to be fewer people on Medicaid, right? That means more people who are not covered by any insurance showing up and expecting uncompensated care.”

Uncompensated care threatens already fragile hospital budgets—especially in rural areas where financial margins are often razor-thin.

Abrams emphasized that the issue isn’t just about funding cuts but about the overall viability of the healthcare system in those regions.

“The biggest threat to access is finding a physician that’s going to take your coverage,” he said. “If they would improve the reimbursement rates for this kind of insurance, that would go a long way toward ensuring, to making sure that there is a provider when someone who’s covered by Medicaid needs one.”

Abrams also argued that improving Medicaid reimbursement schedules should be a central goal of lawmakers if they want to preserve access to essential services—particularly in rural communities where fewer physicians already accept Medicaid due to low payments.

As the rural fund rolls out alongside deep Medicaid changes, how well policymakers manage both will help determine whether this sweeping bill brings relief—or further strain—to the health systems that serve some of the nation’s most vulnerable populations.

https://www.managedhealthcareexecutive.com/view/can-the-rural-fund-improve-access-amid-medicaid-cuts-

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Alternative Headline: Medicaid Cuts Threaten Postpartum Care

[MM Curator Summary]: Hawaii advocates fear Medicaid cuts of up to $300 million will disrupt postpartum care for vulnerable mothers and infants. 

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Maternal health care advocates worry Medicaid cuts could impact postpartum coverage

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Medicaid is the largest single payer of pregnancy-related services, and health advocates worry future cuts could be devastating for new moms and their babies.

By Annalisa Burgos

Published: Jul. 9, 2025 at 9:36 PM MDT

HONOLULU (HawaiiNewsNow) – Medicaid is the largest single payer of pregnancy-related services, and health advocates worry future cuts could be devastating for new moms and their babies.

Health care experts say the state could lose some $300 million each year in federal Medicaid funding.

Many pregnant women without work-subsidized health insurance or can’t return to work after delivery turn to Medicaid to get life-saving medical care and support.

“We were able to get lactation consultant help, and it was accessible to us. It wasn’t expensive or anything, and that’s due to the help from Medicaid for her, and that’s great because we needed all the support we can get,” said first-time mom Marissa Katz Bellani. “I was definitely teetering on the edge of some kind of depression if I didn’t get help, so I’m really glad that we did get the help we needed.”

Medicaid covers more than 40% of the births in Hawaii, and it’s not just prenatal care and delivery, but also the critical period after the baby arrives.

“We’re talking about mental health. We’re talking about losing coverage postpartum,” said Sunny Chen, CEO of nonprofit Healthy Mothers, Healthy Babies Coalition of Hawaii. “We work so hard to advocate for postpartum coverage through 12 months postpartum because the data tells us most moms, they are hurting and they’re dying after 45 days postpartum to 12 months postpartum.”

Federal funding helps the coalition offer free services like lactation consultations in a supportive space, as well as mobile patient care, food pantry, diapers, baby wear, and breast milk pump rentals.

“Things like community-based doula program, those are things that are kind of not traditional healthcare funding that covers through special health plan contracts, pilot programs, I think all of those things potentially might be at stake,” Chen said.

Pregnant women are exempt from new work requirements under the Big Beautiful Bill Act, but it’s unclear how paperwork and red tape will impact eligibility and postpartum services.

“That’s a period when women will often experience complications, that need monitoring, you know, they need to be going be have access to their physician, for regular checkups‚" said Paula Arcena, AlohaCare’s vice president of external affairs. “Also, well-baby visits to make sure that those first months of the infant’s life, that they have the care that they need.”

Advocates say they’re concerned, but remain hopeful that the state, community health centers, and private philanthropy can help fill the gaps.

“I think the key thing is to stay calm and stay informed. This is gonna be challenging, but you know, Hawaii always comes through, with these kinds of challenges,” Arcena said.

For more information, visit www.hmhb-hawaii.org or alohacare.org.

Copyright 2025 Hawaii News Now. All rights reserved.

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Alternative Headline: Senate GOP Plan Cuts Medicaid

[MM Curator Summary]: The Senate Republican budget reconciliation bill would cut Medicaid and CHIP by over $1 trillion and increase the uninsured by 11.8 million by 2034, exceeding House bill impacts.

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In the late evening of Saturday, June 28th, the Congressional Budget Office (CBO) issued preliminary estimates of the current version of the Senate Republican budget reconciliation bill now being debated on the Senate floor.  The CBO estimates confirm that the Senate Republican reconciliation bill as it now stands would cut Medicaid to an even harsher extent than the House-passed reconciliation bill would (the “One Big Beautiful Bill Act” or H.R. 1).  Here are some quick takeaways:

• The Senate Republican reconciliation bill would cut gross federal Medicaid and Children’s Health Insurance Program (CHIP) spending by $1.02 trillion over the next ten years.  That means the Senate bill’s Medicaid and CHIP cuts are $156.1 billion or 18 percent larger than even the House-passed bill’s draconian cuts of $863.4 billion over ten years.1

• These larger gross Medicaid and CHIP cuts are driven by changes to the House-passed bill that would further restrict state use of provider taxes to finance Medicaid, eliminate eligibility for many lawfully present immigrants, cut federal funding for payments to hospitals furnishing emergency Medicaid services, and further reduce certain supplemental payments to hospitals and other providers (known as state-directed payments).  The spending effect of these additional cuts is modestly offset by increased Medicaid and CHIP sp2ending from provisions not in the House-passed bill including a rural health transformation program, increased federal Medicaid funding for Alaska and Hawaii, and expanded waiver authority for home- and community-based services.

• Overall, the Senate Republican reconciliation bill’s Medicaid, CHIP, Affordable Care Act marketplace, and Medicare provisions would increase the number of uninsured by 11.8 million in 2034, relative to current law.  In comparison, the House-passed bill would increase the number of uninsured by 10.9 million in 2034.  (More detailed CBO estimates of the specific Medicaid health coverage effects under the Senate Republican reconciliation bill are not yet available.  For example, CBO estimates the House-passed bill’s Medicaid and CHIP provisions would cut Medicaid enrollment by 10.5 million by 2034 and by themselves, increase the number of uninsured by 7.8 million by 2034.)   

As noted, these CBO estimates are preliminary and do not include more detailed analysis of the impact on Medicaid enrollment and health coverage.  In addition, the Senate Republicans are likely to make further amendments to the reconciliation bill’s Medicaid and CHIP provisions to avoid “Byrd Rule” violations and to try to ensure Senate passage in coming days.

1. These gross figures do not account for interactions with provisions affecting the Affordable Care Act’s marketplaces and marketplace subsidies and also do not include related revenue effects.  However, the CBO estimates of the current Senate Republican reconciliation bill imply that the Medicaid and CHIP estimates may already account for interactions among those provisions and the interactions (if any) between the Medicaid and CHIP provisions and the ACA marketplace provisions would not have the effect of reducing the gross Medicaid and CHIP spending cuts but would instead have the effect of increasing ACA marketplace subsidy spending by as much $78.9 billion over ten years and therefore reducing the net ACA marketplace spending cuts.  (These interactions may also be due to interactions among the ACA marketplace provisions.)  ↩︎

https://ccf.georgetown.edu/2025/06/29/congressional-budget-office-confirms-senate-republican-reconciliation-bills-medicaid-cuts-are-more-draconian-than-the-house-passed-bill/

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Alternative Headline: New Formula Boosts Medicaid Funds

[MM Curator Summary]:  Escambia County revised its Medicaid hospital assessment formula to help local hospitals receive more federal and state funds.

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Escambia County Commissioners on Friday morning approved a new funding formula that could bring more state Medicaid dollars to five local hospitals that care for low-income and uninsured patients.

The decision centers around the Statewide Medicaid Hospital Directed Payment Program (DPP), which allows counties like Escambia to help local hospitals draw down federal and state matching funds by contributing local assessments.

The board adopted a resolution amending how those hospital assessments are calculated for the 2024–2025 fiscal year. The changes are designed to maximize reimbursements through the program, while better reflecting each hospital’s financial operations.

What This Means for Local Hospitals

The new formula replaces the current flat rate of 5.47% of net outpatient revenue with a two-part structure:

• 3.11% of gross inpatient revenue, and
• 0.80% of gross outpatient revenue

This change is expected to reflect each hospital’s earnings more accurately and improve their ability to receive larger reimbursements from the Florida Agency for Health Care Administration (AHCA) and the Low Income Pool (LIP) program.

Participating hospitals include:

• Sacred Heart Health System
• Baptist Health Care
• West Florida Regional Medical Center
• Encompass Health Rehabilitation Hospital of Pensacola
• Select Specialty Hospital Pensacola

These facilities are part of the Escambia County Local Provider Participation Fund, a program that helps fund the assessments necessary to unlock federal support.

Why It Matters

The Statewide DPP is particularly important for “safety-net” hospitals, which serve a high number of Medicaid and uninsured patients and often operate on tight margins. As demand for uncompensated care continues to grow, programs like the DPP help hospitals stay financially stable while continuing to provide essential services to vulnerable populations.

What Is the Medicaid Directed Payment Program (DPP)?

The Directed Payment Program, or DPP, is a funding mechanism approved by the federal government that allows states to direct additional Medicaid payments to hospitals, clinics, and other providers—without requiring new state or federal legislation.

Here’s how it works:

• Local governments (like Escambia County) collect special assessments from hospitals.
• These funds are pooled and sent to the state’s Medicaid agency (AHCA in Florida).
• The state then uses these local dollars to draw down federal Medicaid matching funds.
• The combined funds are returned to the hospitals as increased Medicaid reimbursements.

The DPP is designed to offset the costs hospitals incur when treating Medicaid patients, who are typically reimbursed at rates lower than the cost of care.

Programs like this are becoming increasingly common as states look for ways to support overburdened healthcare systems without raising taxes or cutting services.

https://www.wuwf.org/local-news/2025-06-20/escambia-county-approves-medicaid-reimbursement-plan

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Alternative Headline: Cuts Threaten Kids’ Healthcare

[MM Curator Summary]:  Medicaid budget cuts threaten nationwide pediatric healthcare by endangering children’s hospitals and limiting access to specialized medical services.

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Last year, my daughter’s elementary school science teacher surprised me with a midday phone call. During a nature center field trip, my eight year old fell off a balance beam and seriously hurt her arm. I picked my daughter up and drove straight to the children’s hospital, where I knew she would get everything she needed. Hours later, we were headed home, injury addressed, pain controlled, appropriate follow-up secured, and her arm in a cast after x-rays revealed fractures across both forearm bones.

That children’s hospital, part of a regional academic medical center, is thirty minutes away from our home. Its proximity assures me that we have access to everything my kids could possibly need medically. Until this year, I took this access for granted. Now, as the structure of the classroom yields to summer’s longer, more freeform days, some of the nation’s most important programs scaffolding kids’ health could collapse under the pressure imposed by proposed legislative budget cuts. As a pediatric doctor and as a parent, slashing Medicaid concerns me the most.

Pediatric funding, availability, and access represent America’s biggest current challenges. Proposed cuts negatively impact individual children. But all kids suffer with diminished availability and accessibility of pediatric healthcare. Threats to children’s healthcare started simmering long before this Congress convened and this presidential administration took office, but the size and scope of the cuts in the House draft budget have made that threat existential.

While Medicaid most visibly serves under-resourced individuals and communities, it also bolsters services and institutions that benefit everyone, especially children. Though my family has private insurance coverage through my employer, my kids would not be able to access the depth and breadth of care available without Medicaid, which directly and indirectly supports pediatric programs and professionals.

The risk to children’s hospitals, which rely heavily on Medicaid funding, is often unrecognized. These hospitals, only 1% of all hospitals nationally, represent a lifeline for children, providing primary care, subspecialty medical access, and community programs for children and families of all socioeconomic backgrounds. By contrast, community hospitals comprise nearly 85% of hospitals in the U.S. and are increasingly unlikely to offer pediatric-specific care.

In political battles over Medicaid funding, people obscure the larger but essential question in medicine: should every child have healthcare? On the one hand, the answer is obvious. Pediatricians know every child requires medical access, parents want their children to have what they need, and the American Academy of Pediatrics believes that “the United States can and should ensure that all children, adolescents, and young adults from birth through the age of 26 years who reside within its borders have affordable access to high-quality comprehensive health care.”

Yet since 2008, the number of pediatric inpatient units in general hospitals has declined by nearly 30% and inpatient pediatric beds outside of children’s hospitals decreased by almost 20%. A disconcerting number of hospitals, especially those in rural areas, face full closure. Over the last fifteen years, more hospitals have closed than opened.

As a pediatrician trained in neonatal critical care, I’ve watched with alarm as pediatric units and neonatal-perinatal services constrict faster than adult services and programs. This isn’t because of a lack of demand; in fact, demand for pediatric-specific care has only increased. In areas where there is no pediatric care available, families must go without or travel far for what they need, sometimes spending hours in transit and even crossing state lines. More cuts will only exacerbate that trend.

Increasing gaps in care and coverage mean that emergency medical services and medical providers without extensive pediatric expertise are seeing more children. But this is not an adequate substitute for pediatric experts. Children are not small adults, neither anatomically nor physiologically.

Clinicians who predominantly care for adults can be fooled by pediatric patients. In fact, interventions that heal adults may harm children. Consider extremely high blood glucose levels in patients with diabetes. An adult’s sugar might normalize with rapid intravenous fluid boluses, whereas a child is at risk for brain injury without carefully calculated fluid administered over time. Averting medical danger means recognizing and responding to subtle signs and changes that a pediatric specialist can spot.

Children’s health needs greater investment, not less. Our children embody our greatest potential. To fully realize that potential, it’s time for our national budget to cultivate, not decimate, investment in children’s health—the core of individual and national possibility.

Dr. Brooke Redmond is a neonatal critical care physician at the Yale School of Medicine and a Yale Public Voices fellow of the Op-Ed Project. The views expressed are her own.

https://thefulcrum.us/governance-legislation/medicaid-cuts-child-healthcare

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Alternative Headline: Medicaid Work Rule Risks Coverage

[MM Curator Summary]:  A proposed federal Medicaid work requirement could jeopardize coverage for caregivers like Kimberly Gallagher due to bureaucratic barriers.

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Four years before Kimberly Gallagher enrolled in Medicaid herself, the public health insurance program’s rules prompted her to make an excruciating choice — to give up guardianship of her son so she could work as his caregiver.

Now, another proposed twist in the rules could mean that, even though Missouri pays her to do that work, she might still have to prove to the state that she’s not unemployed.

The Kansas City, Missouri, resident has cared for her disabled son, Daniel, for all 31 years of his life. A rare genetic condition called Prader-Willi syndrome, in addition to autism, left him with an intellectual disability; a constant, excessive hunger; and an inability to speak. His needs left Gallagher, an elementary school teacher by training, with little opportunity to work outside her home.

As congressional Republicans consider slashing about $1 trillion in federal Medicaid spending, Gallagher is among the 18.5 million Americans who could be required to prove that they work enough to keep their health insurance.

Budget bills in the House and Senate would require 80 hours of work or community service a month for adults who are insured through the Affordable Care Act’s Medicaid expansion program, which has allowed states to extend Medicaid coverage to more adults with low incomes. Forty states, plus Washington, D.C., have expanded their programs, additions that now cover about 20 million Americans, including Gallagher.

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She enrolled in the coverage in December 2023, after she could no longer afford her private insurance. Before her husband died of cancer in 2019, the couple paid for private insurance and supported themselves on the income he earned as a master watchmaker. After his death, Gallagher was left to earn a living and find insurance on her own. At 59, she’s too young to collect her husband’s Social Security survivor benefit.

The Medicaid program that pays for in-home care for Daniel and 8,000 other Missourians with disabilities allows family members to be compensated for caregiving, but only if they’re not the legal guardian of the person they care for. So, Gallagher went to court to give up her rights to make decisions for her son and transfer authority to her parents.

“I think it’s appalling that it’s required, but it was necessary,” she said. “There was no way I could work outside of taking care of Daniel.”

Republicans have touted Medicaid work requirements both as a way to reduce federal spending on the program and as a moral imperative for Americans.

“Go out there. Do entry-level jobs. Get into the workforce. Prove that you matter. Get agency into your own life,” Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, said in a recent interview on Fox Business.

Democrats, meanwhile, have cast the requirements as bureaucratic red tape that won’t meaningfully increase employment but will cause eligible people to lose their health insurance because of administrative hurdles.

Indeed, the vast majority of Americans enrolled in Medicaid expansion are already working, caregiving, attending school, or have a disability, according to an analysis by KFF, a health information nonprofit that includes KFF Health News.

And while the Congressional Budget Office estimates the work requirement included in the House bill would cause 4.8 million Americans to lose their insurance, only about 300,000 of those people are unemployed because of lack of interest in working, according to the Urban Institute, a nonprofit research group. Recent history in states that have tried work requirements suggests technical and paperwork problems have caused a substantial portion of coverage losses.

The excruciating decision to give up guardianship of Daniel was prompted by Medicaid rules about who could be compensated for the work. Christopher Smith / KFF Health News

Still, the provisions are generally popular among Republican lawmakers and the public. Sen. Josh Hawley, R-Mo., who has repeatedly cautioned against cutting people off from Medicaid, has signaled support for adding work requirements.

And 68% of Americans favor the requirement described in the House bill, according to a recent poll conducted by KFF. But support for work requirements dropped as low as 35% when respondents learned that most Medicaid recipients already work and could lose their coverage because of paperwork requirements.

That’s what happened in Arkansas, where 18,000 people lost their Medicaid coverage in 2018 after the state phased in a work requirement. Thousands more were on pace to lose coverage in 2019 before a federal judge halted the requirement, largely over concerns about coverage losses. In discussions with focus groups, KFF found that many Arkansas Medicaid participants did not fully understand the requirements, despite the state’s outreach efforts, and some people didn’t receive mailed notices. Others were confused because the work-reporting paperwork and separate forms to renew Medicaid coverage asked for similar information.

Many family caregivers would be exempt from the work requirements proposed in Congress, but Gallagher probably would not, since she had to relinquish guardianship of her son to be paid for the work. While the hours she already logs should be enough to satisfy the requirement, she’ll need to report them again — unless the state can identify her through its existing data. But Missouri has a history of procedural problems in the state agency that administers Medicaid.

In early 2022, for example, Missouri was taking more than 100 days on average to process applications for Medicaid expansion, a wait that prompted patients to put off needed care and was more than twice the processing time allowed by federal law.

And 79% of the more than 378,000 Missourians who lost Medicaid coverage when covid-era enrollment protections ended in 2023 did so because of procedural reasons.

The next year, a federal judge ruled that Missourians were illegally being denied food aid by the state, in part because insufficient staffing at call centers left eligible people without assistance.

“They’re historically understaffed,” Timothy McBride, a health economist at Washington University in St. Louis, said of the state agency that administers Medicaid and food assistance. “I think that’s really the underlying problem.”

McBride’s analysis of Missouri’s Medicaid recipients found that fewer than 45,000 of the people enrolled in expansion in 2023 were unemployed for reasons other than caregiving, disability, attending school, or retirement. But more than twice that many Missourians could lose their insurance if work requirements prompt disenrollment rates similar to Arkansas’ implementation, according to a study from the Center on Budget and Policy Priorities, a left-leaning think tank that analyzes government policies.

The estimate assumes many otherwise eligible people would still lose coverage as a result of falling through the cracks, McBride said.

Hawley, who backed the Senate bill, declined to comment for this article. The senator previously told reporters that “we can sort that out” when asked about eligible people inadvertently losing Medicaid because of work requirements.

Gallagher worries about her coverage, because she recently was diagnosed with Hashimoto’s disease, an autoimmune disorder that attacks the thyroid gland. She said she had to search for her Medicaid card to fill the prescription that followed, having barely used it in the year in a half she’s been covered.

Gallagher is among the 18.5 million Americans who could be required to prove that they work enough to keep their health insurance. Christopher Smith / KFF Health News

She also worries about her son’s Medicaid. A nursing home is not a realistic option, considering his needs. His coverage doubles as Gallagher’s only source of income and also pays for other caregivers, when she can find them, who give her breaks to tend to her own health and to her aging parents.

But nearly all in-home services like those Daniel receives are optional programs that states are not required to include in their Medicaid programs. And the magnitude of the cuts being proposed have prompted fears that the optional programs could be chopped.

“It would destroy our lives,” Gallagher said. “The only income we would have would be Daniel’s Social Security.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

https://www.nbcnews.com/health/health-care/keep-medicaid-mom-caring-disabled-adult-son-may-soon-need-prove-works-rcna216025

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