MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: In which journos pretend they have not seen this movie before.

Clipped from: https://www.vox.com/policy/2023/5/12/23712447/medicaid-work-requirements-us-debt-ceiling

The Republican proposal to require people to work in order to receive Medicaid benefits poses an existential question about the very nature of government assistance: Do you need to do something to earn it?

For years, the GOP’s answer has been yes, some people should. These days, they have very specific people in mind: The 19 million Americans, most of them childless and nondisabled adults, who were not eligible for Medicaid until the Affordable Care Act expanded eligibility a decade ago.

House Republicans are so serious about imposing these new rules that they are trying to make them a condition of lifting the federal debt limit and averting an economic crisis. They don’t seem likely to succeed, given the Biden administration’s clear objections, but the mere demand reveals that the party remains as serious as ever about shrinking the social safety net. They seek to do so by dividing the deserving — in the case of Medicaid, pregnant women, children, those who are elderly or disabled — from the undeserving, who have to work to earn benefits.

“Assistance programs are supposed to be temporary, not permanent,” House Speaker Kevin McCarthy said in a speech on Wall Street outlining his party’s demands in the debt-limit talks. “A hand up, not a handout. A bridge to independence, not a barrier.”

Work requirements for various social programs — housing assistance, food stamps, cash welfare, and Medicaid — have been a policy goal for Republicans since the 1980s. And they have succeeded, sometimes with the help of Democrats, in imposing them. SNAP, the food-stamp program, already has work requirements, which Republicans want to expand, in spite of evidence that they do not significantly increase employment.

But Medicaid, by far the largest of these social programs, has long been the white whale for conservatives in their work requirement crusade. Twice as many people receive Medicaid benefits (about 90 million) as receive food stamps (about 42 million). Briefly, under President Donald Trump, Congress tried to implement them. But the results were disastrous and a federal judge blocked the requirements as counter to the purpose of the Medicaid program.

The entire debate rests on a core disagreement about the nature of Medicaid and, by extension, health insurance itself. Is it something you should have to work to earn, or a right to which Americans are entitled?

“In real life, what I think is most concerning is it will lead to losses of coverage, and that is not what the Medicaid program is supposed to be doing,” Cindy Mann, who oversaw Medicaid under President Barack Obama, told me about work requirements in 2018. “It’s supposed to be promoting coverage and promoting affordable coverage.”

What happened in Arkansas under Medicaid work requirements

States are required to cover some people through Medicaid, such as pregnant women and the disabled, but they also have discretion about who is eligible for the program. Some states have used that discretion to expand coverage (in California, for example, Medicaid covers many undocumented immigrants) while others have kept their eligibility requirements much more stringent.

The Affordable Care Act was a critical turning point for the program. Under the law, 40 states have expanded Medicaid eligibility to the childless, nondisabled adults living in or near poverty who historically have been excluded from the program. About 20 million Americans have been covered by Medicaid expansion in the past decade.

But that has presented an ideological problem for conservatives. The bigger Medicaid grows, the more popular and therefore difficult to cut it becomes. An effort to repeal the Affordable Care Act failed. And so, with the Trump administration in power, Medicaid work requirements became their backdoor way to try to erode the gains of Medicaid expansion.

In early 2018, the Trump health department told states they would, for the first time, approve state proposals requiring work for some Medicaid beneficiaries. Several states lined up and two — Arkansas and Kentucky — had their plans approved.

The Kentucky version of Medicaid work requirements was never implemented due to a court order. But Arkansas did succeed in becoming the first state to ever impose Medicaid work requirements, mandating that some enrollees work or perform some kind of other work-related activity for 80 hours per month — and the result was a public policy disaster.

About 250,000 people were covered by Medicaid in Arkansas at the time of the work requirement’s approval. About 65,000 people were subject to the requirement; the rest were exempt. But only about 10 percent of people who needed to report their activities to the state actually did so. Ultimately, nearly 17,000 people lost health coverage.

This had been one of the biggest fears for health advocates: that a lot of people would lose coverage not because they failed to comply but because they failed to report.

“The low level of reporting is a strong warning signal that the current process may not be structured in a way that provides individuals an opportunity to succeed, with high stakes for beneficiaries who fail,” wrote Penny Thompson, then the chair of MACPAC, which was created by Congress to make policy recommendations for Medicaid, in a review of the Arkansas plan.

Later evaluations of the Arkansas work requirement also found that the policy did not have the desired effect on employment. People fell off of the Medicaid rolls but didn’t seem to find more work.

A study published in the New England Journal of Medicine found that Medicaid enrollment had fallen for working-age adults, the uninsured rate was rising in the state, and there had been little discernible effect on employment. The authors concluded that the work requirement “was associated with significant losses in health insurance coverage in the initial six months of the policy but no significant change in employment.”

They also found that many people either were not aware of the reporting requirement or were confused by it.

The study found that one-third of respondents in the age 30-49 range, the focus of their analysis because they were most likely to be expected to meet the requirement, had not heard anything about Arkansas’s new work requirements for Medicaid. Nearly half of those people, 44 percent, said they were unsure whether the requirements applied to them. A significant number of people said a lack of internet access (32 percent) had contributed to their decision not to report their relevant information to the state.

Those findings provided support to the legal challenges to the Arkansas work requirement that ultimately brought an end to the policy. One of the plaintiffs, Adrian McGonigal, stated that he had not realized they needed to report their activities every month. He showed up at a pharmacy to fill prescriptions for two chronic health conditions and only learned then they were no longer covered by Medicaid; the bill would be $800. He couldn’t afford it, skipped his meds for a while, ended up unable to work because he was sick, and ultimately lost his job.

Citing such experiences and other evidence that work requirements were causing people to lose coverage without encouraging them to find more work, Judge James Boasberg ruled in 2019 that the proposals in Arkansas and Kentucky by the administration were “arbitrary and capricious” and ordered that the work requirements could not be allowed to remain in effect.

“Weighing the harms these persons will suffer from leaving in place a legally deficient order against the disruptions to the State’s data-collection and education efforts due to vacatur renders a clear answer: the Arkansas Works Amendments cannot stand,” Boasberg wrote to conclude his ruling.

Who stands to lose under the House Republican plan

But the experience in Arkansas and Boasberg’s ruling haven’t stopped Republicans from continuing to pursue Medicaid work requirements as part of the debt-limit negotiations with Senate Democrats and the White House.

The House’s work requirement proposal — dubbed a “community engagement” requirement in the bill’s text — would require many recipients to be working, looking for work, or participating in another kind of community service. Children under 18, adults over 56, people with mental or physical disabilities, and parents of dependent children would be exempted.

The Congressional Budget Office had previously estimated requiring nondisabled, non-elderly childless adults to work in order to receive Medicaid benefits would slash the program’s spending by $135 billion over 10 years — largely because more than 2 million people would lose coverage annually for failing to meet the work requirement.

The same fundamental problem remains: There is little evidence of a large number of Medicaid enrollees who are avoiding work to stay on the program’s rolls. One study in Michigan, released while the Trump administration was pushing work requirements, is illustrative.

The research, published in JAMA, looked at the work status of people who enrolled in Medicaid after Michigan expanded the program under Obamacare. It stood out for being based on real interviews with Medicaid enrollees, rather than on administrative data or other information.

The big-picture takeaway was that most Medicaid enrollees in Michigan were working already, unable to work, or at a point in their lives where they would not work (retired or a student). Almost three-fourths of the people in the study fell into those categories. Only 28 percent were “out of work.”

The authors broke down the “out of work” population and, rather than revealing a bunch of lazy hangers-on, they found people with real barriers to working — and who might benefit from having health insurance. Two-thirds said they had a chronic physical illness. More than a third said they had been diagnosed with a mental illness. One-quarter said they had a physical or mental condition that interfered with their ability to function at least half of the time.

Another analysis by the left-leaning Center on Budget and Policy Priorities (CBPP) examined the state proposals to require Medicaid to prove they are employed and came to a startling conclusion: Under those plans, even poorer people on Medicaid who already are working regularly might not meet the requirements and could suffer a lapse in health coverage as a result.

That’s because people working lower-wage jobs are more likely to have irregular working hours or gaps in their employment. By CBPP’s estimate, one in four people who worked enough hours over the course of a year to meet Kentucky’s proposed work requirement would still have at least one month where they fall below the state’s 80-hour monthly requirement, and could therefore be at risk of losing coverage.

Nationally, CBPP found, using census data, that two-thirds of people potentially subject to a work requirement were working, and 70 percent of those worked 1,000 hours over a year, or 80 hours a month, which would have met the Kentucky and Arkansas requirements. But nearly half of people (46 percent) who could be subject to a work requirement and were working had at least one month when they failed to clear the 80-hour bar.

In other words: A Medicaid work requirement could force working people to lose their health insurance because it isn’t structured to reflect the realities of what work looks like for them.

Lower-wage jobs tend to be more volatile, with fewer regular hours. Top industries for people who are likely to face a work requirement are food services, retail, and construction, according to CBPP — jobs that can be subject to seasonal and other shift changes.

Seven in 10 food service workers report that they work irregular hours, according to CBPP, along with 63 percent of retail workers and 54 percent of construction workers. All three industries have above-average rates of people quitting or being laid off; retail and food services have some of the shortest average job tenures.

“Approved and pending state work requirement policies are based on the assumption that people who want to work can find steady employment at regular hours,” the CBPP authors wrote. “This assumption is out of step with the realities of the low-wage labor market.”

Work requirements have also been proposed in such a way that could lead to serious racial discrimination.

During the Trump administration, Michigan lawmakers pushed a plan that would have required Medicaid recipients (with exceptions for the disabled, elderly, and a few other selected populations) to work or search for work at least 29 hours each week. If they fail to meet the work requirement, they could lose Medicaid coverage for a full year.

But the Michigan plan came with a twist: People who live in counties with unemployment rates above 8.5 percent were to be exempted from the requirement. In Michigan, the counties that meet that standard tend to be more rural, with a higher share of white residents. Meanwhile, that would likely lead in practice to rural whiter counties, where unemployment was higher, getting a break from these work requirements, while urban areas with a higher share of Black residents would still be subjected to them. That would have meant that Black Medicaid enrollees would be more likely to lose their health insurance.

George Washington University’s Sara Rosenbaum warned me at the time of “the potential for enormous discrimination, really racial redlining.” The Trump administration had explicitly said it would allow states to account for local conditions, such as high unemployment in certain areas or other factors, to provide exemptions from a work requirement.

“All of these things are potentially much harder to come by in rural areas,” Rosenbaum said. “Because of the demographics, you could have situations where the populations required to work are disproportionately African American.”

America’s complicated relationship with work and welfare

House Republicans still think they can make a winning argument in favor of Medicaid work requirements — and they aren’t necessarily delusional to think so. But the politics of work requirements are complicated and also carry a substantial downside risk for the party proposing them, as Republicans should be well aware.

The last time Republicans tried (and failed) to pass significant cuts to the Medicaid program, in the first year of the Trump presidency as part of their Affordable Care Act repeal plans, they paid the price during the 2018 midterm elections. That’s because Medicaid is popular. Over the past two decades, the health insurance program has become an increasingly crucial part of the safety net. Enrollment has roughly doubled from about 46 million people in 2007 before the Great Recession to more than 92 million today. More than 75 percent of the US public says they have very or somewhat favorable views of the program. Two-thirds say they have some kind of connection to Medicaid, either because they themselves or a loved one was enrolled.

Two polls released while the Trump administration was moving full speed ahead on Medicaid work requirements reveal the paradox of American attitudes to requiring work in order to receive government support.

The Kaiser Family Foundation (KFF), the gold standard of health policy polling, found in June 2017 that 70 percent of respondents said that they would support a work requirement. But a Center for American Progress (CAP) poll released shortly after found that 57 percent said they opposed allowing states “to deny Medicaid health coverage to recipients ages 18 to 64 who do not have a job with a certain amount of hours and do not participate in state-approved work programs.”

The wording of the questions may have played a role — and may hint at how Republicans and Democrats may frame the issue in the debate to come. KFF asked about allowing states to impose work requirements on people “in order to get health insurance through Medicaid.” CAP asked about denying people health insurance if they didn’t meet the requirements set by their state.

This disparity — a huge majority supports work requirements if you frame them one way; a solid majority opposes them if you use a different frame — is telling in the odd relationship Americans have with the social safety net.

On the one hand, Americans believe in work — Max Weber’s Protestant work ethic is crucial to understanding the US psyche for good reason. Work is treated as an inherent good. That might help explain why we collectively are so susceptible to stories about people taking advantage of Medicaid or disability insurance. As Jack Meserve wrote in Democracy in 2021 while Congress was debating another round of stimulus checks for most Americans due to the pandemic-driven economic downturn:

An insidious way that austerity has entrenched itself in the last four decades is by infusing every government program with suspicion and doubt toward the citizens it is supposed to help. That stance leaches into the populace, where soon average citizens look at their neighbors’ unemployment claims with skepticism, their fellow citizens’ need for help as an indication of sloth and greed. We now too often have a country of welfare puritans, all suffused with a haunting fear that someone, somewhere may be getting a benefit she doesn’t deserve.

But on the other hand, Americans increasingly believe in an adequate social safety net. According to the CAP poll, more than 70 percent of people said they opposed cutting home heating assistance for low-income Americans, unemployment insurance, and affordable housing programs.

Medicare and Social Security have long been third rails of American politics. In recent years, Medicaid may have joined them after Republicans proved unable to overhaul it during the Obamacare repeal debate.

So the way these issues are framed is key. Americans are okay with requiring work as a principle. But if you then explain the consequences in vivid terms, that people could be denied health insurance as a result, they’re less comfortable with it.

If the actual result is funding and enrollment cuts — and people understand that — these proposals rapidly become much less popular.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: CMS proposed new regs, released a new guide, and approved 2 SPAs – all designed to make it easier to bill for Medicaid services provided at schools.

Clipped from: https://www.hhs.gov/about/news/2023/05/18/biden-harris-administration-takes-action-help-schools-deliver-critical-health-care-services-millions-students.html

Biden-Harris Administration Takes Action to Help Schools Deliver Critical Health Care Services to Millions of Students

New resources and proposed regulations from U.S. Departments of Education and Health and Human Services advance Administration’s commitment to expanding health care access and fighting youth mental health crisis 

Today, on the Mental Health Awareness Day of Action, the Biden-Harris Administration is taking bold action to make it easier for schools to provide critical health care services, especially mental health services, for millions of students across the nation. These three significant actions support President Biden’s comprehensive national mental health strategy and deliver on his commitment to tackle the nation’s mental health crisis as part of his Unity Agenda.  Through a series of new announcements from the U.S. Departments of Education (ED) and Health and Human Services (HHS), the Administration is continuing to take a whole-of-government approach to meet families where they are and ensure that children have access to the health care they need – especially mental health services.  

Specifically, ED is proposing a new rule that would streamline Medicaid billing permissions for students with disabilities. ED predicts of the 500,000 new students who are found eligible under the Individuals with Disabilities Education Act (IDEA) Part B each year, nearly 300,000 are likely to be eligible for Medicaid and impacted by this rule. HHS is issuing new guidance to make it easier for schools to bill Medicaid. HHS also is approving requests from New Mexico and Oregon to expand health care services that schools can deliver to Medicaid enrolled students.

“Students are six times more likely to access mental health when these services are offered in school, and that’s one important reason why making it easier for schools to provide health care is at the heart of the Biden-Harris Administration’s efforts to address the youth mental health crisis and raise the bar for learning conditions in our schools,” said U.S. Secretary of Education Miguel Cardona. “These new resources and proposed rules will help schools live up to the promise that all students, including those with disabilities, receive a free, appropriate public education. We need to continue breaking down barriers that have long undermined state and local efforts to provide health care services to students, including those covered by Medicaid. Ultimately, more children and youth will gain access to the physical and mental health services they need to succeed in school and in life as a result of the actions the Biden-Harris Administration is taking today.” 

“We are taking bold actions to strengthen school-based health care services through our Medicaid program so that children in every community have the support they need,” said HHS Secretary Xavier Becerra. “President Biden has made clear that strengthening youth mental health is a top priority of this Administration. We are working across the federal government, as well as with all states, territories and tribes, to meet families where they are and provide students with the services and supports they need to be healthy and thrive.”

IDEA Act Notice of Proposed Rulemaking

ED is releasing a Notice of Proposed Rulemaking under IDEA that would streamline consent provisions when billing for Medicaid services provided through a student’s individualized education program (IEP). This would result in a uniform process applicable to all Medicaid enrolled children, regardless of disability.  

Many children with disabilities receiving services under the IDEA are also enrolled in Medicaid either due to their disability status and/or based on their family income. Children with disabilities and are more likely to have low income, and those covered by Medicaid are more likely to have greater health care needs than those who are covered by private insurance. Further, the COVID-19 pandemic reduced access to critical services for children with disabilities and other vulnerable populations. To meet the Administration’s goal of increasing access to health and mental health services, and in fulfillment of the Bipartisan Safer Communities Act (BSCA) provision of expanding access to crucial school-based services for mental health and other care needs, it is crucial to remove barriers for schools so they can more easily provide Medicaid covered services to their students enrolled in Medicaid.

Importantly, the proposed changes announced today do not alter any of the critical parental consent provisions required by IDEA nor do they impact the parental consent obligations under the Family Educational Records and Privacy Act (FERPA). Additionally, the proposed rule does not alter the requirement that IEP services must be delivered at no cost to the child’s family, the requirement that IEP services cannot diminish other Medicaid-reimbursable services, nor Medicaid’s position as payor of first resort for IEP and Individualized Family Service Plan services. Rather, this regulatory change would help cut unnecessary red tape that schools and districts face in billing Medicaid and meet their obligations to ensure students with disabilities receive a free, appropriate public education in accordance with their IEP.

Guide to Expand School-Based Services for Millions of Students 

Today, HHS, through the Centers for Medicare & Medicaid Services (CMS) is releasing a comprehensive guide for Medicaid school-based services to make it easier for schools to deliver and receive payment for health care services to millions of eligible students. Developed in consultation with ED, the Comprehensive Guide to Medicaid Services and Administrative Claiming – PDF represents an important part of the Biden-Harris Administration’s implementation of the BSCA.   

In addition to providing billions in funding for school-based mental health personnel and supports to create safe and welcoming school environments, BSCA charged ED and HHS to expand access to school-based health and behavioral health services. The guide released today outlines flexibilities states can adopt to make it easier for schools to get paid for these critical health services delivered to children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), which together provide health coverage to more than half of all children in the United States.    

“With this guide, we are helping states and schools bring health care to kids where they are, rather than the other way around,” said CMS Administrator Chiquita Brooks-LaSure. “Children spend most of their waking hours in school. We also know that children have suffered serious declines in access to mental and behavioral health care services during the COVID-19 pandemic. We’re making it easier for states and schools to maximize Medicaid coverage to grow connections to care.”  

Medicaid and CHIP cover more than half of all children in this country.  That’s more than 41 million children spending over 30 hours weekly in school during most of the year. This comprehensive policy guide helps states and schools leverage Medicaid and CHIP and offers a roadmap of how they can build a bridge between education and health care, including mental health care, to support children enrolled in these programs and help them thrive.  

The guide clarifies, consolidates, and expands on a wealth of CMS guidance on how schools can receive payment for providing care for Medicaid- and CHIP-enrolled students, and how states can ease the administrative burden on school-based health providers to promote their participation in Medicaid and CHIP while meeting federal statutory and regulatory requirements. This includes helping states and schools operationalize: 

• How payments can be made for school-based services under Medicaid and CHIP; 
  
• How states can simplify billing for school-based services, including in rural and small or under-resourced communities, where care may be particularly challenging. 
  
• Examples of approved methods that state agencies have used to pay for covered services; and  
  
• How to enroll qualified health care providers to participate in Medicaid and furnish services within school settings. 
  

In the months to come, CMS plans to release more resources to help ensure states can optimize children’s access to school-based services. As outlined by BSCA, these resources include $50 million in grant opportunities and a school-based services technical assistance center, in partnership with ED. For more information on the guide, visit Medicaid.gov. 

New Mexico and Oregon School-based Services Expansion Approval

HHS, through CMS, also approved state plan amendments (SPAs) for both New Mexico and Oregon that will allow Medicaid to pay for health care services schools delivered to more of their Medicaid-enrolled students. Specifically, these SPAs will allow New Mexico and Oregon to receive Medicaid funding for services provided to all children covered by Medicaid, rather than only those children with an IEP. These approvals expand access to school-based health services, a key priority for the Biden-Harris Administration, that will strengthen Medicaid and help provide resources to combat the youth mental health crisis. New Mexico and Oregon join 12 other states that have already expanded Medicaid payment for school-based health care services under their state plans. These states include: Arizona, California, Colorado, Connecticut, Georgia, Illinois, Kentucky, Louisiana, Massachusetts, Michigan, Nevada, and North Carolina.  

These announcements collectively are part of the Biden-Harris Administration’s commitment to addressing the nation’s mental health crisis by providing more school-based resources and supports to help address students’ mental health needs. Today’s announcement comes on the heels of ED’s announcement earlier this week on the latest tranche of awards to train school-based mental health professionals through the Mental Health Service Professionals demonstration program, which provided another nearly $100 million in awards as part of an overall appropriation of $1 billion in BSCA for school-based mental health services and supports. 

Collectively, these announcements build on actions HHS, CMS and ED have taken over the last year to expand access to school-based health care and trauma informed services.  Last summer, CMS released guidance for states on to strengthen the delivery of Medicaid and Children Health Insurance Program (CHIP) youth behavioral health services and school-based services. Last fall, ED announced the Stronger Connections Grant program, which provided awards totaling $1 billion to 56 states and territories through BSCA to help schools in high-need districts provide students with safe, welcoming, and supportive learning opportunities and environments that are critical for their success. Last winter, HHS also awarded nearly $245 million to expand trauma informed services and supports for students and their families, including grants to State and Local Education Activities to bolster school-based services.

And at the beginning of the 2022 – 2023 school year, Secretary of Education Dr. Miguel Cardona and Secretary of Health and Human Services Xavier Becerra sent a letter to governors across the country to highlight federal resources available to states and schools to invest in mental health services for students. ED also awarded $122 billion in American Rescue Plan Elementary and Secondary School Emergency Relief funds to help schools reopen and recover, and experts indicate more than $2 billion has been directed to hire more school psychologists, counselors, and other mental health professionals in K-12 schools. With the help of these funds, as of March 2023, compared with the pre-pandemic period, the number of school social workers is up 48%, the number of school nurses is up 42%, and the numbers of school counselors and school psychologists are each up 10%.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: There will be no reductions in Medicaid payments. If you ask again, I will send Cornpop to your house.

Clipped from: https://www.foxnews.com/politics/biden-refuses-accept-work-requirements-medicaid-gop-debt-ceiling-talks

Biden said he ‘voted years ago’ for work requirements but is now opposing the new Republican plan for Medicaid

President Biden said Wednesday that he will not accept any of the Medicaid work requirements in the Republican debt ceiling plan, leaving no room for negotiation even as he admitted to supporting work requirements in the past.

“I’m not going to accept any work requirements that’s going to impact on medical health needs of people,” Biden told reporters Wednesday. “I’m not going to accept any work requirements that go much beyond what is already – well, I voted years ago for the work requirements that exist, but it’s possible there could be a few others, but not anything of any consequence.” 

House GOP lawmakers included new work requirements for able-bodied adults to qualify for Medicaid in the Limit, Save, Grow Act. The Congressional Budget Office has estimated these requirements would save $109 billion in the next decade. Still, Democrats oppose the measure because they say it will make it harder for poor people to access benefits. 

House Speaker Kevin McCarthy, R-Calif., has said requiring Americans to work before they receive government benefits will “help lift millions of Americans out of poverty.” 

MCCARTHY NOT OPTIMISTIC ABOUT DEBT CEILING NEGOTIATIONS, SAYS ‘THERE IS NO MOVEMENT’

“Right now, there are more job openings than people looking for work, in part because the Biden administration has weakened some of the very work requirements that then-Sen. Biden previously supported,” McCarthy said during a floor speech on April 19. 

“Our plan ensures adults without dependents earn a paycheck and learn new skills. By restoring these common sense measures, we can help more Americans earn a paycheck, learn new skills, reduce childhood poverty, and rebuild the workforce,” the speaker said. “It will also protect and preserve Medicare and Social Security because more people will be paying into it.” 

MCCARTHY SAYS BIDEN DRAGGING HIS FEET ON DEBT CEILING: ‘THEY WANT A DEFAULT MORE THAN THEY WANT A DEAL’

The White House and cleaders are engaged in tense negotiations as an early June deadline to raise the debt ceiling quickly approaches. Biden has issued a veto threat against the current GOP plan, which passed the House in April. 

McCarthy said Monday there’s been “no movement” as Republicans seek spending cuts in any deal while Democrats want a clean debt ceiling increase and the president has demanded spending talks be kept separate from debt limit talks. 

BIDEN GETS HEATED WITH REPORTER AFTER ASKED ABOUT DEBT CEILING: ‘YOU DIDN’T LISTEN’

“If you look at the timeline to pass something in the House and pass something in the Senate, you’ve got to have something done by this week, and we are nowhere near any of that,” McCarthy told reporters.

Nevertheless, Biden expressed confidence Wednesday that a deal will be reached in time. 

“I’m confident that we’ll get the agreement on the budget. America will not default, and every leader in the room understands the consequences if we fail to pay our bills, and it would be catastrophic for the American economy, the American people, if we didn’t pay our bills,” he said. 

Fox News’ Greg Wehner contributed to this report.

Chris Pandolfo is a writer for Fox News Digital. Send tips to chris.pandolfo@fox.com and follow him on Twitter @ChrisCPandolfo.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: “Advocates” are already trotting out the Boogeyman that “uncertainty” over debt ceiling talks could maybe someday impact state payments to Medicaid providers. This has never happened and it will not happen.

Clipped from: https://news.bloomberglaw.com/health-law-and-business/debt-breach-risks-71-billion-in-medicare-medicaid-pay-delays

It’s still early, by Washington standards, in negotiations to raise the debt ceiling.

But as the once-routine process continues to devolve into a high-stakes game of chicken, the real-life impact of a debt limit breach on Medicare and Medicaid is already causing angst for policy watchers. President Joe Biden was scheduled to meet with House Speaker Kevin McCarthy (R-Calif.) and other congressional leaders at the White House Tuesday hoping to avoid a looming default.

The Bipartisan Policy Center projects that without action on the debt limit, the “X Date”—when the Treasury is unable to meet all of its financial obligations—will probably occur sometime between early June and early August. That could affect or delay some $49 billion in Medicare payments to medical providers and suppliers and $22 billion in Medicaid payments to states that are both due by June 9, according to the BPC.

For hospitals, doctors, and other health-care providers still working to regain patients amid rising labor and supply costs due to Covid-19, a debt ceiling standoff adds unwelcome uncertainty to their usually reliable Medicare reimbursements. And while reserve funds in most states have swelled during the pandemic, a debt-ceiling stalemate could require using that money to cover delayed federal Medicaid payments, which would leave less to help soften the effects of declining tax revenue and a possible recession.

“A state may say ‘we have sufficient state funds set aside that will cover 100%'” of the federal Medicaid matching payment “with the understanding that we will be reimbursed once this issue is settled,” said G. William Hoagland, a senior vice president at the Bipartisan Policy Center.

But because “all of the different federal sources of funding that states depend on could potentially be jeopardized at the same time” in a debt-limit breach, “I don’t think it’s safe to assume that states would automatically jump in and pay their Medicaid providers,” said Allison Orris, a senior fellow at the Center on Budget and Policy Priorities.

‘A Lot of Lawsuits’

“If the states did not pay, I’m sure there will be a lot of lawsuits,” said Margaret A. Murray, CEO of the Association for Community Affiliated Plans, which represents 79 safety-net health plans nationwide. Medical providers who serve Medicaid patients “don’t always have great reserves to be able to afford to see patients that they’re not being paid for. So I think it’s going to cause a lot of chaos,” Murray said.

Delaying payments could also reduce beneficiary access by pushing providers “over the edge” and causing them to see fewer Medicare and Medicaid patients, said Tricia Neuman, senior vice president of KFF and executive director of its program on Medicare policy.

“It’s hard to say, for sure, what would happen because a debt-limit breach has never happened,” Neuman said. “But failure to raise the debt limit for a prolonged period of time could be hugely destabilizing for Medicare and Medicaid. And it could be disruptive for hospitals, physicians, and other health-care providers.”

Hospitals faced their worst year of the pandemic in 2022, and now face new fiscal challenges related to the May 11 end of the public health emergency. Uncompensated care costs for hospitals are likely to rise this year as the Medicaid “unwinding” increases the numbers of uninsured and underinsured.

And continued medical inflation and other cost pressures are projected to $98 billion in additional costs for hospitals from 2022 to 2023, according to a study by McKinsey. Delayed Medicare and Medicaid payments would only add to their struggle.

Impact on Managed Care Plans

Slow payments would also have downstream effects for private Medicare Advantage plans and Medicaid managed care plans, which “could in turn, have problems meeting their own obligations, paying their staff, and covering their bills,” Neuman said.

The nursing home industry is especially sensitive to that possibility.

“With the long-term care industry already experiencing a historic workforce crisis and recovering from the pandemic, any disruption of lifeline reimbursements will result in devastating consequences for our nation’s most vulnerable individuals who need access to care,” said a statement from the American Health Care Association and the National Center for Assisted Living.

Medicaid’s role in the debt-ceiling debate is complicated by the House Republican bill to raise the debt limit, H.R. 2811. The legislation would cut federal spending by about $130 billion and require able-bodied adults without dependents to complete work-related activities each month or risk losing their Medicaid coverage.

The proposal has little chance to pass the Senate but nonetheless has made Medicaid an unlikely political cudgel as debt-limit negotiations continue.

“I don’t think Medicaid should be used as a bargaining chip right now, given all the other things we’re going through with Medicaid, in terms of staff reductions and redeterminations,” Hoagland said.

“This is just not the time to make work requirements part of the debt limit discussion,” he said. “It doesn’t save a lot of money, It’s more ideological than it is substantive in terms of budget.”

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: WV will resume both its normal eligibility rules processing AND its enforcement of work requirements to get government food assistance.

Clipped from: https://www.thecentersquare.com/west_virginia/article_ae968d86-f35f-11ed-adb3-a726ade5333f.html

SNAP and Food Stamps provide nutrition benefits to supplement the budgets of disadvantaged families.

Jonathan Weiss | Shutterstock

(The Center Square) – The end of the federal COVID-19 emergency has led to two significant changes for those on assistance programs in West Virginia.

The state has re-started the redetermination program for those on Medicaid and WVCHIP. During the public health emergency, rules were suspended and those deemed eligible for programs remained eligible. As of March, the West Virginia Department of Health and Human Resources reported that 665,010 West Virginia residents were on the programs.

That’s part of the estimated 100 million on Medicaid in the United States, according to the Foundation for Government Accountability. The FGA estimates that 20 million of those are actually ineligible for the programs, which is estimated to cost the U.S. $16 billion per month.

The work requirements for those ages 18-49 without children or dependants for the Supplemental Nutrition Assistance Program for Able Bodied Adults Without Dependents will also resume statewide starting July 1.

“All potentially impacted individuals will receive a letter in mid-May with more information,” DHHR said. “Those who believe they should be exempted from this requirement are encouraged to speak with their caseworker.”

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: CMS plans on collecting lots more data for all the different cells it wants to sort people into for use in new policy agenda items. And some rural health and high cost drugs stuff for good measure.

Clipped from: https://www.jdsupra.com/legalnews/cmmi-describes-progress-on-addressing-8654091/

In October of 2021, the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) unveiled its 2030 vision to achieve “equitable outcomes through high quality, affordable, and person-centered care.” One of the objectives to achieve this goal is to focus on “advancing health equity.”  Dr. Dora Hughes, the Chief Medical Officer of CMMI, recently outlined in a blog post the initiatives that CMMI has already conducted and is proposing to implement to advance health equity.

CMS defines health equity as “the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes.” In working to achieve health equity in testing its payment and service delivery models, CMMI has committed to the following:

1. Developing new models and revising existing models to promote and incentivize equitable care.
   
2. Increasing participation of safety net providers.
   
3. Increasing collection and analysis of equity data.
   
4. Monitoring and evaluating models for health equity impact.
   

Developing new models and revising existing models to promote and incentivize equitable care.

CMMI has revised the Medicare Advantage Value based Insurance Design Model, the ACO Realizing Equity, Access, and Community Heath (ACO REACH) Model, and the Maryland Primary Care Program, which is a component of the Maryland Total Cost of Care Model, to promote a more direct focus on health equity. Some of the revisions included providing supplemental benefits, such as food, transportation, and housing assistance to beneficiaries with chronic illness and unmet social needs, and providing payments to allow for additional support for care management services.  CMMI is also collecting better sociodemographic data, requiring model participants to create and implement health equity plans, and ensuring screening of beneficiaries for health-related social needs. CMMI also introduced the Enhancing Oncology Model (EOM) that focuses on cancers that disproportionately affect underserved populations and includes many of these same model policies.

Increasing participation of safety net providers.

To increase model participation among safety net providers, CMMI conducted external and internal analyses. The external analysis included engaging in interviews and listening sessions with safety-net provider stakeholders to identify any barriers to safety-net provider participation. The internal analysis looked at qualitative data related to model application requirements to see if they provided any barriers to participation. This data will be used to operationalize strategies for including more providers that serve Medicaid beneficiaries, as well as federally qualified health centers in CMMI Models.

Increasing collection and analysis of equity data.

CMMI uses data to evaluate findings and inform future model design. CMMI would like to collect equity data to “better stratify and evaluate model outcomes for beneficiary populations defined by factors such as race, ethnicity, gender, geography, disability, sexual orientation, and gender identity.” CMMI has already started to collect equity data in the ACO REACH Model, which requires ACOs to collect sociodemographic data and health-related social needs data. CMMI is also working with other federal agencies and states to obtain equity data in the Integrated Care for Kids Model and the Maternal Opioid Misuse Model.

Monitoring and evaluating models for health equity impact.

CMMI is following a two-pronged approach to evaluate models and measure their impacts on underserved populations. CMMI will publish findings from a retrospective, cross-model review focused on underserved populations for older models. Additionally, this includes current models that will have expanded analytic work to capture health equity impact. For new or modified models, CMMI is designing multiple new forms of analyses to provide a thorough understanding of the health equity impact of the models. In addition to evaluations, CMMI is developing analysis such as “leading indicators” to provide early signals of a model’s performance.

Looking ahead in 2023

For the rest of 2023, CMMI is continuing to refine and improve their current efforts to address health equity. One expectation is that all new models will include health-related social needs screenings and referral components when feasible. CMMI has also, in alignment with cross-agency efforts, developed recommendations for measuring quality of care for underserved populations. Additional efforts CMMI would like to apply in 2023 include:

1. Sharpening the focus on the needs of other underserved populations that are not well represented in models.
   
2. Exploring options to build upon and support earlier investments in rural health, to address the unique access and health care needs of rural and geographically isolated communities.
   
3. Continuing to explore mechanisms for social risk adjustment of payment, such as the use of dual eligibility status to better account for social risk.
   
4. Addressing the high cost of drugs, in response to the Executive Order on Lowering Prescription Drugs.
   
5. Identifying and remedying model designs that may lead to inequities.
   

Dr. Hughes said that CMMI’s equity to-do list is “ambitious but necessary… to ensure that our long-term transformational work equitably benefits all beneficiaries we serve.”

We will keep you informed of new CMMI models and their focus on addressing health equity as the agency provides more updates.