Tag: Medicaid Reform

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Feds withdraw approval for Ohio Medicaid work requirements

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The Biden CMS has reneged on another approved CMS-state agreement.

 
 

 
 

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.

 
 

 
 

The Ohio Statehouse

Credit: Laura A. Bischoff

The federal government has withdrawn its approval for Ohio Medicaid to create the program’s first ever work requirements.

The decision is the latest update in a more than five year effort by conservative lawmakers to require those covered through Medicaid expansion to document they either have a job, are in school or have an exemption.

Two years ago, the U.S. Centers for Medicare and Medicaid Services under the Trump administration approved Ohio’s request to make the changes, which hadn’t been implemented due to the ongoing pandemic. This week, the Biden administration withdrew support for the requirements.

Ohio Gov. Mike DeWine on Wednesday called the decision “extremely disappointing.”

ExplorePREVIOUS COVERAGE: Work rules approved for Ohio Medicaid expansion

“Ohio’s reasonable approach provided individuals with options while supporting them on their way to self-sufficiency,” DeWine said. “The Biden Administration’s decision was short-sited and contrary to our statewide effort to improve public health.”

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About 3.2 million Ohioans are covered by the joint state-federal insurance program, including just under 800,000 covered by the expansion of the program under the Affordable Care Act.

This includes around 43,200 people in Montgomery County, 24,300 in Butler County, 11,000 in Clark County, 8,400 in Greene County and 7,000 in Warren County covered by the expansion of Medicaid eligibility as of June, which is the latest state Medicaid data available.

Work requirements have been hailed by some conservative lawmakers as a way to encourage self sufficiency and has been years in the making.

Ohio Medicaid had requested federal permission to create work requirements under the direction of the Republican-majority Ohio General Assembly during former Gov. John Kasich’s administration.

At the same time, courts have struck down other requirements, and some studies have shown the work requirements lead to people falling off the rolls because they don’t know about the paperwork requirements or don’t keep up with the forms correctly.

“There’s no evidence that work requirements do anything other than disenroll people,” said Loren Anthes, who researches Ohio Medicaid for Cleveland-based Center for Community Solutions.

Anthes said studies since Medicaid was expanded have demonstrated that it’s a key tool in fighting against addiction and infant mortality, and that it helps rural providers stay open.

ExploreMedicaid work requirement ruling could affect Ohio

When submitting the original application, state officials had estimated that about 95% of those covered by the expansion would already either meet the work requirement or be exempt. Some of the exemptions include being age 50 or older, participating in drug or alcohol treatment, being pregnant, or complying with work requirements associated with other programs like SNAP, also known as food stamps.

The Biden administration, however, estimated between 121,000 and 163,000 beneficiaries could lose coverage in the first 12 months of implementation, based on what happened with Arkansas work requirements and with Ohio adding work requirements for SNAP.

The administration noted that people could lose coverage because of documentation errors or lack of awareness.

Additionally, the administration highlighted Ohio’s problems with the computer system used to determine eligibility. State audits have found serious issues with the system and with backlog, including one report indicating that the error rate for determining Medicaid eligibility in the state was 43%, more than double the national average.

ExploreOhio Medicaid director said DeWine administration inherited ‘mess’

“Thus, the introduction of an administratively complex program like the community engagement requirement presents a serious risk of beneficiary disenrollment due to technical errors,” the administration stated in a letter withdrawing support for work requirements.

Republican Ohio Sen. Rob Portman expressed disappointment at the decision, saying the requirements would have “provided greater well-being and self-sufficiency to individuals who are able to work.”

Democratic Ohio Sen. Sherrod Brown commended the move. “We should be making it easier for Ohioans to access care, not harder – especially at a time when Ohioans are fighting against the COVID-19 global pandemic,” Brown said.

 
 

Clipped from: https://www.daytondailynews.com/business/feds-withdraw-approval-for-ohio-medicaid-work-requirements/5CBST6PC5RCW3ALXTILETYTYRA/

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Democrats oppose changes to Medicaid expansion eligibility

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Fiscal conservatives want to be able to remove people whose incomes have grown beyond Medicaid eligibility more often than every 12 months.

 
 

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.

 
 

HELENA, Mont. (AP) — Democratic lawmakers in Montana said they are opposed to a plan to end 12-month continuous eligibility for people who qualify for Medicaid expansion or another program that provides health coverage for those with a disabling mental illness.

The Department of Public Health and Human Services is seeking federal permission to eliminate the continuous eligibility provision for Medicaid expansion at the direction of the Legislature, the agency said in a draft application to the Centers for Medicare and Medicaid Services.

It is seeking the same change for the mental health program because it would reduce the administrative burden to have consistent eligibility requirements, said Darci Wiebe, the administrator of the health department’s Health Resources Division.

About 100,000 Montanans are covered under the Medicaid expansion program that provides health insurance for people who are not eligible for traditional Medicaid coverage, but do not qualify for federal subsidies on policies sold under the Affordable Care Act.

 
 

Republican lawmakers reduced the state’s Medicaid expansion appropriation and included a statement in the budget bill saying: “The Legislature intends that the Department of Public Health and Human Services eliminate the policy of 12-month continuous eligibility for the Medicaid expansion population.“

However, other efforts to pass a standalone bill to end the 12-month eligibility policy failed during the 2021 Legislature, Democrats noted.

“The legislative intent in my view is ambiguous at best and again, DPHHS can do this if they wish, but I don’t think they can put it on the backs of the Legislature,” Democratic Rep. Ed Stafman of Bozeman said Tuesday. “That is what they claim several times in the petition.”

The Children, Families, Health and Human Services Committee discussed the proposals, which must be approved by the federal Centers for Medicare and Medicaid Services. The Medicaid expansion proposal has been the subject of two public hearings. Public comment is being taken through the end of August. Committee members said they plan to include their individual comments on the proposal.

Under Montana’s current Medicaid expansion program, people remain eligible for coverage for a full year, even if their income increases and they no longer meet the financial requirements. Republicans want to be able to move people off the program when they are no longer financially eligible, rather than wait for the end of that 12-month term, arguing it would save the state money.

Opponents counter it will cycle people on and off the program and disrupt continuous care for those with chronic conditions, such as high blood pressure or diabetes, and will lead to higher medical costs through the use of emergency rooms rather than primary care providers.

“The department’s proposal represents a threat to the health care of thousands of Montanans,” Stafman, chair of the committee, said in a statement. “It makes zero sense to take an effective program and make it less efficient, less fair, and more bureaucratic. If the department moves forward with this misguided proposal, they will damage Montanans’ health and hurt the bottom lines of businesses that rely on Medicaid to cover their employees.”

Opponents to ending continuous Medicaid eligibility for people suffering with severe disabling mental illness argued the Legislature did not request changes for that program, which covers about 1,000 people.

There are already fraud and abuse measures within the Medicaid system, said Kristin Page-Nei, whose brother is covered under the program. “We do not need another layer of red tape putting up another barrier.”

Separately, the waiver application notes Montana expects a pending August 2019 Medicaid expansion application that sought to add work requirements and increase premiums for some will be rejected by the Centers for Medicare and Medicaid Services. The Biden Administration has overturned work requirements in several states whose programs were approved under the Trump Administration.

“This is not the time to experiment or test policies that risk a substantial loss of health coverage or benefits, especially for individuals and communities significantly impacted by COVID-19 and other health inequities,” CMS said in a February statement.

No one can lose Medicaid expansion coverage during the public health emergency caused by the coronavirus, which is expected to last at least through the end of the year.

 
 

Clipped from: https://www.theintelligencer.com/news/article/Democrats-oppose-changes-to-Medicaid-expansion-16380932.php

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Mandatory COVID-19 Vaccination for Health Care Workers as a Condition for Medicare and Medicaid Participation – Center for American Progress

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The think tank is calling for CMS to make Medicare and Medicaid reimbursements to hospitals and physicians contingent upon vaccination status.

 
 

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.

 
 

A nurse manager in Washington, D.C., fills a syringe with a dose of the Johnson & Johnson COVID-19 vaccine during a walk-up clinic at the John F. Kennedy Center for the Performing Arts on May 6, 2021.

Despite months of public and private efforts to make vaccines widely accessible, about 40 percent of adults in the United States are not yet fully vaccinated. As coronavirus cases surge, overwhelming hospitals in some parts of the country, colleges and universities, private employers, and states and cities are imposing vaccine mandates for employees, students, and customers. With new evidence suggesting that the delta variant is more transmissible than prior strains and that a majority of the remaining unvaccinated are unlikely to seek out vaccination, the United States urgently needs to use all available tools to increase vaccination rates and avoid continued surges, along with their health and economic impacts. The Medicare and Medicaid Conditions of Participation and Conditions for Coverage are untapped levers the federal government can use to support this effort.

To date, more than 500,000 health care workers have contracted the coronavirus and 1,673 have died from COVID-19. Unvaccinated health care workers put patients at high risk, given that their jobs require close interaction with unvaccinated patients and others who are immunocompromised and at higher risk for complications. Yet by the end of May, 1 in 4 hospital workers still had not been vaccinated at all.

Congregate settings, such as long-term care (LTC) facilities, are particularly susceptible to the spread of infectious disease. In December 2020, the Advisory Committee on Immunization Practices (ACIP) recommended that health care workers and LTC facility residents be prioritized for the COVID-19 vaccination to protect those at the highest risk of severe illness and death. Yet according to an analysis of 300 LTC facilities published by the Centers for Disease Control and Prevention (CDC), only 46 percent of aides and 57 percent of nurses—providers who have the most patient contact—had been fully vaccinated by the beginning of April, with 1 in 3 aides declining the vaccine. Partial vaccination of staff provides insufficient protection: COVID-19 outbreaks have occurred through spread among unvaccinated workers even in LTC facilities with high vaccination rates among residents. As of March 2021, residents and staff of LTC facilities accounted for almost one-third of COVID-19-related deaths in the United States.

According to one public health expert, “vaccinating workers in nursing homes is a national emergency.” In addition, a CDC presentation obtained in late July by The Washington Post asked its audience to “consider vaccine mandates for HCP [health care personnel] to protect vulnerable populations”; it did not, however, propose any mechanism for expanding mandates.

Medicare Conditions of Participation and Conditions for Coverage should be updated to increase COVID-19 vaccination rates

As the largest payers of health care in the United States, the Centers for Medicare and Medicaid Services (CMS) have a variety of regulatory policy tools that can support COVID-19 vaccine administration. One of the most powerful tools the Biden administration has at its disposal is the Conditions of Participation (CoPs) and Conditions for Coverage (CfCs), the federal health and safety standards that health care organizations must meet in order to participate and receive funding from the Medicare and Medicaid programs. Under Section 1861(e) of the Social Security Act, the secretary of the U.S. Department of Health and Human Services has the authority to adopt proposed CoPs that are found to be “necessary in the interest of the health and safety of the individuals who are furnished services in hospitals.” Other health care providers must similarly meet health and safety standards.

Although, typically, CMS must go through notice-and-comment rulemaking to modify Conditions of Participation and Conditions for Coverage, the agency may waive this process and instead adopt changes through interim final rules when it finds there is “good cause,” meaning that notice-and-comment rulemaking is “impracticable, unnecessary, or contrary to the public interest.” CMS has already waived notice-and-comment rulemaking when amending these health and safety standards in response to the COVID-19 pandemic.

For example, in August 2020, CMS added new universal hospital COVID-19 data reporting requirements and critical access hospital CoPs to support virus tracking, prevent spread, and protect the health and safety of patients. CMS invoked a good-cause exception to notice-and-comment rulemaking as well as the typical 30-day delay in a rule’s effective date, stating that “time is of the essence in controlling the spread of COVID-19” and that “universal resident and staff testing will assist public health officials in detecting outbreaks and saving lives.”

More recently, in May 2021, CMS issued an interim final rule establishing new requirements for educating LTC residents and staff about COVID-19 vaccines and for offering the vaccine. Again, CMS explained that these changes were “critically important” given the ongoing pandemic, as it would be “impracticable and contrary to the public interest for [CMS] to undertake normal notice and comment rulemaking procedures” under these circumstances. Moreover, the agency explained it could not “afford sizable delay in effectuating this [change]” due to the ongoing crisis.

CMS should now update these standards to mandate that health care and LTC staff and contractors, as well as health care providers with hospital privileges, are vaccinated against COVID-19; the emergence of the delta variant, stalling vaccination rates, and the threat to patient safety posed by unvaccinated health care workers have created the need for action beyond staff education and vaccine access. It is in the public interest to increase vaccination rates without delay, and mandatory vaccinations for health care workers are of critical importance in protecting patients’ health and safety. Providers would have eight weeks from the effective date of the rule to ensure compliance, allowing the time needed for full vaccination. CMS should also evaluate whether it can impose civil monetary penalties, set to increase over time, for noncompliant organizations.

A policy with nationwide reach is crucial

Importantly, CoPs and CfCs are national in scope, making them a powerful tool to effectuate change when there is local or regional reluctance. For instance, in 1965, federal officials required hospitals to desegregate to be eligible for Medicare reimbursement, leading more than 1,000 hospitals to integrate their medical staffs and hospital floors in less than four months.

Vaccination rates vary significantly from region to region and from state to state. In areas with low vaccination rates, employers—including health care and LTC employers—may be less likely to adopt mandates on their own. State and local officials who have been resistant to public health measures such as masking are unlikely ever to adopt vaccine requirements for all workers in health care, as California has done, or for all nursing home staff, as Massachusetts has done. Some states even have passed laws to limit employer-mandated vaccination. Yet patients, facility residents, and health care workers in all communities deserve the protection afforded by vaccination.

A consistent, national policy is necessary to overcome employers’ perceived financial disincentive to mandate vaccination. While hospitals and other health care employers are well aware of the risks of transmission, the concept of a self-imposed vaccine mandate presents them with a conundrum: In a tight labor market, they fear imposing new restrictions will cause them to lose workers to competing institutions at a time when they are already short-staffed. However, a federal rule requiring full vaccination in virtually all health care jobs would level the playing field, ensuring that no individual facility is disadvantaged by mandating employee vaccination.

Conclusion: The time is right for CMS to act

The movement to ensure that all health care workers are fully vaccinated is gaining momentum. More than 50 health care professional societies and organizations have urged all health care employers to require their employees to be vaccinated against COVID-19 to protect the safety of patients, residents, and communities. Meanwhile, dozens of medical centers and hospital systems, including the U.S. Department of Veterans Affairs, are requiring their workers to get vaccinated. While this movement is encouraging, it is unlikely that all health care and LTC facilities will independently adopt worker vaccination mandates without federal policy intervention.

Making COVID-19 vaccination mandatory for providers participating in Medicare and Medicaid would protect vulnerable patients, set a positive example for other employers, and contribute to the national effort to contain the virus.

Jill Rosenthal is the director of Public Health Policy at the Center for American Progress. Emily Gee is the senior economist for Health Policy at the Center. Maura Calsyn is the vice president and coordinator for Health Policy at the Center.

To find the latest CAP resources on the coronavirus, visit our coronavirus resource page.

 
 

Clipped from: https://www.americanprogress.org/issues/healthcare/news/2021/08/06/502409/mandatory-covid-19-vaccination-health-care-workers-condition-medicare-medicaid-participation/

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Medicare And Medicaid Turn 56 Today. That’s Not Exactly Cause For Celebration.

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The 2 programs have blasted past all estimates of spending and have gone well beyond their original design.

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.

President Lyndon B. Johnson signs the Medicare bill as Vice President Humphrey and Harry S. Truman … [+] both check the time.

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Today, Medicare and Medicaid mark their 56th birthday. They were signed into law by President Lyndon Johnson to ensure that seniors and the poor had access to quality, affordable health coverage as part of his Great Society.

They’ve grown far beyond what their creators envisioned. In 1967, the House Ways and Means Committee forecast that the program would cost $12 billion by 1990. The actual tab that year was $110 billion—nearly 10 times higher. In 2019, Medicare spending was just under $800 billion.

Medicaid isn’t far behind. Spending on the program has surged from roughly $3 billion in 1967 to $613 billion in 2019. It now covers more than 74 million people—about one in five Americans. In 1967, just under 4% of Americans were beneficiaries of the program.

PROMOTED

Now Democrats are pushing to expand Medicare and Medicaid further—to the detriment of taxpayers and their own beneficiaries.

As part of a $3.5 trillion budget package, Democratic leaders have floated lowering the eligibility age for Medicare to 60 from 65. Doing so would cost about $200 billion over a decade. They’re also interested in expanding Medicare to cover dental, vision, and hearing benefits, at a cost of about $360 billion over 10 years.

Older adults are least in need of more government largesse. For starters, they’re well-off, relatively speaking. Americans between the ages of 55 and 64 have an average net worth of just under $1.2 million. Those between 65 and 74, who already enjoy taxpayer-funded health insurance through Medicare, have an average net worth of more than $1.2 million.

Older Americans are also more likely than members of other age groups to have health insurance. The over-65 crowd has access to Medicare, of course. But 92% of those between 60 and 64 have insurance coverage already. Nearly three in four people in this age group have private insurance, whether through their employer or the individual market.

Medicare can’t afford the cost of care for its existing beneficiaries, much less more generous benefits for a new crop of enrollees. According to the Congressional Budget Office, the trust fund for Medicare Part A—the program’s hospital insurance benefit—will become insolvent by 2024.

At that point, the tax revenue flowing into the program will not be enough to pay out the claims coming in. Federal law bars the government from using general revenue to fund the program’s expenses. So it could delay payments to hospitals and physicians—or just pay them less.

It can’t afford to cut payments much. Medicare already pays providers 86.8% of their costs. If the federal government cut payments further, then providers would likely limit the number of Medicare patients they’d see—and thereby jeopardize patient access to care.

And if Medicare swallowed up people aged 60 to 64, the access problems could be even worse, as more people would compete for fewer appointments.

Democrats are also looking to pump up Medicaid enrollment. As part of Obamacare, they opened the program up to everyone making less than 138 percent of the poverty level, including able-bodied adults. The U.S. Supreme Court later made that expansion optional for the states; 12 declined to expand.

Nevertheless, nearly 15 million newly eligible people have enrolled in the program as of December 2020.

Democrats are trying to force Medicaid expansion upon the 12 holdout states by creating a new, Medicaid-like plan paid for and administered by the federal government. If enacted, this new plan would pull 4.4 million more people into taxpayer-funded coverage.

Medicaid beneficiaries may have coverage. But that doesn’t mean they get quality care. A study comparing Medicaid beneficiaries in Oregon to similarly situated uninsured individuals found that those with public health coverage experienced no improvement in health outcomes relative to those without any coverage at all.

The program’s return on investment may be negative, once we consider how much the program loses to fraud. In 2020, one-fifth of Medicaid spending—$86 billion—went toward “improper payments.”

Even with all that waste, the program’s payments to doctors and hospitals are absurdly low. Medicaid pays healthcare providers 62.2% of what employer-sponsored insurance does. It’s no wonder roughly one-third of doctors won’t see new Medicaid patients.

The legacy of Medicare and Medicaid after 56 years is one of relentless growth — in enrollees and in spending. If Democrats have their way this year, the two programs could grow even bigger. That’s not an outcome taxpayers, or even the program’s beneficiaries, should welcome.

Clipped from: https://www.forbes.com/sites/sallypipes/2021/07/30/medicare-and-medicaid-turn-56-today-thats-not-exactly-cause-for-celebration/?sh=6a22828170eb


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California Is Expanding Medicaid To Undocumented Residents Age 50+

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California will use state only funds to pay for healthcare for 235,000 non-citizens starting in 2022.

 
 

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.

 
 

California is expanding Medicaid eligibility to undocumented residents over age 50, Governor Gavin Newsom announced Tuesday afternoon, with the signing of a bill that he says is the first to offer the program for that age group.

 
 

Gov. Gavin Newsom speaks at a news conference in Oakland, Calif., Monday, July 26, 2021. (AP … [+] Photo/Jeff Chiu)

ASSOCIATED PRESS

Key Facts

The law will expand Medi-Cal, the state’s Medicaid program, to about 235,000 low-income undocumented Californians 50 and older, the governor’s office said in a press release.

When the law takes effect in 2022, all low-income Californians without legal status, except those aged 26-49, will be eligible for Medi-Cal, according to the Sacramento Bee.

The state expanded Medi-Cal to children in 2016 and adults up to age 26 in 2020.

Crucial Quote

The Medicaid expansion will “ensure thousands of older undocumented Californians, many of whom have been serving on the front lines of the pandemic, can access critical health care services,” Newsom said in a statement.

Key Background

Under federal law, people who immigrate to the U.S. are eligible for Medicaid—a program for low-income people funded by state and federal dollars—only if they have legal status and have been in the country for five years. To get around the federal restrictions, eight states and Washington, D.C. have extended Medicaid to undocumented children using state dollars. Children and young adults were the only groups that had been made eligible until 2020, when Illinois expanded Medicaid to undocumented residents over 65.

Big Number

46. That’s the percentage of undocumented immigrants under age 65 who were uninsured in 2019, according to the Kaiser Family Foundation. That’s compared to 11.1% of overall U.S. residents who went without insurance in the first half of 2020, according to the Department of Health and Human Services. 

What To Watch For

“There is a lot of momentum at the state level” to expand Medicaid coverage to undocumented children, with several states considering it in the last year, said Kelly Whitener, associate professor at Georgetown University’s Health Policy Institute. In Connecticut, legislators have discussed expanding the program to undocumented people at all ages. “It’s a newer trend to chip away at the age range from both sides,” she said.


(Georgetown University Health Policy Institute)

Clipped from: https://www.forbes.com/sites/graisondangor/2021/07/27/california-is-expanding-medicaid-to-undocumented-residents-age-50/?sh=4a338b29b83b

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Pax­ton Seeks Pre­lim­i­nary Injunc­tion After Biden Admin­is­tra­tion Ille­gal­ly Revoked Med­ic­aid Waiver

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Texas AG has filed a request to stop the Biden administration from un-approving the 1115 DSRIP waiver.

 
 

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.

 
 

Attorney General Ken Paxton sought a preliminary injunction to enjoin the Biden Administration’s illegal action rescinding the extension of the Medicaid Section 1115 waiver negotiated between Texas and the federal government. In a politically motivated move, the administration reversed its agreement to extend that waiver until 2030.   

“In an abuse of power, the Biden Administration blatantly ignored the needs of Texans when it revoked our Medicaid waiver,” Attorney General Paxton said. “Not only does this violate agency regulations, it was clearly intended to force our state into expanding Medicaid under the Patient Protection and Affordable Care Act. This flippant decision is illegal and cruel. Putting the lives of vulnerable Texans on the line for political gain is reprehensible.” 

After taking office, and acting through the Centers for Medicare and Medicaid Services, the Biden Administration purported to revoke that extension, with no warning to Texas. This will cause irreparable harm to Texans. 

Read the motion here.  

 
 

Clipped from: https://www.einnews.com/pr_news/546740767/pax-ton-seeks-pre-lim-i-nary-injunc-tion-after-biden-admin-is-tra-tion-ille-gal-ly-revoked-med-ic-aid-waiver

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Arkansas submits plan for overhauling Medicaid expansion

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Arkansas’ reworked waiver will not require work to be covered, but will require it to get a managed care plan.

 
 

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.

 
 

Arkansas submitted to the federal government on Tuesday a proposal to overhaul its Medicaid expansion after the program’s previous requirement that some recipients work was blocked by the courts.

The state Department of Human Services turned in its proposed waiver for the expansion program, and officials have said they hope to win approval by November or December.

As with the current program, the overhauled expansion would continue using Medicaid funds to place recipients on private health insurance. It also includes incentives aimed at encouraging participants to work or meet certain health goals.

Arkansas unveiled the proposal after the Biden administration moved to roll back Medicaid work requirements in Arkansas and several other states. A federal judge blocked the Arkansas work requirement.

 
 

Clipped from: https://www.modernhealthcare.com/medicaid/arkansas-submits-plan-overhauling-medicaid-expansion

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Hyde Amendment fight just the first step in changing abortion coverage

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Dems continue to push for Medicaid to pay for abortions.

 
 

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.

 
 

The fight over abortion restrictions will likely be a major flashpoint in appropriations debates and on the campaign trail

 
 

Demonstrators rally outside the Supreme Court in June 2016. The fight over abortion restrictions will likely be a major flashpoint in upcoming appropriations debates and on the campaign trail. (Bill Clark/CQ Roll Call file photo)

The partisan fight over whether the federal government will fund abortion coverage for Medicaid beneficiaries threatens to stall action on major appropriations bills, but the on-the-ground impact would be less dramatic than the debate suggests.

Democrats are prioritizing the removal of an annual appropriations rider known as the Hyde amendment, which bans federal funding of abortion except in cases of rape, incest or to protect the life of the woman. The policy, which prevents programs like Medicaid or the Children’s Health Insurance Program from using federal money to cover abortion outside of those three situations, has been in every spending law since 1976.

Additional legislative action outside of the fiscal 2022 Labor-HHS-Education funding bill would be needed to broaden abortion coverage for women who receive care through departments such as Defense or Veterans Affairs.

It would be challenging to remove a long-standing abortion policy that every lawmaker who voted for Labor-HHS-Education funding in previous years allowed to continue.

Even if changes to Hyde become law, the effects would be muted, based on state abortion policies, said Laurie Sobel, the Kaiser Family Foundation associate director for women’s health policy.

 
 

Clipped from: https://www.rollcall.com/2021/07/21/hyde-amendment-fight-just-the-first-step-in-changing-abortion-coverage/

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Fate of Missouri Medicaid expansion in the hands of the state Supreme Court

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The Missouri Supreme Court has heard all arguments and is expected to announce a decision soon.

 
 

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.

 
 

After an eight-year fight over Medicaid expansion, the arguments are over. The question of whether 275,000 people will receive state-paid health care coverage is in the hands of the Missouri Supreme Court.

Oral arguments took place Tuesday in an expedited appeal. The seven judges must decide whether Medicaid eligibility will expand, as directed by the constitutional amendment approved by voters, or, as Cole County Judge Jon Beetem ruled, if it was fatally flawed because it did not include a new source of revenue to pay the anticipated costs.

The court’s only other option, suggested by Attorney General Eric Schmitt’s office in its final written brief, is to leave people eligible for coverage without actually providing it unless lawmakers explicitly fund it.

While there is no deadline for the decision, the expedited schedule indicates the court will rule soon, because coverage was supposed to start July 1.

“What is at stake here is life-saving health care,” Joel Ferber, director of advocacy for Legal Services of Eastern Missouri said to reporters after oral arguments concluded. “Our lead plaintiffs and our clients are desperate for the health care they need.”

In the days and hours leading up to the oral arguments, the judges received plenty of advice on how they should rule. The final written arguments from Schmitt’s office, which wants the court to uphold Beetem, were filed Friday. Friend-of-the-court briefs, along with the final filings from the plaintiffs seeking an order in favor of expansion, were being filed as late as Monday afternoon.

The court, however, heard only from John Sauer, representing the state, and Chuck Hatfield, representing three women who sued when Gov. Mike Parson announced the state would not open enrollment for the expansion group.

Amendment 2, passed last August opened Medicaid eligibility to adults ages 19 to 64 who earn less than 138 percent of the federal poverty guideline. Sauer told the court that while that group is eligible, lawmakers control state spending and did not make room for them in the budget.

“Their intent was not to fund the expansion population and only fund the pre-expansion population,” Sauer said.

Reading the same appropriation bills, Hatfield found a different interpretation. While the spending bills didn’t include the estimated $1.9 billion to cover the expansion population, he said there is money for every service available under Medicaid and there are options to control spending that would provide coverage for everyone eligible.

“The legislature must, of course, follow the priorities the people put in the constitution,” Hatfield said.

The path from passage of the Affordable Care Act in 2010, with a requirement that states expand Medicaid coverage, to Tuesday’s arguments, has been dominated by politics, with Democrats and their supporters pushing the state to go along and Republicans just as strongly resisting.

Then-Gov. Jay Nixon first asked lawmakers to expand coverage in 2013, but here was never a realistic chance the Republican-dominated General Assembly would go along.

Passage of Amendment changed some minds, but not enough. Parson, who opposed Amendment 2, put money for the anticipated costs in his January budget proposal. When the final vote on funding came in May in the Missouri Senate, only four Republicans joined 10 Democrats in support of Parson’s request.

Since 1945, the Missouri Constitution has prohibited initiatives that require appropriations if the same ballot measure does not generate the needed revenue. That is why Beetem ruled Amendment 2 is invalid, writing that because it requires the state to spend money, it is unconstitutional.

“How is it you can look back on an election that is past and decide it is invalid?” Judge W. Brent Powell asked Sauer. “How long can you continue to do that?”

“That is not our argument,” Sauer replied.

In his brief for the state, Sauer of the attorney general’s office argued that the judges have only two choices – find that Amendment 2 is valid but subject to appropriation, or that it was not validly enacted.

“This conflict is real, and it stubbornly resists plaintiffs’ belated attempts to explain it away,” Sauer wrote.

Last year, the court decided lawmakers could not use appropriation bills to make Planned Parenthood ineligible to provide Medicaid-paid family planning services. Sauer asked the court to overturn that decision and allow lawmakers to determine which legally eligible people will and will not receive Medicaid coverage.

The judges don’t have to stretch logic that far, Hatfield argued. The three women who initiated the lawsuit are eligible, the legislature appropriated money for every service provided by Medicaid and therefore they cannot be denied, the attorneys wrote.

“This court has consistently held that every doubt, and every ambiguity, should be resolved in favor of upholding the will of the people,” Hatfield said.

The governor has various methods to control spending and though some may be painful, the options are real, Hatfield said Tuesday.

In the brief filed Monday, Hatfield and his co-counsels in the case wrote that the program’s cost, whether for traditional Medicaid or the expansion population, is uncertain every year, they wrote.

First, no one has any idea whether the amount of money the General Assembly appropriated is too much, not enough, or just right, they wrote. “The number of enrollees in the MO HealthNet program fluctuates from year to year, as do the quantity and types of services used.”

The amicus curiae, or friend of the court, briefs have come in from conservative groups, health care providers, backers of Amendment 2 and lawmakers. There’s even a secondary dispute, with Missouri House Democratic Leader Crystal Quade of Springfield and Assistant Democratic Leader Richard Brown of Kansas City asking the court to reject, or at least ignore, the brief filed in the name of the full House.

The stakes are enormous, both for those who would receive coverage and for the state’s treasury.

In the brief for the state’s 12 Federally Qualified Health Care Centers, which serve 600,000 patients, Jim Layton, formerly the state’s top appellate attorney, wrote that it is essential that the clinics serve paying patients to support their work for those without insurance.

Of the people using them, he wrote, 46 percent are on Medicaid already and another 25 percent are without insurance. Many of the uninsured would receive coverage, he wrote, and lawmakers funded all services provided by Medicaid.

“But the General Assembly cannot, merely by changing a dollar figure in a line of an appropriation bill, change a parameter of the program that was constitutionally defined by the people by initiative, any more than it can, by changing a dollar figure or including a proviso in an appropriations bill, change eligibility for any other program,” he wrote.

Before passage of Amendment 2, Missouri was one of 14 states that had not yet expanded Medicaid under the 2010 Affordable Care Act. The law originally made expansion mandatory but the U.S. Supreme Court ruled in 2012 that penalty provisions that made Medicaid an all-or-nothing program were unenforceable.

Under the terms of the ACA, states pay 10 percent of the cost of expansion and the federal government covers 90 percent. In the traditional Medicaid program, Missouri pays about 35 percent of the cost.

Amendment 2 extended coverage to people aged 19 to 65 with household incomes less than 138 percent of the federal poverty guideline, or $17,774 a year for a single person and $36,570 for a household of four.

Under the current Medicaid program, adults without children are not eligible unless they are blind, have another qualifying disability or are pregnant.

The traditional Medicaid program is expected to cost about $12 billion in the current fiscal year.

In his January budget proposal, Parson estimated the total cost of expansion at $1.9 billion, with $130 million from general revenue, $1.65 billion from the federal treasury and the remainder from taxes on medical providers.

If Missouri does expand Medicaid coverage, it will become eligible for additional support for the traditional program estimated to save the state $1.2 billion over two years.

 
 

Clipped from: https://www.columbiamissourian.com/news/state_news/fate-of-missouri-medicaid-expansion-in-the-hands-of-the-state-supreme-court/article_96a01070-e5b6-11eb-963d-b7dcec94d387.html

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Senators seek Medicaid-like plan to cover holdout states

MM Curator summary

US Congressmen are introducing a bill to sell Medicaid on the exchanges for free in holdout states.

 
 

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.

 
 

Sen. Raphael Warnock, D-Ga., speaks at Alfred E. Beach High School in Savannah, Ga., Thursday, July 8, 2021. Warnock joined fellow Democratic senators Jon Ossoff of Georgia and Tammy Baldwin of Wisconsin in introducing a bill on Monday, July 12, 2021, to require the federal government to set up a Medicaid-like health plan in states that have not expanded Medicaid plans to cover more low-income adults. (Jim Watson/Pool via AP)

Jim Watsdon

ATLANTA (AP) — Three Democratic U.S. senators from states that have refused to expand Medicaid want the federal government to set up a mirror plan to provide health insurance coverage to people in those states.

Sens. Raphael Warnock and Jon Ossoff of Georgia and Tammy Baldwin of Wisconsin are introducing the bill Monday, they told The Associated Press. Congressional Democrats are pushing for a coverage expansion in upcoming legislation.

“The single most effective solution to closing our state’s coverage gap is to expand Medicaid,” Warnock said after a June 29 meeting with health care executives. “What we ought to be doing is expanding Medicaid rather than playing games with the health care of Georgia citizens.”

The effort is crucial for Warnock, who seeks reelection in 2022 facing several Republicans eager to defeat him.

People making more than 138% of the federal poverty level are eligible for federal health insurance subsidies through an online marketplace. But as many as 4 million people who make less don’t get assistance in a “coverage gap,” according to the Kaiser Family Foundation.

President Barack Obama’s Affordable Care Act envisioned states would expand Medicaid programs to cover those people, but many conservative states balked. There are 12 holdouts, while an expansion in Missouri mandated by referendum is in limbo after Republican lawmakers refused to pay for it.

Democrats increasingly say leaving people without coverage is unacceptable. They tried to lure remaining states with two years of extra money for expansion, but none budged. Baldwin said such a refusal is “just wrong.”

“Our legislation will open the door to those who have been shut out and expand access to affordable health care, including preventive care, that people want and need,” she said in a statement.

The bill would mandate a new health insurance plan that looks just like Medicaid offered to residents in holdout states. President Joe Biden proposed during his campaign to offer a public option through the federal healthcare marketplace. Democratic Rep. Lloyd Doggett of Texas and others introduced a bill June 17 to let local governments create local Medicaid expansions.

The Medicaid approach has key advantages, said Jesse Cross-Call, director of state Medicaid strategy with the liberal-leaning Center for Budget and Policy Priorities.

The plan would require no premiums and only small copayments, while those costs can be much higher for individuals on the marketplace. People can enroll in Medicaid year-round, while marketplace enrollment is typically only in the fall, or when someone’s circumstances change.

“The idea is for it to be as close to Medicaid coverage as possible,” Cross-Call said.

A new plan could take years to set up, though. Many states use managed care networks to provide Medicaid services, and it’s unclear if the federal government would be able to contract with the groups.

Sponsors say coverage is already paid for because the original Affordable Care Act included money for all 50 states. States normally shoulder 10% of the cost, but the bill would require no state contributions.

The plan also would boost incentives for holdout states to expand on their own. It would raise the federal share of state-federal Medicaid spending by 10 percentage points this coming decade. The current enticement, included in Biden’s coronavirus relief bill, is 5 percentage points for two years. Based on Kaiser Family Foundation estimates, that could be worth a cumulative $160 billion to holdout states and Oklahoma, which launched expansion July 1.

Republicans, Warnock said in June, are effectively “standing between Georgia voters and their tax dollars that are still being paid to cover Medicaid in other states.”

Republicans aren’t backing down. Georgia Gov. Brian Kemp is pursuing a limited expansion that would impose work or education requirements for benefits. It seeks to add 50,000 Georgia residents in its first two years and require everyone to shop for federally subsidized insurance through private agents. The Biden administration is reevaluating previous approval of the plan by the Trump administration, a reversal Kemp says isn’t allowed.

“The Biden administration has been, in my opinion, trying to throw up roadblocks to our waiver plan that was approved,” Kemp recently told AP. “Senator Warnock can hit me all he wants on Medicaid. What he never mentions is … working on lowering costs for private sector health care. A lot of people don’t want government health care.”

Financial incentives could be required to keep other states from dropping Medicaid expansion to avoid current costs. The bill doesn’t address that.

Warnock spokesperson Meredith Brasher reaffirmed that sponsors want the measure attached to any budget reconciliation measure Democrats use to advance educational and social welfare priorities through the Senate without Republican support.

“Recovery legislation presents a unique, historic opportunity to close the gaps in coverage for the millions of people in the Medicaid coverage gap,” wrote more than 60 members of the Congressional Black, Hispanic and Asian Pacific American caucuses on June 16.

——Clipped from: https://www.pressrepublican.com/news/senators-seek-medicaid-like-plan-to-cover-holdout-states/article_0d7e832b-a349-59d1-a7d3-38a1fa65abdd.html