Count down to shutdown
The Office of Management and Budget has directed agencies to use the looming shutdown as “opportunity to reconsider RIF notices” — firing more federal workers as they also consider furloughs.
Congress has until 11:59 p.m. on Tuesday, Sept. 30 to avert a shutdown. In general, federal workers that support mandatory programs like Medicaid are protected from furlough. However, Medicaid’s unique status as an advanced appropriation means funding runs out in the first quarter of next year, should the shutdown last that long.
When Government Shuts Down: The Effect on Medicaid
Before the House adjourned last week for a scheduled district work period, members passed a bare-bones seven-week continuing resolution (CR) on largely partisan lines (one Democrat supported the measure). This bill would have extended discretionary government funding at current levels. The Senate voted on, and failed to pass, both the House-passed CR and a Democratic alternative authored by Appropriations Committee ranking members Rep. Rosa DeLauro (D-CT) and Sen. Patty Murray (D-WA). As a result, Congress will have roughly 48 hours when it returns next week to avoid a lapse in Executive Branch authority to spend appropriated funds — commonly known as a shutdown. While the Senate is scheduled to return on Monday, the Speaker has not called the House back in session before the shutdown date, widely seen as a tactic to put maximum pressure on the Senate to pass the House measure.
In general, the immediate effect of a shutdown is that all Executive Branch activities funded by appropriations (also known as discretionary programs) can no longer legally operate and the employees supporting them are furloughed without pay. However, the law does make exception for employees deemed “essential,” the definition of which is sufficiently vague to give the administration broad latitude in retaining certain categories of employees. Federal agencies have not updated their staffing contingency plans in the event of a shutdown since President Trump took office. There are some concerns that, given this administration’s focus on shrinking the size of the federal workforce, a narrower definition of “essential” may be employed this time around, resulting in more employees being furloughed.
Keep reading at The 80 Million.
Please join us for The 80 Million’s next Ask Manatt session focusing on the Rural Health Transformation Fund with Patti Boozang and Anne O’Hagen Karl from Manatt Health, Deputy Secretary for North Carolina Medicaid Jay Ludlam and Homeward Health Founder and CEO Jennifer Schneider, MD on Sept. 29.
States Race the Clock to Secure Rural Funding
The Centers for Medicare and Medicaid Services (CMS) released a Notice of Funding Opportunity (NOFO) on Sept. 15 for states to apply for funds under the $50 billion Rural Health Transformation (RHT) Program established under H.R.1. Starting in Fiscal Year (FY) 2026, $25 billion in baseline funding will be distributed across all states with approved applications over five years. The other $25 billion, known as “workload funding,” will be distributed over the same period but funding amounts will be based on a list of factors selected by CMS.
States’ workload funding awards will be assessed based on data indicating how rural a state is compared to other states and information on the state’s rural health facilities, along with the extent to which the state’s policies and the initiatives they are hoping CMS will fund align with the Trump administration’s Make America Healthy Again (MAHA) agenda.
The rub? States have only a handful of weeks left to conduct stakeholder engagement and develop an application that articulates the state’s vision for a transformed rural health care delivery system in alignment with CMS’ policy priorities and instructions. Should a state submit an application that’s not in line with the CMS’ road rules or policy vision, it risks being denied funding.
Keep reading at The 80 Million.
CMS approved Georgia’s Pathways to Coverage extension, which will last through Dec. 31, 2026.
DC Health Link, Washington, D.C.’s official health insurance marketplace, launched a website for its new basic health program. Residents with an annual income between 138% to 200% of the federal poverty level may qualify for a plan with no out-of-pocket costs and coverage of essential health benefits.
Eight states and localities (Connecticut, Maine, Massachusetts, New Jersey, New York City and State, Pennsylvania and Rhode Island) have created the Northeast Public Health Collaborative, a voluntary regional coalition of public health agencies and leaders who aim to protect and promote evidence-based public health.
Montana submitted a request for a new five-year 1115 waiver demonstration to require working-age, able-bodied adults enrolled in Medicaid to pay premiums and either work, pursue job training or education, or engage in community service activities.
Rhode Island’s Office of the Health Insurance commissioner announced that commercial health insurance premiums for 2026 have been approved, with a weighted average rate increase of 21% for the individual market, 17.6% for the small group market, and 19.3% for the large group market.
Trump approves 15-month extension for Georgia’s Pathways to Coverage program – The Associated Press/CBS News
Georgia’s Medicaid Work Requirement Program Spent Twice as Much on Administrative Costs as on Health Care, GAO Says – ProPublica
Health Legislature State, Local Govt. With no NC health funding deal, the state is poised to cut Medicaid rates – NC Newsline
Nursing homes and their residents fear Medicaid cuts impacts – Colorado Public Radio
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