Death by a thousand cuts (ACA Version)
As the Senate considers the House’s reconciliation bill, Medicaid advocates worry one in 10 Medicaid enrollees will lose coverage, children among them.
The Senate is taking up the House’s “one big, beautiful bill.” Hawk-eyed Medicaid experts are analyzing the impact of provisions in the bill, with estimates ranging from 8.7 million to nearly 16 million losing health coverage over the next decade, per Manatt Health’s modeling and this week’s CBO analysis. Some are calling the bill “ACA repeal by paper cut,” including for ACA marketplace coverage for middle- and lower-income American families. In that same vein, others note that the new CBO estimates on the 2025 reconciliation bill show impacts similar in magnitude to the 2017 ACA repeal effort.
The One Big, Beautiful Bill Act Cuts Medicaid The Latest Missives on Trans Care: HHS, CMS Press Providers to Restrict Services for Youth
Leaders of the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) issued letters on May 28 that urged health care providers and other stakeholders like medical boards to discontinue medications and surgical care for transgender youth. The letters also requested information within 30 days from certain hospitals that offer these services.
The letters reflect the Trump administration’s continued implementation of a Jan. 28 executive order (EO) that directs agencies to work toward eliminating access to care for trans youth under the age of 19. Since the EO was issued, the administration has taken a number of steps to push for restrictions, such as suggesting limits on Medicaid coverage, updating guidance on whistleblower protections, and outlining the administration’s perspective on the clinical evidence and ethics of GAC for trans kids, which numerous physician groups have opposed.
Many states continue to authorize licensed providers of gender-affirming medications and surgeries to youth (although surgeries for youth remain rare). Such services remain covered under some Medicaid programs and many private plans. Yet, HHS’ latest letters include the Trump administration’s sharpest language to date — instructing providers to cease offering gender-affirming medications and surgeries to youth.
Keep reading at The 80 Million.
ICYMI: Medicaid Work Requirements: Dismantling Medicaid Expansion by Design
The House-passed budget bill (“House bill”) largely targets the Affordable Care Act (ACA) Medicaid expansion group and other expansion-like adults, including making stringent work requirements a new condition of initial and ongoing Medicaid eligibility. The House bill also establishes an accelerated timeline for states to implement Medicaid work requirements by Dec. 31, 2026.
The Congressional Budget Office (CBO) preliminarily estimates that the work requirements would generate $280 billion in federal savings from 2025 to 2034, driven by terminating people’s Medicaid coverage and access to health care. The latest CBO estimates do not take into account the accelerated implementation of work requirements and savings estimates are likely to increase when they do.
Building on CBO’s estimate and accounting for experience in states that have implemented work requirements, Manatt projects even greater savings: $487 billion in federal funds (and $537 billion all funds — i.e., in federal and state Medicaid funds) over 10 years due to upward of 5 million people losing Medicaid coverage. Manatt’s estimates take the accelerated implementation date into account but will be updated to address other more stringent requirements of the House-passed bill and are expected to increase.
Mass health coverage terminations for Medicaid expansion enrollees are inevitable, not because people aren’t working, but because exemptions and compliance are difficult to identify, manual processes are the status-quo, and reporting requirements will be hard for Medicaid enrollees to parse.
Keep reading at The 80 Million.
California’s health care services department submitted the state’s annual report on community supports to CMS, showing the progress and impact of community supports through California’s CalAIM waiver. Of the 12 community supports studied, nine are proving cost-effective and three are on track to prove to cost efficacy over time.
Colorado Gov. Jared Polis signed several health care bills into law, including one that codifies gender-affirming care (GAC) treatments into statute and prohibits health plans from denying or limiting medically necessary GAC.
The Connecticut governor’s office reached a three-year agreement with SEIU 1199 NE that results in wage increases for direct care workers in nursing and group homes, averting a strike. The agreement also includes incremental increases in Medicaid for nursing homes and group homes.
Florida submitted a request for a new, five-year 1115 waiver aimed at building up its workforce amid a growing and aging population. The proposal includes new workforce programs and student loan repayment offerings.
North Carolina’s health and human services department reported that its Healthy Opportunities Pilots program has generated $1,020 in annual health care costs savings per enrollee. The program will cease operations on July 1 due to state funding cuts.
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CMS Medicaid director resigns – Politico Pro
A Medicaid patient had a heart attack while traveling. He owed almost $78,000 – KFF Health News
Idaho Medicaid to be privately managed in 2029, health officials expect – Idaho Capital Sun
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