Long day’s journey into night reconciliation markup
With budget reconciliation, new CMS guidance, HHS Secretary testimony and more, Medicaid policy watchers are reaching for their next extra-large cup of coffee.
The budget reconciliation process is grinding forward in the House this week, and Medicaid remains the thorniest issue of the House GOP effort to produce “one big, beautiful bill.” Republicans want a series of cuts dramatically reducing enrollment and access for Medicaid expansion eligible people like a new work requirement mandate and mandatory cost-sharing. Democrats are focused on the impact of unprecedented Medicaid cuts on constituents’ health, wellbeing and access to basic, affordable health care.
Why Montana Doubled Down on Medicaid Expansion
Montana’s Medicaid program covers more than 200,000 people, including one in three children residing in the state. In the face of potential federal funding cuts to Medicaid generally and expansion specifically, the Montana Legislature in February approved a bill to extend permanently Medicaid expansion, which provides coverage to about 76,000 of those residents. The measure, supported by a bipartisan coalition of legislators, removed the program's sunset provision that had been in place since Montana’s Medicaid expansion was first implemented in 2016. The effort to make expansion a permanent part of Montana’s Medicaid program had bipartisan support, buy-in from the business community and hospital association, and was bolstered by compelling human stories and data that provided evidence on the value of Medicaid expansion, including work done by the Montana Healthcare Foundation.
Montana’s Medicaid expansion story may be surprising to some: Montana is a red state with a conservative governor and legislature that came to expansion later than many states, but after nearly 10 years’ experience has chosen to make expansion a permanent part of providing affordable health coverage to Montanans. The Montana Medicaid story is an encapsulation of how perceptions and politics around Medicaid have evolved over a decade because of the program’s powerful, positive impact on working low-income people, health care providers, businesses and the economy. Montana’s story aligns with the strong voter support for Medicaid across the nation, including among Trump voters, and should be a wake-up call for members of Congress as they contemplate a series of legislative changes that would significantly reduce Medicaid funding, especially for expansion states, and terminate coverage for 8.6 million people enrolled in Medicaid.
Sen. Josh Hawley, the Republican senator from Missouri — also a red, expansion state, is among those sounding the alarm for his colleagues in Congress saying in his May 12 New York Times op-ed: “If Congress cuts funding for Medicaid benefits, Missouri workers and their children will lose their health care. And hospitals will close. It’s that simple. And that pattern will be replicated in states across the country.”
Montana similarly concluded that Medicaid expansion works, including for working people. Here are the factors that led the state to double down on expansion:
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ICYMI: DOJ and HHS Signal Future Actions to Block Access to Treatment for Trans Youth
Federal agencies are continuing to take action to implement President Trump’s January 28 EO aimed at blocking access to care for transgender individuals under the age of 19. U.S. Attorney General Pam Bondi, on April 22, circulated an internal memo calling on the Department of Justice (DOJ) to enforce existing federal laws — including regarding off-label promotion of drugs like hormones and puberty blockers — and advance new legislation restricting gender-affirming care for youth. On May 1, 2024, the Department of Health and Human Services (HHS) released a report presenting the Trump administration’s conclusions on the clinical evidence and ethics of health care for transgender youth.
It appears the federal government is building an administrative record to cite when taking future action to shut down coverage of gender-affirming care for young people or penalize the providers who offer it. The American Academy of Pediatrics (AAP) has already weighed in on the HHS report, stating that it “misrepresents the current medical consensus and fails to reflect the realities of pediatric care” and that “patients, their families, and their physicians — not politicians or government officials — should be the ones to make decisions together about what care is best for them based on evidence-based, age-appropriate care.”
These steps follow prior federal actions, including HHS signaling funding risks for providers who serve transgender youth and suggesting limits on Medicaid coverage for youth gender-affirming care. The common themes are that none of these actions change existing legal requirements regarding treatment for transgender youth and that all appear to be crafted to promote hesitancy and fear among impacted patients, families, providers and payors, including state Medicaid programs.
Keep reading at The 80 Million.
Louisiana will pilot a new consent-based verification system to streamline Medicaid income verification, starting this month.
North Carolina announced the launch of a digital resource to help people with disabilities navigate Medicaid, along with other public benefits.
Vermont is seeking a state plan amendment (SPA) from CMS to cover doulas under Medicaid, while Utah Gov. Spencer Cox signed legislation to authorize such coverage.
Thanks to everyone who attended today’s inaugural Ask Manatt Anything session! We loved hearing from you. Ping us with what topics you’d like us to dive into for our next session.
Medicaid makes community living possible for people with intellectual, developmental disabilities – Fierce Healthcare
Josh Hawley: Don’t cut Medicaid – The New York Times
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