We’re all in this together
We’re still The 80 Million. We’re still here to make Medicaid better and more accessible.
This month, the vision and growing reality of a more affordable, accessible, equitable, and high-quality system of health took a hit. And we are not going lie — it hurts. As Manatt Health’s modeling team has illustrated (and CBO confirmed) millions of Americans will lose health coverage due to H.R.1. State Medicaid programs face new budget challenges and participating providers face a new era of financial instability as they strive to continue their health care missions.
It’s a moment that requires more innovation and creative thinking than ever to ensure that people eligible for Medicaid and ACA Marketplace coverage can get and keep coverage, and that providers can ensure access to health care for the people they serve. It’s a moment in which we need new affordable health care solutions for those losing access to these programs. In other words, we’re still in a transformation journey together, and it requires our ingenuity, passion and tenacity more than ever.
Trump Administration Restricts Noncitizens’ Access to Federal Benefits, Including Major Health Programs
On July 10, the Trump administration announced it is expanding restrictions on immigrants’ access to federal programs under the Departments of Health and Human Services (HHS), Agriculture, and Education.
These changes do not directly affect Medicaid, the Children’s Health Insurance Program (CHIP), Medicare or the Marketplaces. However, by restricting access to other health care and social services, these policies are likely to broadly impact the health care system and have downstream effects on these health programs.
For years, many federal programs (including Medicaid) have been subject to eligibility restrictions for immigrants under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA). HHS’ announcement expands these restrictions to more than a dozen additional health programs, effective July 14, including funding for community health centers, mental health and substance use disorder services, early childhood education and development, family planning, and other programs. (See the table below for a list of affected programs.)
There are limited exceptions to these restrictions that protect immigrant access to programs related to immunizations, testing, and treatment for communicable diseases; short-term disaster relief; and, under certain circumstances, services delivered by nonprofits. However, effective Aug. 15, the administration has repealed a longstanding exemption for services “necessary for life or safety”— including crisis services and mental health care — pursuant to a recent Department of Justice (DOJ) policy update.
Keep reading at The 80 Million.
ICYMI (We Doubt You Did): H.R.1 Enacted
On July 4, President Trump signed into law Republicans’ reconciliation legislation, H.R.1, making sweeping changes to Medicaid and ACA Marketplaces going forward. House Republicans passed the legislation on July 3 by a vote of 218 to 214 following the longest vote in the history of the House of Representatives on the motion teeing-up the bill. The decisive vote ended up almost entirely along party lines, with Republican Reps. Brian Fitzpatrick of Pennsylvania and Thomas Massie of Kentucky joined Democrats in opposition to the bill.
Manatt Health released an analysis on July 7 for Manatt on Health subscribers that outlines the provisions and implications of the newly enacted budget. The charts below illustrate implementation dates for such provisions starting in 2025.
For more information on how to subscribe to Manatt on Health, Manatt’s premium subscription service providing in-depth insights and analysis focused on the legal, policy and market developments shaping the health care sector, please complete this interest form here.
California’s health care services department posted the Doula Benefit Implementation Report evaluating the first 18 months of implementation since doula services were added as a covered Medi-Cal benefit on Jan. 1, 2023. The report finds utilization is steadily increasing — as of June 30, 2024, more than 1,000 Medi-Cal members utilized one or more doula services, with wide variation by county and Medi-Cal managed care plan.
CMS approved Minnesota’s request to amend its 1115 demonstration, which authorizes the state to extend Medicaid eligibility for individuals under age 26 who were in foster care and enrolled in Medicaid when they aged out of the foster care system. In addition, the amendment enables the state to enroll individuals into the eligibility group serving former foster care children, regardless of whether they are eligible for or enrolled in a separate mandatory eligibility group.
CMS also approved a five-year extension of Texas’ “Healthy Texas Women” section 1115 demonstration. The approval provides new authority for the state to expand the benefit package to include additional postpartum services and move the demonstration from fee-for-service to managed care.
The Montana Department of Public Health and Human Services has opened a 60-day period within which the public may comment on its planned 1115 Medicaid demonstration waiver application for Montana’s Health and Economic Livelihood Partnership (HELP) program. The waiver seeks approval from CMS to implement work requirements and cost sharing as required in state and federal law.
North Dakota Health and Human Services is seeking public comment on proposed amendments to two Medicaid children’s waivers that expand access to services for qualifying children. The autism spectrum disorder waiver provides services to eligible children and supports parents in their efforts to maximize their child’s development, while also preventing out-of-home placements. The Medicaid waiver for medically fragile children allows Medicaid to pay for services for children between the ages of 3 to 18 who are medically fragile.
80 Million subscribers: Join 80 Million Editor Patti Boozang for a conversation about H.R.1 on July 22 from 2-3 p.m. EST. Register today to secure your spot!
States challenge ACA final rule as CMS releases new duplicative enrollment numbers – Fierce Healthcare
The megabill’s Medicaid cuts shocked hospitals, but they may never happen – Politico
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