House Passes Short-Term Spending Bill, But Senate Remains At An Impasse.
The New York Times (1/18, Kaplan, Stolberg, Subscription Publication) reports that on Thursday night, the House “approved a stopgap spending bill…to keep the government open past Friday, but Senate Democrats – angered by President Trump’s vulgar aspersions and a lack of progress on a broader budget and immigration deal – appeared ready to block the measure.” The measure passed by a vote of 230 to 197. However, it remains to be seen if the Senate will also pass the bill and avoid a shutdown by midnight on Friday. The article says at least 12 Senate Democrats would have to vote for the measure and “there was little chance” that would happen. The piece adds that the legislation would also provide CHIP funding for six years, and “delay or suspend” several ACA taxes.
Senate Democrats Say Medicaid Work Requirements May Not Be Legal.
The AP (1/18, Alonso-Zaldivar) reports that on Thursday, 29 senators said the Trump Administration’s policy change which allows states to impose Medicaid work requirements “is legally questionable.” The article adds that they framed “an argument likely to be aired in court.” The lawmakers made the comments in a letter to Acting HHS Secretary Eric Hargan. The letter says “work requirements ‘contradict the plain text and purpose’ of the Medicaid statute, as well as ‘Congress’s longstanding intent for the Medicaid program.’”
Congressional Quarterly (1/18, Williams, Subscription Publication) reports that the senators, led by Senate Finance Committee ranking member Ron Wyden (D-OR), told Hargan, “Ultimately, this leads to poorer health and more frequent use of the emergency room, all of which ends up costing the system and taxpayers more in the long run. … Such harmful proposals clearly undermine the purpose of the Medicaid Act, prioritizing ideology over health.”
Former CMS Official Criticizes Move To Allow States To Impose Medicaid Work Requirements. Vikki Wachino, former deputy administrator and director of the Center for Medicaid and CHIP Services at CMS, writes in an op-ed for The Hill (1/18) that last week, the Trump Administration kept its vow “to reverse longstanding Medicaid policy” when CMS Administrator Seema Verma announced that the agency would allow states to impose Medicaid work requirements. Wachino argues, “This policy turns Medicaid’s long standing role in supporting employment of low-income people on its head.” She adds that this means “Medicaid is no longer a helping hand extended to people who seek financial independence. It is the rug that gets pulled out from beneath the feet of the person who may be getting ready to look for a job.”
Opinion: Administration’s Move To Allow Medicaid Work Requirements May Cause Many Eligible Beneficiaries To Lose Coverage. Margot Sanger-Katz writes in the New York Times (1/18, Subscription Publication) “The Upshot” blog that the Trump Administration’s decision to allow states to impose Medicaid work requirements “has inspired concern that the program will leave behind Medicaid beneficiaries who are unable to find or keep work.” She adds that “a lot of research about the Medicaid program, specifically…shows that sign-ups fall when states make their program more complicated.”
Kentucky’s Move To Impose Medicaid Work Requirements Considered An About-Face. Bloomberg News (1/18, Tozzi, Tracer) reports that Kentucky is preparing “to become the first state to impose a work rule for Medicaid,” and this worries some recipients who may not be able to prove they are working. The article says although “the federal government covers the vast majority of Kentucky’s Medicaid bill, the state still expects to save $2.4 billion over five years by lowering enrollment by 95,000 people.” The piece adds that this “move is a U-turn in the state’s heath-care policy,” because not long ago, “Kentucky was seen as a model for its health insurance expansion.”
CMS Puts Hold On Therapy Claims Amid Uncertainty.
Congressional Quarterly (1/18, Williams, Subscription Publication) reports that the Centers for Medicare and Medicaid Services has stopped “processing certain claims for physical, speech and occupational therapy treatments” because Congress “has yet to extend certain Medicare programs that expired at the end of last year with no resolution in sight.” By not processing the claims, CMS is keeping “patients from having to pay out of their pockets for services once they hit an annual cap.” The piece adds that renewal of the “Medicare extenders” which would renew the exception to the therapy caps is not included in the latest continuing resolution under debate in Congress.
CMS To Focus On Reducing Hospital Regulations.
Congressional Quarterly (1/18, Clason, Subscription Publication) reports that CMS Administrator Seema Verma wants to “reduce oversight and provide more flexibility to the hospital industry.” CMS “will focus on reducing data reporting and reining in qualifying conditions for hospitals seeking to participate in Medicare, which are two of the industry’s top requests.” Verma explained that the current quality reporting metrics are not effective and the burden on hospitals to compile data is too great, and concluded, “That is simply not where we should be” on quality reporting.
Humana Faces Backlash For Increasing Breast Cancer Drug Copays.
Becker’s Hospital Review (1/18, Haefner) reports that Humana “recently reclassified Herceptin – an intravenous drug used to treat metastatic breast cancer – as a nonpreferred drug in some Florida markets.” The company is facing backlash from some policyholders, who claim the change “has stuck them with 20 percent copays, or more than $900 dollars per monthly dose up to their yearly out-of-pocket limit, for the previously preferred treatment.”
Rhode Island Gov. Proposes $166 Million In Medicaid Cuts To Balance Budget.
The Providence (RI) Journal (1/18, Bogdan) reports Rhode Island Gov. Gina Raimondo (D) “proposed balancing next year’s $9.38-billion budget with nearly $166 million in cuts to Medicaid.” The changes will not affect “eligibility or benefits, officials said,” but will include imposing co-pays for the first time – which are estimated to save $3.2 million. The proposal also includes incentives for managed care companies to “provide more efficient patient care,” not increasing hospital reimbursement rates, and will “‘rebalance’ long-term care and nursing home services.”