Advocacy News: February 2024

person holding folder in front of Capitol

Word From Washington

  • According to the KFF Medicaid Unwinding Enrollment Tracker, nearly 17.5 million Americans have lost Medicaid coverage since states were allowed to resume eligibility verifications following the COVID-19 public health emergency. At least 70 percent of Medicaid terminations continue to be for procedural reasons (such as not returning forms on time) and could still be otherwise Medicaid-eligible. HFA remains focused on mitigating erroneous coverage losses as both figures far exceed initial projections by KFF, the Urban Institute, and the Congressional Budget Office.
  • Florida files a lawsuit against the Centers for Medicare and Medicaid Services (CMS) in effort to skirt new 12-month continuous coverage requirement for Medicaid/CHIP children that Congress required starting January 1st. The state insists that it can still terminate coverage for non-payment of premiums even though CMS guidance last fall says otherwise.
  • Oral arguments for Braidwood Management v. Becerra are scheduled for the 5th Circuit Court on Monday, March 4th. HFA and 15 other patient organizations submitted an Amicus Brief in April of 2023 defending consumers’ rights to no-cost, evidence-based preventive services under the Affordable Care Act. The amicus brief demonstrates that preventive services save lives and are cost-effective, and outlines examples of the cost-free services that would be lost for many patients if the lower court’s adverse decision was upheld. The 5th Circuit Court stayed the lower court’s decision in June of 2023, which maintained continued access to cost-free preventive services coverage while the case is deliberated.

State of the States

  • Legislation to protect health plan consumers from copay accumulator adjuster programs (CAAPs) nears the finish line in Missouri and Oregon, and remains pending in at least six others (including California). A total of 19 states (plus DC and Puerto Rico) have already acted to ban CAAPs in state-regulated health plans.
  • Colorado will cap the price of popular arthritis drug Enbrel in the first-ever action by a prescription drug affordability board (PDAB) to limit drug pricing.  Eight other states have already created similar PDABs and several states are considering new legislation to do so.
  • New York governor signs legislation to strengthen consumer protections against step therapy (fail-first) protocols by health plans.Despite staunch opposition from the governor and a work requirement that could prevent federal approval, the Mississippi House and Senate are advancing legislation for the first time in ten years that would expand Medicaid under the Affordable Care Act. (Mississippi remains one of only ten remaining non-expansion states). 
  • Efforts to repeal the Medicaid expansion in Idaho failed to clear committee, however Montana lawmakers have yet to be able to pass legislation that would continue that state’s Medicaid expansion beyond its current sunset in June 2025.
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