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With Medicaid much in the news in August, it seemed timely to offer a refresher on how Medicaid is structured, and why it鈥檚 important to many in the bleeding disorders community.

Medicaid is a public health insurance program for low-income individuals, families, seniors, and people with disabilities. States set up and run their own Medicaid programs, subject to federal guidelines and requirements; the federal government matches a specified percentage of the state鈥檚 spending. Under the Affordable Care Act, states have the option to expand their Medicaid programs to cover adults earning up to 138% of the Federal Poverty Limit. Currently, 38 states and the District of Columbia have opted into (but, in some cases, not fully implemented) Medicaid expansion.

Medicaid is the single largest insurer in the US, covering 1 in 5 Americans. The National Hemophilia Foundation聽estimates聽that聽about 30% of people with a bleeding disorder聽are enrolled in Medicaid.聽This coverage provides essential access to medication, treatment, and care coordination for some of the most vulnerable members of the bleeding disorders community. Advocating for a strong Medicaid program is thus a key priority for HFA.

Over the course of August,

  • Missouri Governor Mike Parson announced that Missouri HealthNet (the state鈥檚 Medicaid program) would begin allowing individuals to enroll, pursuant to a court order upholding the state鈥檚 voter-approved Medicaid expansion. Disturbingly, however, the state has announced that applicants may have to wait two monthsbefore they learn whether their applications will be accepted.
  • CMS reopened the comment period on Tennessee鈥檚 controversial TennCare III waiver. The waiver, approved in the final days of the Trump Administration, would (among other things) allow Tennessee to exclude some drugs from its Medicaid formulary and yet still keep automatic Medicaid rebates. Litigation challenging the Tennessee waiver has been paused during CMS鈥檚 reconsideration of the matter.
  • The U.S. Centers for Medicare and Medicaid Services (CMS) announced that it was revoking approvals of work reporting requirements previously granted to Medicaid programs in South Carolina, Ohio, and Utah. This move 鈥 in the works since last February 鈥 leaves Georgia as the only state that still has work reporting requirements on the books. Georgia and CMS continue to negotiate over the state鈥檚 application to implement a partial and contingent Medicaid expansion.
  • A federal court temporarily blocked CMS from implementing its April 2021 rescission of Texas鈥檚 10-year Medicaid uncompensated care waiver. The court ruled that the rescission was likely unlawful and could cause irreparable harm to Texas.
  • In new guidance published on August 13, CMS announced that states could take up to one year after the end of the COVID-19 public health emergency (PHE) to complete eligibility redeterminations for Medicaid beneficiaries. (The Families First Coronavirus Response Act passed in March 2020 gave state Medicaid programs a boost in federal funding; in exchange, states had to agree not to disenroll Medicaid beneficiaries for the duration of the PHE.) The PHE is expected to continue at least through the end of 2021; once it ends, however, eligibility redeterminations can resume, creating potential red tape barriers for Medicaid beneficiaries and administrative challenges for state health agencies.

Quick Hits:

  • On August 11, the U.S. Senate adopted a budget resolution laying out the framework for a massive infrastructure bill that is expected to encompass numerous health priorities, e.g.: making permanent theAmerican Rescue Plan鈥檚 boost to ACA premium subsidies; expanding Medicare benefits; closing the Medicaid coverage gap; and providing new funds for home and community-based care. HFA and coalition partners support these priorities.
  • The House of Representatives, for its part, approved its own version of a budget resolution on August 24th. Lawmakers will now move forward with crafting a reconciliation bill advancing these health priorities.
  • CMS released a proposal to rescind the Trump Administration鈥檚 Most Favored Nation (MFN) rule, which would have linked Medicare Part B payments for 50 doctor-administered medicines to the lower prices paid overseas. Drug pricing reforms via other avenues remain on the agenda: President Biden has called on Congress to let Medicare negotiate drug prices, cap Medicare beneficiary copays, and limit drug price increases. Observers expect Congress will try to use savings from drug pricing reforms to fund the infrastructure bill鈥檚 health care expansions.
  • On August 15, the COVID-related special enrollment period (SEP) for ACA insurance closed in most states. (In states where the SEP ended, individuals can still enroll in coverage, but only if they experience qualifying life events that confer eligibility). CMS reported that 5 million Americans signed up for coverage via healthcare.gov or a state-based exchange in the six months that the SEP was open. Another 2.6 million insurance enrollees revisited healthcare.gov to access the higher ACA tax credits provided under the American Rescue Plan. According to CMS, consumers who buy ACA coverage are on average saving 40% on premiumsdue to the Rescue Plan鈥檚 enhanced subsidies.

 


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