Advocacy

ADVOCACY ALERT

Proposed Medicaid Changes

The House Energy and Commerce Committee (E&C) released legislation with major changes to the Medicaid program. Please find NRHA’s statement on the legislation here. Funding changes that have been circulating, such as per capita caps and across the board FMAP reductions, are not currently included in this legislation. Most provisions will impact enrollees’ ability to access health care coverage, with the Congressional Budget Office estimating that 8.6 million people will lose health care coverage through these proposals. See below for a summary of major provisions.

Note that this legislation is subject to change through Amendments in the Nature of a Substitute (AINS), which must be filed 24 hours before the markup, or through amendments offered during the markup. E&C is scheduled to meet for a markup on Tuesday, May 13^th at 2pm. It is critical that you continue to contact your members of Congress and tell them how disastrous the proposals below would be for your rural community.

Act Now! Use VRHA’s Congressional Directory to contact your members of Congress

NRHA will continue to monitor the progress of this legislation and analyze impacts on rural patients and providers.

Concerning proposals include:

Freezing at current rates states’ provider taxes in effect as of the date of enactment of this legislation and prohibiting states from establishing new provider taxes.
Directing the Department of Health and Human Services (HHS) to revise existing regulations to limit state directed payments for services furnished on or after the enactment of this legislation from exceeding the total published Medicare payment rate. This would not apply to state directed payments approved prior to the enactment of this legislation.
Implementing work requirements for able-bodied adults without dependents. Each month, affected enrollees would be required to work at least 80 hours, complete at least 80 hours of community service, participate in a work program for at least 80 hours, enroll in an educational program for at least 80 hours, or a combination of these activities for at least 80 hours.
- Exempted individuals include:
  - Pregnant women
  - Enrollees under 19 and over 64
  - Foster youth and former foster youth under 26
  - Members of Tribes
  - Individuals with disabilities
  - Individuals already in compliance with work requirements for Temporary Assistance for Needy Families (TANF) program or Supplemental Nutrition Assistance Program (SNAP)
  - Parents/caregivers of a dependent child with disabilities
  - Incarcerated individuals or those recently released from incarceration
- This provision includes short-term hardship waivers for natural disasters and counties where the unemployment rate is greater than eight percent or greater than 150 percent of the national average.
- Work requirements must be verified by states for the month preceding an individual’s enrolment in Medicaid and as part of an enrollee’s redetermination, which under this legislation would occur every 6 months. States can also choose to verify compliance at more frequent intervals.
Delays implementation of two final rules until January 1, 2035:
- Streamlining Medicaid and CHIP Eligibility and Enrollment
- Medicare Savings Program Eligiblity Determination and Enrollment
Increasing the frequency of eligibility redeterminations from every 12 months to every 6 months.
Limiting retroactive coverage to one month prior to an individual’s application date. Current law allows for up to 3 months prior to the application date.
Modifying the criteria that HHS must consider when determining whether a health-care related tax is considered “generally redistributive.” NRHA is still determining the impact of this provision, but it appears to be similar to previous MFAR proposals.
Sunsetting the temporary 5% FMAP increase for new expansion states. This would not affect states that are currently receiving the enhanced FMAP.
Reducing the FMAP for Medicaid Expansion States who use their Medicaid infrastructure to provide health care coverage for non-citizens.
Prohibiting federal financial participation under Medicaid and CHIP for individuals whose citizenship, nationality, or immigration status has not been verified.
Implementing eligibility and income verification processes for Affordable Care Act enrollees. This proposal would effectively codify the Marketplace Integrity and Affordability proposed rule published by the Centers for Medicare and Medicaid Services earlier this year.
Requiring that any demonstration projects approved under Section 1115 waivers are budget neutral.
Requiring states to establish processes to regularly obtain enrollee address information from certain reliable data sources. HHS must also establish a system to prevent enrollees from being enrolled in multiple state Medicaid programs by October 1, 2029.

Beneficial proposals include:

Delaying Medicaid Disproportionate Share Hospital (DSH) reductions until 2029.
Delaying implementation of the Minimum Staffing Standards for Long-Term Care rule until January 1, 2035.
Pharmaceutical benefit manager (PBM) transparency and accountability provisions in Medicare Part D.
Banning PBM spread pricing in Medicaid program.
Limiting cost sharing for the Medicaid expansion population with incomes over 100% of the Federal Poverty Level. Cost sharing may not exceed $35 per service and primary care, prenatal care, pediatric care, or emergency room care would have no cost-sharing.

++++++++++++++++++++++++++++++++++++++++++++++++++++++++

CONTACT YOUR MEMBERS OF CONGRESS TODAY!

Oppose Medicaid Cuts

NRHA CEO Alan Morgan released the following statement on Medicaid cuts proposed by Congress:

“The National Rural Health Association (NRHA) opposes any decreases in funding to the Medicaid program as part of a budget reconciliation package. The Medicaid program is a lifeline for rural hospitals, providers, and patients. Any cuts to the Medicaid program will disproportionately affect rural communities. Rural Americans rely on Medicaid coverage more so than their urban counterparts with about 20% of adults and 40% of children living in rural areas enrolled in Medicaid and CHIP. Medicaid plays a significant role in sustaining the viability of rural healthcare systems, including hospitals, clinics, community health centers, and long-term care. A strong relationship exists between Medicaid coverage levels and the financial viability of rural hospitals, of which about half are currently operating on negative margins and cannot sustain further cuts. Reductions in Medicaid funding will force rural providers to reduce or eliminate essential services or close their doors, limiting access to care for rural residents.”

Virginia law will automatically terminate Medicaid Expansion if federal funding falls below 90%.

Virginia rural counties have, on average, Medicaid coverage for 21% of the population, compared to 18% in metro areas. 38 rural counties have a higher average than the metro average, with the highest being Emporia (33%), Danville City (30%), Martinsville City (29%), Franklin City (28%), and Norton City (28%).

Act Now! Use VRHA’s Congressional Directory to contact your members of Congress and let them know how many people are covered by Medicaid in your area and what concerns you have if Congress make severe cuts to Medicaid.

For more information, please read NRHA’s letter to congressional leadership, fact sheets on the impact of Medicaid cuts, and a map depicting Medicaid coverage in Virginia. Contact Alexa McKinley Abel with any questions.

Congressional Directory

National Rural Health Association Priority Areas

Advocacy Resources: Coordinated grassroots efforts by NRHA members and other rural health advocates are critical to ensuring rural and underserved populations have access to health care. The documents listed below are resources to articulate specific policy asks on the rural health issues you care most about. Use these materials as resources when talking to your state and federal leaders.

Advocacy Campaigns: Links to current NRHA Advocacy campaigns.

Not sure who your Congressional Representative is? Look it up here.