Earlier I wrote about progress in the Senate on the Medicare Sustainable Growth Rate (SGR) repeal, or “doc fix,” which passed the Finance committee with the Medicaid extenders intact.  Since time was running out for the House and Senate to agree on the exact terms for a permanent SGR fix, the Murray-Ryan budget agreement on its way to President Obama’s desk includes a three-month SGR patch, including two Medicaid extenders (starting on page 34 for those of you interested in some light holiday reading). This means we’ll revisit the the permanent SGR/extender conversation in the first quarter of next year.  Among the important measures extended a few months beyond their New Year’s Eve expiration: Transitional Medical Assistance (TMA)(Section 1202) and Family-to-Family Health Information Centers ($2.5 million until April, Section 1203).  (Never fear, Express Lane Eligibility (ELE) advocates! Since ELE does not expire until September, it was not addressed in the budget deal, but expect talk of its extension to re-emerge in the next phase of the SGR discussion as well!)

One more notable item that will be of interest to states still in Medicaid expansion talks: The deal delays cuts in Medicaid Disproportionate Share Hospital (DSH) funds to 2016, increasing the overall cuts and extending the timeline an additional year to 2023 (Section 1204). Medicaid DSH funds support hospitals that serve a large share of uninsured Americans. The ACA’s DSH reductions, originally planned to begin in 2014, were intended to be replaced with Medicaid expansion dollars for newly-eligible adults, a provision that was made more complicated by the Supreme Court’s decision to, in effect, make the Medicaid expansion a state option. In states that have not yet taken up the Medicaid expansion, delay in DSH cuts could remove some urgency in the push to reach more low-income, uninsured adults.

We’ll continue to keep an eye on Medicaid extenders in 2014.