As my colleague Edwin Park has written, the House Budget Committee “menu” of Medicaid cuts includes rescinding regulations promulgated by the Biden Administration. Of particular interest to readers of SayAhhh!, the menu includes rescinding the Medicaid and CHIP eligibility and enrollment rule and the two companion rules on improving access to care in fee-for-service and managed care delivery systems. I’ve linked to the rules themselves and relevant summaries below, in case you need a refresher on what these rules did as the debate continues about whether they should be rescinded.
Medicaid Eligibility and Enrollment Rule.
This rule was finalized in two parts, September 2023 and March 2024, and once implemented, would make it much easier to apply for, enroll in, and renew Medicaid and CHIP coverage. The first part of the final rule included policies to make it easier for Medicare beneficiaries to enroll in what are known as Medicare Savings Programs – essentially Medicaid programs that make Medicare more comprehensive and/or more affordable for those who qualify. Justice in Aging summarized part one here. The second part of the rule included policies to make it easier for people with disabilities to enroll by aligning the rules for MAGI and non-MAGI groups, among other changes. Read the explainer on part two, written by my colleagues Tricia Brooks and Allie Gardner, here. Note that rescinding this rule would have a particularly harmful impact low-income seniors, people with disabilities and kids (especially those with family income near the Medicaid to CHIP transition), all of which have been overlooked in the public debate so far.
Medicaid Access Rule and Medicaid Managed Care Rule.
In May 2024 CMS finalized two companion regulations – the Medicaid Access Rule and the Medicaid Managed Care Rule. The access rule included policies to promote payment rate transparency and adequacy in fee-for-service, increased oversight of home- and community-based services, and greater beneficiary input at the state level. The managed care rule included parallel policies for managed care delivery systems, aiming to promote rate transparency and adequacy and improve quality of care. Both rules are summarized here, and we also wrote a blog series highlighting key provisions. Research shows that access to care in Medicaid is generally comparable to private insurance, but system-wide gaps to certain providers such as psychiatrists and dentists may be exacerbated for those with Medicaid coverage. Rescinding these rules would make any existing access challenges worse.
The House Budget Committee menu claims rescinding these three rules would cut federal spending by over $300 billion over ten years.