Financing
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The End-of-Year COVID Relief Package: Medicaid and CHIP Highlights
After more than the usual end-of-session drama, the Consolidated Appropriations Act, 2021 (CAA) became law on December 27, 2020 (P.L. 116-260). The sprawling, 2,124-page opus includes not just badly needed COVID relief for millions of unemployed Americans but also funding for the entire federal government and protections against surprise medical bills for consumers with private…
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New CCF-Commonwealth Paper Examines How Block Grant Financing Severely Harmed Puerto Rico’s Medicaid Program
My new paper for the Commonwealth Fund analyzes how Puerto Rico’s Medicaid block grant financing contributed to Puerto Rico’s overall fiscal and debt crisis and resulted in a Medicaid program that is far less generous than what is provided in the states. Puerto Rico’s experience thus offers critical lessons to federal and state policymakers about…
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Congress Should Provide Additional Medicaid Funding and Also Block Medicaid Fiscal Accountability Rule
Despite the House passing the HEROES Act (H.R. 6800) in May, the Senate has not considered further major legislation to respond to the worsening COVID-19 health and economic crisis. But it is expected that Congress will finally act over the next two weeks. As I have explained, an additional, substantial increase in the federal Medicaid…
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As Expected, Medicaid Enrollment is Starting to Increase
As I keep saying, Medicaid is a first responder to the COVID-19 pandemic with respect to both the health crisis and the ensuing economic crisis. With unemployment rapidly rising to double digits, it was only a matter of time until Medicaid/CHIP started to see enrollment increases. Medicaid enrollment has long been closely aligned with the…
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House HEROES Act Would Also Further Raise CHIP Matching Rate
The temporary 6.2 percentage point increase in the federal Medicaid matching rate enacted as part of the Families First COVID-19 legislation (P.L. 116-127) benefited the Children’s Health Insurance Program (CHIP) as well. Because the formula used to calculate each state’s CHIP matching rate is based on the regular FMAP, the Families First FMAP increase resulted…
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CMS Should Withdraw Medicaid State Financing and Supplemental Payment Rule That Undercuts COVID-19 Relief Bill’s Enhanced Federal Medicaid Match
[Editor’s Note: On March 18, 2020 the Senate passed and the President signed into law the bipartisan Families First Coronavirus Response Act (H.R. 6201) after this blog was published.] Today (March 18, 2020), the Senate is expected to pass the House-passed coronavirus relief bill (H.R. 6201) and send it to the President’s desk. The bill…
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Medicaid and COVID-19
One of Medicaid’s many strengths is its ability to help states respond to public health epidemics. Through Medicaid, federal funds are available on an open-ended basis to match state costs of immunizing, testing, diagnosing, and treating over 71 million low-income Americans in the event of an outbreak of an infectious disease. Which is a good…
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Responding to Trump Administration’s Troubling Medicaid Financing and Supplemental Payment Rule
On November 18, 2019, the Trump Administration issued a proposed Medicaid “Fiscal Accountability” rule that seriously threatens to upend state budgets and reduce beneficiaries’ access to needed care. The proposed rule, if finalized, could thus harm Medicaid beneficiaries, including children and families, as well as their health care providers, in most states. As Cindy Mann…
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New Study Finds Medicaid Per Capita Caps and Block Grants Would Lead to Deep Cuts to Children’s Coverage and Access
Avalere Health issued a new study conducted for the Children’s Hospital Association, estimating how much a per capita cap or block grant could significantly cut federal Medicaid spending on children nationally and on a state-by-state basis, relative to current law. The study models the impact of four illustrative per capita caps and block grants. It…
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House Committee Advances Bill to Sustain Medicaid Programs in the Territories and Avoid Deep, Harmful Cuts
On July 11, by voice vote, the Health Subcommittee of the House Energy and Commerce Committee reported out essential legislation (H.R. 3631) to avert large federal Medicaid funding shortfalls the territories will face starting in 2020. Without additional federal funding the bill would provide, the territories would have no choice but to institute damaging cuts…
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Many Unanswered Questions about Trump Budget’s CHIP Financing Proposal
The Trump Administration’s fiscal year 2020 budget, released on March 11, includes a single legislative proposal (described here) related to the Children’s Health Insurance Program (CHIP). Entitled “Strengthen the CHIP Safety Net for States,” the proposal would eliminate the CHIP’s Child Enrollment Contingency Fund in fiscal year 2021 and replace it with a new Shortfall…
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Medicaid and State Budgets: Checking the Facts (Yet Again)
It’s that time of year again. Estimators publish their projections of Medicaid spending, journalists report on the projections, and policymakers decide whether and how they want to act. Medicaid covers up to 35 million low-income children, so getting these projections right, and explaining them correctly, is hugely important for public understanding of the program. Unfortunately,…
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What Does the Partial Government Shutdown Mean for Medicaid and CHIP?
A year ago, the entire federal government was shut down for three days over a dispute about DACA. My colleague Kelly Whitener explained the implications of that full shutdown for Medicaid and CHIP. We are now in the 14th day of a partial government shutdown over a dispute about funding for a border wall. Unlike the full…
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Medicaid at the Ballot Box: More Coverage or More Barriers? (Part 2)
I blogged earlier about which of the 17 non-expansion states might see a change in their status on the horizon post election. Today I take a look at states that already have expanded (yes, I count Maine as an expansion state despite Governor LePage’s best efforts to thwart the will of the people), where we…
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Clearing Up Confusion about the Impact of the CHIP Funding Rescission in Labor-HHS-Education Appropriations Conference Agreement
In June, the Senate rejected a Trump Administration proposal to rescind federal funding for a variety of programs including the Children’s Health Insurance Program (CHIP). At the time, we had raised significant concerns because the Administration’s rescission package would have eliminated $2 billion from CHIP’s Child Enrollment Contingency Fund. Those $2 billion in funds…
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Indexing Capital Gains Would Add to Deficit, Adversely Impact State Budgets and Imperil Medicaid Funding
Even though the Trump Administration almost certainly lacks the authority to do so, press reports indicate that the Administration is considering issuing a new regulation to provide another large tax cut for the wealthy. The regulation would index capital gains for inflation, substantially lowering the amounts that would be subject to taxation. As the Center…
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House Committee to Consider Expanding Health Savings Account Tax Breaks for High Income
Today, July 11, the full House Ways and Means Committee will begin consideration of multiple health-related tax bills, many of which would expand tax breaks for Health Savings Accounts (HSAs). These HSA bills would primarily benefit those with high incomes, rather than make health coverage more affordable for low- and moderate-income children and families. Health…
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New Conservative ACA Repeal Plan Would Likely Make Millions Uninsured
On June 19, a coalition of conservative think tanks unveiled a very brief outline of their plan to repeal the Affordable Care Act (ACA). Like similar 2017 repeal proposals from Senators Cassidy and Graham, the Health Care Choices Proposal would convert funding for the Medicaid expansion and marketplace subsidies into block grants for states. The…
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Federal Investment in Children: Why Capping Medicaid Would Make a Bad Situation Worse
Not that you needed another reason that capping federal Medicaid payments to states would be an unmitigated disaster for children and families. But since the proposal is alive and well in some quarters—notably the President’ FY 2019 Budget—it’s worth marshaling as many as possible. Here’s another one, from the Committee for a Responsible Federal Budget. The…
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HEALTHY KIDS and ACCESS Acts: Summary of Key Provisions Impacting Children
Introduction On January 22, 2018, Congress passed a Continuing Resolution (CR) that included the Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act (HEALTHY KIDS Act) funding the Children’s Health Insurance Program (CHIP) for six years.[note]See P.L. 115-120. The CHIP-related provisions are in “Division C – HEALTHY KIDS…
