Cathy Hope: Good morning, everybody, and thank you for joining us. Today. I'm Kathy Hope. I'm the Communications Director for the Georgetown University Center for Children and families. The center is a nonpartisan research center based at the Mccourt school of public policy. And this year we're celebrating our 20th anniversary.
Cathy Hope: Today, we're releasing a report on the importance of Medicaid to maternal and infant health in small towns and rural areas.
Cathy Hope: First, st we'll hear from Joan Elker, the Executive Director of the Center for Children and Families.
Cathy Hope: and the lead author of this report.
Cathy Hope: Next we'll hear from 2 guest speakers, one from the headwaters of the Mississippi River in Minnesota, and one from the Delta in Louisiana.
Cathy Hope: Dr. Katie Bacas, Cozamano, Co-director of the Rural Health Research Center, and a professor in the Division of Health policy and management at the University of Minnesota.
Cathy Hope: School of Public Health, and Ryan Cross, Vice President of Government Affairs and Advocacy at Franciscan, Missionaries of Our Lady health system, which is a nonprofit Catholic health system serving patients in Louisiana and Mississippi.
Cathy Hope: Following the discussion about the report, we'll get an update on Medicaid changes pending in Congress from Edwin Park, a member of the research faculty here at Georgetown University Center for children and families.
Cathy Hope: Now I'll turn the call over to Joan Elker to walk us through the report findings Joan.
Joan Alker: Thanks so much, Kathy, and good morning, everybody, and thanks for our wonderful guest speakers joining us today. I want to start out by introducing and thanking my co-authors on this report, Aubriana Osorio, who's here if we get some questions and also Tanisha Modestin on our team, contributed to the report.
Joan Alker: I'm going to share the key findings of the report with you today. The latest, this is the latest in a series of research reports that we've been doing for many years now at Georgetown, looking at the role of Medicaid in rural America.
Joan Alker: And today's report focuses on new data that looks specifically at Medicaid's role as a primary coverage source for women of childbearing age between 19 through 44.
Joan Alker: To look at these data, we use the Census Bureau's American Community survey, and also just for awareness, rural areas and small towns are defined as those with central urban areas that have under 50,000 people. So we do have state by state data. But there are 3 States, New Jersey, Rhode Island, and the District of Columbia that don't have any rural areas under this designation. So you won't see them in the report.
Joan Alker: Now, why is it important to have Medicaid for these women? Well, it's absolutely critical for maternal and infant health
Joan Alker: that women have access to affordable comprehensive health care
Joan Alker: before, during and after they get pregnant throughout their reproductive years.
Joan Alker: Unfortunately, women in rural areas already face greater challenges in accessing care because of a shortage of providers. Also, as a consequence of rural hospital closures, and especially the loss of labor and delivery units and obstetrical capacity which we're going to hear about shortly from our other speakers. In fact, one study, and we're going to hear from this study's author. In a moment
Joan Alker: 52% of the rural hospitals that remain open no longer offer obstetrical care. So this is a real challenge for rural communities, and particularly in the face of very large cuts to Medicaid that Congress is contemplating right now.
Joan Alker: So let's turn to the findings. And 1 point to know right up front. I mentioned that we're using American community service community survey data
Joan Alker: that data does undercount Medicaid. So these estimates should be viewed as conservative, and they also should be viewed as a kind of a point in time, over the course of a year. A few years more women than these percentages indicate will be covered by Medicaid.
Joan Alker: So let's go to the 1st slide.
Joan Alker: So our 1st
Joan Alker: question was just to look at the ratio between Metro areas, small towns, and for children. When we did our most recent paper in January, children and non elderly adults in general.
Joan Alker: we found that these folks were more likely to be covered by Medicaid in rural areas and small towns. And indeed, that is true as well for women of childbearing age. And you see that here 23.3% in small towns and rural areas as compared to 20.5%.
Joan Alker: Now let's go to the next slide. Looking at state by state data, we see that there are about a little less than half the States that are higher than the national average, which, as we just saw, is 23.3%.
Joan Alker: And here you see the top 10 States, New Mexico and Louisiana right up there at the top, with 40% of women covered in rural areas, Kentucky, 35%, West Virginia, 32%, Arizona and Oregon at 31%
Joan Alker: next slide.
Joan Alker: Now here, we're looking at counties. The top 20 counties in the country, and we we're not able to get county by county data for every county in the country, just due to some small sample sizes.
Joan Alker: But these counties we can assume that roughly, about half of the women or more, are covered by Medicaid, and what you'll notice about these counties. There are 6 of these top 20 counties in Louisiana which Ryan can speak to.
Joan Alker: 5 are in New Mexico, and 3 are in Montana, and you'll notice that in both of my last 2 slides, and we can go to the next slide
Joan Alker: all of these counties and states that have the highest percentage of women of childbearing age are states that have adopted the affordable Care act Medicaid expansion. This map shows you which States have adopted the affordable Care Act medicaid expansion. So the Affordable Care Act Medicaid expansion has clearly had very important benefits for women of childbearing age in rural communities.
Joan Alker: and that's very important, because a lot of the cuts, although by no means all of the cuts Congress is considering, as we'll hear later from Edwin, do target this expansion population.
Joan Alker: So let's go to the next slide.
Joan Alker: So we've talked about how Medicaid is vital for women of childbearing age in rural communities and states that have expanded Medicaid. But in fact, Medicaid is vital
Joan Alker: for women of childbearing age in all states, and what this slide looks at is, while more women, as a raw number, are covered in states that have expanded Medicaid under the Aca, in states that have not expanded Medicaid under the Aca. And, as you saw on the map, primarily, those are states in the South, 10 States that still have not
Joan Alker: because of the eligibility rules. Women are a larger share. Almost 40% of the non elderly adults who are covered in those States so critical issues for them there as well.
Joan Alker: So that is my last slide. I will just say a couple of more things as we have this conversation today, Congress is moving very, very quickly to cut Medicaid by at least 625 billion dollars over a 10 year period. These proposed cuts will impact states that have picked up the A/C medicaid expansion like Louisiana, but also states that have not picked up the Medicaid expansion like Mississippi.
Joan Alker: So rural communities have much at stake in this debate that is happening right now in Congress. The loss of Medicaid revenue would put additional pressure on a very strained system.
Joan Alker: In general. Nearly half of all births in rural areas are covered by Medicaid, and less access to obstetrical care leads to worsen outcomes for both mom and baby.
Joan Alker: If we see more hospital closures and loss of labor and delivery units, all women
Joan Alker: living in rural areas are at risk of losing out on the care they need, regardless of who is their insurer. If that care is just not available, so these communities will not be able to grow and thrive without a robust system to support women and families, and I'm going to hand it back to Kathy. Hope.
Cathy Hope: Thank you, Joan. And now we're going to hear from our next speaker, Dr. Katie Bacchus Cozymano. And if you need pronunciation, help any of you broadcast journalists out there. She has it on her bio, which is in our chat.
Katy B. Kozhimannil: Thank you, Kathy. Good morning. Thank you for the opportunity to be with you today and to comment on these important findings. I'm Katie Bacchuscazimanal Professor at the University of Minnesota School of Public Health and Co-director of the University of Minnesota Rural Health Research Center.
Katy B. Kozhimannil: It's our mission to conduct policy relevant research to improve the lives of rural residents and families, to advance population health, and to enhance the vitality of rural communities.
Katy B. Kozhimannil: I also lead our rural maternity care team. And we've been leading research on access to and quality of care for pregnant rural residents and rural families. For more than a decade
Katy B. Kozhimannil: one of the areas of focus of our work came from very good questions that rural residents themselves asked.
Katy B. Kozhimannil: Grandmothers in rural Alabama noticed that hospitals were closing their obstetric units nearby, and their daughters could not give birth locally, and had to travel long distances for prenatal care and for labor and delivery. They wondered if this was happening in other rural communities as well, and whether there were effects of these closures on the health of their daughters and their grandbabies.
Katy B. Kozhimannil: It turns out. Our research showed that these grandmothers were right. Hospital-based obstetric care has been steadily declining in rural communities, and the declines that we measured were steepest in States with the most restrictive Medicaid eligibility, criteria
Katy B. Kozhimannil: Medicaid really matters for rural maternity care access. And as our work has continued, we've begun to learn more about the role that Medicaid plays.
Katy B. Kozhimannil: The data we see today from Georgetown provides clear evidence of the importance of State Medicaid programs for reproductive age. Women in both rural and urban communities where you saw 23, and 20% respectively are insured by Medicaid.
Katy B. Kozhimannil: These numbers are higher during pregnancy, and Medicaid is an essential source of financing for childbirth services, paying for 47% of all births in rural hospitals. And in some communities, as we saw, this is much higher.
Katy B. Kozhimannil: Medicaid is extremely important throughout rural America, for families, clinicians, healthcare systems, and the communities that these people and places are located in
Katy B. Kozhimannil: changes in Medicaid programs that happen at either State or Federal levels have disproportionate impacts on reproductive age. Women, mothers and families in rural areas, and the statistics reported today help tell us why this is the case.
Katy B. Kozhimannil: My team's recent research on closures and hospital labor and delivery units provide one clear example of how Medicaid policies can affect rural hospital decisions and local access to care.
Katy B. Kozhimannil: In 2010, 43% of rural hospitals and 29% of urban hospitals did not offer obstetric care
Katy B. Kozhimannil: between 2010 and 2022, there were 537 hospitals that lost obstetrics that closed their units. As Dr. Elker noted our research shows that by 2022, 52.4% of rural hospitals did not offer obstetric care
Katy B. Kozhimannil: more than a decade into a maternal health crisis. In this country fewer and fewer. Us. Hospitals provide obstetrics every year with rural hospitals, experiencing the greatest losses.
Katy B. Kozhimannil: I do want to note that we have forthcoming research on differences across states in hospital obstetric unit closures during this time period, and it will be important to examine these closure data in the context of medicaid coverage and the data released today. Looking at higher coverage rates among reproductive age women in some states versus others.
Katy B. Kozhimannil: Let's connect medicaid policy back with rural obstetric care, access. So with hospital labor and delivery closures, the question is often, why
Katy B. Kozhimannil: offering obstetric care is a financial challenge for hospitals, as frequently revenues do not cover expenditures. Medicaid covers over 40% of births nationally, and a higher percentage of births in rural areas.
Katy B. Kozhimannil: Now, the financial puzzle for healthcare delivery systems that need that want to offer an obstetric service line is a challenge. Obstetrics has high fixed costs requiring dedicated space equipment and trained staff that are available to support labor and delivery 24 HA day, 7 days a week.
Katy B. Kozhimannil: The revenues to cover these fixed costs are variable, and depend on the volume of births at each hospital, which disadvantages lower birth, volume facilities.
Katy B. Kozhimannil: and the reimbursement rate for each birth. That is another factor that leads into revenues. This disadvantages facilities that serve a high proportion of patients that are uninsured or without health insurance, or those that are insured by Medicaid, which generally pays less than private health plans for childbirth care. So these dynamics all lead into hospitals, decisions about their obstetric service lines.
Katy B. Kozhimannil: the effects on rural communities of a hospital closing its labor and delivery unit, or closing altogether, cannot be overstated. Every person and family in a community is affected by the loss of birth in that community it can change the way a community sees itself when it's a place where babies can no longer be born.
Katy B. Kozhimannil: This also presents a challenge for economic vitality and recruitment of skilled labor, attracting and sustaining businesses, schools, and other investments.
Katy B. Kozhimannil: while the influence of Medicaid policy may begin at birth, or even before the effects of changes in Medicaid are felt across the life course in rural communities and in communities across the country. Many policy changes that are currently being considered from work requirements to financing changes, to immigrant coverage, to administrative re-enrollment.
Katy B. Kozhimannil: They require attention to 2 key issues that are highlighted in the Georgetown reports, first, st effects on reproductive age, women, including pregnant rural residents, mothers, and families, who have higher risks of maternal morbidity and mortality, and diminishing access to care.
Katy B. Kozhimannil: We need to pay attention to how Medicaid is related to those things. With each rural hospital that closes its obstetric unit. The closest one gets further and further away, and with that come risks for some of the folks that are already at the highest risks of maternal morbidity and mortality.
Katy B. Kozhimannil: Secondly, we want to look at the effects of changes in Medicaid policies on rural communities, and considering
Katy B. Kozhimannil: a term that's often used is called rural proofing. Our policies, so thinking specifically as policies are proposed about how they will affect rural communities differently from urban areas just because of infrastructure, population, density, and other geographic and other features.
Katy B. Kozhimannil: The rural communities are already suffering worse health outcomes and struggling to access care. So this is especially important. Right now, these data provide an important input to the current policy discussion on next steps for Medicaid, and I hope they provide data that can help us avoid unintended consequences of sweeping policies which often fall heaviest on residents of rural communities.
Katy B. Kozhimannil: Thank you for the chance to speak with you today, and I will pass the mic back to my colleagues.
Cathy Hope: Thank you very, very much, Dr. Cazamano, and now we'd like to turn it over to Ryan Cross with the Franciscan missionaries of Our Lady health System. Ryan.
Ryan Cross: Thanks so much, and thanks for having me. We're so glad to be here. Represent Fmol, where we serve families across Louisiana and in Jackson, Mississippi. You know Becker's article recently noted that from 2010 to 2022 there were 238 rural hospitals that closed their ob units.
Ryan Cross: while only 26 new hospitals open new units, and as we look across the landscape here in my home state, at at the fragile nature of our rural hospital safety net that
Ryan Cross: we couldn't feel that more as we rely on vital Medicaid funding and on the dollars that are provided for Medicaid expansion to protect and take care of those vulnerable families in our communities, those that are going to work that can't afford commercial insurance, those that are pregnant mothers, children, and as I go through, we're going to look at 3 of the markets where we serve primarily in some of these parishes that are mentioned in the in the Georgetown report
Ryan Cross: and the vital services that they provide. Pregnant women and their children and their newborn babies are so vitally important. Louisiana struggles with maternal morbidity and timely affordable access to care
Ryan Cross: is critical. But it's also more than just the access to cares. The wraparound services that we provide. We've been working with Congresswoman Letlow on the newborn essential Support Toolkit Act, the Nest Act that was introduced last year, knowing that the cost of a baby in the 1st year is $15,000. And how are we going to help that new mom
Ryan Cross: provide the services she needs to her child when she goes home? In additionally, in addition, nearly one in 5 women, regardless of age, income, or race, are going to suffer from maternal mental health conditions.
Ryan Cross: And so the stress of a newborn baby. The financial issues, the life transition are all contributing factors to those mental health complications. And how are we playing a role in having the ability to provide those services and access to care, and that all comes back to the Medicaid dollar that all comes back to the conversations that we've been having in Washington over the last several months about financing and about public policy that has a direct impact on our patients lives
Ryan Cross: as noted, 40% of the women in Louisiana that are childbearing age are on Medicaid, and as I go through some of these numbers from our facilities, you'll see that our patient population is even higher. St. Francis Medical Center is in Monroe, Louisiana, for those of you, not from here. It's in the northeast corner of the State, and 4 of the parishes that are listed in the report fall within our primary service area. East Carroll, Concordia, Tensaw, and Madison Parish.
Ryan Cross: all fall within those highest rates of having those women of childbearing age on the Medicaid program
Ryan Cross: within an hour and a half to the east and 2 h to the west. Our facility is the only facility that provides a level. 3. Nicu level, 3. Obstetrics level 2. Pick you and an obstetrics emergency room.
Ryan Cross: There is no other access to that high level of care in that community.
Ryan Cross: All of these areas serve our 12 parish region for labor and delivery. Nicu picu Obed, and our patient mix, there is 70% Medicaid.
Ryan Cross: We'll get down to some of the impacts if we see funding changes and what that would do to a hospital like St. Francis, or like Our Lady of Lourdes in Lafayette, the only specialized hospital for women and children in Louisiana where there's 1 61 beds, 51 of which are neonatal, intensive care beds that receive transfers from 22 different hospitals across South Louisiana.
Ryan Cross: 56% of the deliveries in that hospital are Medicaid. Both of those hospitals also recently opened healthy moms clinics where there's an ob-gyn and an Np. And nurse practitioner focused on access to prenatal care to meet the needs of our vulnerable moms and babies, seeking to improve those outcomes and those healthy deliveries by starting to deliver access to care in an affordable
Ryan Cross: way earlier on in the pregnancy.
Ryan Cross: Those healthy moms clinics are so vitally important and rely on funding. Those are kind of the additional services that we're able to provide when funding is stable and secure.
Ryan Cross: and then we'll go down to Our Lady of the Angels in Bogalusa, Louisiana. It's a parish that I was surprised to not see on the report as far as the number of women of childbearing age. It's Washington Parish, is.
Ryan Cross: It's a very rural community in Louisiana. Without Our Lady of the Angels, a mom going to deliver her child would have to drive upwards of 45 min either direction to find an obstetrics, a hospital that provides obstetrics, a hospital that can deliver her baby in an emergency.
Ryan Cross: It's 45. The entire payer mix of that hospital is 45% Medicaid. The other 40% is Medicare. It's 85% government payer hospital in a rural community where it's the largest employer. It is the backbone of that community in Bogalusa, and it provides lifesaving care every single day to the women and children in that parish that need it.
Ryan Cross: And without that hospital. We don't know what the future of Bogosa would look like. We don't know what would happen to the jobs at the paper mill that has supported families there for decades upon decades. And this is a hospital that
Ryan Cross: doesn't drive a profit margin. We hope that it supports itself, and we're able to support it from some of our services in places like Baton Rouge, because it's such a vital lifeline to the people of Washington Parish, and if we see some of these changes to the Medicaid program that have been discussed.
Ryan Cross: That puts those funding at risk. It's going to be a struggle to keep hospitals like Our Lady of the Angels open. It's going to be a struggle to invest in the 55 million dollars we're looking at investing in the women's and children's facility in Lafayette over the next 2 years. It's gonna be struggle to make those investments. If funding is uncertain and unstable changes to the F map block grants per capita caps, limiting directed payment programs and financing tools
Ryan Cross: can cause significant harm in the communities of Monroe, Bogalusa, and other small towns and rural communities across the State of Louisiana.
Ryan Cross: We can all agree that if Medicaid and Medicare, for that matter, were to reimburse providers at an appropriate rate, or well above what was necessary. We would be having a very different conversation with Washington right now.
Ryan Cross: but they don't. Every dollar is critical to maintaining these services and being able to reinvest into the community, not for market share, but to meet community need and to save lives. So we continue our dialogue with leadership with the White House with the Senate on how this text is going to continue to evolve. I know that we're going to get into Edwin's going to get into some of the details of the text that was released. And we're happy to talk.
Ryan Cross: Talk a little politics in the Q. And a. But I hope that, being able to talk through this information kind of just exposes some communities in a state like Louisiana that rely on this funding and the services that we're able to provide.
Ryan Cross: And you can see the downstream impact, not to a financial statement, but to the patients that we are privileged to serve across Louisiana. And with that, Kathy, I'll turn it back over to you.
Cathy Hope: Thank you so much, Ryan, and thank you, Katie, that really drove home. What we're really talking about in this report and
Cathy Hope: making no place of you know a place where babies can no longer be born. I think that is a very
Cathy Hope: poetic way to frame what we're talking about here. And so now we would like to open this up to questions from reporters that have registered in advance, and you can raise your hand if you have a question it looks like.
Cathy Hope: do we have any questions yet? Yulia?
Center for Children and Families Georgetown University: There is a question in Q&A.
Cathy Hope: Oh, okay, there we go.
Cathy Hope: Do you want to? Can you read the question from the Q. And A.
Joan Alker: I can read it. The question. And I think it's for you, Ryan, is what would happen in Louisiana if you had another catastrophic weather event, and people need help.
Ryan Cross: Look, that's a that's a great question. We are hurricane prone here in South Louisiana, communities like Bogalusa, Baton Rouge. Obviously our healthcare safety net down in New Orleans, and people forget that health care is also
Ryan Cross: homeland security. It's national security. It's a critical service when it comes to times of disaster, whether that's natural or manmade, and being able to have infrastructure in place to provide care not only to those that are most vulnerable in our community, but all of our community all goes back to being able to protect vital funding sources like Medicaid, like Medicare, to ensure that the communities
Ryan Cross: care and the safety nets there for everybody. Because when Medicaid funding gets cut it's not just Medicaid patients that it impacts. It impacts whether you have a Blue Cross plan, a united plan. It doesn't matter. The type of insurance you have. You will feel the negative effects as service lines and facilities are impacted that commercially insured patient in Bogalusa. If Our Lady of the Angels is forced to close because we suffer a massive cut to Medicaid.
Ryan Cross: that commercially insured patient's gonna have to drive just as far to get their care, and then, when seconds matter, we want the hospital to be really close.
Cathy Hope: Thank you. So we have another question in the queue. This pertains more to what we're going to be talking about. Once Edwin gives us a brief on what's happening.
Cathy Hope: on on Capitol Hill right now, which is very timely. Is there anybody else that has a question about the actual findings of the report and the importance of Medicaid to women of childbearing age.
Cathy Hope: Okay, we have. Someone has their hand raised.
Cathy Hope: Nope.
Cathy Hope: Oh, Christine Sexton has her hand raised. Can Yulia, can you bring her up.
Christine Sexton: I'm sorry I didn't have a question. I I want to lower my hand.
Cathy Hope: Oh, okay.
Christine Sexton: I apologize.
Cathy Hope: Okay.
Cathy Hope: alright, and I won't.
Joan Alker: You. Why don't we just take this question for Ryan in the chat, and then we'll go to Edwin. So the next question for you, Ryan is. Thank you, Ryan. Your message is important to share for those of us. Not in the rooms you're in. Can you tell us what feedback you're getting in your discussions with Congress. Anything you can share.
Ryan Cross: Look, we've
Ryan Cross: we're fortunate in Louisiana to have both the Speaker, the the majority leader, and to have folks like Congresswoman Julia Letlow, who are incredible supporters of of the health care that we deliver to rural communities across Louisiana.
Ryan Cross: And what I'll say from the Louisiana delegation is that they understand the importance of the Medicaid program to the patients that that are in their communities. I was with the speaker just a couple of weeks ago, and off the top of his head, he was able to rattle off the numbers in his community of the folks that rely on Medicaid
Ryan Cross: for care. Obviously, Speaker Johnson has a very difficult job today in navigating the dynamics in Washington, and we continue to talk with all of the staff of the delegation to ensure that the policy implications or the impacts of the policies that they're pursuing will not.
Ryan Cross: will will not disproportionately harm those rural healthcare deliveries in Louisiana, and the folks that are mentioned in this report, and so that those conversations are ongoing. I think Edwin's going to get into a little bit more of those details.
Cathy Hope: Okay, I I think we should give Edwin, you know, 5 min to give us an update on what's been happening in energy and Commerce Committee over the past 48 h. Edwin.
Edwin Park: Thanks, Kathy. So on Sunday the House Energy and Commerce Committee unveiled its section of the Budget Reconciliation Bill, which includes provisions related to Medicaid. There was a 26 and a half hour markup in the energy and commerce that completed yesterday afternoon.
Edwin Park: That included both medic changes to Medicaid as well as changes to the Aca's marketplaces. There are
Edwin Park: incomplete preliminary estimates from the Congressional Budget Office, but the top lines are that the Medicaid provisions in the Energy and Commerce Committee, which passed on a party line vote would cut net Medicaid, spending by at least 625 billion dollars over 10 years
Edwin Park: Medicaid enrollment would fall by about 10 million, and the number of uninsured as a result of these provisions would increase by 7.6 million.
Edwin Park: Timing is expected to be the House Rules Committee. Maybe as early as the end of this week. I'm Sorry House Budget Committee would collect all the different committee bills and put it together in a single Budget Reconciliation Bill, with the intent from the Speaker to try to get it to the House floor next week.
Edwin Park: and then on to the Senate after that, so I'll just quickly summarize
Edwin Park: the Medicaid provisions. I won't cover all of them only a couple minutes, but I'll
Edwin Park: say that there are probably 3 sort of buckets of Medicaid cuts that were included in what was reported out of the House Budget House, Energy Commerce Committee in its version of the Budget Reconciliation Bill, one. Provisions targeting the Medicaid expansion while not including explicit cuts to the Federal Medicaid matching rate for the expansion or imposing a per capita cap. There are a number of provisions intended to reduce enrollment among those
Edwin Park: who are enrolled in the Medicaid expansion today.
Edwin Park: the most notable would be a mandatory work requirement in all States applying to Medicaid expansion enrollees. It was actually a more extensive harsher proposal than was proposed in 2023 by then, Speaker Mccarthy. It's extended up to age 64. For example, people have to satisfy the work. Requirement
Edwin Park: upon application with States. Given the flexibility to look back multiple months potentially even more than a year back or more, to see if people could satisfy the work requirement or qualify for an exemption
Edwin Park: and, unlike a requirement that states try to automate verification of work.
Edwin Park: There is no requirement that States have to automatically institute the exemptions that are included in the work requirement provisions in addition as quickly. There are
Edwin Park: separate proposals to require all states that have the Medicaid expansion to conduct redeterminations more frequently where they're checking for eligibility, for renewal. So it would be every 6 months instead of 12 months.
Edwin Park: as well as requirement, that all States for expansion rollies above the Poverty Line Institute mandatory cost, sharing with that cost sharing charges for most services as high as $35. The second bucket is related to State financing of their share of the cost of Medicaid programs.
Edwin Park: There is a provision that prohibits
Edwin Park: starting with enactment of this Budget Reconciliation Bill. If it is enacted into law States would no longer be able to add any new provider taxes or to increase existing provider taxes. These are taxes on hospitals, nursing homes, other health care providers
Edwin Park: to raise revenues to finance States share the cost of the Medicaid program. As Medicaid is a Federal State partnership where states have to contribute a portion of the cost. So no new taxes, no increases in taxes, so that would really limit the ability of States to identify sufficient revenues to not only make improvements to the Medicaid program over time, but also sustain existing Medicaid programs. Over the long run
Edwin Park: there are a separate provision that actually restricts some existing provider taxes which States use to finance Medicaid today in certain types of taxes, it's highly technical. But in those States that have taxes that could be subject to this new prohibition. Upon date of enactment they would
Edwin Park: lose access to the revenues associated with that provider tax, and there's a possibility that they can't even fix the provider taxes to come into compliance, because that might involve increasing the rate or replacing that tax with another provider tax, because that would be prohibited by
Edwin Park: that moratorium on any new taxes. The last bucket
Edwin Park: quickly involves changes to eligibility, enrollment, imposing other red tape beyond work requirements on a number of different populations in Medicaid, including rescinding a rule finalized in the Biden Administration that makes it easier for people to apply for enroll in and renew their coverage, particularly among children, seniors, and people with disabilities.
Edwin Park: provisions related to limiting retroactive coverage, where people can get their medical costs picked up for up to 90 days before they apply for Medicaid. And that's particularly important for those who have sudden long-term care needs or sudden
Edwin Park: healthcare needs such as hospitalization due to an accident a stroke, something else, where they will take some time, they and their families to be able to apply for Medicaid, gather the necessary information, but this ensures that the services that they do incur are picked up by Medicaid, and they don't take on medical debt
Edwin Park: as well as other provisions related to those who can't immediately be verified by some of the automated systems related to citizenship and verifying immigration status. So all that together is why the
Edwin Park: Congressional Budget Office finds a significant reduction in medicaid enrollment relative to current projections as well as a sizable increase in the number of uninsured compared to expected levels of insurance coverage from the Congressional Budget Office.
Edwin Park: So with that I will stop and turn it back over to Kathy.
Cathy Hope: Thank you, Edwin. You packed a lot in there, and for our listeners, Edwin is a frequent blogger on the Georgetown University Center for children and families say, health policy blog where other researchers at our center also unpack what's happening in the health policy world. And we have quite a bit of content coming out so you can check that out if you need to learn more about what Edwin just covered.
Cathy Hope: So I don't see any questions in the chat yet if you have any questions from the media, please
Cathy Hope: go ahead and put them in the Q. And a.
Cathy Hope: And if we don't have any other media questions. I think. What?
Cathy Hope: We should go ahead, Joan, and turn it over to you to make some closing remarks.
Joan Alker: Yeah, I just want to thank everybody for joining us. You can see this data on our website, which is Ccfgeorgetownedu for those of you who are not familiar with that, and we will continue to keep folks updated on what Congress is doing, and appreciate your interest and have a good rest of your day.