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Volume 13 Number 51 News: Medicaid Reps. John D. Dingell (D-Mich.) and Tim Murphy (R-Pa.) March 13 introduced a bill (H.R. 5613) that would delay implementation of seven federal rules they say would reverse long-standing Medicaid policy and make significant cuts to the program. H.R. 5613, the proposed Protecting the Medicaid Safety Net Act of 2008, would delay the Centers for Medicare & Medicaid Services rules by enacting moratoriums or extending existing ones until April 1, 2009. "If the administration's proposed cuts move forward, those most in need will pay the highest price," Dingell, chairman of the House Energy and Commerce Committee, said in a statement. "The restrictions the administration is imposing on Medicaid are harmful and will undoubtedly put the health of thousands of our most vulnerable children at unnecessary, indefensible risk." Dingell and Murphy's release cited Congressional Budget Office estimates that nearly $20 billion in Medicaid funding is at stake over five years. However, a recent report by the House Committee on Oversight and Government Reform said states estimate they could lose up to $50 billion in federal payments over five years (No. 42 HCDR 3/4/08) a0b6d5h8t9 According to Dingell and Murphy, the seven rules in question would negatively affect the following: Medicaid payments to public providers; coverage of rehabilitation services for people with disabilities; outreach and enrollment in schools as well as specialized medical transportation to school for children covered by Medicaid; graduate medical education payments; coverage of hospital clinic services; case management services; state provider tax laws; and appeals filed through the Department of Health and Human Services.
CMS has said the regulations are meant to shore up the integrity of the federal-state Medicaid program by ensuring that federal funding is not being used to pay for services covered under other federal, state, or local programs and by ensuring that states are administering the programs in accordance with federal laws (No. 13 HCDR 1/22/08) a0b5r6y5y9 Many Stakeholders Critical of Rules
However, the rules, all issued in 2007, have been subject to sharp criticism from members of Congress, state Medicaid directors, hospitals, provider groups, and others who say they would undermine the nation's health care safety net.
For example, Dingell March 14 pointed to a report by First Focus, a children's health advocacy group, that says the rules would have a disproportionate impact on children with special health care needs, who have a high reliance on Medicaid as a primary source of coverage or as a supplement to private coverage.
Children with special needs include those with chronic physical, developmental, behavioral or emotional conditions and those who require health care beyond what children typically require, according to the report.
"This report is definitive proof that Congress can wait no longer to take immediate action to halt CMS' attempts to usurp Congressional authority through these regulatory changes to long-standing Medicaid policy. No child who is currently covered under [the State Children's Health Insurance Program] or Medicaid should lose their health coverage as a result of the administration's actions," Bruce Lesley, president of First Focus, said in a statement.
Also among the other groups protesting the rules is a coalition of hospital organizations that March 11 filed a lawsuit against CMS regarding the rules' effects on hospitals (No. 48 HCDR 3/12/08) a0b6e3y7z4.
In 2007, Congress enacted moratoriums for four of the seven regulations, but they all would expire by June 30, 2008.
Sens. Jeff Bingaman (D-N.M.) and Elizabeth Dole (R-N.C.) introduced legislation (S. 2460) in December 2007 to extend until May 25, 2009, a current moratorium on the public providers cost limit and the graduate medical education payment rules. The Senate bill also would expand the moratorium to include the outpatient services rule.
More information about H.R. 5613 is available. The First Focus report is available.
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