Medicaid

Experts say President Joe Biden could stop Medicaid programs from hemorrhaging beneficiaries once the public health emergency ends by reworking some regulations and rewriting a Trump administration guidance on how to restart the redetermination process -- otherwise some experts predict up to 30% of Medicaid beneficiaries could lose insurance.

The Biden administration's COVID-19 response strategy boosts funding for community health centers and offers more help to safety net providers and nursing homes, and it asks CMS to consider increasing its pay rate for vaccine administration and to take any steps necessary to promote coverage of safe and effective COVID-19 treatments and care.

The Biden administration is expected to fortify existing policies and increase funding to deal with social determinants of health.

CMS Administrator Seema Verma is resigning her post effective Jan. 20 – when President-elect Joe Biden assumes office, she announced in a tweet Friday (Jan. 15) that spurred comments from some Democrats and consumer advocates happy to see her go.

CMS Administrator Seema Verma touted as a possible national model the agency’s Friday (Jan. 8) approval of a wide-ranging Medicaid 1115 demonstration that was panned by 21 patient groups and was expected to be rescinded by the incoming Biden administration -- with Verma stressing the Trump CMS changed the state’s proposed financing mechanism for the demo and the waiver shouldn’t be considered a block grant.

Less than two weeks before the new Biden CMS takes over, current Administrator Seema Verma is quietly instituting new procedures that could make it more difficult for the new team to revoke the Trump administration’s controversial Medicaid 1115 demonstrations, including a new requirement that existing demos continue for at least nine additional months before being axed.

The Biden administration should immediately work to lower health care costs by quickly implementing the surprise billing compromise in the year-end legislation, extending financial assistance to struggling providers and working with Congress to incentivize states to expand Medicaid, the National Coalition on Healthcare says in a letter to the Biden transition team outlining its priorities.

CMS will delay for two years a policy of subtracting copay coupons and other patient financial assistance from prices used to determine how much Medicaid pays for drugs, according to the final Medicaid best price rule out Monday (Dec. 21).

Drug makers are largely unscathed by the year-end government spending bill because Congress instead used hospital surprise billing legislation to pay for coronavirus relief, but the legislative package does include proposals that were part of drug price transparency bills, including one to give congressional Medicare and Medicaid advisers data on closely guarded rebates.