Medicaid

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8) approval of a wide-ranging Medicaid 1115 demonstration that was panned by 21 patient groups and was expected to be rescinded by the incoming Biden administration -- with Verma stressing the Trump CMS changed the state’s proposed financing mechanism for the demo and the waiver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.

Health care policy experts and beneficiary advocates are circulating briefs and roadmaps laying out ideas on how President-elect Joe Biden could achieve his health policy agenda through regulatory actions if the Senate stays in GOP hands.

Policymakers could help drive down Affordable Care Act premiums by letting smaller, mission-driven Medicaid managed care insurers sell exchange plans to a limited number of enrollees at first and then expand as capital allows, says the lobby that represents safety net plans.

The health insurance industry says that with COVID-19 surging and unemployment still twice as high as before the pandemic, the 116th Congress must act quickly with timely, targeted and temporary relief solutions, which include strengthening Medicaid and helping people to keep and afford their private coverage in addition to providing more funding for testing and vaccine distribution.