Medicaid

As 2019 opens with a divided Congress and a partially closed federal government, the debates about what Medicaid should cover and who it should be for show no signs of letting up.

CMS’ Medicaid chief, an outspoken critic of Medicaid expansion, is leaving the agency after less than three months on the job.

Medicare beneficiaries start 2019 with a new Medicare Advantage open enrollment period, lobbyists and stakeholders continue to pore over the administration’s revamp of the Accountable Care Organization program unveiled late in December and others are waiting on interoperability and electronic health records rules that at the start the new year are still under White House Review.

The judge overseeing a challenge to CMS’ approval of Medicaid work requirements in Arkansas agreed to give the federal government more time to respond to the challengers’ legal arguments due to the partial government shutdown.

CMS Administrator Seema Verma said on Twitter that “Christmas came early” for Michigan and Maine as the agency announced Friday (Dec. 21) that it has approved Medicaid work requirements in those states.

The White House Office of Management and Budget is reviewing a CMS request to rescind a rule, proposed in March, that would exempt states with at least 85 percent of their Medicaid population in managed care from certain fee-for-service access monitoring requirements and allow for certain “nominal” pay cuts to be exempt from access analyses requirements.

Sen. Cory Booker (D-NJ) will introduce a bill this week that would require drug manufacturers to report perks given to pharmacists and others who serve on boards that determine which drugs end up on states’ Medicaid preferred drug lists, National Public Radio first reported Monday (Dec. 17).

The White House cheered the Texas federal district court's decision late Friday to toss out the entire Affordable Care Act along with the individual mandate as Democrats and key healthcare stakeholders blasted the ruling, but all parties noted the law will remain in effect pending appeal. California Attorney General Xavier Becerra immediately announced he would appeal Judge Reed O'Conner's sweeping ruling.

The Medicaid and CHIP Payment and Access Commission discussed recommending that Congress or CMS create “safe harbors” for the Medicaid best price rule to allow states to experiment with new payment models for high-cost prescription drugs.