Administration’s Medicaid Regulations Will Weaken Coverage, Harm States, and Strain Health Care System
End Notes
[1] For a detailed discussion of these Medicaid regulations, seeMedicaid: Overview and Impact of New Regulations," Kaiser Commission on Medicaid and the Uninsured, January 2008, http://www.kff.org/medicaid/upload/7739.pdf.
[2] In 2005, the Administration tried — and failed — to persuade Congress to restrict certain rehabilitative services as part of the Deficit Reduction Act in the same way that the Administration has now restricted these very same services. Testimony of Dennis Smith, Senate Committee on Finance, June 28, 2005, at http://www.senate.gov/~finance/hearings/testimony/2005test/DStest062805.pdf In that same year, the Administration’s budget included a legislative proposal that would have limited payments to public hospitals. Congress did not act on that proposal, and the Administration is now attempting to accomplish the same result through a regulation.
[3] For discussion of this interim final rule, see Judith Solomon, “New Medicaid Rules Would Limit Care for Children in Foster Care and People with Disabilities in Ways Congress Did Not Intend,” Center on Budget and Policy Priorities, revised, February 8, 2008, https://www.cbpp.org/12-21-07health.htm. The National Governors Association recently submitted comments to the Centers for Medicare and Medicaid Services to request that the agency consider revisions to make the interim final rule consistent with congressional intent. Letter from Raymond G. Scheppach, Executive Director, National Governors Association, to Kerry Weems, Acting Administrator, Centers for Medicare and Medicaid Services, February 4, 2008.
[4] OMB’s estimate of the federal savings that the regulations would produce are, for all regulations other than targeted case management and provider tax rules, taken from the President’s Fiscal Year 2009 Budget, Analytical Perspectives, Table 25-6, “Impact of Regulations, Expiring Authorizations, and Other Assumptions in the Baseline,” February 4, 2008. Estimated federal savings for the targeted case management and provider tax regulations are based on the cost estimates of these regulations that the Administration issued in 2007.
[5] According to the recently revised Congressional Budget Office budget baseline, the cumulative estimated savings from the regulations are approximately $17 billion over five years (FY 2009 – FY 2013). However, because CBO uses “probabilistic scoring” to reflect the possibility that some of these regulations may not, in fact be finalized and implemented, it has discounted the estimated savings derived from some of these regulations for purposes of its budget baseline. Without this discounting, CBO’s estimate of the savings that would result from implementation of all the regulations is $21.1 billion over five years. Congressional Budget Office, Medicare, Medicaid and SCHIP Administrative Actions Reflected in CBO’s Baseline, February 29, 2008, at: http://www.cbo.gov/budget/factsheets/2008b/medicaremedicaid.pdf.
[6] The Administration has also recently proposed a new regulation that overhauls administrative appeals, diminishing the likelihood of meaningful review while increasing Secretarial authority in an unprecedented way.
[7] The rules affecting school-based services and rehabilitative services have been delayed until June 30, 2008. Two of the regulations affecting payments to hospitals — the elimination of payments recognizing the costs of graduate medical education and the limits on payments to the costs of providing services — are delayed until May 25, 2008. (See the Appendix for more details.)
[8] See, for example, Maria Glod, “Area Schools Set to Lose Millions Under Medicaid Policy Changes,” The Washington Post, February 3, 2008.
[9] For more details about how Medicaid has contracted with schools for various administrative services and how the new regulation will disrupt this practice, see Judith Solomon and Donna Cohen Ross, “Administration Moves to Eviscerate Efforts to Enroll Uninsured Low-Income Children in Health Coverage Through the Schools: Bipartisan SCHIP Bill Would Temporarily Block Such Action,” Center on Budget and Policy Priorities, revised October 1, 2007, https://www.cbpp.org/9-17-07health.htm.
[10] United States Department of Health and Human Services,Ready to Learn: A Guide for State Agencies Doing School-Based Outreach for Medicaid and SCHIP," November 2000.
[11] See Judith Solomon, “Administration Moves to Withdraw Key Health Services from Children and Adults With Mental Illness and Other Disabilities,” Center on Budget and Policy Priorities, revised October 22, 2007, https://www.cbpp.org/9-25-07health.htm.
[12] A recent study by Families USA found that more than one third of the total cost of health care services provided to people without health insurance is paid out-of-pocket by the uninsured themselves. Of the remainder, roughly one-third is reimbursed by a number of government programs, and two-thirds is paid through higher premiums for people with health insurance. See Families USA, “Paying a Premium: The Added Cost of Care for the Uninsured,” June 2005, http://www.familiesusa.org/assets/pdfs/Paying_a_Premium731e.pdf.
[13] U.S. House of Representatives, Committee on Energy and Commerce, Subcommittee on Health, January 16, 2008.
[14] Under EPSDT, states are supposed to ensure that all children enrolled in Medicaid receive regular check-ups, including vision, dental, and hearing exams, as well as necessary immunizations and laboratory tests and follow-up testing and treatment. States are required to inform families about the availability of EPSDT services and to help them access health care services for their children.