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Tags Posts tagged with "Medicare"

Medicare

The Senate today approved the “Big Beautiful Bill” with the collateral impact of taking away health care from hundreds of thousands of Pennsylvanians. The bill will now return to the House for a final vote before it goes to the President’s desk for signature and approval. The House is expected to act quickly.

The Senate bill makes even more drastic cuts to health coverage than the House version, totaling over $1 trillion, including Medicaid. Millions of Americans will lose access to health care; specifically, these cuts will take away health care from more than 600,000 Pennsylvanians and could double health insurance premiums for many more. In addition, the bill adds trillions to the growing Federal deficit by way of sizable tax cuts.

This will deeply impact our most vulnerable individuals and families that our members serve in the Commonwealth. We must act now to save access to health care. Find your legislator and their contact information here to let them know that you do not support the passage of the “Big Beautiful Bill.”

Capitol hill building in the morning with colorful cloud , Washington DC.

The Trump Administration’s “Big Beautiful Bill” was passed by House Republicans on May 22 and contains significant Medicaid cuts that could leave millions of Americans without coverage as well as severely reduce access to care. The proposed bill also includes cuts to Medicare funding, new restrictions on federal loans for medical students, and provisions to create a permanent, inflation-based mechanism for annual updates to Medicare physician payments. The legislation now heads to the Senate, where it will face further debate by lawmakers.

The proposed legislation seeks to accomplish the following:

Medicaid: 

  • The bill introduces a two-year acceleration of Medicaid work requirements for able-bodied adults ages 18 to 64, which is slated to take effect no later than December 31, 2026, instead of 2029. States have the ability to implement these requirements earlier to secure quicker savings.
  • Beginning October 21, 2027, states will be mandated to determine Medicaid eligibility every six months for people in the expansion population.
  • Medicaid and CHIP federal financial participation is prohibited under the bill revisions for people who fail to verify immigration status, citizenship, or nationality in the designated “reasonable opportunity” window.
  • States will also be required to cross-check their Death Master File quarterly to confirm deceased individuals are disenrolled. Should errors occur, there will be reinstatement provisions.
  • The Social Security Act is amended to cut retroactive Medicaid coverage from three months to one month before the application date.
  • Federal Medicaid and CHIP funding is prohibited for “specific gender transition procedures” provided to people under 18 years of age.
  • Eligibility for increased federal medical assistance percentage for states that are newly expanding Medicaid will be wound down. To qualify, states must start expansion by January 1, 2026, to restrict late expansion states from receiving an elevated match rate.
  • New rules for waiving the uniform tax requirement for Medicaid provider taxes will be imposed, which tightens conditions for states to use the financial tools.

Medicare:

  • A proposed staffing mandate is halted under the bill for long-term care facilities that receive Medicaid and Medicare funds.
  • The bill promotes the use of artificial intelligence to recover and reduce improper Medicare payments.
  • A May 20 report from the nonpartisan Congressional Budget Office found that the bill could cut nearly $500 billion over the next decade in Medicare funding.
  • The budget bill includes provisions to increase Medicare physician payments by an estimated 2.25% in 2026. This would be achieved by tying payments to 75% of the Medicare Economic Index. Starting in 2027, annual payments would be adjusted by 10% of the index, establishing a permanent, inflation-based update mechanism.
  • Under current law, physician pay is set to increase by just 0.25% in 2026 and 2.5% by 2035. The proposed changes would boost payments to 4.3% by 2035 instead. Physician groups, including the American Medical Association, strongly support the provision, calling it a critical step toward restoring stability after years of payment cuts.
  • The bill also adjusts the Medicare Physician Fee Schedule’s conversion factor, a key formula used to calculate final physician reimbursement. While the legislation introduces inflation-based updates, changes to the conversion factor could offset those increases and slow long-term payment growth. Physician groups have welcomed the update mechanism as a step in the right direction, though they say further reforms are needed to ensure physician payments fully reflect inflation and keep pace with rising practice costs over time.

CMS:

Outside of Congress, the Center for Medicaid Services (CMS) has also made announcements that could threaten access to healthcare:

  • On May 27, CMS announced increased federal oversight to prevent states from using federal Medicaid dollars to cover healthcare for undocumented immigrants for anything beyond emergency services, which violates federal law.
  • CMS outlined plans to increase audits of state Medicaid spending, eligibility systems, and financial controls, with recoupment of funds if misuse is found.

Please contact Emma Sharp with any questions.

The Centers for Medicare and Medicaid Services (CMS) recently released their CMS Fast Facts resource document for 2022 – 2025. The document includes summary information on Medicare and Medicaid total program enrollment, utilization, and expenditures, as well as the total number of Medicare providers, including physicians by specialty area.

There are a number of new items provided in 2025:

  • Medicare Populations, Calendar Year (CY) 2024
  • Medicaid & Children’s Health Insurance Program (CHIP) Populations, CY 2024
  • Medicare Deductibles, Coinsurance, Premiums, CY 2025
  • Original Medicare Persons Served and Payments by Type of Service, CY 2023
  • Medicare Part D Utilization and Expenditures, CY 2023
  • Medicaid & CHIP Payments by Type of Service, FY 2023
  • Medicare Institutional Providers, CY 2023
  • Medicare Non-Institutional Providers by Specialty, CY 2023
  • Medicare Durable Medical Equipment Prosthetics, Orthotics & Supplies (DMEPOS) Providers by Specialty, CY 2023
  • Medicare Prepaid Contracts, February 2025
  • National Health Expenditures, CY 2023
  • CMS Financial Data, FY 2024

Help shape the future of healthcare technology for Medicare beneficiaries. Register now for an upcoming Question and Answer session with The Centers for Medicare & Medicaid Services (CMS).

Date: Tuesday, May 20, 2025
Time: 1:00 pm EST
Location: Virtual via Zoom (link will be provided following registration)
Who Should Attend:
Technology developers, patients, caregivers, providers, payers, and other healthcare stakeholders.

Event Description:
Help create modern digital technologies to empower seniors to manage their health journey. We want YOUR ideas. Please join us for a Q&A session on the recent CMS Request for Information (RFI) on Improving Technology to Empower Medicare Beneficiaries. The session will also review how to submit responses to the RFI.

The CMS Office of the Administrator team will be present to hear your valuable input as we shape the future for Medicare beneficiaries. Our panel includes:

  • Stephanie Carlton, Chief of Staff and Deputy Administrator;
  • Amy Gleason, Strategic Advisor to HHS/CMS & Acting Administrator, U.S. DOGE Service;
  • Arda Kara, Senior Advisor for Technology; and
  • Alberto Colon Viera, Senior Advisor for Technology.

Why Attend:
Your insights will directly contribute to improving technology solutions for Medicare beneficiaries. This is your opportunity to help shape the future of Medicare.

Register Here

Note: Space is limited. Please register early to secure your spot. Official comment should be made in the Federal Register by June 16.

The PA Developmental Disabilities Council (PADCC) has shared their 2024 Impact Report, which you can read here. Lisa Tesler, Executive Director of PADCC, shares her thoughts on their 2024 achievements:

“As I think back on this past year, I feel proud of our achievements and the many ways we have improved the lives of people with Intellectual and Developmental Disabilities (I/DD) and their families. PADDC has succeeded because of effective leadership from Council Members and the hard work of our grantees, staff, partners, and collaborators…

In 2025, we will continue our existing work and increase our focus on collective advocacy. Considering the anticipated changes ahead, our efforts will prioritize access to quality services and Medical Assistance.”

Read the 2024 PADDC Impact Report.