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Tags Posts tagged with "Trump Administration"

Trump Administration

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The passage of the “One Big Beautiful Bill Act” has made significant changes to Medicaid, the Children’s Health Insurance Program, and Medicare, with strict requirements to maintain Federal support and criteria to qualify and maintain enrollment in Federal healthcare programs. There are several key provisions that will result in hundreds of thousands of Pennsylvanians losing access to healthcare:

  • “Community Engagement” Requirements which will require able-bodied adults to study, work, or volunteer for a minimum of 80 hours per month for expansion enrollees aged 19 – 64.
    • There are exceptions to these work requirements for people who are: enrolled in Medicare; incarcerated (and for 90 days following incarceration); pregnant or receiving postpartum coverage; Urban and California Indians; are caretakers of dependents under the age of 14; veterans with a total disability rating; are “medically frail”; participate in SNAP and are not exempt from its work requirements; or who have a substance use disorder or a disabling mental disorder (though neither of those exemptions are clearly defined). In addition, individuals who are participating in a drug or alcohol treatment and rehabilitation program (as defined in section 3(h) of the Food and Nutrition Act [FNA] of 2008) are exempt. However, FNA defines drug addiction or alcoholic treatment and rehabilitation programs as “any such program conducted by a private nonprofit organization or institution.” With no clear guidance at this point on how an individual is determined to qualify as having an SUD, the definition of drug addiction or alcoholic treatment and rehabilitation program could be an issue for for-profit providers.
    • States may request an exemption for 2027 and 2028 if they show a “good faith” effort to implement the program.
  • Limits to certain non-citizen access to federal health services, which will prevent certain individuals from enrolling in or receiving Medicaid or CHIP benefits. Medicaid will no longer be available to refugees, asylees, victims of trafficking, or other people under temporary protected status, with certain exceptions.
  • Eligibility redeterminations must be made every six months for Expansion enrollees. Individuals who are exempt from the community engagement requirements are also exempt from the bi-annual eligibility redeterminations.

Additional Resources:

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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.”

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Earlier this week, the Senate Parliamentarian advised lawmakers that several provisions in the budget reconciliation bill will not be able to pass with a simple majority vote. This includes the Senate’s proposed reductions to state provider taxes that were expected to result in billions of cost savings to the federal government. Senate Republicans now have several options to consider before moving forward, including removing key Medicaid provisions in the bill or re-drafting and re-submitting them to try to earn Parliamentarian approval. Other policies that were ruled unallowable under the Byrd Rule included the exclusion of specific groups of immigrants from Medicaid and withholding federal funds from states that use their own funds to provide coverage.

Senators are expected to vote in the coming days. While Pennsylvania Federal legislators are hearing the message from RCPA and other state associations, they are hearing very little from the constituencies in their home districts.

To assist with outreach and to help tailor the letter provided above, National Council and RCPA have provided additional resources below:

  • Find your US legislators here.
  • Call or write to your legislators here.

Your outreach TODAY is critical. If hundreds of billions of dollars are cut:

  • Millions of people are expected to lose access to lifesaving care and services;
  • Community behavioral health providers, operating on the thinnest of margins already, will face additional financial hardship; and
  • The cuts are unlikely to save any money overall because costs will simply shift to states, who will be forced to try and make up the funding difference.

Specific proposals under consideration, like mandatory work requirements and provider tax policy changes, are expected to create huge administrative burdens that are likely to result in eligible people losing their coverage, plus massive funding losses for states that could result in reduced availability of mental health and SUD services.

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A new Center for American Progress (CAP) analysis estimates that if H.R. 1 were to become law, more than 1.6 million Medicaid-expansion enrollees receiving SUD treatment would become uninsured. Although these estimates reflect the House-passed bill, the Senate’s more extreme Medicaid cuts could cause even greater coverage losses and disruptions to care.

KFF developed a table that provides a summary comparison of Medicaid provisions, including details on work requirements, in the House and Senate budget reconciliation bills.

The reconciliation legislation still needs to pass the Senate, and the House and Senate will need to reconcile any outstanding differences. President Trump expects to have the reconciliation bill on his desk for signing by July 4.

The bulk of those coverage losses would come from the bill’s proposed burdensome work-reporting requirements on adults enrolled in Medicaid through the Affordable Care Act’s expansion option. Specifically, the bill would require nonpregnant, nondisabled, non-caregiver adults ages 19 to 64 to document at least 80 hours of work per month or other qualifying activities (such as job training or volunteering) in order to maintain their Medicaid coverage. Individuals unable to meet the requirement would risk losing coverage. The Senate Finance Committee text goes even further, eliminating the exemption and requiring compliance from parents with children older than age 14.

Though the bill includes an exemption for individuals with SUD from work-reporting requirements, it remains unclear how states would implement or enforce that exemption.

CAP estimates that the states with the largest coverage losses among Medicaid enrollees being treated for SUD include California (nearly 170,000), New York (nearly 166,500), Ohio (134,500), and Pennsylvania (nearly 118,000). These coverage losses reflect the size of each state’s Medicaid expansion population as well as each state’s rate of SUD treatment take-up among people with Medicaid.

Medicaid is the largest payer of behavioral health services in the United States, including for SUD treatment. According to the latest available data, Medicaid covered nearly 60 percent of all national spending on SUD treatment in 2019 — accounting for $17 billion out of the $30 billion spent across all payers.

ACA improved SUD treatment access by making SUD services one of ten essential health benefits that nearly all insurers are required to cover. The ACA also allowed states to expand Medicaid eligibility to adults with incomes up to 138 percent of the federal-poverty level, providing millions of previously uninsured low-income adults with access to life-saving SUD treatment.

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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.

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Congress is making decisions that could deeply harm people with intellectual and developmental disabilities (I/DD). A proposed budget could slash Medicaid by at least $715 billion, putting essential supports and lives at risk.

These cuts aren’t just numbers on a budget document; they’re a threat to the independence, dignity, and community of those we support.

📣 Take Action Today: Call or email your U.S. Senators and Representative.

Tell them: Reject Medicaid cuts. Protect services for people with I/DD.

Your voice matters. Now more than ever, it must be heard.

Use the ANCOR Advocacy Toolbox to contact your federal officials today!

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