
CMS Innovation Center plans hiring spree after cuts
With Simon Levien
Driving the Day
HELP WANTED — CMS's Innovation Center plans to expand its workforce as it prepares to launch new health care payment models, POLITICO's Ruth Reader and Robert King report.
The decision comes after CMS cut nearly 300 people, about 5 percent of its workforce, earlier this year as part of a massive HHS reorganization.
'The CMS Innovation Center is hiring passionate leaders eager to make meaningful change in the healthcare delivery and outcomes in Medicare and Medicaid,' Sarah Fogler, director for the center's Patient Care Models Group, wrote on LinkedIn recently.
The Innovation Center wants to fill roughly 100 positions, according to former and current staffers at CMS granted anonymity to discuss internal operations.
'There will be a mix of new hires with subject matter expertise in economics, clinical and data,' according to an official granted anonymity to speak freely on the hiring blitz.
Although the center didn't lose staff in the reduction-in-force, it lost probationary employees in February.
Two former CMS workers fired as part of the reduction-in-force said they tried to apply for the new positions but were told the agency can't hire RIF-ed employees.
One shared an email from Fogler with POLITICO.
'We aren't able to hire individuals who were affected by the reduction in force,' Fogler wrote to one of the former employees who attempted to submit their resume. 'We'll have two postings for direct hire (economist and nurse) otherwise we'll be hiring through the CMS Fellow pathway.'
Fellowships are intended to be temporary; the center's payment models are time-limited and sometimes end early. Fellows stay on for at least one year.
CMS said in a statement that all hiring decisions follow federal guidelines and 'reflect CMS commitment to program integrity and fiscal responsibility.'
Background: The Innovation Center was established under the Affordable Care Act in 2010. It has long promoted creative models of preventive care and has piloted some 50 payment models.
Why it matters: The hiring blitz, which will occur in phases, comes as the center is developing new payment models to implement agency policies, with chronic disease prevention a major priority.
WELCOME TO MONDAY PULSE. An Indiana Amish community is 'considered one of the least allergic populations ever measured in the developed world,' The Washington Post reports. I'm Carmen Paun, POLITICO's global health reporter, filling in today for Kelly Hooper and Sophie Gardner.
Send your surprise reaction, tips, scoops and feedback to cpaun@politico.com, khooper@politico.com, sgardner@politico.com and follow along @carmenpaun, @kelhoops and @sophie_gardnerj.
In Congress
DEMS DIG IN THEIR HEELS — Congressional Republicans seek to pass a bipartisan health care package by year's end.
But Democrats are playing hardball, suggesting that Republicans poisoned the well with their party-line domestic policy megabill, POLITICO's Ben Guggenheim reports.
One demand they're making as a condition of engagement: a costly extension of expanded tax credits for Affordable Care Act insurance premiums set to expire at the end of the year.
The tax credits, which Democrats enacted over Republican objections during the Biden administration, reduced insurance costs on the 2010 health law exchanges for millions of middle- and upper-income people for the first time. Extending them will be a tough pill to swallow for Republicans, particularly in the House, where Ways and Means Chair Jason Smith of Missouri recently suggested it could be a nonstarter for his conference.
Why it matters: There's been chatter for months about reviving a sweeping bipartisan health care package that was on track for passage last December as part of a larger government funding bill, but House GOP leaders dropped the health care provisions after President Donald Trump and billionaire Elon Musk said the funding bill was overly broad and threatened to tank it.
A major part of the health package included proposals to crack down on pharmacy benefit managers, which critics accuse of charging health plans more for drugs than the reimbursements they send to pharmacies, among other things. PBMs negotiate drug prices among manufacturers, pharmacies and health plans.
It remains to be seen whether Republicans want a PBM overhaul badly enough to trade an extension of the subsidies.
RURAL HOSPITAL LIFELINE? Republicans clinched a $50 billion fund to blunt blowback from a near $1 trillion Medicaid rollback — but some rural health experts say it's not nearly enough.
The Rural Health Transformation Program, tucked in President Donald Trump's One Big Beautiful Bill Act, aims to offset deep Medicaid cuts with allotments of $10 billion per fiscal year from 2026 through 2030. Rural communities are expected to lose $155 billion in Medicaid support over the next decade, according to KFF.
The program's rollout, however, remains murky, POLITICO's Amanda Friedman reports.
CMS will administer the grants, with half the funds distributed equally to states with approved plans. The other half will be allocated at the discretion of CMS Administrator Mehmet Oz, based on each state's rural population, number of rural facilities and the overall 'situation' facing a hospital.
In a statement to POLITICO, CMS didn't provide requested details about how Oz would assess which states receive more money and how the agency will remain impartial throughout the approval process.
'The program is under development, and CMS is working in coordination with whole-of-government partners,' CMS spokesperson Alexx Pons said via email. 'Additional details will be shared as implementation advances.'
Michael Topchik, a national leader of the Chicago-based consulting firm Chartis Center for Rural Health, which counts hospitals among its clients, told POLITICO the grant program will bring hospitals 'closer to whole,' though he doubts most will escape unscathed.
Eligible providers include rural hospitals, clinics, community mental health centers and federally qualified health centers. But because funding must be shared among them, rural hospitals — which bring in more than $12 billion a year from Medicaid, according to Chartis — are expected to face major shortfalls.
States have a Dec. 31 deadline to submit a 'detailed rural health transformation plan' outlining how they'll improve rural health access and outcomes, use technology and recruit health care workers.
OZ ON THE HILL — CMS Administrator Mehmet Oz is scheduled to meet with members of the House Ways and Means Committee on Wednesday, Ben reports.
A meeting notice viewed by POLITICO says committee members are invited 'to discuss the priorities' of CMS on July 23, including issues 'involving health care matters' that fall within the panel's jurisdiction.
Hospitals
'TOUGH TIMES AHEAD' — NASHVILLE — The American Hospital Association announced the head of a large rural hospital system will become board chair in 2027 at what was likely the largest gathering of health care leaders since President Donald Trump signed into law his 'big, beautiful bill' — which drives deep cuts into Medicaid, Simon reports.
The mood among some attendees was understandably dour.
The AHA Leadership Summit, which drew about 1,200 hospital C-suite executives and managers, began with a commiseration. Tina Freese Decker, the group's board chair, said they 'did everything they could' to stop the cuts, noting her team's sleepless nights working to blunt the bill's impacts.
'There are very tough times ahead,' she said, calling the current health care system unsustainable and then rallying members to reform it.
One health care executive in attendance granted anonymity to speak candidly gave their read on the opening speeches, which featured dire predictions of health care under the cuts. 'AHA must show it recognizes that bad shit happened,' the executive told POLITICO. 'But now we have work to do.'
A new leader: Bill Gassen, president and CEO of Sanford Health in Sioux Falls, South Dakota, will be the AHA's board chair-elect, taking over in 2027, Decker announced. Gassen, who says he leads the largest rural health system in the U.S., will begin his tenure as hospitals — particularly those in remote areas with slim margins — could suffer huge financial hits when many cuts take effect after the 2026 midterms.
Trump's law will disburse around $50 billion to rural health providers, but many industry groups say the fund isn't enough to offset the cuts. Rural clinics rely on Medicaid to a greater degree than other providers.
In his remarks Sunday, Rick Pollack, AHA president, warned to expect potential clinic closures, a slimmer workforce, fewer patients and fewer services if Medicaid cuts aren't negotiated down or repealed.
PHARMA WATCH
THE TARIFF EFFECT ON DRUGS — If President Donald Trump implements the tariffs on foreign-made drugs he's been threatening, the U.S. could see a shortage of critical medicines, the generic drugs sector and analysts have warned.
Trump said he'll impose a low tariff on drugs coming from abroad as of next month and give drugmakers a year to build up production capacity in the U.S. After that, tariffs could rise to 200 percent, he's warned.
But while the higher-value, branded pharmaceutical sector might gradually adapt, Europe's generics manufacturers — operating on razor-thin margins and cheaper competition from India and China — face a stark choice: absorb massive costs or abandon the U.S. market entirely, POLITICO's Giedre Peseckyte reports.
Why it matters: The U.S. relies heavily on imported generic drugs. Generics account for 92 percent of all prescriptions filled in the U.S., dominating by volume but not by revenue due to their low cost.
Tariffs would worsen ongoing U.S. shortages for essential hospital medicines and injectables and deepen America's reliance on Chinese and Indian suppliers, according to Medicines For Europe, Europe's generics drug lobby.
Public Health
MAHA CELEBRATES — HHS Robert F. Kennedy Jr. and other proponents of his Make America Healthy Again movement celebrated over the weekend the latest announcements from food companies about eliminating artificial food dyes and other ingredients considered harmful over the next few years.
Kennedy posted a Reuters report to the social platform X about PepsiCo planning to remove artificial dyes and flavors from its potato and tortilla chips, which it sells under the brands of Lay's and Tostitos.
WK Kellogg, the maker of Froot Loops cereals, said Friday it would remove artificial dyes from its cereals by the end of 2027.
WHAT WE'RE READING
The New York Times' Brian M. Rosenthal and Julie Tate report about how a push for more organ transplants is putting donors at risk.
Reuters' Bhanvi Satija reports that Sarepta Therapeutics won't comply with the FDA's request to stop shipping its Duchenne muscular dystrophy gene therapy after the death of a clinical trial patient.
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Newsweek
2 minutes ago
- Newsweek
Democratic Party Hits Lowest Approval in Over 30 Years: Poll
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. Newsweek AI is in beta. Translations may contain inaccuracies—please refer to the original content. A Wall Street Journal poll published on Friday shows the Democratic Party's image has deteriorated to its lowest point in over three decades according to the newspaper's records that date back to 1990. Only 8 percent of registered voters said they view the Democratic Party "very favorably," while 63 percent said it's out of touch with the everyday concerns of Americans. In contrast, Republicans are now trusted more on key issues like the economy, immigration and crime. The poll, which surveyed 1,500 registered voters between July 16-20, found Republicans have taken the lead on eight of 10 issues tested. Despite President Donald Trump's continued unpopularity in the polls, the GOP leads in overall party identification. The Journal's poll has a margin of error of plus or minus 2.5 percentage points. Why It Matters In last year's presidential election, Trump beat then-Vice President Kamala Harris, the Democratic presidential nominee, by 2 points in the popular vote, 50 to 48 percent. Trump also won the electoral vote, which decides the winner, 312-226. The Democratic Party faced a string of defeats in the 2024 election cycle when it came to the U.S. House and Senate, with the party's struggles for a clear message and effective leadership intensifying as the 2026 midterm elections approach. The new poll signals a significant warning for Democrats. Although Trump remains a polarizing figure, the data suggests that voters are increasingly viewing the party as ineffective on core issues like inflation, border security, and crime. What To Know According to the Journal's poll, Democrats now face a net favorability of -30 points, with only one-third of voters expressing any positive sentiment toward the party. This marks the worst performance for Democrats in the newspaper's polling history to date. While Trump's handling of inflation and tariffs drew significant disapproval—11 and 17 points respectively—voters still trust Republicans more than Democrats to manage those issues in Congress. The GOP holds a 10-point advantage on inflation and a 7-point edge on tariffs. The only policy areas where Democrats outperform Republicans in the poll are health care and vaccine policy, suggesting the party retains some credibility on public health issues. The president's net unfavorability stands at -7 points, with the GOP slightly worse at -11. However, Trump's favorability has remained relatively steady through the first six months of his second term, even as other polls show sharper declines. Despite the negative sentiment, 46 percent of voters say they would back a Democrat for Congress if an election were held today, compared to 43 percent who would support a Republican. That margin is narrower than the 8-point advantage Democrats had at the same point in Trump's first term in 2017. Senate Minority Leader Senator Chuck Schumer, a New York Democrat, speaks as Senate Minority Whip Sen. Richard Durbin, an Illinois Democrat, and Senator Cory Booker, a New Jersey Democrat, listen during a news briefing at... Senate Minority Leader Senator Chuck Schumer, a New York Democrat, speaks as Senate Minority Whip Sen. Richard Durbin, an Illinois Democrat, and Senator Cory Booker, a New Jersey Democrat, listen during a news briefing at the U.S. Capitol on July 22 in Washington, D.C. MoreWhat People Are Saying Bill McInturff, a Republican pollster not connected to the Journal's survey, said: "We were already watching the tide moving out for the Republican Party by this point in 2017, and that's not where we are today. And that's worth jumping up and down and trying to explain: how much more competitive Trump and the Republicans are today than in 2017." John Anzalone, a Democratic pollster who worked on the Journal survey, said: "The Democratic brand is so bad that they don't have the credibility to be a critic of Trump or the Republican Party. Until they reconnect with real voters and working people on who they're for and what their economic message is, they're going to have problems." What Happens Next? Democrats face mounting pressure to redefine their economic message and rebuild trust with working-class voters. Meanwhile, Republicans are likely to double down on their perceived strengths in fiscal and foreign policy ahead of next year's midterms.

Miami Herald
2 hours ago
- Miami Herald
Why Florida is missing out on $200 million a year in Medicaid funding for schools
Florida lawmakers reached a rare consensus after the deadly Parkland school shooting: More money was needed for mental health counseling at schools. 'We haven't put enough resources into mental health issues,' said then-Sen. Kathleen Passidomo, R-Naples. 'And look what happens.' Two years later, lawmakers passed a bill allowing Medicaid dollars assigned to school districts to be used for more types of care for kids, including counseling. But state officials didn't adopt the changes. And they have refused to comply with federal guidelines that would help school districts provide that care. Florida schools have missed out on about $200 million a year in Medicaid funding — a total of $2.2 billion since 2014 — to support children's mental health counseling, physical therapy and other services, advocates say. Their calls to recoup funding come as schools face multimillion-dollar shortfalls in the budget year that began July 1 — and as kids struggle with the fallout from the COVID-19 pandemic. They say the problems lie with the Florida Agency for Health Care Administration, which oversees Medicaid in the state and reports to Gov. Ron DeSantis. Documents show that for more than a decade, the agency hasn't followed federal reimbursement guidelines for school-based services — one of the few areas of Medicaid the Trump administration and Congress have not targeted for reductions. The federal program provides in-school medical care and instruction for school-age children with physical or developmental disabilities who qualify for Medicaid. About 2 million children in Florida are on Medicaid, which provides free or low-cost health care to people who qualify. Without the money, school districts have struggled to find therapists, nurses and others to treat children. Some kids experienced lower-quality care or had that care delayed during critical periods of their lives, observers say. The state agency strayed from federal guidelines in 2014, when the U.S. government changed its rules regarding the reimbursements. Experts consulted by the Times said Florida is one of the few states, and perhaps the only one, that is using the outdated payment method. The federal Center for Medicaid and Children's Health Insurance Program Services warned the agency in 2020 that it was 'not in compliance with current financing rules,' but no substantial action followed. Over that time, instead of collecting $2.2 billion from federal coffers to cover school-based expenses, the state received about $250 million. With money tight, school officials want the agency to make the necessary fixes. 'This is a significant agency failure,' said Ken Kniepmann, former state assistant deputy secretary for Medicaid Policy and Quality at the agency. He was hired in part to improve the system but said he was later instructed to stop. 'It's really unconscionable. Nobody should be OK with this.' A spokesperson for the agency said it did not have sufficient funding to update its reimbursement method until this year's legislative session, and it is committed to getting it done next year. Kniepmann said the agency had not asked the Legislature for permission to draw down the federal dollars needed to enact the changes until this year. The Hillsborough County school board held a workshop in April to address the Medicaid funding gap. Hillsborough received about $6 million in Medicaid reimbursements a year ago for the services it provided, specialist Deneen Gorassini told her board, but would have gotten about $10 million more if the state agency followed federal guidelines. It's money that could have expanded medical and mental health services in schools. Other districts experienced similar-sized gaps, according to Kniepmann's calculations. 'If we can get (the agency) to do their job and submit a (state plan amendment), we could start getting reimbursed based on our expenses, which are way more than what we are getting reimbursed now,' Gorassini told the board. Since 1997, the state has been reimbursing school districts for services — such as counseling or speech therapy — based on a flat rate. In 2014, the federal government required states to reimburse school districts based on the actual costs of those services, which is much higher. Five years ago, federal officials wrote Florida telling them it hadn't adopted the change, and the state had 90 days to comply. 'Please note that you may not pay a rate from a fee schedule and use this as a certification of cost,' Center for Medicaid and CHIP Services acting director Todd McMillion wrote Florida officials in March 2020. The center said it is working with the state to resolve the concerns listed in that letter. Florida is still paying schools a flat rate that has changed little since 1997. Karen Thomas, a Medicaid specialist for Leon County schools for more than 20 years, said that while the formulas are complex, the solution should be 'extremely simple.' 'We're 90% there, maybe 95% already, in the way we are doing things,' Thomas said of districts' processes for collecting receipts and monitoring providers' time. 'They have everything they need to be in compliance with federal payment methodology. They just need to change the invoice, one line on the invoice. ... The fault is squarely in the agency's failure to come into compliance.' The state has shown it can make the switch, Thomas said. She pointed out that when federal authorities ordered county health departments to start billing for actual costs instead of flat rates in 2020, the state quickly shifted. She noted that school-based services are 'a very niche portion' of the state's Medicaid budget — somewhere in the neighborhood of 1% — and that over time agency officials have paid less attention to them, decreasing communication with school districts and reducing staff dedicated to the service. The issue shouldn't be a side note, as it affects the lives of some of Florida's neediest children, she said. And the pandemic made kids' mental health a national crisis. 'Kids used to miss school because of asthma,' Thomas said. 'Now they're missing school because of anxiety and depression.' After the 2018 Parkland attack, state lawmakers wanted to make sure students were getting proper mental health assistance in schools. In 2020, they passed legislation allowing schools to use Medicaid dollars for other types of care. DeSantis signed it into law. But his Agency for Health Care Administration never rewrote the agency's rules to allow school districts to use the new law. 'The law was very clear,' said retired Sen. Bill Montford, D-Tallahassee, who sponsored the 2020 bill. 'Why they didn't do it I don't know.' Rep. Christine Hunchofsky, a Democrat who represents Parkland in the House, repeatedly has asked agency officials if the state is doing all it can to leverage federal money for student services. The issue comes up frequently on the Commission on Mental Health and Substance Use Disorder, to which Hunchofsky was appointed by the Republican House speaker. She said the agency has provided few clear answers. Meanwhile, she's heard plenty from the school districts, and said she plans to pursue the questions further. Montford, also executive director of the state's superintendents association, said agency officials have told his group that they are preparing a rule revision to go into effect in mid-2026. That's when states are supposed to comply with an updated 2023 federal guidance on school-based services. But Kniepmann, who worked as associate director for health at the Florida Conference for Catholic Bishops before moving to the health agency, argued the state is stalling for reasons that remain unclear to him. He said the 2023 guidance was not intended to be a way for Florida to further delay implementing rules put in place more than a decade ago. Every holdup, he and others said, means less money available to pay for medical and related services. 'Eleven years and $2.2 billion is not a little thing,' he said. Hillsborough district officials, also leery of the state's ability to pull off a new rule by mid-2026, said they are looking into a different approach to bring in more Medicaid money. Gorassini told the board that her department would conduct a rate study for each service it provides and submit the updated amounts to the state for inclusion on the existing reimbursement schedule. Kniepmann said it's a long-shot effort that requires a lot of work at the district level, adding that the agency has discouraged such an approach. It's worth a shot, though, Gorassini told the Hillsborough school board. 'We'll never get what we spend,' she said. 'But in the meantime we're going to try to maximize our reimbursement.' What's really at stake is student health, said Thomas, the Leon County Medicaid specialist who also serves on the National Alliance for Medicaid in Education leadership team. Her district stands to reap about $2 million more per year if the change is made. 'That is the difference between being able to hire actual medical professionals who have the ability to recognize actual medical issues, and purchase medical equipment, actual things that could help the children that are most medically needy in this county,' she said. 'When I can't afford to pay for a nurse, all kids suffer.'


Boston Globe
3 hours ago
- Boston Globe
Dozens gather at Boston Medical Center to protest Trump''s ‘Big Beautiful Bill,' cuts to Medicaid
Donald Trump's tax bill, which he signed into law on July 4, will strip about $186 billion from SNAP and close to $1 trillion from Medicaid over the next decade, the Globe Advertisement The bill could strip healthcare coverage from some 250,000 Massachusetts residents, Governor Maura Healey Advertisement Republicans frame the bill as a way to target Medicaid fraud and save money. It would require states to 'We're here to expose the harm of this big, bad bill that will transfer wealth from working people to wealthy people,' said Marlishia Aho, the regional communications director for 1199SEIU. Franswa Jean-Enard, a personal care attendant for his mom and a member of the union, said he's anxious his mom could be stripped of her healthcare benefits 'at any time' because of the cuts even though he has 'all the paperwork to justify her need for it.' She has several conditions, including advanced arthritis, and relies on Medicaid for 'all her care,' including physical therapy and medication. Jean-Enard said it was important for him to protest because even if he isn't ultimately affected, he doesn't want other people to lose access to life-saving treatment. 'Back home in Haiti, there's a saying — when your friend's or neighbor's beard is on fire, put yours in order — which means when something is happening to your neighbor, it could happen to you,' he said. The state requiring more frequent eligibility checks would also be a burden, as Jean-Enard said the paperwork for his mom's Medicaid is already time-consuming and can take months to process. 'I'm hoping it doesn't get to that, but I'm hoping with the help of the union, what we're doing and organizing, we can push back,' he said. Advertisement Jean-Enard said he understands the government wants to streamline spending, but that it shouldn't come at the expense of healthcare. 'Every single PCA is doing crucial work,' he said, adding that his mom's needs will only grow with time. Janice Guzman, also a PCA for her mom, was cut from 'That's why I'm here, fighting back,' Guzman said. 'My mom needs my assistance 24/7 — and I don't get paid for 24/7 — but it's helping me pay my bills. Right now, it's like, what am I going to do?' Others at the protest, like 70-year-old Fe Guidry, a PCA in New Bedford, said they're worried about cuts to SNAP, which Guidry said SNAP 'really helps' her purchase healthy food. 'We're fighting for the benefits that we have,' she said. Emily Spatz can be reached at