Latest news with #CenterforChildrenandFamilies
18-07-2025
- Health
Georgia shows rough road ahead for states as Medicaid work requirements loom
This is a KFF Health News story. Every time Ashton Alexander sees an ad for Georgia Pathways to Coverage, it feels like a "kick in the face." Alexander tried signing up for Pathways, the state's limited Medicaid expansion, multiple times and got denied each time, he said, even though he met the qualifying terms because he's a full-time student. Georgia is one of 10 states that haven't expanded Medicaid health coverage to a broader pool of low-income adults. Instead, it offers coverage to those who can prove they're working or completing 80 hours a month of other qualifying activities, like going to school or volunteering. And it is the only state currently doing so. "Why is this marketing out here?" said the 20-year-old, who lives in Conyers, east of Atlanta. "It's truly not accessible." Each denial used the same boilerplate language, Alexander said, and his calls to caseworkers were not returned. State offices couldn't connect him with caseworkers assigned to him from the same state agency. And when he requested contact information for a supervisor to appeal his denial, he said, the number rang to a fax machine. "It's impenetrable," Alexander said. "I've literally tried everything, and there's no way." Millions of Americans trying to access Medicaid benefits could soon find themselves navigating similar byzantine state systems and work rules. Legislation signed into law by President Donald Trump on July 4 allocates $200 million to help states that expanded Medicaid create systems by the end of next year to verify whether some enrollees are meeting the requirements. Conservative lawmakers have long argued that public benefits should go only to those actively working to get off of government assistance. But the nation's only Medicaid work requirement program shows they can be costly for states to run, frustrating for enrollees to navigate, and disruptive to other public benefit systems. Georgia's budget for marketing is nearly as much as it has spent on health benefits. Meanwhile, most enrollees under age 65 are already working or have a barrier that prevents them from doing so. What Georgia shows is "just how costly setting up these administrative systems of red tape can be," said Joan Alker, executive director of Georgetown University's Center for Children and Families. Over the past two years, KFF Health News has documented the issues riddling Georgia's Pathways program, launched in July 2023. More than 100,000 Georgians have applied to the program through March. Just over 8,000 were enrolled at the end of June, though about 300,000 would be eligible if the state fully expanded Medicaid under the terms of the Affordable Care Act. The program has cost more than $100 million, with only $26 million spent on health benefits and more than $20 million allocated to marketing contracts, according to a KFF Health News analysis of state reports. "That was truly a pretty shocking waste of taxpayer dollars," Alker said. The Government Accountability Office is investigating the costs of the program after a group of Democratic senators -- including both members of the Georgia delegation -- asked the government watchdog to look into the program. Findings are expected this fall. A state report to the federal government from March said Georgia couldn't effectively determine if applicants meet the qualifying activities criteria. The report also said the state hadn't suspended anyone for failing to work, a key philosophical pillar of the program. Meanwhile, as of March, more than 5,000 people were waiting to have their eligibility verified for Pathways. The Pathways program has strained Georgia's eligibility system for other public benefits, such as food stamps and cash assistance. In April, the state applied to the federal government to renew Pathways. In its application, officials scaled back key elements, such as the requirement that enrollees document work every month. Critics of the program also say the red tape doesn't help enrollees find jobs. "Georgia's experience shows that administrative complexity is the primary outcome, not job readiness," said Natalie Crawford, executive director of Georgia First, which advocates for fiscal responsibility and access to affordable health care. Despite the struggles, Garrison Douglas, a spokesperson for Georgia's Republican governor, Brian Kemp, defended the program. "Georgia Pathways is doing what it was designed to do: provide free healthcare coverage to low-income, able-bodied Georgians who are willing to engage in one of our many qualifying activities," he said in an emailed statement. New federal requirements in the tax and spending legislation mean that the 40 states (plus Washington, D.C.) that expanded Medicaid will need to prepare technology to process the documentation some Medicaid recipients will now have to regularly file. The federal law includes exemptions for people with disabilities, in addiction treatment, or caring for kids under 14, among others. The Trump administration said other states won't face a bumpy rollout like Georgia's. "We are fully confident that technology already exists that could enable all parties involved to implement work and community engagement requirements," said Mehmet Oz, head of the Centers for Medicare & Medicaid Services, in an emailed statement. In a written public comment on Georgia's application to extend the program, Yvonne Taylor of Austell detailed the difficulties she faced trying to enroll. She said she tried to sign up several times but that her application was not accepted. "Not once, not twice, but three times. With no response from customer service," she wrote in February. "So now I am without coverage." Victoria Helmly of Marietta wrote in a January comment that she and her family members take care of their dad, but the state law doesn't exempt caregivers of older adults. "Georgia should recognize their sacrifices by supporting them with health insurance," she wrote. "Let's simplify this system and in the end, save money and lives."
Yahoo
05-07-2025
- Health
- Yahoo
Trump's Medicaid cuts are coming for rural Americans: ‘It's going to have to hit them first'
When Hurricane Helene drowned western North Carolina in muck and floodwater last year, it caught folks off-guard. Now, local leaders in places like Asheville expect the Republican-led reconciliation bill – called the 'big, beautiful bill' by Donald Trump – to bear down on rural America. And they wonder whether people are missing the warning signs. 'It's going to have to hit them first,' said Laurie Stradley, CEO of Impact Health in Asheville, a Medicaid-funded non-profit providing social services to some people still digging out from the flood. Medicaid is the single largest health insurance program in the US. The public program covers 71 million low-income, disabled and elderly US residents. It pays for half of all US births and the care of six in 10 nursing home residents. When Trump's sprawling tax-and-spending bill passed on Thursday, it heralded more than $1tn in federal cuts to Medicaid, which experts worry will push Republican-led states to abandon parts of the program and leave people without access to timely healthcare. 'This is an extraordinarily regressive bill,' said Joan Akler, executive director and co-founder of Georgetown University's Center for Children and Families. 'This is the largest rollback of healthcare coverage that we've ever seen and all in service of an agenda to drive tax cuts that will disproportionately benefit wealthy people and corporations.' Medicaid 'expansion' is a key provision of Obamacare, formally called the Affordable Care Act of 2010. The expansion provides largely no-cost health insurance to people earning up to 138% of the federal poverty level, or $36,777 for a family of three. Although Obamacare has been the law for more than a decade, Medicaid expansion proved politically divisive in Republican states, and many only recently decided to accept enormous federal subsidies to cover their residents. The Medicaid cuts in the bill could have particularly acute consequences in North Carolina, a politically competitive state, where experts said the bill could trigger a 'kill switch' to end Medicaid expansion. 'If the state spends any state dollars to implement the expansion population or expansion coverage, it triggers an automatic ending to Medicaid expansion,' said Kody Kinsley, North Carolina's former secretary of health and an architect of the state's Medicaid expansion. North Carolina is set to lose $32bn in federal funding in the next decade, according to an analysis by the office of the Republican senator Thom Tillis, who represents the state. He's one of just three Senate Republicans who voted against the bill on Tuesday. North Carolina's expansion only went into effect in December 2023, and in less than 19 months it enrolled more than 650,000 people – all of whom will lose coverage if the program ends. Those North Carolinians are only some of the 17 million people expected to lose health insurance by 2034 across the country, according to estimates from the non-partisan Congressional Budget Office. Nearly 12 million people will lose insurance because of attacks on Medicaid. 'Ultimately, Medicaid being cut is going to kill people,' said Molly Zenkler, a nurse at Mission hospital in Asheville. 'I deal with people getting their feet literally amputated because they don't have access to diabetic care. This is just going to get increasingly worse.' The reconciliation bill cuts state funding through a number of provisions. On healthcare specifically, the bill attacks complex financial maneuvers states use to draw down federal funds. It also requires states to spend enormous sums – perhaps tens of millions of dollars per state – implementing work requirements, effectively adding layers of expensive red tape. Congressional Republicans in favor of the bill argue it targets 'waste, fraud and abuse'. However, it is already well-known that most Medicaid beneficiaries who can work do, and that Medicaid is one of the most cost-efficient health programs in the US, according to the American Hospital Association. North Carolina is one of a dozen conservative states that wrote a 'trigger' law into Medicaid expansion. Not all function like North Carolina's – the laws are, in the words of an expert with Georgetown University's McCourt School of Public Policy, a 'lesson in federalism' – but they nevertheless underscore the difficult choices state legislators will face because of congressional Republicans' cuts. One such program that could be on the chopping block is a pilot with Impact Health, which uses Medicaid expansion funds for social needs that affect health – an effort to reduce long-term costs. Stradley gave the example of a Medicaid-covered child with severe asthma who hit the local emergency room three times a week for breathing treatments. Impact's program used Medicaid funds to replace moldy rugs with laminate flooring in the child's home, and to buy a vacuum with a Hepa filter. The cost to Impact Health was about $5,000, 'but now this child is going to the emergency room a couple times a year instead of a couple times a month. And so, every month we're saving about $4,500.' The program's knock-on effects boost the local economy: the work to replace the rug was done by a local carpenter, and the child's mother isn't calling out from work, increasing her job stability. 'One of the ways that we talk about this program is that it's a hand up rather than a handout,' she said. 'Almost half of the folks that are recipients in our program are children … Then you look at the adults. Most of them are working multiple jobs, and those jobs don't come with benefits, because they're working two or three part-time jobs in order to make ends meet.' The enormity of Medicaid means large cuts to the program imperil not only patients, but the institutions that serve them – especially rural hospitals and clinics hanging on 'by a thread', according to Kinsley. One of US residents' few rights to healthcare is in emergency departments, where hospitals are required to stabilize patients regardless of ability to pay. That makes emergency departments the go-to source for healthcare for the uninsured. An analysis released by the Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill earlier this year showed that 338 rural hospitals around the country were at risk of imminent closure with the cuts to Medicaid contained in the bill. Rural states such as Kentucky are expected to be disproportionately hard-hit as well. Thirty-five of the rural hospitals at risk of closure – about 10% – are in Kentucky, even though Kentucky's 4.5 million residents comprise about 1.3% of the US's population. About a third of Kentucky residents are on Medicaid, according to figures from Kentucky's cabinet for health and family services. The program benefits about 478,900 adults. The situation is similarly dire in Arizona, another battleground state, which also has a trigger law on the books. Although the reconciliation bill may not 'trigger' a rollback of Medicaid expansion, it does undermine a key financing mechanism for the state's program called a 'provider tax'. 'We estimate Arizona's healthcare system would lose over $6bn over the next seven years,' said Holly Ward, a spokesperson for the Arizona Hospital and Healthcare Association, in a statement. 'In other words, more than 55% of Arizona hospitals would be operating in the red,' she said. 'Hospitals will be, at best, forced to restrict services such as obstetrics, behavioral healthcare and other complex services, and at worst, will close their doors altogether.' Another issue is the potential for Republicans' cuts to drive up the cost of healthcare for Americans who are privately insured, including through employers. As hospitals fight to survive, they will try to extract as much money as possible from other sources of funding – namely, commercial insurance. In addition, rural healthcare providers worry the water will be muddied by the sheer complexity of US healthcare. Private companies have a hand in managing – and therefore branding – state Medicaid programs. 'A lot of our rural voters may not even realize that what they have is Medicaid, because there are so many names for it,' said Stradley. However, the precarious situation is already worrying people whose lives have been stabilized because of Medicaid. Amanda Moynihan is a single mother of three children – ages nine, 12 and 16 – living in Kuna, Idaho. Medicaid expansion has helped her become a 'functioning human in society', she said. Routine medical care for herself and her children, along with other assistance programs, has meant the difference between grinding poverty and a shot at the middle class. Idaho, one of the most politically conservative states in the union, expanded Medicaid in 2018 with an overwhelming ballot-referendum vote of 61-39. Even if Idaho's 'trigger law' does not go into effect, the state could face similar fiscal challenges to Arizona. 'Back two years ago, before I started school, I was just in fight-or-flight, just trying to pay the bills there. I didn't ever see a future of what I could do. And then I just started with one class,' she said. Moynihan has completed an associate degree in psychology and is starting the social work bachelor's degree program at Boise State University in the fall. For now, she's working part time with the Idaho Commission for the Blind and Visually Impaired and planning to pick up work at a gas station because it has a college scholarship benefit. But without stability to pursue higher education, her future 'would be making the minimum wage, which is about $15 an hour, barely paying rent in a low-income household'.
Yahoo
03-06-2025
- Business
- Yahoo
'Big Beautiful Bill' dings states that offer health care to some immigrants here legally
Jun. 3—The Republican budget bill the U.S. House approved last month includes a surprise for the 40 states that have expanded Medicaid: penalties for providing health care to some immigrants who are here legally. Along with punishing the 14 states that use their own funds to cover immigrants who are here illegally, analysts say last-minute changes to the bill would make it all but impossible for states to continue helping some immigrants who are in the country legally, on humanitarian parole. Under the bill, the federal government would slash funding to states that have expanded Medicaid and provide coverage to immigrants who are on humanitarian parole — immigrants who have received permission to temporarily enter the United States due to an emergency or urgent humanitarian reason. The federal government pays 90% of the cost of covering adults without children who are eligible under Medicaid expansion, but the bill would cut that to 80% for those states, doubling the state portion from 10% to 20%. That's the same penalty the bill proposes for states that use their own money to help immigrants who are here illegally. Ironically, states such as Florida that have extended Medicaid coverage to immigrants who are here on humanitarian parole but have not expanded Medicaid under the Affordable Care Act would not be harmed by the bill, said Leonardo Cuello, a Medicaid law and policy expert and research professor at the Center for Children and Families at Georgetown University's McCourt School of Public Policy. It is "wildly nonsensical and unfair" to penalize expansion states for covering a population that some non-expansion states, such as Florida, also cover, Cuello said. "It would appear that the purpose is more to punish expansion states than address any genuine concern with immigrant coverage." West Virginia is one of the states where lawmakers are nervously watching U.S. Senate discussions on the proposed penalty. Republican state Rep. Matt Rohrbach, a deputy House speaker, said West Virginia legislators tabled a proposal that would have ended Medicaid expansion if the federal government reduced its share of the funding, because the state's congressional representatives assured them it wasn't going to happen. Now the future is murkier. Cuello called the proposed penalty "basically a gun to the head of the states." "Congress is framing it as a choice, but the state is being coerced and really has no choice," he said. There are about 1.3 million people in the United States on humanitarian parole, from Afghanistan, Cuba, Haiti, Nicaragua, Ukraine and Venezuela as well as some Central American children who have rejoined family here. The Trump administration is trying to end parole from some of those countries. A Supreme Court decision May 30 allows the administration to end humanitarian parole for about 500,000 people from Cuba, Haiti, Nicaragua and Venezuela. Not many of those parolees qualify for Medicaid, which requires a waiting period or special status, but the 40 states with expanded Medicaid could be penalized if immigrants qualify for the program, said Tanya Broder, senior counsel for health and economic justice policy at the National Immigration Law Center. It would appear that the purpose is more to punish expansion states than address any genuine concern with immigrant coverage. — Leonardo Cuello, Georgetown University research professor Meanwhile, an increasing number of states and the District of Columbia already are considering scaling back Medicaid coverage for immigrants because of the costs. The federal budget bill, named the One Big Beautiful Bill Act, is now being considered by the Senate, where changes are likely. The fact that so many states could be affected by the last-minute change could mean more scrutiny in that chamber, said Andrea Kovach, senior attorney for health care justice at the Shriver Center on Poverty Law in Chicago. By her count, at least 38 states and the District of Columbia would be affected by the new restrictions, since they accepted some options now offered by Medicaid to cover at least some humanitarian parolees without a five-year waiting period. "They're all going to be penalized because they added in parolees," Kovach said. "So that's 38 times two senators who are going to be very interested in this provision to make sure their state doesn't get their reimbursement knocked down." The change to exclude people with humanitarian parole was included in a May 21 amendment by U.S. Rep. Jodey Arrington, a Texas Republican who chairs the House budget committee. Arrington's office did not reply to a request for comment, though he has stressed the importance of withholding Medicaid from immigrants who are here illegally. "[Democrats] want to protect health care and welfare at any cost for illegal immigrants at the expense of hardworking taxpayers," Arrington said in a May 22 floor speech urging passage of the bill. "But by the results of this last election, it's abundantly clear: The people see through this too and they have totally rejected the Democrats' radical agenda." Some states already are considering cutting Medicaid coverage for immigrants, though Democratic lawmakers and advocates are pushing back. Washington, D.C., Democratic Mayor Muriel Bowser has proposed phasing out a program that provides Medicaid coverage to adults regardless of their immigration status, a move she says would save the District of Columbia $457 million. Minnesota advocates protested a state budget deal reached last month with Democratic Gov. Tim Walz to phase out health care coverage for adults who are here illegally, a condition Republican lawmakers insisted on to avoid a shutdown. Similarly, Illinois advocates are protesting new state rules that will end a program that has provided Medicaid coverage to immigrants aged 42-64 regardless of their legal status. The program cost $1.6 billion over three years, according to a state audit. The state will continue a separate program that provides coverage for older adults. "Our position is that decision-makers in Illinois shouldn't be doing Trump's work for him," said Kovach, of the Shriver Center on Poverty Law. "Let's preserve health coverage for immigrants and stand up for Illinois immigrant residents who have been paying taxes into this state for years and need this coverage." Illinois state Sen. Graciela Guzmán, a Democrat whose parents are refugees from El Salvador, said many of her constituents in Chicago may be forced to cancel chemotherapy or lifesaving surgery because of the changes. "It was a state budget, but I think the federal reconciliation bill really set the tone for it," Guzmán said. "In a tough fiscal environment, it was really hard to set up a defense for this program." Oregon Democratic Gov. Tina Kotek is among the governors holding firm, saying that letting immigrants stay uninsured imposes costs on local hospitals and ends up raising prices for everyone. "The costs will go somewhere. When everyone is insured it is much more helpful to keep costs down and reasonable for everyone. That's why we've taken this approach to give care to everyone," Kotek said at a news conference last month. Medicaid does pay for emergency care for low-income patients, regardless of their immigration status, and that would not change under the federal budget bill. Franny White, a spokesperson for the Oregon Health Authority, said her state's Medicaid program covers about 105,000 immigrants, some of whom are here illegally. She said the policy, established by a 2021 state law, can save money in the long run. "Uninsured people are less likely to receive preventive care due to cost and often wait until a condition worsens to the point that it requires more advanced, expensive care at an emergency department or hospital," she said. California was among the first states, along with Oregon, to offer health insurance to immigrants of all ages regardless of their legal status. But it now is considering cutting back, looking to save $5 billion as it seeks to close a $12 billion budget deficit. In May, Democratic Gov. Gavin Newsom proposed freezing enrollment of immigrant adults who are here illegally, and charging them premiums to save money. "It's possible that other states will decide to cut back these services because of budgetary concerns," said Drishti Pillai, director of immigrant health policy at KFF, a health policy research organization. If the federal budget bill passes with the immigrant health care provision intact, states would have more than two years to adjust, since the changes would not take effect until October 2027. "We have time to really understand what the landscape looks like and really create a legal argument to make sure folks are able to maintain their health care coverage," said Enddy Almonord, director for Healthy Illinois, an advocacy group supporting universal health care coverage. Editor's note: This story has been updated to clarify remarks from Tanya Broder at the National Immigration Law Center. Stateline reporter Tim Henderson can be reached at [email protected]. YOU MAKE OUR WORK POSSIBLE.
The Herald Scotland
18-05-2025
- Health
- The Herald Scotland
What to know about the proposed Republican cuts to Medicaid
The proposal is part of a massive policy package that aims to implement President Donald Trump's campaign promises, including an array of tax cuts that will cost an estimated $4 trillion over the next 10 years. Under pressure from ultraconservatives in the Republican conference, congressional leaders are trying to find ways to offset that revenue loss with commensurate cuts to federal spending. Health insurance benefit programs are one of the largest federal spending categories. Trump has said Medicare cuts are off the table, so changes to Medicaid became a central focus of potential cost savings for Republicans. One in five Americans are on Medicaid nationwide, including around 40% of all children. While the lawmakers did not include some of the more draconian cuts to Medicaid they had considered, the proposed changes are significant. They would save the federal government at least $625 billion and cause 7.6 million Americans to lose their health insurance over the next 10 years, according to initial estimates by the nonpartisan Congressional Budget Office. However, the impacts are likely greater, as the agency was unable to analyze the effects of at least 10 provisions in the bill by the time the estimates were released. The CBO also estimates 1.3 million people who are both on Medicaid and Medicare, which provides health care for seniors, would lose Medicaid coverage. That means some benefits that Medicaid covers but Medicare does not, such as long-term care, would be lost. "Medicaid is absolutely critical for children, for families, for people with disabilities and seniors," said Joan Alker, executive director of the Center for Children and Families at Georgetown University. "There's a great deal at stake here." Both Republicans and Democrats alleged the other side was lying about its impacts during a tense House committee hearing May 13 to debate the proposal. Republicans argued the changes are intended to eliminate "waste, fraud and abuse" from the program and said it would not hurt the people who most need Medicaid, while Democrats argued the proposal would dramatically reduce access to essential healthcare. "Medicaid was created to provide health care for Americans who otherwise could not support themselves, but Democrats expanded the program far beyond this core mission," said Rep. Brett Guthrie, R-Kentucky, chair of the House Energy and Commerce Committee that has spearheaded the Medicaid portion of the legislation. "We are cutting money and health care from people and families who are suffering to pay for tax cuts for the rich," said Rep. Alexandria Ocasio Cortez, D-New York. So what's really in the legislation? Here's what you need to know. Changes to Medicaid expansion Medicaid was originally designed to provide health coverage for low-income Americans. The Affordable Care Act, also known as Obamacare, expanded Medicaid to cover low-income adults who are not seniors in every state and made people eligible if they were making up to 138% of the federal poverty level. That law also said the federal government would pay for 90% of the cost of the expansion, with the other 10% made up by states. But states needed to adopt the expansion in order for it to be offered to their residents. Another law passed under former President Joe Biden created a financial incentive for states to do so. This bill would eliminate that incentive. Right now, 41 states and Washington, DC, have adopted the Medicaid expansion. The bill would also allow states to charge up to $35 per service for these adults covered under Medicaid expansion who make between 110% and 138% of the federal poverty level, which is currently $35,365 to $44,367 annually for a family of four. Work requirements The biggest change under the proposed bill would be the implementation of work requirements for adults enrolled in Medicaid expansion. "Large shares - almost half of the (bill's) estimated savings - are coming from provisions to require states to impose work requirements," said Robin Rudowitz, vice president at the nonpartisan health policy organization KFF. "We know from other analyses and earlier estimates of these provisions that they do result in significant coverage loss." Even people who have jobs or are disabled can lose coverage if they don't clear the bureaucratic hurdles. For example, a Medicaid work requirement program in Arkansas resulted in around 25% of those subject to the requirement losing coverage, primarily because they failed to regularly report work status or prove their eligibility for an exemption. Guthrie said during the committee debate that Republicans are not trying to model Arkansas, listing a the bill's multiple exemptions. Under the proposed legislation, people ages 19 to 64 would be required to show that they are working, doing community service or participating in an educational program for at least 80 hours a month. Some adults - such as pregnant women, people with disabilities, and people who are caregivers of dependent children - would be exempt. It would also explicitly prevent the policy from being waived for certain states. These changes would only go into effect in January 2029, after Trump's term is over, though GOP hardliners are pushing leadership for those to go into effect sooner. Increased eligibility checks Right now, states are required to check whether Medicaid enrollees are still qualified for benefits once every year. The Republican proposal would increase the frequency of those checks to every six months. States would also be required to proactively obtain updated contact information for Medicaid participants, including checking enrollee addresses to prevent enrollment in multiple states and regular review of the Master Death File to see if enrolled people have died. States are also required to provide Medicaid coverage for qualified medical expenses up to 90 days before someone applies for coverage. The bill would limit that retroactive coverage to just one month before a person applies. Medicaid providers would also be checked every month to determine whether they are still eligible to provide services under the program and would also be checked against the Master Death File. The bill also includes provisions aimed at reducing the price of prescription drugs by adding new requirements for pharmacy benefit managers to prevent them from overpricing medication. Discouraging coverage for undocumented children It is already illegal for undocumented immigrants to get federal Medicaid benefits. However, states are required to provide Medicaid coverage to otherwise qualified applicants for 90 days while their immigration status is being verified. The proposed legislation would end the requirement for states to provide coverage during that 90-day period. States would still be allowed to do so if they choose, but the bill bars states from receiving matching funds during that period. Fourteen states use their own funds to provide health coverage to undocumented children, and seven states do so for adults. The bill would punish states for using their own money to provide those services by reducing the expansion match rate from 90% to 80%. Planned Parenthood in the crosshairs Medicaid recipients are currently allowed to get services from any qualified provider, including clinics like Planned Parenthood, though federal funds cannot be used to directly pay for abortions. The bill would bar Medicaid from paying for services of any kind at nonprofits that are primarily engaged in family planning or reproductive health and provide abortions. That could be a sizable blow to Planned Parenthood and the women it serves: Around one in 10 female Medicaid beneficiaries between the ages of 15 and 49 receive family planning services at Planned Parenthood, according to KFF. In addition to abortions, Planned Parenthood clinics offer birth control, pregnancy testing, STD testing, and basic gynecological services. Another provision in the bill would bar federal matching funds for "gender transition procedures" for Medicaid or CHIP enrollees under age 18, including puberty blockers, hormone treatment or surgery. Financing restrictions Right now, states are allowed to raise money to pay for their portion of Medicaid spending through local government, state government, and health care-related taxes known as "provider taxes." The proposed legislation would bar states from creating new provider taxes or increasing the rates of any existing taxes. People who support limiting provider taxes argue they are used to artificially inflate the amount of money the federal government pays into the program. Experts say restricting provider taxes would likely force states to make difficult choices to make up additional costs. "There are very big cuts to Medicaid here, and states will not have any good choices to make up these lost federal funds," said Alker of Georgetown. "States have to either raise taxes, cut people off, or restrict access and benefits."
Yahoo
28-02-2025
- Health
- Yahoo
How 7 states could thwart GOP plans to overhaul Medicaid
Republicans are facing a nationwide backlash over the fate of Medicaid — but the potential program cuts are most threatening in seven conservative-leaning states where voters have cast ballots to expand the entitlement in recent years. It's a growing problem as Republicans hunt for enough savings to pay for the White House's proposed tax cuts. Republican Sen. Mike Rounds of South Dakota, which has enrolled more than 24,000 people in Medicaid since voters expanded the insurance program for low-income people in 2022, told POLITICO he's been arguing against some of his own party's proposals. One would reduce significantly how much funding for the program comes from the federal government. 'That's not a cost cutting measure — that's a cost transfer,' he said. 'And when you've got partnerships with the states, you shouldn't be doing that without having them involved in the discussion.' Republicans face similar skepticism across red and purple swaths of the country where voters have used ballot initiatives to expand Medicaid since Congress last targeted the safety net health insurance program in 2017 – not only in South Dakota, but also in Idaho, Nebraska, Maine, Oklahoma, Missouri and Utah. President Donald Trump won all of those states except Maine. And even there, he won an electoral vote by defeating Kamala Harris in the state's 2nd Congressional District, where nearly a third of people are enrolled in Medicaid. The president's conflicting guidance to Congress about whether and how much to cut from the program suggests he is aware of the political peril. Additional states could expand Medicaid in the coming years, making future rollbacks even more challenging. There's currently a campaign underway in Florida to put expansion on the ballot in 2026, underscoring the popularity of Medicaid even in the most MAGA-friendly states. 'Cutting Medicaid seems to be popular with some Republican elites and some right wing think tanks that are getting funded by some right wing billionaires, but they're unquestionably not popular with the Republican voters,' Joan Alker, the executive director of the Center for Children and Families at Georgetown University's McCourt School of Public Policy, told reporters at a briefing on Medicaid this week. 'We've seen many polls recently asking voters to rank what they wanted … and cutting Medicaid was literally the last on the list for voters of all stripes.' Coalitions on the ground in the seven states that passed Medicaid expansion initiatives — made up of powerful hospital associations, grassroots advocacy groups and other strange bedfellows — are now re-mobilizing to defend them. They're sending people to town halls. They're publishing op-eds in local newspapers. They're flooding the phone lines of their members of Congress. And they're mulling a revival of some of the more aggressive tactics activists used to protest attempts to repeal the Affordable Care Act in 2017. 'We're going back to the old playbook,' said Matt Slonaker, the executive director of the Utah Health Policy Project who spearheaded the state's ballot initiative campaign in 2018. 'It's always hard to get folks to act, but they seem to be really, really ready to do this right now.' With pressure mounting to find hundreds of billions in savings, lawmakers who are usually on board with slashing government spending remain on high alert about the blowback they could face in their states over Medicaid. And as they struggle to keep their members united behind Trump's budget plan, GOP leadership is taking notice. House Speaker Mike Johnson on Wednesday night backed away from some of the most sweeping changes the GOP had been debating, including capping the funds states get for each Medicaid enrollee and rolling back federal support for expansion states, even as he dismissed outrage his members have recently faced over threatened cuts at fiery town halls across the country as the work of 'paid protesters.' 'All this attention is being paid to Medicaid because that's the Democrats' talking point,' Johnson said. 'We're talking about finding efficiencies in every program, but not cutting benefits for people who rightly deserve them.' Pro-expansion health care groups in these seven red and purple states mounted expensive and time-consuming ballot initiative campaigns to circumvent conservative state legislatures and governors who refused to expand Medicaid, and some of those same state officials are currently working to roll back the expanded coverage their constituents enacted. That's left Republicans on Capitol Hill from Medicaid-expansion states as the loudest — and in some cases the only — effective voices of opposition to the proposed cuts now that Democrats are locked out of power. And while some House Republicans who represent red districts are feeling the heat, senators will have to answer to their entire state. 'I don't quite think Republicans know the backlash they're in for,' said Brad Woodhouse, a former Democratic National Committee official who now runs the progressive health care advocacy group Protect Our Care. 'And it's going to be a particularly bitter pill in these states that have used ballot initiatives because in those cases, the voters have really spoken about their preference.' Republican Sens. Josh Hawley of Missouri and Susan Collins of Maine — both of whom hail from states that expanded Medicaid by ballot measure — crossed the aisle earlier this week to support a Democratic amendment to the Senate budget resolution that would have blocked tax cuts for the wealthy if any Medicaid funding is cut. Hawley, who represents about 326,000 people who became eligible for Medicaid under the state's 2021 expansion, has said he wouldn't support 'severe' cuts to Medicaid — specifically cuts that would lead to reduced benefits — calling it a 'red line' for securing his vote. The politics are especially tricky for representatives of more rural states where Medicaid has been a lifeline for hospitals struggling to keep the lights on — hospitals that in some instances are among the state's biggest employers. In Idaho, for example, voters approved expanding Medicaid in 2018 with 61 percent support, extending coverage to about 90,000 more residents. But if federal funding for Medicaid decreases as a result of the current negotiations in Washington, the state legislature has the power to intervene and potentially repeal the expansion. Idaho House Minority Leader Ilana Rubel, a Democrat, is among those warning that such an outcome would threaten the state's remaining rural hospitals. 'That's a disaster, not only for the people on Medicaid, but for the people on private insurance,' Rubel said. 'Because when you live in these rural areas, you know you can have the best insurance in the world, but if the hospital in your area has gone out of business and you fall off a ladder or have a heart attack, there will be nobody to help you.' Yet not every Republican from an expansion state is worried about the sweeping reforms hardliners in their caucus are pushing for. Sen. James Lankford of Oklahoma, where more than 245,000 people became eligible for coverage after the state voted to expand Medicaid in 2020, echoed Speaker Johnson's argument that the final budget would not impact individuals' health care benefits and said he hadn't heard from concerned citizens about it. 'I have not heard anyone talking about cutting off Medicaid to people,' he said. 'It has been dealing with formulas. It's been dealing with fraud.' Utah Sen. John Curtis told POLITICO this week that after discussing the matter with Republican Gov. Spencer Cox, he's not sweating the political implications. He said he's 'not near as concerned' about cuts to the safety net program as he is 'about the fiscal irresponsibility that we're facing,' adding that he's 'in total harmony with our state leaders on this.' Medicaid enrollment in Utah grew nearly 60 percent after a ballot measure expanding the program passed in 2018. But Utah is among the nine states that has a 'trigger' law in place to automatically end Medicaid expansion or require major changes to the program if federal funds decline, threatening coverage for millions of people. For Curtis, that's a feature rather than a bug. 'Our state is one of more fiscally responsible states, in my opinion, and they saw this coming,' he said.
