Latest news with #Medicaid-eligible
CNBC
26-06-2025
- Health
- CNBC
Supreme Court rules for South Carolina over bid to defund Planned Parenthood
WASHINGTON — The Supreme Court on Thursday ruled for South Carolina over its effort to defund Planned Parenthood, concluding that individual Medicaid patients cannot sue to enforce their right to pick a medical provider. The court held in a 6-3 ruling on ideological lines with the conservative justices in the majority that the federal law in question does not allow people who are enrolled in the Medicaid program to file such claims. The ruling authored by Justice Neil Gorsuch is a boost to the state's effort to prevented Planned Parenthood from receiving funding through Medicaid, a federal program for low-income people that is administered by the states, because it prevents individual patients to enforce their right to choose their preferred health care provider. Federal funding for abortion is already banned, but conservatives have long targeted Planned Parenthood, which provides reproductive health services including abortions where allowed, for any funding it receives even it is for other health care-related services. They argue that even non-abortion related funding that flows to Planned Parenthood would help it carry out its broader agenda that favors abortion rights. The state's efforts to defund Planned Parenthood came before the Supreme Court, which has a 6-3 conservative majority, overturned the landmark Roe v. Wade abortion rights ruling in 2022. South Carolina now has a six-week abortion ban, meaning abortions are rare in the state. Planned Parenthood has facilities in Charleston and Columbia that provide abortion care in compliance with the new law, as well as other health care services, including contraception, cancer screenings and pregnancy testing. In 2018, Gov. Henry McMaster issued an executive order that prohibited Planned Parenthood of South Atlantic, the local affiliate of the national group, from providing family planning services under Medicaid. Julie Edwards, a Medicaid-eligible patient who wants to use Planned Parenthood, joined a lawsuit filed by the group, saying that under federal civil rights law she could enforce her rights in court. A federal judge ruled in her favor, and after lengthy litigation, the Supreme Court agreed to weigh in.
NBC News
26-06-2025
- Health
- NBC News
Supreme Court rules for South Carolina over bid to defund Planned Parenthood
WASHINGTON — The Supreme Court on Thursday ruled for South Carolina over its effort to defund Planned Parenthood, concluding that individual Medicaid patients cannot sue to enforce their right to pick a medical provider. The court held in a 6-3 ruling on ideological lines with the conservative justices in the majority that the federal law in question does not allow people who are enrolled in the Medicaid program to file such claims. The ruling authored by Justice Neil Gorsuch is a boost to the state's effort to prevented Planned Parenthood from receiving funding through Medicaid, a federal program for low-income people that is administered by the states, because it prevents individual patients to enforce their right to choose their preferred health care provider. Federal funding for abortion is already banned, but conservatives have long targeted Planned Parenthood, which provides reproductive health services including abortions where allowed, for any funding it receives even it is for other health care-related services. They argue that even non-abortion related funding that flows to Planned Parenthood would help it carry out its broader agenda that favors abortion rights. The state's efforts to defund Planned Parenthood came before the Supreme Court, which has a 6-3 conservative majority, overturned the landmark Roe v. Wade abortion rights ruling in 2022. South Carolina now has a six-week abortion ban, meaning abortions are rare in the state. Planned Parenthood has facilities in Charleston and Columbia that provide abortion care in compliance with the new law, as well as other health care services, including contraception, cancer screenings and pregnancy testing. In 2018, Gov. Henry McMaster issued an executive order that prohibited Planned Parenthood of South Atlantic, the local affiliate of the national group, from providing family planning services under Medicaid. Julie Edwards, a Medicaid-eligible patient who wants to use Planned Parenthood, joined a lawsuit filed by the group, saying that under federal civil rights law she could enforce her rights in court. A federal judge ruled in her favor, and after lengthy litigation, the Supreme Court agreed to weigh in.
Yahoo
11-06-2025
- Health
- Yahoo
Legislature eyes changing Medicaid eligibility rules for people with intellectual disabilities
House Speaker Daniel Perez (R) with House budget chief Rep. Lawrence McClure (L). (Photo by Jay Waagmeester/Florida Phoenix) Florida could be poised to make it easier for people with developmental and intellectual disabilities (IDD) to maintain their Medicaid services. The latest round of budget negotiations between the House and Senate includes a proposal by the House to eliminate a requirement for people with IDD to annually be redetermined eligible for the health care safety net program for the poor, elderly, and disabled. If approved once, they would be presumptively eligible the rest of their lives unless they no longer qualify for Medicaid or their condition changes. The proposal, if accepted by the Florida Senate, would require approval from the U.S. Centers for Medicare & Medicaid Services to take effect. 'I'd call it a game changer for our population,' Florida Developmental Disabilities Council Executive Director Valerie Breen told the Florida Phoenix Wednesday. The council aims to increase the capacity of individuals with IDD to be included in their communities. The House health care budget conferees made the offer Tuesday. As of this publication, the budget negotiators had not met again. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX Breen said people with these disabilities face difficulties when they have to be re-determined Medicaid-eligible. She said people with IDD erroneously fell off the Medicaid rolls when, following the end of the public health emergency associated with Covid 19, people had to requalify for Medicaid. Breen guessed that as many as 1,000 people with IDD who were eligible for Medicaid erroneously lost their coverage. For people with IDD the redetermination process requires the Department of Children and Families (DCF), which determines eligibility, to communicate with the state Agency for Health Care Administration (AHCA), which administers the Medicaid program, and the Agency for Persons with Disabilities (APD), which is charged with oversight of programs that serve these populations. Sometimes, Breen said, redetermination also included interaction with the Social Security Administration. 'Those were the critical components, and the agencies did not communicate with each other,' she said. As a result people with IDD lost access to the home and community-based services that help them with the activities of daily living like eating and grooming. 'They were not able to access any of those services,' Breen said. The Legislature was forced to extend the 2025 Session after legislative leadership couldn't reach an agreement on how much state money to spend in state fiscal year 2025-26, which begins July 1, and how much tax relief to provide residents. House Speaker Daniel Perez and Senate President Ben Albritton ultimately agreed to extend the session until June 16 and to spend about $50 billion in general revenue, or state tax dollars, across various government agencies. Most of the money will go to two areas: education and health care, with the former receiving more than $22 billion and the latter about $17.5 billion. Budget negotiators have been meeting to try to hammer out the details of how the money should be spent. The state budget must be printed and distributed to legislators by June 15 in order to vote on it by June 18. That's because of a constitutional provision that requires the budget to cool off for 72 hours before legislators can vote on it. New law brings managed care to people with intellectual disabilities The move to allow people with IDD to remain on Medicaid after initially being determined eligible is one of several proposals relating to people with IDD that are being championed by the House. Perez vowed to make those issues a priority during his two year tenure. To that end, Perez championed HB 1103, a proposal to make a small managed care pilot program, available statewide for people with IDD. HB 1103 also requires APD to publicly publish reports regarding the number of people with IDD the state serves and the number of people on a wait list for the Medicaid services. Gov. Ron DeSantis has signed the legislation. SUPPORT: YOU MAKE OUR WORK POSSIBLE
Miami Herald
05-06-2025
- Health
- Miami Herald
Millions of kids are caregivers for elders. Why their numbers might grow
High school senior Joshua Yang understands sacrifice. When he was midway through 10th grade, his mom survived a terrible car crash. But her body developed tremors, and she lost mobility. After countless appointments, doctors diagnosed her with Parkinson's disease, saying it was likely triggered by brain injuries sustained in the wreck. At 15, Yang, an aspiring baseball player and member of his school's debate team, took on a new role: his mother's caregiver. Researchers estimate that Yang, now 18, counted among at least 5.4 million U.S. children who provide care to an adult in their home. As state officials eye federal Medicaid funding cuts that could drastically reduce home care services for those who are disabled or have chronic health conditions, many predict that number will rise. That's bad news for kids: Studies show that when young people take on care for adults with medical conditions, their health and academic outcomes decline. At the same time, their loved ones receive untrained care. 'It all fell to me,' said Yang, whose sisters were 9 and 10 at the time of their mom's accident, and whose stepdad worked nights. His grades fell and he quit after-school activities, he said, unable to spare the time. Early on, Yang found reprieve from a personal care nurse who gave them supplies, such as adult diapers, and advice on items to purchase, such as a chair for the shower. And for about a year, Yang was able to work for a personal care agency and earn $1,000 a month caring for his mom — money that went toward her medication and family needs. But at the beginning of 11th grade, a change to his mom's insurance ended her personal care benefit, sending him into a runaround with his county's Medicaid office in Minnesota. 'For a solid month I was on my phone, on hold, in the back of the class, waiting for the 'hello,'' he said. 'I'd be in third period, saying, 'Mr. Stepan, can I step out?'' A report published in May by the U.S. Government Accountability Office reminded states that National Family Caregiver Support Program grants can be used to assist caregivers under 18. However, the future of those grants remains unclear: They are funded through the Older Americans Act, which is awaiting reauthorization; and the Administration for Community Living, which oversees the grants, was nearly halved in April as part of the reorganization of the Department of Health and Human Services under President Donald Trump. Additionally, if Congress approves proposed cuts to Medicaid, one of the first casualties likely will be states' home- and community-based service programs that provide critical financial relief to family caregivers, said Andrew Olenski, an economist at Lehigh University specializing in long-term health care. Such programs, which differ by state but are paid for with federal dollars, are designed to ensure that Medicaid-eligible people in need of long-term care can continue living at home by covering in-home personal and nursing care. In 2021, they served almost 5% of all Medicaid participants, costing about $158 billion. By law, Medicaid is required to cover necessary long-term care in a nursing home setting but not all home or community care programs. So, if states are forced to make cuts, those programs are vulnerable to being scaled back or eliminated. If an aide who makes daily home visits, for example, is no longer an option, family caregivers could step in, Olenski said. But he pointed out that not all patients have adult children to care for them, and not all adult children can afford to step away from the workforce. And that could put more pressure on any kids at home. 'These things tend to roll downhill,' Olenski said. Some studies show benefits to young people who step into caregiving roles, such as more self-confidence and improved family relationships. Yang said he feels more on top of things than his peers: 'I have friends worrying about how to land a job interview, while I've already applied to seven or eight other jobs.' But for many, the cost is steep. Young caregivers report more depression, anxiety, and stress than their peers. Their physical health tends to be worse, too, related to diet and lack of attention to their own care. And caregiving often becomes a significant drag on their education: A large study found that 15- to 18-year-old caregivers spent, on average, 42 fewer minutes per day on educational activities and 31 fewer minutes in class than their peers. Schools in several states are taking notice. In Colorado, a statewide survey recently included its first question about caregiving and found that more than 12% of high schoolers provide care for someone in their home who is chronically ill, elderly, or disabled. Rhode Island's education department now requires every middle and high school to craft a policy to support caregiving students after a study published in 2023 found 29% of middle and high school students report caring for a younger or older family member for part of the day, and 7% said the role takes up most of their day. Rates were higher for Hispanic, Asian, and Black students than their white peers. The results floored Lindsey Tavares, principal of Apprenticeship Exploration School, a charter high school in Cranston. Just under half her students identified as caregivers, she said. That awareness has changed conversations when students' grades slip or the kids stop showing up on time or at all. 'We know now that this is a question we should be asking directly,' she said. Students have shared stories of staying home to care for an ill sibling when a parent needs to work, missing school to translate doctors' appointments, or working nights to pitch in financially, she said. Tavares and her team see it as their job to find an approach to help students persist. That might look like connecting the student to resources outside the school, offering mental health support, or working with a teacher to keep a student caught up. 'We can't always solve their problem,' Tavares said. 'But we can be really realistic about how we can get that student to finish high school.' Rhode Island officials believe their state is the first to officially support caregiving students — work they're doing in partnership with the Florida-based American Association for Caregiving Youth. In 2006, the association formed the Caregiving Youth Project, which works with schools to provide eligible students with peer group support, medical care training, overnight summer camp, and specialists tuned in to each student's specific needs. This school year, more than 700 middle and high school students took part. 'For kids, it's important for them to know they're not alone,' said Julia Belkowitz, a pediatrician and an associate professor at the University of Miami who has studied student caregivers. 'And for the rest of us, it's important, as we consider policies, to know who's really doing this work.' In St. Paul, Joshua Yang had hoped to study civil engineering at the University of Minnesota, but decided instead to attend community college in the fall, where his schedule will make it simpler to continue living at home and caring for his mom. But he sees some respite on the horizon as his sisters, now 12 and 13, prepare to take on a greater share of the caregiving. They're 'actual people' now with personalities and a sense of responsibility, he said with a laugh. 'It's like, we all know that we're the most meaningful people in our mom's life, so let's all help out,' he said. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Newsweek
28-05-2025
- Health
- Newsweek
Trump Administration Takes Action on Illegal Immigrants Getting Medicaid
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. The Centers for Medicare & Medicaid Services (CMS) has announced heightened oversight to stop states from using federal Medicaid funds to provide nonemergency health care to undocumented migrants. The policy change, linked to an executive order President Donald Trump signed in February, places states on notice for potential recoupment of funds spent in violation of federal law. Newsweek has contacted the CMS for comment via email. Why It Matters This effort marks a significant escalation in federal and state tensions over the boundaries of Medicaid eligibility and the use of taxpayer funds, particularly as debates over immigration policy and public program funding sharpen nationwide. Medicaid, which serves tens of millions of low-income Americans, operates with shared funding and regulatory authority by both federal and state governments. The new measures could affect state budgets and access to care for some populations in states with broader interpretations of Medicaid eligibility. A stock image of migrants gathering for a rally at the U.S.-Mexico border. A stock image of migrants gathering for a rally at the U.S.-Mexico border. Aimee Melo/dpa via AP What To Know The CMS said in a news release on Tuesday, "Under federal law, federal Medicaid funding is generally only available for emergency medical services for noncitizens with unsatisfactory immigration status who would otherwise be Medicaid-eligible, but some states have pushed the boundaries, putting taxpayers on the hook for benefits that are not allowed." The heightened federal oversight includes focused evaluations of selected state Medicaid spending reports, in-depth reviews of states' financial management systems and assessments of eligibility policies to close loopholes. States found to have misallocated funds would face federal recoupment. The CMS announcement did not specify which states were under review or directly affected by the new enforcement, simply citing "select states." Currently, 14 states and Washington, D.C., offer health coverage to undocumented migrants: California, New York, Illinois, Washington, New Jersey, Oregon, Massachusetts, Minnesota, Colorado, Connecticut, Utah, Rhode Island, Maine and Vermont. These states offer different kinds of support for those without legal status in the U.S. Some offer coverage to those over 65 years old, while others offer covered care to children and pregnant women. The agency's action focuses specifically on states using federal Medicaid dollars, not state funding only, in ways CMS deems improper. CMS urged all states to immediately review and update internal controls, eligibility systems and cost allocation policies to ensure federal compliance. The agency made clear that "any improper spending on noncitizens will be subject to recoupment of the federal share." The CMS announcement directly ties the initiative to Trump's Ending Taxpayer Subsidization of Open Borders executive order, which seeks to ensure that federal programs serve only those eligible under law. What People Are Saying Dr. Ben Sommers, a professor of health care economics at Harvard T.H. Chan School of Public Health, Boston, told Newsweek: "Federal law already prohibits Medicaid funds for nonemergency care for undocumented immigrants. I have not seen any data to suggest that what the administration is discussing here is a substantial problem. Emergency Medicaid (which is legal) already represents a very small share of Medicaid spending, which suggests that this additional enforcement is unlikely to yield any notable savings. It sounds more like a political message and posturing about immigration, rather than a genuine attempt to detect fraud or improve the financial circumstances of the Medicaid program." He added: "More notably, when you couple this with the ongoing legislative efforts in the Congressional Budget Bill to cut millions of people from Medicaid, it appears that the administration is more interested in cutting health care services and satisfying its conservative anti-immigrant base than in making health care more affordable for people." Tiffany Joseph, a professor of sociology and international affairs at Northeastern University, told Newsweek: "This move will have a significant impact on the health care access and health of undocumented and even documented immigrants in states that use their own funds to provide nonemergency care to these populations. As those states will be under more scrutiny from the federal government, they will have to make hard choices between complying with the law and extending care to some of the most vulnerable in their states. The targeting of immigrants will have ripple effects for naturalized and U.S.-born citizens in mixed-status families and deter those individuals from applying for and using Medicaid and other social safety nets for which they are eligible due to fear of increased surveillance." She added: "If people do not have access to health coverage through Medicaid or some other means, they will have less access to regular preventive care and go to emergency rooms for care with more severe health problems. As this is the most expensive form of health care, this will increase health care costs for everyone and significantly increase already very long wait times in emergency departments around the country. Though focused on immigrants, this enhanced federal oversight will negatively affect health care access for the broader population. This decision alongside the proposed Medicaid cuts in the recently approved GOP House Budget Bill show that the Trump administration and supporting legislators are not concerned about health care access or the collective health of people living in the United States." Alexandra Filindra, a professor of political science and psychology at the University of Illinois, Chicago, told Newsweek: "If people are excluded from routine care, they may not get vaccinated for all kinds of contagious diseases, increasing the risk of disease for children and susceptible adults. People may delay care until their symptoms are acute, landing in the ER. Emergency care is far more expensive than routine care, and the costs will either have to be absorbed by hospitals, leading to financial trouble, or states, leading to higher taxes. Pregnant women may not get necessary prenatal care leading to health problems in American citizen babies that will have to be addressed by the health care system for the next century. Excluding undocumented people from health insurance will not make them self-deport, it will make Americans less healthy and poorer. It is also cruel and unbecoming of a civilized, democratic society." Dr. Mehmet Oz, the administrator of the Centers for Medicare & Medicaid Services, said in a news release: "Medicaid is not, and cannot be, a backdoor pathway to subsidize open borders. States have a duty to uphold the law and protect taxpayer funds. We are putting them on notice—CMS will not allow federal dollars to be diverted to cover those who are not lawfully eligible." He told Fox News' Sunday Morning Futures: "We do have to support Americans who are most vulnerable. That stated, we have to make the program sustainable. We have to protect it." "There's much we can do as a country. It's a shared responsibility. We have to do it together. But the buck stops here. We've got to clean up the system. We're not paying $200 million for housekeeping anymore a year. We're not going to pay for illegal immigrants in states that are submitting those claims. Why should people living in Mississippi, Texas, or Florida be paying for illegal immigrants getting health care in California?" Drew Snyder, the deputy administrator of the CMS, said in the news release: "Medicaid funds must serve American citizens in need and those legally entitled to benefits. If states cannot or will not comply, CMS will step in." What Happens Next CMS said it would continue "to act decisively to ensure Medicaid dollars serve their true purpose—protecting people eligible for the program under federal law."
