Word from Washington: September 2023

On Sept. 18, the Centers for Medicare and Medicaid Services (CMS) released final regulations that will make it easier for millions of people who receive Supplemental Security Income (SSI) to access help with their Medicare costs, through enrollment in the Medicare Savings Program (MSP).  

MSPs are eligibility groups through which a state Medicaid program pays the Medicare Part A and B premiums (and often cost-sharing) for Medicare beneficiaries with limited incomes, helping them to better afford food, housing, and other life necessities. However, burdensome and complicated application and verification policies have prevented about half of eligible beneficiaries from enrolling in MSPs. CMS’s new rule will simplify the MSP paperwork burden and verification process.  

These changes should greatly benefit people who receive federal SSI disability benefits. The final rule provides that many SSI recipients will now be automatically enrolled in MSPs (except in the eight so-called 209(b) states where Medicaid eligibility is not automatic for those receiving SSI).  This change alone is expected to increase enrollment for nearly one million SSI individuals by 2027. 

HFA fully supports the changes implemented by CMS in the final rule as the new rule will increase access and minimize coverage gaps in critical affordability programs for low-income persons with disabilities.   

Quick Hits: 

• A government shutdown at the close of the federal fiscal year (September 30) was narrowly averted when Congress passed a “continuing resolution,” funding the government for another 45 days. Congress will have to pass full-year funding, or renew the continuing resolution, shortly before Thanksgiving.  
• According to the latest figures from the KFF Medicaid Enrollment and Unwinding Tracker, nearly 7.8 million Medicaid enrollees have lost coverage in 48 states and DC since redeterminations resumed in April, most for paperwork reasons. Alarmingly, children make up 42% of all Medicaid terminations among the 16 states reporting age breakouts. CMS warned in an August 30^th letter to states that states may be erroneously terminating coverage for children if the state systems are processing automatic renewals at the family-level and rather than the  individual-level (new mothers, young children, newborns, etc., within a single family may each have different eligibility requirements). In response, CMS has paused Medicaid disenrollments in 30 states that self-reported such system errors, and is requiring states to restore coverage for those wrongly disenrolled – a group that includes more than 500,000 Medicaid enrollees nationwide. 

• Bipartisan efforts to reform the business practices of pharmacy benefit managers (PBMs) continue in both houses. Nearly a dozen different bills, focusing largely on transparency and PBM pricing and rebate arrangements, remain in play in six different Congressional committees. 
• The U.S. Department of Health and Human Services (HHS), through its Office for Civil Rights, proposed a rule that would update and expand protections against discrimination on the basis of disability under Section 504 of the Rehabilitation Act. The proposed revisions would help people with disabilities access services from HHS-funded programs and would more closely align Section 504 protections with the Americans with Disabilities Act.   
• The Consumer Financial Protection Bureau (CFPB) announced that it is beginning a rulemaking process to remove medical bills from consumer credit reports, prevent creditors from relying on unpaid medical bills for underwriting purposes, and stop coercive collection practices related to medical debt.  According to CFPB, roughly 20 percent of all Americans had medical debts as part of their credit reports in 2022. Administration officials said the rules will be developed next year. 
• HFA along with NBDF and the Immune Deficiency Foundation (all, members of the American Plasma Users Coalition), visited Capitol Hill on September 20^th to raise awareness of the importance of plasma protein therapies, encouraging lawmakers to join the newly-formed Congressional Plasma Caucus. Please consider adding your voice to this effort here: bit.ly/PlasmaCaucus!