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Tags Posts tagged with "Medicaid"

Medicaid

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There’s been a lot of talk — and a lot of concern — about the federal budget and what it could mean for Medicaid. We’re all hearing it from you, too: “What’s actually happening?” “What does this mean for our funding?” “Are these changes final?”

This guide will help answer those questions. It lays out what’s in the current House bill, what’s at stake for providers, and what we’re watching next as the Senate and CMS weigh in.

Inside, you’ll find:

  • What changes are being proposed, like new work requirements and copays
  • What it could mean for your clients and funding
  • What we know, what we don’t, and what comes next

These updates aren’t always easy to follow, so we’re breaking them down in plain language, and we’ll keep doing so as things evolve. Stay up to date with our Medicaid Intel here.

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

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

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

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

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

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

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

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

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Effective Monday, June 16, 2025, the PA Consumer Service Center (Inspiritec) began accepting Long-Term Care (LTC) and Home and Community-Based Services (HCBS) applications over the phone. Individuals can call 1-866-550-4355 to apply for Medicaid, including LTC and HCBS. This information can be found on the DHS website, as well.

To communicate this change, the Department of Human Services (DHS) publicized this info with external stakeholders, posted banner messaging to multiple DHS web pages, added messaging to the Statewide Customer Service Center (CSC) wait time menu, and shared this information internally. DHS also provided Consumer Service Center staff with additional information needed to accurately capture information specific to LTC and HCBS applications.

Questions regarding this initiative can be directed to the DHS helpline at 800-692-7462.

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RCPA, in its partnership with the PA Health Access Network (PHAN), is asking organizations to consider signing on to their new letter, which opposes cuts to Medicaid and Pennie. The latest proposal in Congress would take healthcare away from 600,000 Pennsylvanians who receive their coverage through Medicaid or Pennie. This is a separate letter than was previously shared with members in February; we ask your organization to join PHAN and show your opposition to potential cuts. This new communication reflects some of the specific areas that will be impacted.

Enter your information to publicly sign on to the letter on behalf of your organization. Please note: this sign-on page is for organizations only. Please contact Bill England with any questions or if you do not want to be listed publicly.

RCPA continues its state and federal advocacy efforts for state mental health funding and preserving Medicaid funding. If you are interested in joining the Mental Health Safety Net Coalition, please contact RCPA Policy Associate Emma Sharp.

Thank you for all you do in working to preserve Pennsylvania’s healthcare.

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Capitol hill building in the morning with colorful cloud , Washington DC.

The Trump Administration’s “Big Beautiful Bill” was passed by House Republicans on May 22 and contains significant Medicaid cuts that could leave millions of Americans without coverage as well as severely reduce access to care. The proposed bill also includes cuts to Medicare funding, new restrictions on federal loans for medical students, and provisions to create a permanent, inflation-based mechanism for annual updates to Medicare physician payments. The legislation now heads to the Senate, where it will face further debate by lawmakers.

The proposed legislation seeks to accomplish the following:

Medicaid: 

  • The bill introduces a two-year acceleration of Medicaid work requirements for able-bodied adults ages 18 to 64, which is slated to take effect no later than December 31, 2026, instead of 2029. States have the ability to implement these requirements earlier to secure quicker savings.
  • Beginning October 21, 2027, states will be mandated to determine Medicaid eligibility every six months for people in the expansion population.
  • Medicaid and CHIP federal financial participation is prohibited under the bill revisions for people who fail to verify immigration status, citizenship, or nationality in the designated “reasonable opportunity” window.
  • States will also be required to cross-check their Death Master File quarterly to confirm deceased individuals are disenrolled. Should errors occur, there will be reinstatement provisions.
  • The Social Security Act is amended to cut retroactive Medicaid coverage from three months to one month before the application date.
  • Federal Medicaid and CHIP funding is prohibited for “specific gender transition procedures” provided to people under 18 years of age.
  • Eligibility for increased federal medical assistance percentage for states that are newly expanding Medicaid will be wound down. To qualify, states must start expansion by January 1, 2026, to restrict late expansion states from receiving an elevated match rate.
  • New rules for waiving the uniform tax requirement for Medicaid provider taxes will be imposed, which tightens conditions for states to use the financial tools.

Medicare:

  • A proposed staffing mandate is halted under the bill for long-term care facilities that receive Medicaid and Medicare funds.
  • The bill promotes the use of artificial intelligence to recover and reduce improper Medicare payments.
  • A May 20 report from the nonpartisan Congressional Budget Office found that the bill could cut nearly $500 billion over the next decade in Medicare funding.
  • The budget bill includes provisions to increase Medicare physician payments by an estimated 2.25% in 2026. This would be achieved by tying payments to 75% of the Medicare Economic Index. Starting in 2027, annual payments would be adjusted by 10% of the index, establishing a permanent, inflation-based update mechanism.
  • Under current law, physician pay is set to increase by just 0.25% in 2026 and 2.5% by 2035. The proposed changes would boost payments to 4.3% by 2035 instead. Physician groups, including the American Medical Association, strongly support the provision, calling it a critical step toward restoring stability after years of payment cuts.
  • The bill also adjusts the Medicare Physician Fee Schedule’s conversion factor, a key formula used to calculate final physician reimbursement. While the legislation introduces inflation-based updates, changes to the conversion factor could offset those increases and slow long-term payment growth. Physician groups have welcomed the update mechanism as a step in the right direction, though they say further reforms are needed to ensure physician payments fully reflect inflation and keep pace with rising practice costs over time.

CMS:

Outside of Congress, the Center for Medicaid Services (CMS) has also made announcements that could threaten access to healthcare:

  • On May 27, CMS announced increased federal oversight to prevent states from using federal Medicaid dollars to cover healthcare for undocumented immigrants for anything beyond emergency services, which violates federal law.
  • CMS outlined plans to increase audits of state Medicaid spending, eligibility systems, and financial controls, with recoupment of funds if misuse is found.

Please contact Emma Sharp with any questions.

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The Centers for Medicare and Medicaid Services (CMS) recently released their CMS Fast Facts resource document for 2022 – 2025. The document includes summary information on Medicare and Medicaid total program enrollment, utilization, and expenditures, as well as the total number of Medicare providers, including physicians by specialty area.

There are a number of new items provided in 2025:

  • Medicare Populations, Calendar Year (CY) 2024
  • Medicaid & Children’s Health Insurance Program (CHIP) Populations, CY 2024
  • Medicare Deductibles, Coinsurance, Premiums, CY 2025
  • Original Medicare Persons Served and Payments by Type of Service, CY 2023
  • Medicare Part D Utilization and Expenditures, CY 2023
  • Medicaid & CHIP Payments by Type of Service, FY 2023
  • Medicare Institutional Providers, CY 2023
  • Medicare Non-Institutional Providers by Specialty, CY 2023
  • Medicare Durable Medical Equipment Prosthetics, Orthotics & Supplies (DMEPOS) Providers by Specialty, CY 2023
  • Medicare Prepaid Contracts, February 2025
  • National Health Expenditures, CY 2023
  • CMS Financial Data, FY 2024

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

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

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

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

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

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

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