Senate 2016 Budget Released; Disability-related programs targeted

Senator Mike Enzi (R-WY), Chairman of the Senate Budget Committee, released the proposed Senate FY 2016 Budget Resolution on March 18, one day after the release of the House Budget. In a party-line vote, the Senate Budget Committee passed the measure on March 19. The proposed Senate budget provides for a slightly smaller overall spending cut goal of $5.1 trillion over 10 years, with $4.3 trillion cut from mandatory programs and $97 billion from discretionary programs. The combined Medicaid cuts would exceed $1.3 trillion over ten years. Specific provisions of great concern to the disability community are:

  • Medicaid. The Senate budget would radically restructure Medicaid by converting much of it into two block grants (no information is provided on how the funding levels would be set). It “improves Medicaid based on the CHIP model” and “increases state flexibility in designing benefits and administering its programs, to encourage efficiency and reduce wasteful spending” for long term services and supports. (Fortunately, it makes no changes to the funding of acute care services for the low-income elderly and persons with disabilities.)
  • Repeal of the ACA, including Medicaid expansion. The Senate budget seeks to repeal the ACA.
  • Medicare. $435 billion in Medicare savings is proposed, none of it specified.
  • Discretionary Programs. The Senate budget “strengthens the caps” on discretionary spending. It would maintain full sequestration in 2016, and cuts funding for non-defense discretionary programs at least $236 billion below the sequestration levels through 2025. By 2025, total funding for non-defense discretionary programs would be at least 24 percent below the 2010 level adjusted for inflation.

New HCBS Resource: Questions and Answers About the Home and Community Based Services (HCBS) Settings Rules

The Arc is pleased to share a new Q&A document designed to be a resource to assist advocates understand the impact of the HCBS Settings Rule as the March 17, 2015 deadline for states to submit a transition plan to the Centers for Medicare and Medicaid Services (CMS) approaches. The document provides answers to frequently asked questions about the Rule as well as links to primary source documents and additional information members of The Arc may find helpful as they advocate for the full inclusion and community participation of people with I/DD.

Centers for Medicare & Medicaid Services (CMS) Leader Resigning

Marilyn Tavenner, the chief administrator for the federal agency that oversees Medicaid, Medicare and most of the Affordable Care Act is resigning at the end of the month. She was confirmed overwhelmingly by the Senate in May, 2013 and oversaw the roll out of the Affordable Care Act. Prior to her announcement, several other key leaders at CMS had resigned including Cindy Mann, who was the Deputy Administrator and Director of the Center for Medicaid and CHIP Services. Under the leadership of Ms. Tavenner and Ms. Mann, several important initiatives were advanced and there was increased openness to working with advocates and stakeholders.

50th Anniversary of Medicare and Medicaid Commemorated in the Senate

Last week, Senator Ron Wyden (D-OR), along with 44 colleagues, introduced “A resolution commemorating 50 years since the creation of the Medicare and Medicaid Programs,” S.R. 25. In his introductory remarks, Senator Wyden recalled the historical importance of these programs to people, including those with disabilities, stating “Medicare and Medicaid were bipartisan efforts, and the enactment of these programs shows that Congress can craft bipartisan solutions to complex problems. As this new Congress begins, I hope we can use that 50-year-old spirit to strengthen, protect, and improve Medicare and Medicaid to keep that guarantee strong, ensure health care to those who need it most, and protect a program that has been a lifeline to millions of Americans.”

House Holds Hearing on Health Care Spending Priorities for the 114th Congress

Last week, the House Energy and Commerce Committee Subcommittee on Health, Chaired by Rep. Joe Pitts (R-PA), held a hearing on “Setting Fiscal Priorities” to hear testimony related to key policy decisions the Committee may face in the 114th Congress related to health care spending by Medicaid and Medicare. Visit the Committee’s web site to view testimony and archived video of the hearing.

Updates to the Centers for Medicare & Medicaid Services Website

Last week, the Centers for Medicare & Medicaid Services (CMS) announced several changes to the Medicaid.gov website including a new home page with quick links including federal policy guidance and other new technical assistance resources.   Additionally, they have expanded State Medicaid and CHIP profiles to provide a more complete picture of the many policy and programmatic features that make up each state’s Medicaid and CHIP programs.  New elements include a state-specific list of approved state plan amendments and waivers and links to detailed Medicaid managed care profiles.

Centers for Medicare and Medicaid Services Will Not Move Forward With Controversial Provisions to the Medicare Prescription Drug Program

Last week, the Centers for Medicare and Medicaid Services (CMS) indicated to Members of Congress that they will not include several controversial provisions in regulations addressing the Medicare prescription drug program.  The Arc was particularly concerned about a proposal that would limit access to certain drugs in order to save money.  The Arc is pleased that this harmful provision will not be included at this time and looks forward to working with CMS to ensure that Medicare beneficiaries and people who receive both Medicare and Medicaid will continue to have access to the medications they need.  The Arc is grateful to the people who responded to our action alert on this important policy.

New Report Provides Overview of Ongoing Work to Improve Care for Dual Eligibles

The Medicare-Medicaid Coordination Office released its 2013 Report to Congress providing an overview of activities and accomplishments and ongoing work to improve care for Medicare-Medicaid enrollees.  MMCO made three legislative recommendations to Congress:

  • Streamline the appeals mechanisms available to beneficiaries through health plans and other qualified entities offering Medicare and Medicaid services;
  • Improve access to needed prescription drugs for Medicare-Medicaid enrollees by making the LI NET demonstration permanent; and
  • Develop a pilot for the Program for All-Inclusive Care for the Elderly (PACE) Eligibility for individuals between Ages 21 and 55.

In the report, MMCO identified two areas for further exploration that it believes may have potential to improve the experience of Medicare-Medicaid enrollees:

  • Coverage standards for Medicare-Medicaid enrollees; and
  • Cost-sharing rules for Qualified Medicare Beneficiaries (QMBs).

Medicare Reimbursement Rates Addressed by Congress

The House and Senate are moving forward on two tracks to address the problematic formula for reimbursing doctors and other Medicare health care providers.  Both chambers are planning to pass a short term measure that would prevent steep cuts to Medicare providers that would happen after January 1, 2014 as part of the budget agreement.  The House Ways and Means and Senate Finance Committees both passed separate legislation to permanently repeal the formula and replace it with a new approach.  The Senate Finance Committee will also include a provision to repeal the cap on therapy visits in the Medicare program. The House bill did not address the therapy issues or any of the other provisions that are normally extended as a part of the package.  The House and Senate have not addressed how the permanent fix will be paid for.