Democratic Governors Call On Congress To Block Bush Administration Rules That Would Make It Harder For States To Expand SCHIP
At a House Energy and Commerce Health Subcommittee hearing, Massachusetts Gov. Deval Patrick (D) said that under the state's health insurance law, "CMS agreed to permit Massachusetts to expand SCHIP to children at or below 300% of the federal poverty level. As a result, Medicaid and SCHIP enrollment has grown by 40,000 children, including 18,000 newly eligible because of the expansion." Patrick said that the new directive "could have devastating effects on our progress, particularly our ability to cover families who have no affordable options in the unsubsidized private marketplace." He added that "as a practical matter in Massachusetts, this directive would leave thousands of children between 250% and 300% of the federal poverty level uninsured while their parents are covered by other features of our federally approved health care reform."
In addition, Washington state Gov. Chris Gregoire (D) said the directive will prevent the state from expanding its SCHIP eligibility limit from 250% of the poverty level to 300% next year. She said that no state will be able to meet the 95% standard. "The effect of the rule intended or otherwise is to preclude states from covering children in low-income households," Gregoire said. Washington is one of nine states that has filed a lawsuit challenging the directive. Ohio Gov. Ted Strickland (D) also criticized the directive and said it prevents states from enrolling uninsured children in the program (Reichard, CQ HealthBeat, 2/26).
Two Republican governors -- Mississippi Gov. Haley Barbour (R) and Georgia Gov. Sonny Perdue (R) -- at the hearing said that expanding SCHIP coverage to middle-income families would reduce funding for poorer states (AP/Houston Chronicle, 2/26). Response
House Health Subcommittee Chair Frank Pallone (D-N.J.) and House Energy and Commerce Committee Chair John Dingell (D-Mich.) said the directive would require states to reduce the number of beneficiaries currently enrolled in SCHIP programs, in addition to preventing states from implementing plans to expand their programs. However, "they offered governors no assurances about legislative prospects for overturning the controversial set of CMS instructions," CQ HealthBeat reports.
CMS spokesperson Mary Kahn said the directive "states that there is no effect on current enrollees," adding that the directive "does not impact those children, so they would not be dropped at redetermination" (CQ HealthBeat, 2/26).
NPR's "All Things Considered" on Tuesday reported on the hearing. The segment includes comments from Barbour, Gregoire and Patrick (Rovner, "All Things Considered," NPR, 2/26). Audio of the segment is available online. Suspension of Regulations
According to the AP/Chronicle, "While the governors were divided about SCHIP, they were unanimous in asking Congress to stop changes that the Bush administration is seeking for Medicaid." The administration has proposed changes to Medicaid rules that would save about $13 billion over five years (AP/Houston Chronicle, 2/26). The changes include provisions that would prohibit states from using federal Medicaid funds to help pay for physician training, place new limits on Medicaid payments to hospitals and nursing homes operated by state and local governments, and limit coverage of rehabilitation services for people with disabilities, including those with mental illnesses (Kaiser Daily Health Policy Report, 2/25).
Senate Budget Committee Chair Kent Conrad (D-N.D.) on Tuesday said the regulations should be suspended until the next administration, CongressDaily reports. Conrad said that the freeze Congress has placed on four final Medicaid regulations could be extended into the next Congress for $1 billion, with a longer suspension costing $15 billion. He said, "I think it's probably best to deal with that this year and then have a new administration, whoever it might be, deal with that separately" (Johnson, CongressDaily, 2/27). FMAP
Also during the hearing, Pallone said that he, Dingell and other House members have introduced legislation (HR 5268) that would temporarily increase the federal medical assistance percentage for states' Medicaid programs "during the economic downturn." Strickland during the hearing suggested that that House Minority Leader John Boehner (R-Ohio) has told him the FMAP could be included with supplemental legislation that includes funding for the wars in Iraq and Afghanistan, "but Pallone said no decision has been made on a vehicle," according to CQ HealthBeat (CQ HealthBeat, 2/26). Elderly Home Care
In related news, governors at the winter meeting of the National Governors Association last weekend in Washington, D.C., discussed how Medicaid wavers could be used to fund elderly home care to reduce spending on more-costly nursing homes, CQ HealthBeat reports. Congressional Budget Office Director Peter Orszag said, "It is true that moving a patient from a nursing home into their own home does substantially reduce costs," adding, "But there's a 'woodwork effect,' where, if you provide benefits to people in their homes, a lot more people may claim the benefits than would have gone into the nursing home."
However, Vermont, which already allows Medicaid beneficiaries to receive home care, has not experienced this problem, according to Patrick Flood, deputy secretary of the Vermont Agency of Human Services. He said, "Because it's cheaper, you can handle a pretty significant woodwork effect, because you're going to be able to serve a lot more people." Under the Vermont plan, people with "lighter-care needs" are placed on a waiting list.
New Jersey's plan screens Medicaid beneficiaries and then grants monthly allowances that are similar to what the state would have had to pay an agency, according to William Ditto, director of the New Jersey Division of Disability Services. He said, "What we did is to say to our consumers, 'you build into your monthly allowance any kind of training, any kind of in-service education, anything you want to make this person capable of performing the functions you need them to perform'" (Grimaldi, CQ HealthBeat, 2/26).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Democrat guvernatorilor apel la Congres pentru a bloca administraþiei Bush reguli care ar face mai dificilã membre de a extinde SCHIP - Democratic Governors Call On Congress To Block Bush Administration Rules That Would Make It Harder For States To Expand SCHIP - articole medicale engleza - startsanatate