Week in Washington 05/09/24

CMS Regulations


CMS finalized its DACA rule last week. The rule grants DACA recipients (DACA recipients are a cohort of undocumented immigrants that received deferred action) access to APTCs and CSR variant plans (currently they’re ineligible). The rule would go into effect for the 2025 Open Enrollment Period (i.e., they’d have coverage starting in 2025). CMS estimates that this could increase Exchange enrollment by about 100,000.  While there were not state specific estimates, this link has a breakdown of state by state DACA recipients.

Bias Rule Litigation

Florida and several other states filed a lawsuit this week against the recently finalized 1557 anti-discrimination rule. In particular, the rule strengthens protections for LGBTQ+ patients from discrimination. Florida and other parties argue that the rule interferes with state laws and goes beyond non-discrimination. 

Trustee Report

The Office of the Actuary (CMS) released its annual Trustee Report on the state of the Medicare trust fund. The report states that the Medicare Hospital Insurance Fund will stay solvent until 2036, which is 5 years longer than it projected last year. The year over year difference is a function of higher-than-expected wage growth and lower than expected expenditures (specifically around policy changes that reduce Medicare Advantage spending).


FDA Updates

The FDA is scheduled to have its advisory committees to meet in June to discuss the formulation of this fall’s Covid-19 shot, potential approval of Eli Lilly’s experimental Alzheimer’s drug, and an application to allow MDMA-assisted therapy.

ACA Fraud Updates

CMS released an update on their efforts around fraud. In particular they announced they had received about 90,000 complaints around either unauthorized plan switching or enrollment. CMS has resolved about 90% of these cases already and looking into regulatory and operational changes that could reduce these cases in the future.

Medicaid Redetermination Updates

The Urban Institute released its analysis on how Medicaid and CHIP “unwinding has gone”. The analysis focuses on comparing Medicaid disenrollment patterns (observed through November 2023) relative to expectations. States that publicized intent to finish unwinding in less than 12 months, states that obtain few waivers to streamline renewal rates, and states that prioritized ineligible cohorts first had higher net disenrollment rates relative to other states. States that had any of the three characteristics had an average child disenrollment over 120% of Urban’s initial projections.

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