Budget Bill
Congress passed a budget bill this week to end a short-term partial government shutdown. The budget bill funds most of the federal government agencies through the end of the fiscal year. The exception is the Department of Homeland Security (DHS), which only received a 2-week extension. Negotiations are expected to continue and if no resolution is reached then only DHS would be shut down (for example HHS would be unaffected).
The budget bill includes a number of health care related items, such as, PBM reform , extension to Medicare telehealth program for two years (it also extends the types of practitioners that are eligible for telehealth), extension for the Acute Hospital Care program for five years, and requires Medicare Advantage plans to provide accurate provider list.
CMS and Provider Taxes
CMS finalized a rule that reduces state’s flexibility around healthcare related taxes. The rule would disallow higher taxes on Medicaid managed care business. CMS estimates the changes would reduce federal spending by about $78 billion, with 95% of the fiscal impact being felt in California, Massachusetts, Michigan, and New York.
CMS Announces 2027 MOOP
CMS announced the annual maximum out of pocket (MOOP) limits for 2027 commercial plans. The MOOP will be $12,000 for self-only coverage and $24,0000 for family coverage. This is a 13.2% increase from 2026.
Medicaid Enrollment
CMS released its monthly enrollment snapshot. The latest snapshot covers Total Enrollment in Medicaid/CHIP , Marketplace, and BHPs through October 2025. Overall, there were 101.2 million people in these programs (76.8 million in Medicaid/CHIP, 22.6 million in Marketplace, and 1.8 million in BHP). This is a decline of about 9.5 million since March 2023 when Medicaid unwinding started.
