The Big Beautiful Bill, formally known as H. R. 1, includes numerous provisions affecting Medicaid, primarily focused on reducing waste, fraud, and abuse, as well as implementing work requirements and eligibility verification measures. Here’s a summary of the key ways it will impact Medicaid:
Eligibility Verification and Redeterminations:
- The bill mandates increased frequency of eligibility redeterminations for certain Medicaid populations, which could lead to more frequent verification of eligibility status and potential disenrollment if individuals no longer qualify.
- It also emphasizes the use of address verification and data sharing to prevent multiple issuances and ensure that only eligible individuals remain enrolled.
Restrictions on Coverage for Certain Procedures:
- The bill prohibits federal Medicaid and CHIP funding for gender transition procedures, which could reduce coverage for these services in some states.
Wastage and Fraud Prevention Measures:
- It introduces measures to prevent abusive spread pricing and improve payment accuracy to pharmacies, which could reduce improper payments and waste.
- The bill includes provisions for increased oversight and audits, which might lead to more stringent enforcement against fraud and abuse.
Work and Community Engagement Requirements:
- Medicaid community engagement (work) requirements are to be established for certain individuals, which may lead to disenrollment for those who do not meet these work or community activity standards, depending on state implementation.
Retroactive Coverage and Retroactive Payments:
- The bill modifies retroactive coverage rules, potentially affecting how and when individuals can access Medicaid services after initial eligibility.
Immigration and Citizenship Verification:
- It tightens citizenship and immigration status verification requirements, which could lead to disqualification or disenrollment of some non-citizen enrollees who cannot verify their status.
Other Administrative Changes:
- The bill limits the authority of the Secretary of Health and Human Services to propose or issue regulations, possibly restricting future administrative changes to Medicaid.
Overall Impact:
The bill aims to make Medicaid more cost-effective by tightening eligibility verification, reducing improper payments, and imposing work requirements and other restrictions. However, these measures could result in fewer people qualifying for or remaining enrolled in Medicaid, especially those who face difficulties in meeting verification or work requirements, or who are affected by restrictions on certain procedures. The net effect is likely to be a reduction in Medicaid enrollment and expenditures, as well as increased administrative oversight and potentially more disenrollments of ineligible or non-compliant individuals.
