Certainly! Here's a more detailed breakdown of specific provisions within the Big Beautiful Bill (H.R. 1) related to Medicaid, highlighting key sections and their potential impacts:
1. Eligibility Verification and Redetermination (Section 102)
- Provision: The bill requires states to conduct redeterminations of Medicaid eligibility at least once every 12 months for certain populations, including adults.
- Impact: Increased frequency of eligibility checks may lead to disenrollment for individuals who no longer meet criteria, especially if they face barriers to timely verification.
2. Use of Data and Address Verification (Section 102)
- Provision: Mandates enhanced use of data sharing between federal and state agencies to verify eligibility and prevent duplicate enrollment.
- Impact: Improved fraud detection and reduced waste, but may also lead to disenrollment if discrepancies are found.
3. Restrictions on Coverage for Gender Transition Procedures (Section 203)
- Provision: Prohibits federal Medicaid funding for gender transition procedures.
- Impact: Reduces coverage for specific procedures in states that currently cover them, potentially limiting access for transgender individuals.
4. Work and Community Engagement Requirements (Section 401)
- Provision: States are encouraged or required to establish work requirements for certain Medicaid populations.
- Impact: Non-compliance with work requirements may lead to disenrollment, which could decrease overall Medicaid enrollment among affected groups.
5. Pharmacy Payment and Spread Pricing (Section 301)
- Provision: Implements measures to prevent "spread pricing," where pharmacies bill inflated prices.
- Impact: Expected to reduce improper payments and waste in pharmacy benefits, improving program integrity.
6. Retroactive Eligibility and Coverage (Section 105)
- Provision: Modifies rules around retroactive coverage, possibly limiting coverage to a shorter period before enrollment.
- Impact: Could delay access to services for newly enrolled individuals.
7. Citizenship and Immigration Verification (Section 402)
- Provision: Tightens requirements for verifying citizenship and immigration status.
- Impact: Potential disenrollment of non-citizens who cannot verify their status, decreasing enrollment in some populations.
8. Restrictions on Administrative Authority (Section 503)
- Provision: Limits the Secretary of HHS from issuing certain regulations related to Medicaid.
- Impact: Could restrict future administrative changes aimed at expanding or modifying Medicaid policies.
Summarized Effects:
- Cost Savings: By tightening eligibility and reducing waste, the bill aims to lower Medicaid expenditures.
- Access Limitations: Increased verification and work requirements may result in eligible individuals losing coverage.
- Administrative Burden: States may face increased administrative costs and complexities in implementing new verification systems.
- Population Impact: Certain vulnerable groups (non-citizens, transgender individuals, low-income workers) may experience reduced access.
