Latest news with #Medicaid-eligible
Newsweek
6 days ago
- Health
- Newsweek
Trump Administration Takes Action on Illegal Immigrants Getting Medicaid
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. Newsweek AI is in beta. Translations may contain inaccuracies—please refer to the original content. The Centers for Medicare & Medicaid Services (CMS) has announced heightened oversight to stop states from using federal Medicaid funds to provide nonemergency health care to undocumented migrants. The policy change, linked to an executive order President Donald Trump signed in February, places states on notice for potential recoupment of funds spent in violation of federal law. Newsweek has contacted the CMS for comment via email. Why It Matters This effort marks a significant escalation in federal and state tensions over the boundaries of Medicaid eligibility and the use of taxpayer funds, particularly as debates over immigration policy and public program funding sharpen nationwide. Medicaid, which serves tens of millions of low-income Americans, operates with shared funding and regulatory authority by both federal and state governments. The new measures could affect state budgets and access to care for some populations in states with broader interpretations of Medicaid eligibility. A stock image of migrants gathering for a rally at the U.S.-Mexico border. A stock image of migrants gathering for a rally at the U.S.-Mexico border. Aimee Melo/dpa via AP What To Know The CMS said in a news release on Tuesday, "Under federal law, federal Medicaid funding is generally only available for emergency medical services for noncitizens with unsatisfactory immigration status who would otherwise be Medicaid-eligible, but some states have pushed the boundaries, putting taxpayers on the hook for benefits that are not allowed." The heightened federal oversight includes focused evaluations of selected state Medicaid spending reports, in-depth reviews of states' financial management systems and assessments of eligibility policies to close loopholes. States found to have misallocated funds would face federal recoupment. The CMS announcement did not specify which states were under review or directly affected by the new enforcement, simply citing "select states." Currently, 14 states and Washington, D.C., offer health coverage to undocumented migrants: California, New York, Illinois, Washington, New Jersey, Oregon, Massachusetts, Minnesota, Colorado, Connecticut, Utah, Rhode Island, Maine and Vermont. These states offer different kinds of support for those without legal status in the U.S. Some offer coverage to those over 65 years old, while others offer covered care to children and pregnant women. The agency's action focuses specifically on states using federal Medicaid dollars, not state funding only, in ways CMS deems improper. CMS urged all states to immediately review and update internal controls, eligibility systems and cost allocation policies to ensure federal compliance. The agency made clear that "any improper spending on noncitizens will be subject to recoupment of the federal share." The CMS announcement directly ties the initiative to Trump's Ending Taxpayer Subsidization of Open Borders executive order, which seeks to ensure that federal programs serve only those eligible under law. What People Are Saying Dr. Ben Sommers, a professor of health care economics at Harvard T.H. Chan School of Public Health, Boston, told Newsweek: "Federal law already prohibits Medicaid funds for nonemergency care for undocumented immigrants. I have not seen any data to suggest that what the administration is discussing here is a substantial problem. Emergency Medicaid (which is legal) already represents a very small share of Medicaid spending, which suggests that this additional enforcement is unlikely to yield any notable savings. It sounds more like a political message and posturing about immigration, rather than a genuine attempt to detect fraud or improve the financial circumstances of the Medicaid program." He added: "More notably, when you couple this with the ongoing legislative efforts in the Congressional Budget Bill to cut millions of people from Medicaid, it appears that the administration is more interested in cutting health care services and satisfying its conservative anti-immigrant base than in making health care more affordable for people." Tiffany Joseph, a professor of sociology and international affairs at Northeastern University, told Newsweek: "This move will have a significant impact on the health care access and health of undocumented and even documented immigrants in states that use their own funds to provide nonemergency care to these populations. As those states will be under more scrutiny from the federal government, they will have to make hard choices between complying with the law and extending care to some of the most vulnerable in their states. The targeting of immigrants will have ripple effects for naturalized and U.S.-born citizens in mixed-status families and deter those individuals from applying for and using Medicaid and other social safety nets for which they are eligible due to fear of increased surveillance." She added: "If people do not have access to health coverage through Medicaid or some other means, they will have less access to regular preventive care and go to emergency rooms for care with more severe health problems. As this is the most expensive form of health care, this will increase health care costs for everyone and significantly increase already very long wait times in emergency departments around the country. Though focused on immigrants, this enhanced federal oversight will negatively affect health care access for the broader population. This decision alongside the proposed Medicaid cuts in the recently approved GOP House Budget Bill show that the Trump administration and supporting legislators are not concerned about health care access or the collective health of people living in the United States." Alexandra Filindra, a professor of political science and psychology at the University of Illinois, Chicago, told Newsweek: "If people are excluded from routine care, they may not get vaccinated for all kinds of contagious diseases, increasing the risk of disease for children and susceptible adults. People may delay care until their symptoms are acute, landing in the ER. Emergency care is far more expensive than routine care, and the costs will either have to be absorbed by hospitals, leading to financial trouble, or states, leading to higher taxes. Pregnant women may not get necessary prenatal care leading to health problems in American citizen babies that will have to be addressed by the health care system for the next century. Excluding undocumented people from health insurance will not make them self-deport, it will make Americans less healthy and poorer. It is also cruel and unbecoming of a civilized, democratic society." Dr. Mehmet Oz, the administrator of the Centers for Medicare & Medicaid Services, said in a news release: "Medicaid is not, and cannot be, a backdoor pathway to subsidize open borders. States have a duty to uphold the law and protect taxpayer funds. We are putting them on notice—CMS will not allow federal dollars to be diverted to cover those who are not lawfully eligible." He told Fox News' Sunday Morning Futures: "We do have to support Americans who are most vulnerable. That stated, we have to make the program sustainable. We have to protect it." "There's much we can do as a country. It's a shared responsibility. We have to do it together. But the buck stops here. We've got to clean up the system. We're not paying $200 million for housekeeping anymore a year. We're not going to pay for illegal immigrants in states that are submitting those claims. Why should people living in Mississippi, Texas, or Florida be paying for illegal immigrants getting health care in California?" Drew Snyder, the deputy administrator of the CMS, said in the news release: "Medicaid funds must serve American citizens in need and those legally entitled to benefits. If states cannot or will not comply, CMS will step in." What Happens Next CMS said it would continue "to act decisively to ensure Medicaid dollars serve their true purpose—protecting people eligible for the program under federal law."
Yahoo
21-05-2025
- Business
- Yahoo
James G. Johnston Memorial Nursing Home to close in July
JOHNSON CITY, N.Y. (WIVT/WBGH) – United Methodist Homes has made the 'very difficult decision' of closing a Johnson City nursing home, which has been in operation since 1974, this summer. The Executive leadership of United Methodist Homes' Hilltop Campus told News 34 that the 27 current residents of James G. Johnston Memorial Nursing Home will have to find alternate housing as of 'tentatively' July 19, 2025, which meets the required 60-day notice for residents. Vice President of Sales and Marketing for United Methodist Homes, Betsy Vannatta, says the leadership is working closely with families and residents to help them find new facilities to reside. 'Each and every resident and their families will be guided through the process and will be assisted in securing a new housing option as residents and their families are, and will continue to be UMH's top priority. The staff are equally valued and a priority and it is the goal of UMH to retain and reposition as many staff as possible. They are working closely with staff members to identify other employment opportunities within the organization,' Vannatta said. JGJ Memorial has been caring for Broome County seniors and those in need for over 50 years. CEO of UMH, Brian Picchini, says the reasoning for the closure is due to financial strain brought on by the 'insufficient Medicaid Program reimbursement available for nursing home services,' particularly in Broome County, where the number of Medicaid-eligible seniors is higher than usual. 'Essentially, the inadequate reimbursement rate system has not kept pace with the rising cost of care. Therefore, it has been determined the best course of action is to cease operations at JGJ,' Vannatta said. Vannatta did note that the closure is specifically to the nursing home facility, which does not affect the independent and assisted living operations on the Hilltop Campus. 'We remain committed to providing seniors a safe, secure community where they can continue to have access to the care and services needed when the time comes. While we regret the need to cease operation of our nursing home, we are forward looking and have plans to enhance ourcommunity by expanding resident access to wellness and preventative care programs and expand services in other areas which we believe will not only be successful in meeting resident needs, but will better match resident preferences,' stated Ron Patti, Chief Operating Officer. Vannatta says the nursing home will remain open and operational until they 'have successfully secured placement for each and every resident.' Village could use eminent domain on Pope Leo XIV's childhood home, attorney says SUNY Leaders outline priorities in State of the University Address Zeldin slams Whitehouse in heated exchange: Americans 'put President Trump in office because of people like you' Trump confronts South African president over claims of 'white genocide' Mace files resolution to expel McIver over ICE assault charges Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
30-04-2025
- Politics
- Yahoo
Opinion - Medicaid work-requirements are great, but states need flexibility to make them work
I was the first governor to implement work requirements on the working-age population that was on Medicaid. So I feel I have some standing to offer observations on what happened in Arkansas — a few lessons learned and recommendations to Congress as it considers a federal mandate on states to impose work and work-related activities as a condition of Medicaid eligibility. For a number of reasons, I am firmly in favor of work requirements for able-bodied working-age adults on Medicaid. Most importantly, work meets the objectives of Medicaid as an anti-poverty program. Work is a vital part of our human dignity, and participation is a fair way to honor the social contract between working-age adults on public assistance and their neighbors and communities. The first question about work requirements is the most important one: What is the goal? If the answer is to simply lower federal spending, then it will be easy to construct rigid rules that result in savings due to noncompliance and reducing the number of people receiving benefits. But if the goal is to actually help individuals and families escape poverty and achieve long-term self-sufficiency — which I believe should be the answer — then the assignment is much harder. This goal requires some flexibility for states to design programs that match their unique differences. Arkansas has one of the highest poverty levels among the states at 16 percent. However, the work opportunities in Benton County, Ark., home to Walmart and other large corporations, are very different from those in the Delta counties. Benton County has a higher median income for both households and individuals than the national income levels. In contrast, Phillips County, in the Mississippi Delta, has a poverty rate of 33 percent. The approaches to help people cross from poverty to independence cannot be the same between these two counties. The federal government created the so-called 'poverty trap' in which a person who goes to work loses more in in public benefits than he or she gains in income. This discourages work and results in more dependence. That is the compelling reason we need a work requirement that also supports increased training opportunities for the able-bodied. States need flexibility in devising work requirements that actually help people move up the employment ladder. One of the lessons learned in Arkansas was that relying on technology and data-matching for implementing a work requirement is insufficient. The results were poor. The human element is needed to make sure people are given every opportunity to have both health care and work or worker training. A quick look at the data shows the diversity of the Medicaid-eligible population. Many in the youngest age group move from the children's coverage under Medicaid into Affordable Care Act coverage simply because they have a birthday. They have little or no income because they have chosen to extend their education or have not been fully assimilated into the workforce. Many of these young adults will find their own way off Medicaid within 12 months without any further intervention. It is quite a different story for a 55 year-old single adult with a significant work history who ended up on Medicaid due to a major illness or accident. A single mother with prior work experience and at least some post-high school education may be one of the most interested and motivated individuals to return to work if proper support is available. The differences in the demographics serve as a lesson for Congress to resist the temptation to take a cookie-cutter approach. Congress must allow states sufficient latitude to tailor interventions to different populations. Blanket exemptions will result in missed opportunities, but so will limitations on ways to demonstrate compliance with work requirements. It has been widely reported that about 18,000 Arkansans lost their Medicaid eligibility due to noncompliance with work requirements. There has been little attention to the fact that 6,000 of these returned to Medicaid within 12 months. What happened to the rest? Although Arkansas didn't have the opportunity to study what happened to those who did not return, the answer is likely similar to what occurred nationally after the pandemic-era Public Health Emergency ended ('the unwind'). That is when the states were once again allowed to review Medicaid eligibility. As the unwind was concluding in late 2024, Medicaid and CHIP enrollment returned to 79.4 million and Marketplace coverage increased to 23.5 million. In other words, people moved from public coverage to private coverage because work opportunities increased. That should be the explicit goal of work requirements as well, and it must be the real measure of success. Congress has a unique opportunity to allow states to have a work requirement under Medicaid and at the same time allow the states to innovate and try different approaches that function best for those who value the dignity of work. Asa Hutchinson, a Republican, was the 46th governor of Arkansas. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
The Hill
30-04-2025
- Politics
- The Hill
Medicaid work-requirements are great, but states need flexibility to make them work
I was the first governor to implement work requirements on the working-age population that was on Medicaid. So I feel I have some standing to offer observations on what happened in Arkansas — a few lessons learned and recommendations to Congress as it considers a federal mandate on states to impose work and work-related activities as a condition of Medicaid eligibility. For a number of reasons, I am firmly in favor of work requirements for able-bodied working-age adults on Medicaid. Most importantly, work meets the objectives of Medicaid as an anti-poverty program. Work is a vital part of our human dignity, and participation is a fair way to honor the social contract between working-age adults on public assistance and their neighbors and communities. The first question about work requirements is the most important one: What is the goal? If the answer is to simply lower federal spending, then it will be easy to construct rigid rules that result in savings due to noncompliance and reducing the number of people receiving benefits. But if the goal is to actually help individuals and families escape poverty and achieve long-term self-sufficiency — which I believe should be the answer — then the assignment is much harder. This goal requires some flexibility for states to design programs that match their unique differences. Arkansas has one of the highest poverty levels among the states at 16 percent. However, the work opportunities in Benton County, Ark., home to Walmart and other large corporations, are very different from those in the Delta counties. Benton County has a higher median income for both households and individuals than the national income levels. In contrast, Phillips County, in the Mississippi Delta, has a poverty rate of 33 percent. The approaches to help people cross from poverty to independence cannot be the same between these two counties. The federal government created the so-called 'poverty trap' in which a person who goes to work loses more in in public benefits than he or she gains in income. This discourages work and results in more dependence. That is the compelling reason we need a work requirement that also supports increased training opportunities for the able-bodied. States need flexibility in devising work requirements that actually help people move up the employment ladder. One of the lessons learned in Arkansas was that relying on technology and data-matching for implementing a work requirement is insufficient. The results were poor. The human element is needed to make sure people are given every opportunity to have both health care and work or worker training. A quick look at the data shows the diversity of the Medicaid-eligible population. Many in the youngest age group move from the children's coverage under Medicaid into Affordable Care Act coverage simply because they have a birthday. They have little or no income because they have chosen to extend their education or have not been fully assimilated into the workforce. Many of these young adults will find their own way off Medicaid within 12 months without any further intervention. It is quite a different story for a 55 year-old single adult with a significant work history who ended up on Medicaid due to a major illness or accident. A single mother with prior work experience and at least some post-high school education may be one of the most interested and motivated individuals to return to work if proper support is available. The differences in the demographics serve as a lesson for Congress to resist the temptation to take a cookie-cutter approach. Congress must allow states sufficient latitude to tailor interventions to different populations. Blanket exemptions will result in missed opportunities, but so will limitations on ways to demonstrate compliance with work requirements. It has been widely reported that about 18,000 Arkansans lost their Medicaid eligibility due to noncompliance with work requirements. There has been little attention to the fact that 6,000 of these returned to Medicaid within 12 months. What happened to the rest? Although Arkansas didn't have the opportunity to study what happened to those who did not return, the answer is likely similar to what occurred nationally after the pandemic-era Public Health Emergency ended ('the unwind'). That is when the states were once again allowed to review Medicaid eligibility. As the unwind was concluding in late 2024, Medicaid and CHIP enrollment returned to 79.4 million and Marketplace coverage increased to 23.5 million. In other words, people moved from public coverage to private coverage because work opportunities increased. That should be the explicit goal of work requirements as well, and it must be the real measure of success. Congress has a unique opportunity to allow states to have a work requirement under Medicaid and at the same time allow the states to innovate and try different approaches that function best for those who value the dignity of work.
Forbes
29-04-2025
- Health
- Forbes
Hospitals Lose Supreme Court Case: Key Implications for DSH Patients
WASHINGTON, DC - OCTOBER 07: United States Supreme Court (front row L-R) Associate Justice Sonia ... More Sotomayor, Associate Justice Clarence Thomas, Chief Justice of the United States John Roberts, Associate Justice Samuel Alito, and Associate Justice Elena Kagan, (back row L-R) Associate Justice Amy Coney Barrett, Associate Justice Neil Gorsuch, Associate Justice Brett Kavanaugh and Associate Justice Ketanji Brown Jackson pose for their official portrait at the East Conference Room of the Supreme Court building on October 7, 2022 in Washington, DC. The Supreme Court has begun a new term after Associate Justice Ketanji Brown Jackson was officially added to the bench in September. (Photo by) n a 7-2 decision, the Supreme Court ruled against hospitals in Advocate Christ Medical Center v. Kennedy, addressing how to account for patients in Disproportionate Share Hospitals (DSHs). A DSH serves a high volume of low-income, Medicaid-eligible and uninsured patients, receiving special payments to offset uncompensated care costs. The case, led by Advocate Christ Medical Center in Oak Lawn, Illinois, and joined by over 200 hospitals, sought to clarify patient eligibility for enhanced DSH payments. Plaintiff hospitals argued they were entitled to additional DSH payments for any patient eligible for Supplemental Security Income (SSI), a federal program supporting low-income disabled, blind, or elderly individuals. However, Medicare, represented as Secretary Robert F. Kennedy Jr, maintained that only patients actively receiving SSI cash payments should count, excluding those merely eligible or enrolled. This distinction impacts billions in Medicare payments to hospitals serving low-income populations. Associate Justices Ketanji Brown Jackson and Sonia Sotomayor dissented, advocating for broader eligibility. The ruling reinforces stricter criteria for DSH calculations, potentially straining hospital finances, particularly for safety-net systems. As healthcare costs rise, this decision underscores ongoing tensions between federal policy, hospital reimbursement and healthcare's growing dependency on government reimbursement for fiscal solvency. Commonly known as safety-net hospitals, physicians at DSHs treat a significant proportion of low-income, Medicaid-eligible, and uninsured patients, often at an academic trauma center. For these patients, alternative care options are frequently unavailable. Mandated by federal law, Medicaid programs provide DSH payments to qualifying hospitals to ensure financial stability and maintain access to care for vulnerable populations. This was established during the 1985 Consolidated Omnibus Budget Reconciliation Act, the DSH program uses a formula based on the hospital's DSH patient percentage, which includes Medicare patients receiving Supplemental Security Income and Medicaid-eligible inpatient days. These facilities incur significant financial losses caring for underserved populations, and DSH payments supplement reimbursements to support their operation. It's not a trivial program. In 2021, Medicaid DSH payments totaled $18.9 billion, funded by federal and state contributions Supplemental Security Income (SSI) is a federal program administered by the Social Security Administration that provides monthly financial assistance to individuals with limited income and resources who are disabled, blind, or aged 65 and older. SSI aims to ensure a minimum income for basic needs like food, clothing, and shelter. Eligibility requires meeting income and asset limits, and disability must prevent substantial gainful activity. In 2025, the maximum federal SSI payment is $967 for an individual and $1,450 for a couple. In essence, the federal government has established a formula to assess the proportion of indigent patients served by a health system. This determines eligibility for DSH payments. The DSH patient percentage is the sum of two fractions: the Medicaid fraction and the Medicare/SSI fraction. The formula looks at what percentage of the total patients treated are Medicaid eligible and what percentage of Medicare patients treated received SSI payments. These are indicators for low-income patients. Generally, a hospital qualifies for DSH payments if the DSH patient percentage exceeds 15% or meets state-specific threshold. There some nuances, but that's the broad policy strokes. Hospitals reported losses exceeding $1.5 billion annually in DSH payments from 2006 to 2009 due to restrictive patient accounting methods. This interpretation creates an estimated 15% payment shortfall based on eligibility criteria. The Supreme Court's ruling in Advocate Christ Medical Center v. Kennedy upheld two lower court decisions, reinforcing that DSH calculations should include only patients actively receiving SSI cash payments. In 2022, the U.S. District Court for the District of Columbia ruled in favor of the government, a decision affirmed by the U.S. Court of Appeals for the District of Columbia. The legal consensus centers on the variability of SSI eligibility, which depends on monthly income and assets. Justice Amy Coney Barrett, writing for the majority, explained, 'Recipients must apply and be deemed eligible for benefits, and eligibility can fluctuate monthly based on income and resources.' This dynamic underscores why only active SSI recipients are counted, aligning with federal policy to ensure precise DSH funding allocation. The ruling, while clarifying eligibility, may exacerbate financial challenges for safety-net hospitals serving low-income populations. Hospitals are increasingly reliant on government funding for fiscal solvency, a trend perhaps warned by Frederick Hayek et al. Safety-net facilities face significant financial strain, prompting strategic responses. Immediate tactics will include lobbying Congress to delay DSH cuts, adopting value-based care models and perhaps enhancing operational efficiencies through digital tools and artificial intelligence. Leveraging the 340B Drug Pricing Program offers another avenue to offset losses. Rising labor costs further complicate finances, hospitals were certainly look to curb that growth. It's importance to recognize that a large majority of physicians are now employees of DSHs, not independent providers. Will they be caught up in the downward pressure on hospital labor costs? At it's core, stakeholders must closely monitor the sector for ripple effects, such as reduced services or closures, which could disproportionately impact low-income communities.
