Latest news with #non-Medicaid
The Intercept
8 hours ago
- Health
- The Intercept
South Carolina Can Deny Medicaid Patients Planned Parenthood Care, SCOTUS Rules
The Supreme Court moved to limit access to health care for over 1.3 million South Carolinians on Thursday by allowing the state to block Medicaid recipients from getting care at Planned Parenthood. The tight restriction on reproductive rights will likely pave the way for similar bans in other states, as ongoing attacks on abortion providers further impinge on access to maternal, gynecological, and other basic forms of health care. In a 6-3 decision, the court determined that Planned Parenthood clinics and patients in South Carolina may not sue the state for denying Medicaid funding to the reproductive care provider. The ruling overturns repeated lower court decisions that affirmed Medicaid recipients' rights to visit a provider of their choosing that accepts the program. It comes against the backdrop of looming federal cuts to Medicaid, which would further restrict health care access for millions of low-income Americans. In South Carolina, abortion is already subjected to a near-total ban. State law prohibits abortion after six weeks with limited exceptions — which is often before someone would be aware that they're pregnant. Republican South Carolina Gov. Henry McMaster has been direct about wanting to target Planned Parenthood because the network of clinics is known as an abortion provider. 'South Carolina has made it clear that we value the right to life,' McMaster said in a February statement. 'Therefore, taxpayers should not be forced to subsidize abortion providers who are in direct opposition to their beliefs.' The idea that Medicaid is subsidizing abortion care in South Carolina is incredibly misleading, said Susanna Birdsong, general counsel and vice president of compliance at Planned Parenthood South Atlantic. 'Medicaid does not cover abortion except in very narrow circumstances of rape, incest in life of the pregnant person,' Birdsong said. 'That's been a federal rule since the 1970s.' Planned Parenthood provides care for a host of other sexual and reproductive wellness concerns — meaning that low-income South Carolinians will lose access to 'health care that has nothing to do with abortion,' Birdsong said. She pointed to things like testing for sexually transmitted infections, cancer screening, and birth control. In its ruling, the Court made clear that it was aware of the other services Planned Parenthood provides. 'Planned Parenthood South Atlantic operates two clinics in South Carolina, offering a wide range of services to Medicaid and non-Medicaid patients,' reads a summary of the decision. 'It also performs abortions.' The Court noted that Planned Parenthood and a patient sued under the any-qualified-provider provision, which allows Medicaid patients to seek care from a provider of their choosing, but the majority determined they did not necessarily have an 'enforceable' right to do so. Experts expect that this decision will open the floodgates for other states to pass similar bans, limiting access to the largest provider of reproductive and sexual health care in the United States for millions of lower-income Americans. 'Other states certainly have tried it before,' said Dr. Jamila Perritt, an OB-GYN and president of the nonprofit Physicians for Reproductive Health. 'Much in the same way that abortion bans really swept this country, I think we're going to see similar effects.' The decision to limit where Medicaid patients can access care disproportionately affects women of color, said Perritt. As of 2023, the majority of people enrolled in Medicaid in South Carolina were nonwhite, and roughly 39 percent of Medicaid enrollees were Black, according to health policy research nonprofit KFF. Even before the decision, access to health care — particularly reproductive and sexual health care — in South Carolina was a challenge for lower-income residents. Roughly 41 of the state's 46 counties are considered federally designated 'Health Professional Shortage Areas,' and Medicaid recipients are disproportionately likely to live in communities with provider shortages. 'We're talking about communities that are already marginalized from care, communities that already have disproportionately poor reproductive and sexual health outcomes,' said Perritt, who predicted the decision would have 'significant negative health consequences.' Aside from having one of the strictest abortion bans in the country, South Carolina is one of only 10 states not to expand Medicaid coverage since the Affordable Care Act was passed in 2010. South Carolina also has the eighth-highest maternal mortality rate in the country, hovering around 47.2 pregnancy-related deaths per 100,000 live births, and some of the highest rates of sexually transmitted infections in the nation. 'It's really a state that should be investing more in its public health infrastructure and making sure that people who live in the state have access to the care that they need,' said Birdsong. Jennifer Driver, senior director of reproductive rights for State Innovation Exchange, said, like the state's abortion ban, lower-income people in South Carolina will bear the brunt of the burden of this decision. 'It targets people who are already limited on resources to say, 'You know what? On top of that, you actually don't get to have a decision on the care that you get and the provider you get it from,' she said. Read Our Complete Coverage At the same time, the Trump administration and Congress are seeking to further restrict health coverage for low-income Americans. A Congressional Budget Office report found that the House of Representatives' version of the 'Big, Beautiful, Bill' would leave 16 million Americans without health insurance and kick 7.8 million people off of Medicaid. Senate Republicans are considering their own set of Medicaid cuts, though they've been snarled by political opposition. 'This is a clear and obvious attack on people with low income, people who rely on Planned Parenthood clinics to get life-saving health services,' said Perritt. She described the decision as part of the government's broader efforts 'to eliminate access to comprehensive health care for folks, really across the country. This has to also be understood as an attack that reaches far beyond the borders of South Carolina.'
Newsweek
13-05-2025
- Business
- Newsweek
Medicaid Change Could Save Taxpayers $30 Billion
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. A proposed regulatory change from the Centers for Medicare & Medicaid Services (CMS) aims to shut down a decades-old "tax loophole" in Medicaid financing, a move the agency says could save federal taxpayers over $30 billion across five years. CMS said in a press release issued on Monday that it plans to prohibit states from levying targeted taxes on managed care organizations' (MCOs) "Medicaid business" designed to draw higher federal reimbursements. Why It Matters According to CMS, this type of tax, which can be structured in such a way that it specifically targets MCOs' Medicaid operations, basically inflates a state's Medicaid spending and allows it to collect more matching funds from the federal government. The maneuver has been described by officials as a legal workaround used by states to secure inflated Medicaid funds while freeing up their own budgets for unrelated spending, such "new benefits for illegal immigrants." File photo: a "hands off Medicaid" sign in the House of Representatives. File photo: a "hands off Medicaid" sign in the House of To Know CMS said that these "loophole taxes are solely designed to game the higher federal match" by taxing a type of entity, drawing down a high federal match. It then added that federal dollars are being redistributed back to the entities that were taxed, deeming the tax practice "what most Americans call money laundering." CMS cited the example that in California, Medicaid business in "certain cases" is taxed at $274 per member/per month, while non-Medicaid business is taxed at $2 per member / per month. The proposed rule would bar higher tax rates on Medicaid business, tighten language standards on Medicaid-specific taxes to prevent regulatory evasion, and implement a transition plan for states with older waivers. CMS projects the proposed rule would save federal taxpayers billions of dollars, and that if the expansion of these financing tactics were left unchecked, and just two more states adopted the schemes each year, it could drive excess Medicaid costs above $74 billion in the next five years. The organization also pointed to waivers approved in the final year of the Joe Biden administration for California, Michigan, Massachusetts and New York, saying that those four states alone account for more than 95 percent of the projected losses stemming from the loophole. What People Are Saying CMS Administrator Dr. Mehmet Oz said in the CMS press release issued on Monday: "States are gaming the system—creating complex tax schemes that shift their responsibility to invest in Medicaid and rob federal taxpayers. This proposed rule stops the shell game and ensures federal Medicaid dollars go where they're needed most—to pay for health care for vulnerable Americans who rely on this program, not to plug state budget holes or bankroll benefits for noncitizens." Drew Snyder, CMS deputy administrator and Medicaid director, said: "This isn't just wasteful—it's wrong. Medicaid was designed to protect low-income seniors, pregnant women, children, and people with disabilities—not subsidize coverage schemes that displace our most vulnerable. We are restoring Medicaid to its original purpose and ensuring the intent of the law is followed." What Happens Next The proposed rule is open for public comment through July 14, 2025, and can be accessed through the Federal Register.
Yahoo
08-05-2025
- Business
- Yahoo
Campbell accuses CVS of unfair prescription drug pricing, Medicaid fraud
BOSTON (WPRI) — Massachusetts Attorney General Andrea Joy Campbell is suing Woonsocket-based CVS Health for allegedly charging the state's Medicaid program more for prescription drugs than cash-paying customers. Campbell accused the drugstore giant of neglecting to offer lower and discounted rates to MassHealth — which offers benefits to qualifying adults, children, families and seniors, as well as those with disabilities. She claimed CVS Health worked with ScriptSave to provide non-Medicaid customers with lower drug prices through a discount card program, which any cash-paying customer could sign up for. CVS Health avoided submitting the lower drug prices as its 'Usual & Customary' prices (U&C) under the guise that those discounts were being offered by a third party, according to the lawsuit. 'CVS Health worked strategically with ScriptSave to set pricing, and thus CVS Health (and not ScriptSave) was the party offering these discounts to the general public,' the lawsuit stated. Campbell explained that MassHealth has had a 'Most Favored Nation' drug pricing clause on the books since 1995, which entitles the statewide Medicaid program to the lowest U&C drug prices pharmacies charge or accept from other payers. SEE ALSO: Healey looks to tax pharmacies for prescription drug sales She also claimed CVS Health's methodology for submitting U&C drug pricing to MassHealth has not included the pharmacy's best prices, particularly for generic medications. The lawsuit further noted that, from January 1, 2016, to the present day, CVS Health has failed to comply with regulations requiring that it submit U&C prices on prescription drug claims to MassHealth, 'the goal of which is to ensure that Medicaid does not pay higher prices than non-Medicaid payers.' Campbell claimed she uncovered numerous transactions throughout that time period in which cash-paying customers received lower drug prices than the ones being offered to MassHealth. 'When pharmacies offer discounted drug pricing to its customers, they must also charge MassHealth that same low price,' Campbell said. 'At a time when costs are sky-high, our taxpayers should not have to foot the bill for pharmacies' inaccurate price reporting.' RELATED: CVS hit with lawsuit, accused of unlawfully filling opioid prescriptions Campbell is suing CVS Health jointly with the attorneys general of Connecticut, Indiana, and Oklahoma. In a statement to 12 News, CVS Health spokesperson Amy Thibault noted that the four states involved in the lawsuit 'have never issued guidance to pharmacies contending that third-party discount card prices constitute a pharmacy's usual and customary prices.' 'We strongly dispute the allegations that our prices to Medicaid programs were inaccurate or inflated,' Thibault wrote. 'We've always been transparent with Medicaid programs concerning the prices we were submitting.' Download the WPRI 12 and Pinpoint Weather 12 apps to get breaking news and weather alerts. Watch 12 News Now on or with the new 12+ smart TV app. Follow us on social media: Close Thanks for signing up! Watch for us in your inbox. Subscribe Now Daily Roundup Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. For the latest news, weather, sports, and streaming video, head to
Yahoo
01-04-2025
- Health
- Yahoo
Washington, Oregon file lawsuit against ‘dangerous' cuts to health grants under RFK Jr., HHS
PORTLAND, Ore. () – Washington State Attorney General Nick Brown is co-leading a lawsuit filed Tuesday against the Trump administration in an effort to reinstate billions of dollars in health grants for states that were abruptly terminated under the Department of Health and Human Services. In total, two dozen attorneys general joined the lawsuit, which was filed against the department and HHS Secretary Robert F. Kennedy Jr. for 'abruptly and illegally' ending $11 billion in public health grants, Attorney General Brown's office said. According to Brown, the terminations came with no warning or legally valid explanation, noting the slashed funds 'have quickly caused chaos for state health agencies.' 'Better off burning $1K in the middle of street' 'We can't make America healthy by spreading preventable diseases,' Brown said. 'Aside from the illegality of these actions, the administration is also choosing to neglect the biggest public health challenges, including substance abuse and mental health crises, facing our communities.' According to Brown, state health agencies relied on the grants for a variety of urgent public health needs from infectious disease management, emergency preparedness mental health and substance abuse services to modernizing public health infrastructure. Now, Washington state could lose over $159 million from the terminated grants, Brown said, adding, if that funding is not restored, some state health programs will be disbanded. Close Thanks for signing up! Watch for us in your inbox. Subscribe Now Because of the funding cuts, Washington's Department of Health has canceled its Car-A-Van mobile health clinics – which offer services such as vaccinations and health education to historically underserved communities including Washingtonians in rural areas, BIPOC communities, immigrants and refugees, unhoused populations, along with children and schools. 'These immediate cuts impact work carried out by more than 200 DOH fulltime employees, as well as DOH partners, which include local health jurisdictions, tribal health clinics and organizations, and community-based organizations, which receive some of this funding,' a spokesperson for Washington's Department of Health told KOIN 6 News on Tuesday. 'The funding also supports critical DOH IT systems for public health (e.g. disease surveillance, lab reporting), or key capabilities that prevent and address outbreaks of respiratory illnesses and vaccine preventable disease. DOH continues to assess the impact of this immediate funding loss and will continue to provide additional information as soon as it becomes available.' The end of the funding also threatens Washington's Health Care Authority's work with regional Behavioral Health Administrative Service Organizations, which offer behavioral health care to low-income, non-Medicaid people with serious mental illnesses and substance use disorders and populations disproportionately impacted by the COVID-19 pandemic. These cuts, Brown said, also come at a time when states are facing emerging disease threats such as the rise of measles and bird flu cases. Eagle Creek Fire led to hundreds of debris flows in Columbia River Gorge Across the Columbia River, Oregon has also reported a 'very chaotic' scene as local health officials deal with the terminated grants. On March 28, the Oregon Health Authority announced that the federal government abruptly terminated $117 million from the state health agency which was meant to support a variety of programs including substance use treatment, immunizations and virus testing. 'This reckless termination of billions of dollars in grants is not just an attack on the states, it's an assault on the well-being of every American,' Oregon Attorney General Dan Rayfield said in a statement on Tuesday. 'We can't stand by idly while the very foundation of our public health system is dismantled. The Department of Health and Human Services and Robert Kennedy have made a dangerous mistake, and we will hold them accountable for their actions that jeopardize the lives of our citizens.' 'Cat out of bag': Oswego Lake remains open to public The public health grants were previously authorized by Congress, which also appropriated new and increased funding for these grants through COVID-19-related legislation. However, Kennedy Jr. terminated the grants ''for cause'' on March 24, claiming the pandemic is over and the grants are no longer necessary, the attorneys general explained. HHS spokesman Andrew Nixon pointed to the agency's statement from last week, when the decision to terminate the funding was announced, saying HHS 'will no longer waste billions of taxpayer dollars responding to a non-existent pandemic that Americans moved on from years ago,' as reported by The Associated Press. These are the top 10 Oregon cities to live in, according to Travel + Leisure In their lawsuit – which was filed in U.S. District Court in Rhode Island – the attorneys general argue that the mass terminations are against federal law because the end of the pandemic is not a ''for cause'' basis for ending the grants, especially as none of the grants are tied to the end of the pandemic. With the lawsuit, the attorneys general are seeking a temporary restraining order to invalidate HHS and Secretary Kennedy's grant terminations in the plaintiff states, claiming the terminations violate the Administrative Procedure Act. The attorneys general are also asking the court to stop HHS from reinstating the terminations and any agency actions implementing the terminations. Other attorneys general leading the lawsuit with Brown include Phil Weiser of Colorado, Peter Neronha of Rhode Island, Rob Bonta of California and Keith Ellison of Minnesota. They are joined in the lawsuit by the attorneys general of Arizona, Connecticut, Delaware, the District of Columbia, Hawaii, Maine, Maryland, Massachusetts, Michigan, Nevada, New Jersey, New Mexico, New York, North Carolina and Wisconsin, as well as the Governors of Kentucky and Pennsylvania. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
18-03-2025
- Health
- Yahoo
Caregivers rally, urge Nebraskans in Congress to protect Medicaid
Jeremy Nordquist, president of the Nebraska Hospital Association, at podium, leads a rally urging Medicaid to be protected during ongoing federal budget negotiations. March 17, 2025. (Courtesy of Nebraska Hospital Association) LINCOLN — The Nebraska Hospital Association and nearly 10 other organizations rallied Monday in defense of Medicaid ahead of federal budget negotiations. Jeremy Nordquist, a former state senator and president of the Nebraska Hospital Association, led the rally on the west side of the Nebraska State Capitol on Monday. It came after the U.S. House last month passed a budget blueprint directing the U.S. House Energy and Commerce Committee, which oversees Medicaid, to reduce $880 billion in spending over the next 10 years. 'Medicaid is under threat, and that means Nebraska and Nebraska patients are under threat,' Nordquist said. The resolution doesn't mention 'Medicaid' by name, but the caregivers and outside observers have said that with a budget goal that high, Medicaid spending would have to be reduced. The Congressional Budget Office, in a March 5 letter replying to U.S. Reps. Brendan Boyle, D-Pa., and Frank Pallone, Jr., D-N.J., essentially confirmed that there isn't enough non-Medicaid or Medicare spending to reach the targeted amount of cuts. Medicaid costs over the next 10 years, estimated at $8.2 trillion, would account for about 93% of all spending under the House committee's jurisdiction, excluding Medicare, which it estimated would account for $8.8 trillion over the same span. Monday's rally sought to highlight the potential Medicaid cuts that Nordquist said would touch all Nebraskans, even those who have commercial health coverage and might think, 'I'm fine.' 'The reality is, without Medicaid covering care for vulnerable citizens and low-income workers, very little of that care would be paid for, and therefore those services would no longer be sustainable in communities across our state,' Nordquist said. Nordquist and others asked Nebraska's all-Republican congressional delegation — U.S. Reps. Mike Flood, Don Bacon and Adrian Smith and U.S. Sens. Deb Fischer and Pete Ricketts — to be 'leaders' and 'stand up to the efforts to jeopardize health care in our rural state.' 'We know our delegation understands these issues and how vulnerable access to care is across Nebraska,' Nordquist said. 'Now it's time for them to use that knowledge and push back against these proposed cuts.' Bacon has voiced some concerns about potential Medicaid cuts but said he was assured by GOP leadership 'that the final bill will not affect the quality of healthcare covered by Medicaid.' 'They all said the final numbers will be more moderate,' Bacon said in a Feb. 25 statement after his vote for the resolution. 'We'll have a chance to vote on these two more times to get it right. Therefore, I am supporting the budget reconciliation because I want to secure the border, expand our energy production, improve our military and extend the tax cuts.' National and local Democrats have targeted Republicans, including Bacon, for the vote and vowed to use it in the 2026 election cycle. Bacon has fended off challengers in each of his past four election cycles. 'Don Bacon can spread all the falsehoods he wants, but there is no escaping the fact that the House Republican budget will result in massive cuts to Medicaid and hurt millions of families. Another fact: Their terrible, unpopular budget will cost Bacon his seat next year,' Justin Chermol, a spokesperson for the Democratic Congressional Campaign Committee, said in a recent statement. Among other organizations in attendance at the rally or supporting the call to action: Nebraska Medical Association. Nebraska Nurses Association. LeadingAge Nebraska. Health Center Association of Nebraska. Nebraska Association of Behavioral Health Organizations. Nebraska Rural Health Association. Nebraska Nurse Practitioners. Nebraska Pharmacists Association. Nebraska Home Care Association. Dr. Robert Wergin, a family physician from Seward and president-elect of the Nebraska Medical Association, said physicians can't 'sit idly by' without making clear what is at stake. 'Cuts will hurt the entire health care system in Nebraska, and cuts will ultimately hurt all Nebraskans by decreasing access, increasing costs of health care and hurting our communities,' Wergin said. Linda Hardy, a registered nurse for more than 48 years and president of the Nebraska Nurses Association, said 79 million Americans rely on Medicaid for health care. This includes preventive care for chronic diseases and prenatal or postpartum care. Wergin said the 'safety net' helps roughly 350,000 Nebraskans, including 180,000 children, and helps pay for care ranging from immunizations and dental care to speech and physical therapies. Should Medicaid be cut, Wergin and others said it would lead to an elimination of services, exacerbating maternal health care deserts in Nebraska and would increase the burden on Nebraska's already strained state budget. In a given year, Medicaid contributes $3 billion to the state economy, Wergin said. Jed Hansen, executive director of the Nebraska Rural Health Association, said the cuts 'aren't just numbers on a budget sheet' and that in rural health care, it's a 'numbers game' where one cut could be the 'final blow.' Amy Behnke, chief executive officer of the Health Center Association of Nebraska, supporting seven community health centers, said Medicaid is integral to patient health and well-being. Medicaid cuts would eat into services, Behnke said, leading to widespread reductions. Hansen said that when many services are eliminated they don't come back. 'These cuts translate into real-life consequences: closed hospitals, shuttered clinics and rural families left without access to care that they need,' Hansen said. Roger Reamer, chief executive officer of Memorial Health Care System in Seward, and Tami Lewis-Ahrendt, chief operating officer of the Lincoln-based nonprofit CenterPointe, also spoke of Medicaid's importance. Lewis-Ahrendt said the state's voter-approved Medicaid expansion in 2018 has helped the nonprofit provide critical care to 700 more people each month than in 2019. She said many Nebraskans were unable to access care before the expansion, with some delaying care until a crisis arose. She said it's not just 'numbers on a report' but the 'real people,' such as a mother accessing treatment for postpartum depression, a young adult getting support and medication for schizophrenia or an individual in recovery who finally has access to outpatient services. 'Access to Medicaid means more families can find hope in knowing that their loved ones are getting the care they desperately need,' Lewis-Ahrendt said. Kierstin Reed, chief executive officer of LeadingAge Nebraska, said Medicaid cuts could be detrimental for nursing homes, assisted living facilities, home and community-based services and other post-acute programs. Reed noted about half of Nebraskans enrolled in Medicaid live in rural communities that have been hit most by the state's loss of 17% of nursing homes and 11% of assisted living facilities in recent years. 'Families will be forced to shoulder the burden of care for their older family members, which may lead to financial ruin for multiple generations,' Reed said. Reed and Lewis-Ahrendt said Medicaid 'isn't just about policy.' 'It's about giving Nebraskans the chance to heal, to thrive, to live in recovery and to contribute fully to our society,' Lewis-Ahrendt said. 'That is something worth protecting.' SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
