Medicaid and SCHIP Rules

April 25, 2008

The U.S. House of Representatives voted 349-62 on April 23 to impose a moratorium until April ’09 on CMS restrictions on case management, reimbursement of public providers, outpatient hospital and clinic services, school-based administration and transportation, rehabilitative services, hospital-based graduate medical expenditures, and provider-related taxes.  The Congressional Budget Office (CBO) scored H.R. 5613 as budget neutral because it also includes new Medicaid asset verification requirements.   A Senate version, S. 2819, has 24 co-sponsors but does not contain asset verification requirements, is not budget neutral, and faces more opposition.   It would also reverse an 8/17/07 CMS directive restricting SCHIP expansions, a directive that Government Accountability Office (GAO) attorneys indicated on April 18 was issued by CMS without a mandatory notification to Congress.  Massachusetts, Connecticut, and New Jersey filed suit against CMS in U.S. District Court in New Jersey on April 9 about that directive.   New York joined Maine, Maryland, New Jersey, Oklahoma, Tennessee, and Kentucky on April 18 in a lawsuit, in U.S. District Court, Washington, D.C., against the CMS restrictions on case management.

Tom Entrikin

Tom Entrikin is a PCG manager and former Medicaid policy specialist with the U.S. Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Services (CMS).