Congress reaches major health policy deal on Medicare, Medicaid

WASHINGTON — Leaders in Congress have reached a sweeping deal to ease Medicare pay cuts to doctors, make major changes to post-pandemic Medicaid policy, and to help prepare for future pandemics.

Lawmakers are aiming to pass a health care policy package along with legislation to fund the federal government by Friday. The details of the omnibus spending package were confirmed by two lobbyists and two congressional aides.

The bill’s text is not yet finalized, and the deal is still subject to changes.

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Medicare policy

Doctors were facing down 4.5% Medicare pay cuts at the end of the year, and had pleaded with Congress to cancel the cuts altogether. Lawmakers met them halfway: In 2023, physicians will face a 2% cut, and in 2024, the amount will increase to 3.5%, two lobbyists said.

Lawmakers are also expected to waive a rule that would have resulted in further cuts to Medicare. The Medicare hospital at home program is also supposed to be extended for two years.

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Some of the package will be paid for by extending future Medicare pay cuts until 2032. Leftover Medicare funds from the gun safety bill that Congress passed earlier this year were also used to pay for some of the policy.

Some behavioral health policy could also be included, as well as two-year extensions of programs that support safety-net and rural hospitals.

Medicaid policy

Lawmakers also agreed to allow states to begin kicking ineligible people off their Medicaid rolls in April, regardless of when the Covid-19 public health emergency ends. Previously, states had to agree to hold off on re-evaluating people’s eligibility in exchange for more federal Medicaid money, and the end date was contingent on the end of the public health emergency.

In addition, lawmakers are expected to extend the Children’s Health Insurance Program until 2029. Children on Medicaid are expected to get one year of continuous eligibility, which means they won’t lose insurance even if their circumstances change. But while Democrats fought to require every state Medicaid program cover postpartum care for a year, the final legislation has fallen short and instead would only make permanent 33 states’ extended coverage.

Advocates have long argued that expanded coverage could help reverse staggering maternal and infant mortality rates, among the worst for high-income countries. Thirty-three states had already extended care for a year after Congress passed the option in last year’s American Rescue Plan, but among the 17 holdouts are some of the states with the highest maternal mortality rates in the country — figures that have only surged during the pandemic.

More robust federal Medicaid funding for Puerto Rico and other territories will be extended for five years, which offers some certainty for territorial governments and providers, according to one congressional aide and and one lobbyist.

Telehealth

Pandemic-era telehealth flexibilities are expected to be extended for two years, which was a major ask from the health care industry.

Pandemic preparedness

The pandemic preparedness package negotiated by Senate health committee leaders Patty Murray (D-Wash.) and…