Yesterday, several Medicaid provisions, including the ones impacting Medicaid state directed payments, were dropped from the “One, Big, Beautiful Bill.” The provisions didn’t pass the Senate’s Byrd rule, which has governed the budget reconciliation process since the 1980s. Many of these provisions were being used to fund the extension of tax cuts expiring by the end of the year. Without those savings, Congress must look elsewhere for payment cuts. This makes it harder for Congress to meet the President’s deadline of signing the bill by July 4th. AHPA will keep tracking changes to the language and engaging in advocacy.  

Senate Parliamentarian Elizabeth MacDonough found that the following provisions are not relevant to a budget reconciliation bill, forcing Republicans back to the drawing board. These provisions are now subject to a 60-vote Byrd Rule point of order: 

• Section 71120: Prohibits non-expansion states from increasing rates of provider taxes or the base tax for items and services where that tax did not previously apply.  

• Sections 71109: Prohibiting Medicaid and CHIP participation for patients without verified citizenship, nationality or satisfactory immigration status. This would have overridden the current 90-day “reasonable opportunity period” for states to verify individuals’ immigration status.  

• Section 71110: Denying federal funding to states for Medicaid coverage for certain immigrants who are not citizens. 

• Section 71111: Lowering Federal Medical Assistance Percentage (FMAP) for states that use their own money to fund Medicaid coverage for undocumented immigrants. This policy would have lowered FMAP from 90% to 80% for these states.  

AHPA extends our gratitude to emerging colleagues Aimal Irteza and Jenna Wilson,
guest co-authors of this article. Aimal is an undergraduate studying Political Science and Public Policy at Rollins College. Jenna is completing her graduate studies at the University of Central Florida’s School of Global Health Management and Informatics.