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What the ‘One Big Beautiful Bill’ does on healthcare

EMS agencies should pay close attention to the potential Medicaid and Medicare changes proposed in this bill that will likely impact reimbursements to EMS agencies. Specifically:

Medicaid – 

– Reduces the number of Medicaid beneficiaries through work requirements and other eligibility limitations.
– Bars states from using State Directed Payments to require Medicaid HMOs from reimbursing more than 100% of Medicare reimbursement for similar services, or 110% of Medicare in non-Medicaid expansion states.
– Mandates cost-sharing up to $35 for services provided to Medicaid expansion enrollees with incomes above the federal poverty level, which is $15,650 for a single person.
– Limits retroactive provider reimbursements for newly enrolled Medicaid recipients to one month instead of three.

Medicare – 

– Triggers Medicare cuts under the Statutory Pay As You Go Act of 2010 that could include reductions in provider reimbursements.

Also recall that CMS released a proposed rule last week, that according to the language in CMS’ release, “would end states’ ability to exploit a health care-related tax loophole currently used by seven states to generate billions in federal Medicaid payments—without contributing their fair share or expanding care for Medicaid enrollees”.

We recommend strong engagement with local and national EMS advocacy organizations and keeping abreast of these potential legislative and regulatory changes.