Should Medicaid Provisions to Protect Vulnerable Populations & Enable Community-Based Care Be Extended? (H.R. 3253)
Do you support or oppose this bill?
What is H.R. 3253?
(Updated June 28, 2020)
This bill was enacted on August 6, 2019
This bill — the Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 2019 — would extend a number of provisions within the Medicaid program that serve to make the program more effective. A breakdown of the extensions can be found below.
Money Follows the Program Rebalancing Demonstration (MFP)
This bill would extend the Money Follows the Person Rebalancing Demonstration (MFP), which helps states rebalance their Medicaid long-term care systems by transitioning people with chronic conditions and disabilities into community-based care, through FY 2024. It’d also extend research and evaluation requirements for MFP through FY 2024 and clarify the process by which states apply for the MFP by requiring each state to include a description of their planned use of MFP funds and program evaluation plans in their applications.
Additionally, this bill would require a report to the president and Congress describing findings and conclusions on best practices for MFP implementation. Finally, it’d require a Medicaid and CHIP Payment and Access Commission (MACPAC) report to Congress on the Commission’s position on the Home and Community Based Services (HCBS) Final Rule published on January 16, 2014.
State Medicaid Fraud and Abuse Control Units’ Authority to Investigate and Prosecute Medicaid Patient Abuse and Neglect
This bill would clarify that state Medicaid fraud and abuse control units are authorized to investigate abuse and neglect of Medicaid patients in board and care facilities, as well as patients receiving Medicaid-funded care in noninstitutional settings.
Protection for Medicaid Recipients Against Spousal Impoverishment
This bill would extend spousal impoverishment protections for seniors who receive long-term care in their homes or community settings through March 31, 2024.
Community Mental Health Services Demonstration Program
This bill would extend the Community Mental Health Services Demonstration Program through December 21, 2021 and require a report to Congress recommending whether the program should be continued, expanded, modified or terminated by June 30, 2021.
Inappropriately Low Rebates Under Medicaid Drug Rebate Program
This bill would prohibit drug manufacturers from blending the average manufacturer price of branded drugs and their authorized generics for the purposes of determining Medicaid rebates. It’d also eliminate drug manufacturers from being defined as drug wholesalers.
Medicaid Improvement Fund
Finally, this bill would appropriate $45.5 million for the Medicaid Improvement Fund.Argument in favor
This bill’s proposed reforms would collectively strengthen Medicaid by making it more responsive to beneficiaries’ needs, protecting vulnerable Medicaid beneficiary populations and their spouses and ensuring that Medicaid drug prices are reasonable.
Argument opposed
This bill combines too many disparate Medicaid reforms & extensions, not all of which are urgent. For example, the MFP demonstration has already been extended through September 30, 2021 — there’s no need for a preemptive extension so far in advance of its expiration.
Impact
Medicaid beneficiaries; state health systems; states; Medicaid; state Medicaid fraud and abuse control units; drug manufacturers; drug prices; Money Follows the Program Rebalancing Demonstration (MFP); Medicaid spousal impoverishment protection; Community Mental Health Services Demonstration Program; inappropriately low rebates under the Medicaid drug rebate program; and the Medicaid Improvement Fund.
Cost of H.R. 3253
A CBO cost estimate is unavailable.
Additional Info
In-Depth: Sponsoring Rep. Debbie Dingell (D-MI) originally introduced two bills — the Ensuring Medicaid Provides Opportunities for Widespread Equity, Resources and Care (EMPOWER Care) Act, which extends the MFP program through 2024 and the Protecting Married Seniors from Impoverishment Act, which permanently extends spousal impoverishment protections for Medicaid beneficiaries receiving long-term care in a home or community care setting — which are included in this bill. When she introduced those bills, Rep. Dingell said in a press release:
“The long-term care system in this country is broken. Seniors, families, and caregivers are often desperate, stressed, and don’t know where to turn. The Money Follows the Person program and spousal impoverishment protections have shown they can create better outcomes for people receiving long-term care in the home or in the community. These proposals have strong bipartisan support and I hope the House passes them quickly.”
The Partnership for Medicaid Home-Based Care expressed its support for extending the MFP demonstration in February 2019, upon Rep. Dingell’s introduction of the EMPOWER Care Act. Its Chairman, David J. Totaro, said:
“This important legislation will ensure that individuals who could be helped by MFP to live in their homes and communities will not be forced into an institution instead, and it’s for that reason that we will be proud to advocate for its passage.”
The National Council on Aging’s Vice President for Public Policy and Advocacy, Howard Bedlin, noted that MFP and spousal impoverishment programs are “essential” for older adults and those with disabilities who want to live at home:
“For older adults and people with disabilities wanting to live at home with dignity and independence, federal Medicaid programs like Money Follows the Person and spousal impoverishment protections are essential. The Money Follows the Person program helps people move out of institutions and back home, while spousal protections keep older couples together, reducing unnecessary nursing home placement. Every community across this country has someone who would benefit from one of these important safeguards.”
Justice in Aging advocates making the spousal impoverishment protection permanent:
“Married seniors and adults with disabilities overwhelming want to live at home and age in place. Increasingly, federal and state Medicaid rules have prioritized home and community-based services (HCBS) which allow people to stay in their homes and in their communities. Congress recently helped these efforts by expanding a Medicaid eligibility rule, known as the spousal impoverishment protection, to individuals eligible for HCBS. The protection makes it possible for an individual who needs a nursing home level of care to qualify for Medicaid while allowing their spouse to retain a modest amount of income and resources. However, the expansion of the spousal impoverishment protection is set to expire on March 31, 2019 unless Congress acts. This means that individuals who qualified under the expanded protection may lose access to Medicaid and to their HCBS and may be left with no choice but to move into institutional long-term care, away from their spouses. Letting the spousal impoverishment protection expire will hurt families and force more people out of their homes and their communities. We urge Congress to make the expanded spousal impoverishment protection permanent so seniors and people with disabilities can age in place and with dignity.”
This bill has nine bipartisan cosponsors, including five Republicans and four Democrats.
Of Note: The MFP demonstration has already been extended through September 30, 2021 through the enactment of the Medicaid Extenders Act of 2019.
Media:
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Sponsoring Rep. Debbie Dingell (D-MI) Press Release on Included Bills
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Justice in Aging Fact Sheet (In Favor of Permanent Spousal Impoverishment Protection)
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Money Follows the Person (MFP) (Context)
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Spousal Impoverishment (Context)
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Section 223 Demonstration Program to Improve Community Mental Health Services (Context)
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Countable (Related Bill)
Summary by Lorelei Yang
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