Medicare Advantage Reform

by Kristin Rowan | Nov 25, 2025 | CMS, Editorial, Medicare, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Medicare Advantage Reform

Background

Traditional Medicare is available to any U.S. citizen over the age of 65 or with a qualifying disability. Part A covers hospital care, skilled nursing facility care, hospice care, and some medically necessary home health care while Part B covers doctor visits and outpatient care. Medicare is billed through and paid by the federal government.

Medicare Advantage (originally Medicare+Choice) is Medicare coverage offered by private insurance companies who are then reimbursed by the government. The goal was to create competition and lower costs. It has done neither. Medicare Advantage plans are supposed to provide all of the coverage from Parts A, B, & D except hospice care. That is still handled by traditional Medicare.

Hospice Carve-in Plan

Despite the epic failure of the recent hospice carve-in experiment, House representative Schweikert (R-AZ) introduced H.R. 3467 to reform the Medicare Advantage program and included a requirement for hospice care. The goal, according to Schweikert, is to eliminate waste and fraud and stop MA insurance companies from making billions in profits by upcoding. The solutions, outlined in H.R.3467, include requiring MA recipients to stay on the same plan for at least three years and permanently including the hospice benefit in MA plans.

Eight New Bills

On November 19, 2025, Representative Mark Pocan (D-WI), with the support of 12 other members of the House, introduced eight separate bills aimed at Medicare Advantage reform and strengthening traditional Medicare. The eight bills include:

1. Disincentives for delaying and denying lifesaving care due to prior authorization requirements
2. Automatic appeals for any denial of care
3. Visually and audibly disclosing delay and denial rates in advertising
4. Banning participation in MA for any company convicted of defrauding the government
5. Lowering MA reimbursement rates to at or below traditional Medicare rates
6. Limiting the number of MA plans a company can offer to 3 per year
7. Prohibiting MA from being the default option
8. Creating a website listing all doctors by plan

Commentary

In addition to the package cosponsors and six endorsing organizations, Rep Pocan received industry expert support for his bill package.

“Big Insurance has long pitched Medicare Advantage as a key tool to lowering health care costs and delivering better care, but like so much of their rhetoric, this is nothing but bold-faced lies. The truth is, Medicare Advantage is neither Medicare nor an advantage. And it certainly doesn’t exist to lower costs. It exists to help Big Insurance make sky-high profits and enrich shareholders. It is long past time Congress stepped in and protected patients. The legislative package Congressman Pocan is introducing is the most comprehensive plan ever introduced to rein in Medicare Advantage and protect patients. Congress should pass these bills without delay.”

– Wendell Potter, President, The Center for Health and Democracy

“Medicare Advantage insurers profit from withholding medically necessary care, and can withhold care with near impunity. So, people enrolling in corporate MA plans are forced to gamble with their health and with their lives. They can’t avoid the bad actors. It’s time Congress protected older Americans and people with disabilities from bad actor Medicare Advantage insurers, as Congressman Pocan’s MA Bill package would do.”

– Diane Archer, President and Founder, Just Care

Rep. Pocan’s bills do not include the hospice carve-in and would leave hospice care under traditional Medicare.

Faulty Logic?

Medicare Advantage plan payors have been accused of upcoding, fraud, overbilling, delays in care, and denials that circumvent the rule that MA must cover everything traditional Medicare does. It may be naive to assume that passing these bills will force unscrupulous companies to suddenly have integrity.

MA enrollees pay the standard Part B premium and might pay an additional MA premium depending on their income, geographic locations, and/or additional plan benefits. Rep. Pocan’s bill lowers what MA charges the government (aka tax payers) but does not address what the plans charge enrollees. If MA plans are required to lower reimbursement rates by 10%, for example, won’t they just increase premiums, deductibles, and copays or remove additional benefits? Sure, the government spends less, but out-of-pocket costs increase and quality of care drops.

The “Seniors Choice” bill limiting the number of plans to three is unclear in its direction. A 2019 rule removed the meaningful difference requirement for MA plans. This bill seeks to reinstate that requirement, but changes the term to “significantly different” in premiums, benefits, and cost-sharing. There are too many variables in health insurance to limit the choices to three. Three choices per company lessens the competitive need to keep prices low.

Not so Hidden Agenda

Medicare Advantage reform is sorely needed. MA is largely fraudulent, misleading, and costly both in spending and health. Chipping away at some of these pieces is for the good of the enrollees on their surfaces. But dig just a little deeper and the goal is clear.

Overwhelmingly, the organizations in support of this bill package are proponents of a single payer system. The prior authorizations disincentive is termination of the entire contract for the year. The disallowing participation bill includes all companies and individuals convicted of any crime, misdemeanor or greater, in any way connected to healthcare, all financial misconduct in or out of healthcare, and all acts of fraud, kickbacks, and misrepresentation of material fact. Any plan charging more than its traditional Medicare counterpart will be eliminated. Given these restrictions, it will not take long for every Medicare Advantage plan to be eliminated entirely.

The recent government shutdown centered around the ACA subsidies that are set to expire at the end of the year. The elimination of those subsidies could push healthcare insurance premiums to a level that few can afford, furthering the need for a single payer plan.

Final Thoughts

The White House has promised a health care proposal with much speculation but no facts. The proposal has yet to be released. Congress is still negotiating the extension of Covid-era subsidy increases with only a few weeks remaining before they adjourn for the holidays. ACA participants are having to renew their health insurance without knowing what the final cost will be and many believe the number of participants will drop significantly, leaving millions uninsured.

None of the proposed solutions will fix all the problems with healthcare. But, a temporary stay is better than losing access to healthcare altogether. This is an ongoing issue and The Rowan Report will continue to bring you the latest information as it becomes available.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Government Shutdown

by Kristin Rowan | Oct 9, 2025 | Medicaid, Medicare, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Government Shutdown Threatens Care at Home

Lawmakers on opposite sides of the aisle failed to come to a budget agreement by the deadline. This causes an immediate cease to all non-essential government functions and many government employees aren’t being paid.

UPDATE: Shutdown, Day 16

–As of October 16, 2025–

What it Means for Care at Home

After 10 attempts, the government is no closer to an agreement than they were on September 30th. The Senate is expected to break at the end of the day, leaving the next opportunity to negotiate until at least Monday.

Telehealth

The biggest impact on care at home during the government shut down is the ability to complete required face-to-face visits using telehealth appointments. Both home health and hospice have employed telehealth for face-to-face encounters since the COVID-era waiver, which has now been extended several times. The most recent extension, which we anticipated Congress to extend in this budget, expired on September 30th.

All face-to-face encounters occurring after October 1, 2025 must be in person.

According to home health expert Melinda A. Gaboury of Healthcare Provider Solutions says it is unlikely an extension would be retroactive even if Congress includes an extension in the finalized budget.

Payments

Conflicting information on Medicare payments leave us unsure of the actual impact. Some reports say there will be no delay while others mention 10-day holds. It is unclear whether this is in addition to the standard 14-day hold. Either way, we are anticipating (and hoping for) minimal payment disruptions.

Surveys

Initial Medicare certification for home health and hospice as well as recertifications will be delayed. If ACHA, CHAP, or another accrediting body is conducting your survey, however, there should be no delay. These accrediting bodies are continuing without interruption. State agency surbveys will be delayed until after the budget is finalized and the shutdown ends.

Look for continued updates from The Rowan Report as the shutdown and negotiations continue.

–As of October 9, 2025–

The Disagreement

Reporters and spokespoeople from both sides of the debate have suggested various reasons for the shutdown. Equally, both sides claim they are not the holdouts. What we do know for sure is that one of the primary points of contention is the continuation of subsidies for Affordable Care Act Marketplace Insurance plans. One group wants an extension written into the current budget while the other says it’s not necessary since the subsidies currently run through the end of the calendar year.

Push to Extend

The lawmakers who are pushing to get the subsidy issue resolved believe that marketplace users are not going to sign up for insurance in November and do it again in January when the subsidies are fixed. Instead, insurance commissioners warn that without the subsidies, many people will opt not to have insurance at all and others will select substandard plans based on affordability. They will be priced out of the plans they want without the subsidies in place.

Priced Out

In 2025, even with the subsidies, the average family was paying $800 per month on health insurance through the marketplace. When the subsidies expire, those same families will see their existing plan rates jump to $3,000 per month. KFF, the nonpartisan health research organization, estimates that most users will have a 114% rate increase.

Photo Credit – The New York Times

Counter

According to ND insurance commissioner Jon Godfread, lawmakers who oppose the subsidies are actually opposing the cost of health care and insurance across the board. They insist the subsidies aren’t necessary if healthcare and insurance costs drop instead. Proponents of the subsidies agree, but say that is a longer discussion that will take a lot of time to resolve and the subsidies provide an immediate solution to a bigger problem. They are urging the holdouts to include the subsidies in the budget and tackle the rising cost of healthcare later.

Open Enrollment

The clock is ticking. Open enrollment for 2026 begins November first in every state except Idaho, where open enrollment starts next week. Insurers have already locked in their 2026 premium rates, which will likely cause sticker shock for most marketplace users. Most insurers have prepared subsidy and non-subsidy rates, but without the extension, we will only see the much higher non-subsidy rates. These rates are unlikely to change before enrollment starts and the only hope for marketplace buyers is for Congress to extend the subsidies.

Care at Home Impact

There are several ways in which the shutdown and the loss of the subsidy may impact care at home.

Payment delays are the most pressing risk. Government officials have promised no delay for some essential services like SNAP and WIC. It is likely Medicare and Medicaid payments will be delayed. While those payments will come through eventually, care at home agencies have to operate without payment or hope the

payers will process payments locally while waiting on the government to reopen. The longer the shutdown lasts, the more likely it is that payments will be delayed. The 6th Senate budget vote failed today, sending the shutdown to day 8.

The longer term impact for care at home will come if the subsidies are not renewed. If insurance rates increase by more than 100% on November 1, users will opt for lower priced coverage, which may no longer include care at home benefits. Fewer patients seeking care at home means less money for agencies. Long-term, it also means higher hospital and ER usage and costs, which increases government spending and usually leads to additional care at home cuts to offset the costs.

National Alliance for Care at Home has identifed current and potential implications of the shutdown. Read their analysis here.

This is an ongoing story and we will continue to provide additional information as it happens.

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OBBB Care at Home Adjustments

by Kristin Rowan | Jul 18, 2025 | Advocacy, CMS, Medicaid, Medicare, Regulatory

by Kristin Rowan, Editor

Care at Home Through Medicare and Medicaid

Adjustments from OBBB

Despite the passing and subsequent signing of the reconciliation bill, numerous lawsuits have paused its implementation in some areas. We will continue to report on those court decisions as they arise. In the meantime, the care at home industry can look at the few adjustments that will positively impact the industry.

Medicaid Waivers

Prior to this, the HHS Secretary could only approve Medicaid waivers to cover home and community-based services for beneficiaries who already met institutional level-of-care criteria. This bill provides additional flexibility to define waiver eligibility without the institutional level-of-care criteria.

For FY 2026, CMS has an additional $50 million to oversee the new waivers. There is an additional $100 million earmarked for FY 2027 to deliver HCBS under new and existing waivers. Although the expanded waivers and additional budget will not satisfy the more 700,000 on waiting lists for HCBS, it is a start.

Rural Health Transformation Program

For five years, beginning in 2026, states can apply for a portion of a $10 billion annual fund for rural health providers. To qualify, providers must submit a rural health care plan that includes technology adoption, local partnerships, using data-driven methods, and setting strategies for financial stability. This could provide an opportunity for care at home agencies to partner with rural hospitals to help provide care in rural settings.

Health Savings Accounts

Health Savings Accounts (HSAs) allow insurance beneficiaries to save money to pay for deductibles, copays, and other services not covered by insurance (such as non-medical supportive care and home health). Currently, people can only use HSAs if they have a high deductible health plan (HDHP). The bill allows for a plan to be considered an HDHP even if it covers telehealth and remote health services prior to meeting the deductible. Insurance companies can design new HDHPs that can be used with HSAs.

Another change to HSAs involves the type of plan that qualifies. Currently, bronze and catastrophic plans cannot be considered HDHPs because their out-of-pocket limits exceed IRS limits for HDHPs. The bill allows bronze and catastrophic plans to qualify as HDHPs and have access to HSAs.

Additionally, current regulations prohibit anyone with a Direct Primary Care (DPC) arrangement from contributing to our using HSAs. DPC is an arrangement with a flat monthly fee for services rather than using insurance for routine care. The bill removes the limitations, allowing people with DPC arrangements to contriute to HSAs and use them for DPC arrangements.

Adding telehealth/remote plans, bronze plans, and catastrophic plans to HSA eligibility could provide opportunities for care at home agencies to connect with beneficiaries of these plans who did not have expendable funds for non-covered services before, but can now use HSAs. Allowing patients with DPCs to use HSAs could provide yet another path to increasing patients by partnering with DPC offices.

Final Thoughts

As a whole, we are anticipating great disruption to Medicare and Medicaid stemming from the budget reconciliation bill. While we await the final word on legality from the U.S. Supreme Court on many of the provisions, we can look to the ones that may help brace the industry in the meantime.

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Injunctions Overturned

by Kristin Rowan | Jul 10, 2025 | CMS, Legal, Regulatory

by Kristin Rowan, Editor

District Court Injunctions Overturned

Agencies to resume layoffs.

The now infamous “Memo” from the Office of Management and Budget and the Office of Personnel Management instructed agency leaders to cut their workforce as part of the President’s DOGE Workforce Optimization Initiative. The memo from late February started with divisions and employees whose work was not mandated by law and is not considered essential during government shutdowns.

District Court Block on Workforce Downsizing

In May, District Court Judge Susan Illston ruled that the administration lacked congressional approval to make sweeping cuts, and blocked the federal workforce reductions. The order came after lawsuits from labor unions and nonprofit groups argued that the cuts would have drastic negative effects on the American people. They also posed the argument that reorganizing government functions and laying off workers en masse without congressional approval is not allowed by the Constitution. A panel of the U.S. 9th Circuit Court of Appeals voted against overturning Illston’s order.

Supreme Court Overrules

On July 8th, the Supreme Court ruled to allow federal agencies to resume the layoff directive. The 8-1 decision lifts one block on reduction in workforce, but there are smaller injunctions across different courts that have not made it to the Supreme Court yet. The decision overturns the injunction for 17 of the 19 agencies included in the initial memo. The Department of Veterans Affairs is among those cleared to resume layoffs. The departments of Defense, Education, Homeland Security and Justice were not included in the directive.

Restructuring Not Included

The Court was careful to convey there has been no decision on whether the reorganization plan for any specific agency is legal. Each agency’s restructuring plan may eventually reach the Supreme Court.

The order also only clears the way for the reduction in workforce. It is also not a blanket green light. The administration has to provide details on how it selects the staff being laid off. In some cases, they must notify Congress and the labor unions.

Dissent, and Agreement

The Supreme Court decision was 8-1 in favor of overturning the injunction. Only Justice Ketanji Brown Jackson dissented.

“In my view, this decision is not only truly unfortunate but also hubristic and senseless. [The] statutory shortfalls likely to result from implementation of this executive order will be immensely painful to the general public, and the plaintiffs, in the interim, causing harm that includes ‘proliferat[ing] foodborne disease,’ perpetuating ‘hazardous environmental conditions,’ ‘eviscerat[ing] disaster loan services for local businesses,’ and ‘drastically reduc[ing] the provision of healthcare and other services to our nation’s veterans.’”

Kentanji Brown Jackson

Justice, United States Supreme Court

Justice Sotomayor, who voted to overturn the injunction, wrote a one-paragraph solo opinion saying she agrees with Jackson that the administration cannot “restructure federal agencies in a manner inconsistent with congressional mandates.”

“The plans themselves are not before this Court, at this stage, and we thus have no occasion to consider whether they can and will be carried out consistent with the constraints of law,” Sotomayor warned.

Blocks Still Standing

The Supreme Court ruling overturned the injunction put in place on May 22nd by the U.S. District Court for the Northern District of California. This is the only injunction impacted by the ruling. Other injunctions remain in place.

On July 1, U.S. District Judge Melissa DuBose granted an injunction to stop the downsizing and restructuring of HHS. This injunction was not explicitly mentioned in the latest ruling, but could still be impacted.

U.S. District Judge Matthew Maddox ordered the reinstatments of AmeriCorps employees who were laid off or put on leave and blocked any additional reductions that affect union employees.

U.S. District Judge Myong Joun indefinitely blocked the reduction of workforce of school districts in Boston. An emergency bid with the Supreme Court to lift the block could be heard and decided at any time.

A federal appeals court blocked a 90 percent reduction of the staff at the Consumer Financial Protection Bureau; federal judges reversed similar reductions at DEI foundations, and all actions under Pete Marocco are voided.

Final Thoughts

Numerous cases remain undecided in lower courts and the Supreme Court. Whether any layoffs will be finalized and whether departmental restructing is legal remain to be seen. For now, expect a reduction in personnel at the VA, but not yet at HHS or CMS. We will continue to report on updates as they occur.

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Planned Parenthood Cut Halted

by Kristin Rowan | Jul 10, 2025 | CMS, Legal, Medicaid, Regulatory

by Kristin Rowan, Editor

Part of Big Beautiful Bill Halted

Medicaid Cuts to Planned Parenthood Blocked

The tax and immigration bill, dubbed “One Big Beautiful Bill,” signed by President Trump on July 4th, included removing all Medicaid payments to any nonprofit organization that provides medical services, received more than $800,000 in federal funding in 2023, and also provides abortions.

On Monday, July 7th, the first business day after the bill was signed into law, U.S. District Judge Indira Talwani granted a temporary halt to Medicaid funding cuts to Planned Parenthood.

Planned Parenthood Claims Unfavorable Treatment

The portion of the bill in question does not specifically name Planned Parenthood. The bill cuts Medicaid funding to groups “primarily engaged in family planning services, reproductive health, and related medical care” that also provide abortions and abortion education. According to the lawsuit, however, because of the federal funding threshold of $800,000, Planned Parentood locations comprise almost all of the impact.

[It’s a] “naked attempt to leverage the government’s spending power to attack and penalize Planned Parenthood and impermissibly single it out for unfavorable treatment.”

Planned Parenthood

Immediate Decision

The decision came before the federal government responded. Judge Talwani ruled within hours and provided no explanation other than a brief note stating that Planned Parenthood showed good cause for immediate intervention.

Decision Unlikely to Stand

The decision came within hours of the lawsuit filing
Congress is generally lawfully allowed to make determinations on spending
This was an egregious judicial usurpation of legislative power
This makes her court look like a fast food drive-through
The House could initiate impeachment proceedings against the judge for this decision

These are just a few of the statements made in opposition to the injunction, mostly claiming that the judge did not have the authority to make the decision. Talwani set a hearing for July 21 to hear from both Planned Parenthood and the agencies named in the lawsuit, HHS, and CMS.

Precedent

A previous ruling from the Supreme Court in June of this year provides that any state can remove any provider from the list of “Qualified Providers” using its own Medicaid criteria. The court further ruled that, although patients have the right to choose their own provider, patients do not have the right to sue based on who those qualified providers are.

This lawsuit is the first against the tax and immigration bill, but it is most likely not the last. We will continue to report on this and other lawsuits as they arise.

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Alliance Statement on House Passage of Reconciliation Bill

by Rowan Report | Jul 3, 2025 | Advocacy, Breaking News, Partner News, Regulatory

FOR IMMEDIATE RELEASE

Contact: Elyssa Katz
571-281-0220
communications@allianceforcareathome.org

Medicaid Provisions Threaten Home and Community-Based Services for Millions of Vulnerable Americans

Alexandria, VA and Washington, DC, July 3, 2025. The National Alliance for Care at Home (the Alliance) issued the following statement today in response to the House’s passage of the “One Big Beautiful Bill Act,” also known as the Reconciliation bill, which now heads to President Trump’s desk for his signature.

“The Alliance is deeply troubled by the Medicaid provisions within the One Big Beautiful Bill Act, which has passed both chambers of Congress and now awaits President Trump’s signature,” said Alliance CEO Dr. Steve Landers. “These provisions—including work requirements, reduced provider taxes, and new cost-sharing mandates—prioritize short-sighted budget savings over the health and wellbeing of our most vulnerable citizens who rely on home and community-based services (HCBS).”

Dr. Steve Landers

CEO, The National Alliance for Care at Home

The Alliance Advocates for Care at Home

The home care community advocated throughout the legislative process for Congress to mitigate these harmful Medicaid provisions. The legislation will reduce state provider tax rates, cutting funding that states rely on to support HCBS programs. New work requirements and mandatory cost-sharing will also create administrative burdens for both providers and beneficiaries, likely resulting in coverage losses that extend beyond those directly targeted by these policies. Further, new limits on home equity for long-term care recipients will force older adults to sell their homes, leading to unnecessary institutionalization.

Continued Advocacy

“As these Medicaid provisions become law, the Alliance will work tirelessly to monitor their implementation and advocate for the protection of Medicaid enrollees, families, and providers nationwide,” said Dr. Landers. “We will continue to champion the delivery of HCBS – proven services that are preferred by beneficiaries and save the system money.”

Careful Consideration Needed

Landers CEO The Alliance Reconciliation Bill

The Alliance calls on federal and state officials to implement these new requirements with careful consideration of their impact on vulnerable populations and to work collaboratively with providers to minimize disruption to essential services.

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About the National Alliance for Care at Home

The National Alliance for Care at Home (the Alliance) is the leading authority in transforming care in the home. As an inclusive thought leader, advocate, educator, and convener, we serve as the unifying voice for providers and recipients of home care, home health, hospice, palliative care, and Medicaid home and community-based services throughout all stages of life. Learn more at www.AllianceForCareAtHome.org.

© 2025 The National Alliance for Care at Home. This press release originally appeared on The Alliance website and is reprinted here with permission. For additional information or to request permission to print, please see the contact information above.

Follow our continuous updates on the bill passage, what it means for Medicare and Medicaid, and how the provisions of the bill will be rolled out in our accompanying article here.

BREAKING NEWS: House Passes Bill

by Kristin Rowan | May 23, 2025 | Breaking News, Medicaid, Regulatory

by Kristin Rowan, Editor

House Passes Bill

House passes bill in early-morning vote. The House of Representatives, predictably split along party lines, passed the “Big, Beautiful Bill” in a 215-214 narrow win. All but three Republican representatives cheered at its passing. Republicans who previously stated they would not vote for a higher deficit caved and voted along party lines. The House expects an uphill battling getting the bill passed through the Senate.

House Objections

All House Democrats and two House Republicans voted against the bill. One Republican voted “present.” Democrats were vocal in their opposition.

“Children will get hurt. Women will get hurt. Older Americans who rely on Medicaid for nursing home care and for home care will get hurt. People with disabilities who rely on Medicaid to survive will get hurt. Hospitals in your districts will close. Nursing homes will shut down. And people will die. That’s not hype. That’s not hyperbole. That’s not a hypothetical.”

Hakeem Jeffries

Representative, D-NY

Medicaid Changes

Work Requirement

One controversial change in Medicaid is the community engagement requirement for eligibility. Eligibility is at least one of the following:

Working at least 80 hours in a month
Completing at least 80 hours of community service
Participating in a work program for at least 80 hours
Enrolling at least part-time in an educational program
Any combination of the above totaling at least 80 hours
Having a monthly income greater than minimum wage for 80 hours per month

Exceptions

This rule applies to all eligible individuals at least 19 years old and is under 65 years old, is not pregnant, does not have children under age 7, and is not enrolled in or eligible for Social Security benefits. Mandatory exceptions to the community engagement requirement are:

Indian, Urban Indian, California Indian, or eligible as an Indian for the Indian Health Service
The parent, guardian, or caretaker of a disabled individual or dependent child
A veteran with a total disability rate
Medically frail or has special medical needs including those who:
- are blind or disabled
- have a substance use disorder
- have a disabling mental disorder
- live with a physical, intellectual, or developmental disorder that impairs 1 or more activities of daily living
- live with a serious and complex medical condition
- have any other medical condition approved, but not listed here
In compliance with requirements imposed by the State
The member of a household receiving SNAP benefits
Participating in a drug or alcohol rehabilitation program
An inmate of a public institution
Meet other criteria deemed appropriate

Senate Poised for a Fight

After the vote, the Senate made it clear that it will not send the bill to the President without “major changes.” The problem, however, is that different members of the Senate are calling for different changes. Some want even more spending reductions, others want to keep more of Biden’s green-energy incentives, and still others want to soften the Medicaid cuts. Here is some of the feedback from Senators:

Ron Johnson, Senator (R-Wis.) wants to take the bill “line by line” to find $6.5 trillion in cuts over 10 years.

Rand Paul, Senator (R-Ky.) supports the tax agenda, but not the debt ceiling hike.

Lisa Murkowski, Senator (R-Alaska) is expecting significant changes and wants to address the Medicaid cuts, call them “challenging.”

Patty Murray, Senator (D-WA) called the bill a “scam” and urged Republican senators to vote against it.

“House Republicans don’t want you to know they just passed a bill that makes health care MORE expensive and kicks MILLIONS off Medicaid, all to pass tax cuts for billionaires & giant corporations. We need to make sure America knows. And we need to kill this bill in the Senate.”

Patty Murray

Senator, D-WA

House Passes Bill to Senate

Because of the way the House presented the bill, designed to prevent a filibuster, there are constraints on what can be included.

First, everything included in the bill has to be about the budget. Challenges to parts of the bill and whether they are directly related to the budget go to the Senate parlimentarian. A non-partisan advisor, the parlimentarian advises the Senate if a provision is challenged. Elizabeth MacDonough is the current Senate parlimentarian and has served under Senate Majority Leaders from both parties.

Second, the Senate gets to make its own changes to the bill. If the House does not accept those changes, the debt ceiling will not go up. An impasse means the government defaults on its debt. Congress has to raise the debt ceiling by the summer to avoid default. This could put pressure on the House to accept whatever changes the Senate makes.

More to Come

This is an ongoing story and The Rowan Report will continue to provide updates as they become available. Read our accompanying article this week on organizations and courts attempting to stop Trump’s sweeping changes.

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Vision for CMS

by Kristin Rowan | Apr 24, 2025 | CMS, Medicaid, Medicare, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Vision for CMS from Dr. Oz

Last week, Dr. Mehmet Oz issued a statement on his vision for the future of CMS. Dr. Mehmet Oz is a cardiothoracic surgeon and former host of his own TV show. Under the Department of Health and Human Services, CMS has a $1.7 trillion budget and oversees the health outcomes of more than 160 million people.

“I want to thank President Trump and Secretary Kennedy for their confidence in my ability to lead CMS in achieving their vision to Make America Healthy Again. Great societies protect their most vulnerable. As stewards of the health of so many Americans – especially disadvantaged youth, those with disabilities, and our seniors, the CMS team is dedicated to delivering superior health outcomes across each program we administer. America is too great for small dreams, and I’m ready to get work on the President’s agenda.”

Dr. Mehmet Oz

Administrator of CMS, Department of Health and Human Services

Make America Healthy Again

With HHS Secretary Kennedy, Oz is throwing his support behind Make America Healthy Again, under direction from President Trump. Senator Kennedy says that, under the leadership of Dr. Oz, CMS will work to modernize Medicare, the Marketplaces, and Medicaid. The goal is to get Americans the care they want, need, and deserve. The agenda includes:

Empowering the American People with personalized solutions with which they can better manage their health and navigate the complex health care system. As a first step, CMS will implement the President’s Executive Order on Transparency to give Americans the information they need about costs.
Equipping health care providers with better information about the patients they serve and holding them accountable for health outcomes, rather than unnecessary paperwork that distracts them from their mission. For example, CMS will work to streamline access to life-saving treatments.
Identifying and eliminating fraud, waste, and abuse to stop unscrupulous people who are stealing from vulnerable patients and taxpayers.
Shifting the paradigm for health care from a system that focuses on sick care to one that fosters prevention, wellness, and chronic disease management. For example, CMS operates many programs that can be used to focus on improving holistic health outcomes.

Letter to Medicaid

Following the vision statement, Dr. Oz released a letter to state Medicaid Agencies outlining the use of Medicaid dollars during his tenure as Administrator. The two-page letter, citing recent studies on gender dysphoria, directed Medicaid agencies to eliminate gender reassignment surgery from covered procedures, opting instead for psychotherapy. Hormonal interventions will be reserved for exceptional cases.

“My top priority is protecting children and upholding the law. Medicaid dollars are not to be used for gender reassignment surgeries or hormone treatments in minors – procedures that can cause permanent, irreversible harm, including sterilization. We have a duty to ensure medical care is lawful, necessary, and truly in the best interest of patients. CMS will not support services that violate this standard or place vulnerable children at risk.”

Read the full letter here.

Final Thoughts

We believe this will be the first of many changes made to Medicare and Medicaid rules under Dr. Oz. We will continue to share updates from the CMS newsdesk.

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Is Medicaid Down for the Count?

by Kristin Rowan | Feb 6, 2025 | Breaking News, Regulatory

by Kristin Rowan, Editor

Medicaid Payment System Goes Dark

On Monday, January 27, President Trump, through the Office of Management and Budget, announced a temporary freeze on federal spending while his newly designated head of the Department of Government Efficiency ensures all spending follows the executive orders the President has signed. The memo was vague and caused widespread confusion across government departments. Almost immediately after the memo was circulated, Medicaid programs could not access the Payment Management Services web portal, the entity responsible for paying Medicaid claims.

The Memo

The language used in the memo on federal spending was broad and overreaching. As such, many federal organizations were unclear as to whether the memo applied to them. The message in the memo was that the administration intended to curb any spending that does not improve the day-to-day lives of the people. Throughout the day Monday, the White House sent clarifications about what programs would not be impacted. Among them were food assistance programs like SNAP, WIC, and Meals on Wheels, and Medicaid. The medicaid payment portal went down, despite this clarification.

Exclusions

Multiple state and federal agencies reached out to the White House for clarification following the release of the memo. Explicitly excluded from the freeze are direct benefit plans like Social Security and Medicare. In addition to the programs named in the memo, clarification on additional programs that would not be impacted included Medicaid. Despite the temporary website outage, claims were still being processed and payments were still being made.

Immediate Lawsuits

Almost simultaneously with the distribution of the memo, several non-profit organizations filed suit against the federal government. They called Trump’s action an “unlawful and unconstitutional” act, even temporarily. The pause on federal spending was set to go into effect at 5 p.m. ET on Tuesday. Minutes before, U.S. District Judge Loren L. AliKhan put a pause on the pause.

Temporary Freeze on the Temporary Freeze

To allow both sides time to construct an argument, the judge stayed the funding freeze until Monday, February 3. That morning, the judge will hear arguments and consider the issue. After the stay, attorneys general from 22 states and D.C. filed their own lawsuit to permanently block the freeze and prevent any future attempts to cut off already approved federal funding.

Then Comes the Thaw

If the judge allows the freeze to move forward, Trump has given every agency until February 10 to account for and explain all spending programs within their departments. Once the accounting has been reviewed, likely the OMB and the Department of Government Efficiency will determine which federal spending programs can resume operation.

There is no indication yet as to whether Trump will extend the February 10 deadline, given the delay in the courts. By the time the judge rules on Monday, however, we hope the White House will have issued additional details and guidance to avoid additional disruption to essential services like Medicare and Medicaid.

Final? Ruling

Early Monday, Judge AliKhan said she was not convinced by the argument that nonprofit groups have no case against the funding freeze since the OMB rescinded the memo. The administration argued that a brief pause on funding to align federal spending is within the law. The administration also suggests that the courts have no standing to block it. AliKhan has indicated that she will likely grant a longer temporary order to stay the funding freeze.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com