Daily on Healthcare: CMS says it’s reviewing state Medicaid lifetime limit proposals

CMS says it’s reviewing state Medicaid lifetime limit proposals. Arizona, Kansas, Maine, Wisconsin and Utah are applying for waivers under Medicaid that would limit how long certain enrollees can remain on the program. These types of limits have never been approved before, and it’s not clear that they would be under the Trump administration. A representative for the Centers for Medicare and Medicaid Services said the agency works with each state individually to evaluate the waivers. “To protect the integrity of that process, we do not comment on pending applications,” the representative said. “However, in general, a handful of states have approached CMS and proposed some type of time limit provision as part of their broader 1115 demonstration project applications,” which is the formal name for the waiver. CMS issued some general guidance last year saying that it considered certain ideas to be “novel approaches,” such as promoting efficiencies so Medicaid will be sustainable over the long term, and helping people achieve “upward mobility, greater independence, and improved quality of life.” Recently the administration approved waivers from Kentucky and Indiana that would require certain enrollees to demonstrate they are working, in school or volunteering as a condition of staying enrolled. Like work requirements, lifetime limits are considered part of conservative policies in states that say they want to keep the program open to the most vulnerable residents, such as pregnant women or people with disabilities.

Democrats blast the possibility. The news drew ire from Rep. Frank Pallone Jr., the top Democrat on the Energy and Commerce Committee. “Any attempt by the Trump administration to implement a lifetime limit on Medicaid would amount to a massive breach of the nation’s social safety net designed to protect children, the elderly, and the impoverished,” the New Jersey Democrat said. Sen. Tina Smith, D-Minn., also blasted the policy on Twitter. “URGENT: The Trump Admin is mulling lifetime Medicaid caps,” she wrote. “That’s the worst kind of policy — one that undermines the purpose of Medicaid & hurts people who may not have other care options. Join me in fighting this brazen attack on millions of Americans.” States can request a wide range of changes to Medicaid through the waivers, and they must undergo a review process by federal officials before approval, though some have lingered for years without being accepted. States see different administrations as either more or less inclined to accept their proposals. The lifetime limits, and other Medicaid waivers, can be found on CMS’s website.

Trump meets with Azar. The president is meeting right now with Health and Hu​man Services Secretary Alex Azar, an appointment that began at 11:30 this morning, according to the White House schedule. Hogan Gidley, a White House spokesman, said the two “will continue the conversation on how to address crucial issues, like healthcare reform, lowering drug prices and combating the opioid crisis.” During his first week Azar appeared at the State of the Union address and traveled to Indiana to approve a Medicaid waiver.

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​California spends $110 million on Obamacare outreach, enrollment rises 3 percent. In all, 423,484 Covered California ​customers selected health insurance plans in the nation’s most populous state, a 50,000 increase in new customers from last year. California’s deadline was Jan. 31, six weeks later than that of the federal government, which runs the healthcare.gov website that most states use. The amount the state ​spent ​on reaching customers ​was higher that of the federal government, which budgeted $10 million for outreach and $36 million for navigators. California spent $99 million a year ago. Peter Lee, executive director of Covered California, said the agency considered the rise in enrollment in California to be a success. “With robust marketing and strong partnerships in communities across California, we attracted more people to Covered California to newly enroll in health insurance this year,” he said in a statement. He also credited the increase to the way that the state had structured its subsidies. California’s data show that many people chose to pay extra to get a gold plan, which has higher premiums but more generous coverage, rather than a bronze plan which has fewer benefits but that many would have been able to have fully subsidized. In total, 15 percent chose a gold plan, which is more than triple the percentage from a year ago.

House passes bill to avoid Friday shutdown, sends it to the Senate. The House passed legislation Tuesday to temporarily fund the government into late March and provide full-year funding for the military. But the spending battle isn’t over, as the GOP bill passed along party lines, and now heads to the Senate, where lawmakers likely will reject it in favor of a bipartisan deal to fund the government for the rest of the fiscal year, and lift mandatory spending caps for two years. The House-passed bill is the fifth short-term funding measure passed in fiscal 2018 and comes ahead of a Feb. 8 deadline, when the fourth temporary funding measure passed last month will expire. Lawmakers passed it 245-182 Tuesday evening. House Democrats voted against the bill and are awaiting the Senate accord on a broad spending measure which, according to Senate Minority Leader Chuck Schumer, D-N.Y., includes near-parity on defense and domestic spending increases, although defense is likely to get about $20 billion more than the domestic budget, according to some lawmakers. The Senate would have to pass the broad spending package by Thursday to give the House enough time to pass it ahead of the midnight deadline, when current funding expires. The Senate bill is likely to include provisions the House added to the measure, including funding for community health centers and a score of provisions to bolster Medicare Advantage programs.

Senators press for more opioid funding as budget deal nears. Senators are aiming for more money to combat the opioid epidemic as Congress inches closer to the bipartisan deal on spending levels. Several senators have said they want more opioid funding to be included, but talk of exact figures has been on hold while negotiators work on budget caps. Sen. Rob Portman, R-Ohio, said he wants to at least keep the minimum dedicated opioid funding that has been made in 2017 and 2018. That extra funding came as part of the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act, which Portman sponsored. “We have been able to get $1.4 billion of additional funding this year and last year,” he told the Washington Examiner. “We want to continue on that and build on that.”

Public divided over Trump’s handling of opioid epidemic. A new poll found voters are nearly split over how Trump is tackling the opioid epidemic. The poll from Morning Consult and Politico released Wednesday found that 38 percent thought Trump has done a “sufficient amount” to address opioid abuse and 36 percent felt he did not, with 26 percent who had no opinion or didn’t know. About 40 percent of the respondents who lean Democratic believe Trump hasn’t done enough to fight opioid abuse, compared to 35 percent of Republicans who find Trump’s actions weren’t enough.

Sen. Ron Johnson ‘frustrated’ right-to-try bill hasn’t moved in House. Sen. Ron Johnson said he is frustrated that the House has not passed his bill to give terminally ill children the ability to try experimental treatments, even though the Senate passed it unanimously in August. “It is frustrating that we hit this logjam for months,” said the Wisconsin Republican, lead sponsor of the Senate bill. However, Johnson said President Trump’s support for “right to try” legislation during his State of the Union address and at a separate speech at the GOP retreat last week could help break that logjam. Vice President Mike Pence is also a major supporter, having signed a state law for right-to-try when he was Indiana’s governor. House Energy and Commerce Committee Chairman Greg Walden, R-Ore., is mulling changes to the legislation to ensure bipartisan support in the House. Johnson disagreed with changes the committee is pursuing. “I am concerned they want to narrow it to a very, very tight definition of the terminally ill,” Johnson said.

Humana to boost wages for employees following tax law. Health insurer Humana will be raising its full-time employees’ hourly pay to a $15 minimum thanks to the Republican-backed tax bill that Trump signed into law late last year, the company’s CEO announced during its quarterly earnings call Wednesday. Bruce Broussard, the company’s CEO, said half of the windfall from the tax law would go to customers, such as investing in community programs, as well as to employees, both in the form of higher wages as well as through investing in an incentive-based compensation program. The other half of the return from the tax law will be returned to shareholders. Humana’s overall quarterly report came out better than expected. The company reported a profit of $184 million, or $1.29 per share. Earnings were $2.06 per share and revenue rose 2.4 percent, to $13.19 billion.

House votes to loosen Obamacare’s menu labeling rules. The House voted Tuesday to loosen Obamacare rules that require restaurant chains, supermarkets and convenience stores to make calorie counts and other nutrition information available to customers. Under the Common Sense Nutrition Disclosure Act, introduced by Rep. Cathy McMorris Rodgers, R-Wash., food retailers would no longer need to provide calorie counts and other information for every possible combination of food, such as the thousands of options that can be created with pizza toppings. The rules, created by the Food and Drug Administration, mandate that the menu calories are posted on menu boards for people to see inside a restaurant. Retailers that oppose this say it’s cumbersome and expensive to post information for food that is made to order, and there have been particular objections by those whose products are sold mostly through delivery.

FDA declares kratom an opioid as scheduling remains in limbo. The Food and Drug Administration released an agency analysis that could put additional pressure on drug enforcement agencies to effectively ban an herbal supplement taken by people who suffer from pain, depression and addiction. The product in question is a Southeast Asian tree leaf known as kratom, which is legal under federal law. The FDA’s latest analysis, released Tuesday, included details about deaths associated with kratom and a conclusion by the agency that kratom contains some of the same components as opioids, which have caused tens of thousands of U.S. deaths annually. Commissioner Scott Gottlieb said his agency was concerned about reports that people had been using kratom to wean themselves off off opioids, saying “there is no reliable evidence to support the use of kratom as a treatment for opioid use disorder and significant safety issues exist.”

RUNDOWN

Washington Post The Trump administration is giving states another way around Obamacare regulations

Indianapolis Star Child abuse deaths rise, notably in Indiana and Texas, new report shows

Axios Tronc sells Los Angeles Times to world’s richest doctor

Politico Trump campaign’s evangelical advisor raises furor over flu comments

Associated Press Administration calls family planning program ‘important’

Healthcare Dive Slavitt leads heavy hitters in health access effort

STAT News If you drink untreated water, and you shouldn’t, this is what you are getting

Calendar

WEDNESDAY | Feb. 6

Feb. 5-6. Academy Health National Health Policy Conference. Details.

Feb. 6-8. Rural Health Policy Institute with the National Rural Health Association. Details.

THURSDAY | Feb. 8

House in recess. House Democrats head to retreat in Cambridge, Md.

Deadline for government spending bill.

8 a.m. 555 13th St NW. Economist event on “New Approaches to Infectious Disease Intervention.” Details.

10 a.m. 430 Dirksen. Health, Education, Labor and Pensions Committee hearing about the impact of the opioid crisis on children and families. Details.

10 a.m. National Press Club event with mental health experts. Details.

FRIDAY | Feb. 9

Noon. 226 Dirksen. George Mason University Law & Economics Center event on “Inventing New Liability? Who Should We Blame When Generic Drugs Harm Patients?” Details.