Summary
Tomorrow at midnight government funding expires and a government shutdown will begin. Last week, Office of Management and Budget (OMB) Director Russ Vought threatened to permanently terminate federal jobs during the potential shutdown if Democrats do not agree to the Republican continuing resolution (CR). However, Democrats are remaining steadfast with House Minority Leader Hakeem Jefferies (D) indicating that they will not cave to the pressure without Republicans providing an “iron clad and in legislation” agreement to address health care.
After cancelling last week’s meeting with Democrat leaders, President Trump will meet with both Republican and Democrat leadership today to discuss the possibility of averting a shutdown. However, each side is dug in on their approach, with no compromise in sight. Republicans continue to support their CR with funding through November 21 and would prefer to address the enhanced premium tax credits later this year, while Democrats are seeking an extension of the enhanced premium tax credits, coupled with repealing H.R. 1’s Medicaid cuts in any government funding deal. If a government shutdown ensues, Impact Health will provide an update on potential health care implications.
Regulatory Update
The Office of Management and Budget (OMB) completed reviewing the following:
- Medicaid and Immigration Status. A final rule titled, “Medicaid Eligibility Changes Under the Affordable Care Act of 2010; Giving States Freedom to Use Immigration Information to Determine State Residency for Medicaid Eligibility.” The final rule is part of the Trump administration’s efforts to increase federal oversight on states using Federal Medicaid funding for the health care of undocumented immigrants.
OMB is also reviewing the following:
- Medicare:
- CY 2027 Medicare Advantage/Part D Policy. Proposed CY 2027 policy and technical changes to Medicare Advantage, Medicare Prescription Drug Benefit, Medicare Cost Plan, and PACE
- CY 2026 Physician Fee Schedule. The final rule for the CY 2026 CY 2026 Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B
- Procurement of Domestic PPE. An advance notice of proposed rulemaking that would detail program incentives and requirements for Medicare providers and suppliers to invest and phase-in the procurement of American made personal protective equipment (PPE) and essential medicine to secure our nation’s health and safety.
- Medicaid:
- Gender-Affirming Care.
- A proposed rule titled, “Medicaid Program; Prohibition on Federal Medicaid Funding for Sex Trait Modification Procedures Furnished to Children and Youth.”
- A proposed rule titled, “Medicare and Medicaid Programs; Hospital Condition of Participation: Limiting Participation Based on the Performance of Sex Trait Modification Procedures on Children.”
- State Directed Payments. A proposed rule titled, “Medicaid Managed Care-State Directed Payments.” The proposed rule appears intended to advance a presidential memorandum released on June 6, which directs HHS to “eliminate waste, fraud, and abuse in Medicaid, including by ensuring Medicaid payments rates are not higher than Medicare, to the extent permitted by applicable law.”
- Gender-Affirming Care.
- Prescription Drugs:
- A proposed rule titled, “Improving Transparency into Pharmacy Benefit Manager Fee Disclosure.”
- CMMI Drug Pricing Model. A proposed rule for a Global Benchmark for Efficient Drug Pricing (GLOBE) Model.
- Nutrition:
- Head Start. A notice from the Administration for Children and Families titled, “Publish Request for Information: Nutrition Services in Head Start Programs
- Immigration:
- Unaccompanied Children. An interim final rule titled, “Unaccompanied Children Program Foundational Rule; Update to Include Proof of Identity and Income Verification Standards.”