Electronic Health Records


What the government shutdown means to Medicare, Medicaid

By Kyle Murphy, PhD

UPDATE: The federal government has agreed to a temporary plan to reopen the government. For news on the latest impact of the government shutdown on Medicare and Medicaid, visit HealthPayerIntelligence.com.

For the Department of Health & Human Services, the first of October was supposed to be all about open enrollment in health insurance exchanges. Instead, it’s now focused on supporting its current activities while dealing with the repercussions of a government shutdown. Indeed, as the federal agency revealed in its contingency plan, 40,512 members of staff will be furloughed with 37,686 being retained “as of day two of a near-term funding hiatus.” That’s a 52/48 split for those doing the math.

While these figures are significant, here’s the short and quick of things for providers who rely on the Centers for Medicare & Medicaid Services (CMS).

Of the activities that will be continued, Medicare and Medicaid are part of that group. As Alex Hecht, Steven Weiner, and Andy Shin of Mintz Levin emphasized last week, Medicare and Medicaid funding is mandatory:

If the federal government is forced to shut down as a result of a budget impasse in Congress, discretionary programs and federal employees would be the most affected, while payments for Medicare services, the Affordable Care Act (ACA), and other mandatory programs would continue, albeit at a slower rate if the government were to undergo a long term shut down.

What’s more, CMS receives the most funding of any HHS agency, enough that “components like the Center for Consumer Information and Insurance Oversight that administers the health insurance exchanges, would be able to operate at near full capacity based on mandatory funding,” they add.

Therefore, the effects of the government shutdown are most likely to be experienced in the form of delays in reimbursement and other payments as a result of staff shortages.

“CMS would continue large portions of ACA activities, including coordination between Medicaid and the Marketplace, as well as insurance rate reviews, and assessment of a portion of insurance premiums that are used on medical services,” states the HHS contingency plan. “In the short term, the Medicare Program will continue largely without disruption during a lapse in appropriations.”

What will be lacking at CMS during a sustained government shutdown is discretionary funding for its healthcare fraud and abuse strike force. “Fewer recertification and initial surveys for Medicare and Medicaid providers would be completed, putting beneficiaries at risk of quality of care deficiencies,” says HHS.

In short, Medicare and Medicaid providers and beneficiaries are protected. Depending on how long the government shutdown plays out, the amount and timeliness of CMS support will be what varies.




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