White House targets CHIP, CMMI for budget cuts

 

The White House is requesting cuts of about $7 billion to the Children’s Health Insurance Program as part of $15.4 billion budget cut using a rare maneuver known as rescission.

The package also includes an $800 million cut to the Centers for Medicare & Medicaid Innovation (CMMI), a policy incubator that the Centers for Medicare & Medicaid Services uses to test innovative payment approaches.

Kativ/iStockphoto

According to the rescission request sent to Congress on May 8, the CHIP cut is comprised of more than $5.1 billion “in amounts made available by the Medicare Access and CHIP Reauthorization Act of 2015 to supplement the 2017 national allotments to states, including $3.1 billion in unobligated balances available on Oct. 1, 2017, and $2 billion in recoveries as of May 7, 2018.”

These funds were a one-time, additional appropriation “to reimburse states for eligible CHIP expenses.” According to the rescission request, the authority “to obligate these funds to states expired on Sept. 30, 2017, and the remaining funding is no longer needed.”

A second request would rescind nearly $1.9 billion from the Child Enrollment Contingency Fund, which provides payments to states that experience shortfalls from higher-than-expected enrollment. The White House notes that there were $2.4 billion available as of March 23, 2018, and that CMS “does not expect that any state would require a contingency fund payment in fiscal year 2018; therefore, this funding is not needed.”

If enacted, these rescissions “would have no programmatic impact,” according to the White House.

A broad coalition of physicians’ organizations and other advocates protested the proposed cuts in a May 9 letter to Congress.

 

“While White House officials insist that the CHIP cuts would not harm access to care for children and families, that is simply not the case,” according to the letter signed by more than 500 organizations. “Our nation is facing an increasing number of natural disasters ... [and] each catastrophe leaves families more vulnerable and more likely to qualify for CHIP. In addition to natural disasters, the Child Enrollment Contingency Fund provides states needed protection and security should their CHIP enrollment suddenly spike due to an economic recession or a public health crisis.”

The letter was signed by officials of the American Academy of Pediatrics, the American College of Physicians, the American College of Obstetricians and Gynecologists, the American College of Surgeons, and the American Psychiatric Association, among others.

Regarding the CMMI cut, the $800,000 would be rescinded from funds appropriated through fiscal year 2019. The White House notes that $3.5 billion was available as of Oct. 1, 2017.

The rescission represents funds that “are in excess of amounts needed to carry out the Innovation Center’s planned activities in fiscal 2018 and fiscal 2019, and the Innovation Center will receive new mandatory appropriation in fiscal 2020. Enacting this rescission would allow the Innovation Center to continue its current activity, initiate new activity, and continue to pay for its administrative costs,” according to the rescission request.

 

CMMI “is our best hope to innovate & achieve better health outcomes at lower costs,” Patrick Conway, MD, former deputy administrator and chief medical officer at CMS said in a May 8 tweet. “Cutting $800M or any amount would be a bad decision. CMS spends over $1 trillion per year; over $100M/hour. CMMI is key to better system.”

American Academy of Family Physicians President Michael Munger, MD, agreed.

“We’re also concerned about the $800 million rescission in funding for the CMS Innovation Center,” he said. “This initiative has been at the forefront of innovative demonstrations that can pave the way for a health care system that improves the quality of care and cuts health care spending.”

Congress has 45 days to act on the White House’s rescission proposal. If it takes no action, the proposal expires and the funds cannot be targeted by the same mechanism in the future. If Congress addresses the rescission request, it would need just a simple majority to pass each chamber.

Despite slashing more than $15 billion from the budget, the White House notes that the rescission request would reduce spending by only $3 billion.

gtwachtman@mdedge.com

 

The White House is requesting cuts of about $7 billion to the Children’s Health Insurance Program as part of $15.4 billion budget cut using a rare maneuver known as rescission.

The package also includes an $800 million cut to the Centers for Medicare & Medicaid Innovation (CMMI), a policy incubator that the Centers for Medicare & Medicaid Services uses to test innovative payment approaches.

Kativ/iStockphoto

According to the rescission request sent to Congress on May 8, the CHIP cut is comprised of more than $5.1 billion “in amounts made available by the Medicare Access and CHIP Reauthorization Act of 2015 to supplement the 2017 national allotments to states, including $3.1 billion in unobligated balances available on Oct. 1, 2017, and $2 billion in recoveries as of May 7, 2018.”

These funds were a one-time, additional appropriation “to reimburse states for eligible CHIP expenses.” According to the rescission request, the authority “to obligate these funds to states expired on Sept. 30, 2017, and the remaining funding is no longer needed.”

A second request would rescind nearly $1.9 billion from the Child Enrollment Contingency Fund, which provides payments to states that experience shortfalls from higher-than-expected enrollment. The White House notes that there were $2.4 billion available as of March 23, 2018, and that CMS “does not expect that any state would require a contingency fund payment in fiscal year 2018; therefore, this funding is not needed.”

If enacted, these rescissions “would have no programmatic impact,” according to the White House.

A broad coalition of physicians’ organizations and other advocates protested the proposed cuts in a May 9 letter to Congress.

 

“While White House officials insist that the CHIP cuts would not harm access to care for children and families, that is simply not the case,” according to the letter signed by more than 500 organizations. “Our nation is facing an increasing number of natural disasters ... [and] each catastrophe leaves families more vulnerable and more likely to qualify for CHIP. In addition to natural disasters, the Child Enrollment Contingency Fund provides states needed protection and security should their CHIP enrollment suddenly spike due to an economic recession or a public health crisis.”

The letter was signed by officials of the American Academy of Pediatrics, the American College of Physicians, the American College of Obstetricians and Gynecologists, the American College of Surgeons, and the American Psychiatric Association, among others.

Regarding the CMMI cut, the $800,000 would be rescinded from funds appropriated through fiscal year 2019. The White House notes that $3.5 billion was available as of Oct. 1, 2017.

The rescission represents funds that “are in excess of amounts needed to carry out the Innovation Center’s planned activities in fiscal 2018 and fiscal 2019, and the Innovation Center will receive new mandatory appropriation in fiscal 2020. Enacting this rescission would allow the Innovation Center to continue its current activity, initiate new activity, and continue to pay for its administrative costs,” according to the rescission request.

 

CMMI “is our best hope to innovate & achieve better health outcomes at lower costs,” Patrick Conway, MD, former deputy administrator and chief medical officer at CMS said in a May 8 tweet. “Cutting $800M or any amount would be a bad decision. CMS spends over $1 trillion per year; over $100M/hour. CMMI is key to better system.”

American Academy of Family Physicians President Michael Munger, MD, agreed.

“We’re also concerned about the $800 million rescission in funding for the CMS Innovation Center,” he said. “This initiative has been at the forefront of innovative demonstrations that can pave the way for a health care system that improves the quality of care and cuts health care spending.”

Congress has 45 days to act on the White House’s rescission proposal. If it takes no action, the proposal expires and the funds cannot be targeted by the same mechanism in the future. If Congress addresses the rescission request, it would need just a simple majority to pass each chamber.

Despite slashing more than $15 billion from the budget, the White House notes that the rescission request would reduce spending by only $3 billion.

gtwachtman@mdedge.com

 

The White House is requesting cuts of about $7 billion to the Children’s Health Insurance Program as part of $15.4 billion budget cut using a rare maneuver known as rescission.

The package also includes an $800 million cut to the Centers for Medicare & Medicaid Innovation (CMMI), a policy incubator that the Centers for Medicare & Medicaid Services uses to test innovative payment approaches.

Kativ/iStockphoto

According to the rescission request sent to Congress on May 8, the CHIP cut is comprised of more than $5.1 billion “in amounts made available by the Medicare Access and CHIP Reauthorization Act of 2015 to supplement the 2017 national allotments to states, including $3.1 billion in unobligated balances available on Oct. 1, 2017, and $2 billion in recoveries as of May 7, 2018.”

These funds were a one-time, additional appropriation “to reimburse states for eligible CHIP expenses.” According to the rescission request, the authority “to obligate these funds to states expired on Sept. 30, 2017, and the remaining funding is no longer needed.”

A second request would rescind nearly $1.9 billion from the Child Enrollment Contingency Fund, which provides payments to states that experience shortfalls from higher-than-expected enrollment. The White House notes that there were $2.4 billion available as of March 23, 2018, and that CMS “does not expect that any state would require a contingency fund payment in fiscal year 2018; therefore, this funding is not needed.”

If enacted, these rescissions “would have no programmatic impact,” according to the White House.

A broad coalition of physicians’ organizations and other advocates protested the proposed cuts in a May 9 letter to Congress.

 

“While White House officials insist that the CHIP cuts would not harm access to care for children and families, that is simply not the case,” according to the letter signed by more than 500 organizations. “Our nation is facing an increasing number of natural disasters ... [and] each catastrophe leaves families more vulnerable and more likely to qualify for CHIP. In addition to natural disasters, the Child Enrollment Contingency Fund provides states needed protection and security should their CHIP enrollment suddenly spike due to an economic recession or a public health crisis.”

The letter was signed by officials of the American Academy of Pediatrics, the American College of Physicians, the American College of Obstetricians and Gynecologists, the American College of Surgeons, and the American Psychiatric Association, among others.

Regarding the CMMI cut, the $800,000 would be rescinded from funds appropriated through fiscal year 2019. The White House notes that $3.5 billion was available as of Oct. 1, 2017.

The rescission represents funds that “are in excess of amounts needed to carry out the Innovation Center’s planned activities in fiscal 2018 and fiscal 2019, and the Innovation Center will receive new mandatory appropriation in fiscal 2020. Enacting this rescission would allow the Innovation Center to continue its current activity, initiate new activity, and continue to pay for its administrative costs,” according to the rescission request.

 

CMMI “is our best hope to innovate & achieve better health outcomes at lower costs,” Patrick Conway, MD, former deputy administrator and chief medical officer at CMS said in a May 8 tweet. “Cutting $800M or any amount would be a bad decision. CMS spends over $1 trillion per year; over $100M/hour. CMMI is key to better system.”

American Academy of Family Physicians President Michael Munger, MD, agreed.

“We’re also concerned about the $800 million rescission in funding for the CMS Innovation Center,” he said. “This initiative has been at the forefront of innovative demonstrations that can pave the way for a health care system that improves the quality of care and cuts health care spending.”

Congress has 45 days to act on the White House’s rescission proposal. If it takes no action, the proposal expires and the funds cannot be targeted by the same mechanism in the future. If Congress addresses the rescission request, it would need just a simple majority to pass each chamber.

Despite slashing more than $15 billion from the budget, the White House notes that the rescission request would reduce spending by only $3 billion.

gtwachtman@mdedge.com