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Illustration: Aïda Amer/Axios

Major health industry groups, governors and state Medicaid directors have all raised significant concerns with a Trump administration proposal that would change the rules and oversight of some forms of state Medicaid financing.

Why it matters: Billions of dollars are on the line for both states and providers, which they say in turn threatens the health care of some of America's most vulnerable people.

The big picture: The proposal from the Centers for Medicare & Medicaid Services, called the Medicaid Fiscal Accountability Regulation, or MFAR, would be mandatory for states.

  • CMS says the proposal, which was announced in November, would strengthen Medicaid program integrity as its costs continue to rise.
  • “We have seen a proliferation of payment arrangements that mask or circumvent the rules where shady recycling schemes drive up taxpayer costs and pervert the system,” CMS administrator Seema Verma said in a statement when the proposal was announced. “Today’s rule proposal will shine a light on these practices."

The other side: Provider groups say the new rules would threaten the money doctors and hospitals rely on to serve Medicaid patients.

  • The American Hospital Association wrote in a comment letter to CMS that MFAR could reduce Medicaid spending by 5.8%–7.6%.
  • Medicaid payments to hospitals could be reduced by $23 billion–$31 billion a year, or by 12.8%–16.9%, per the AHA.
  • The American Medical Association struck a similar tone, saying the rule "could result in the loss of funding for our nation’s most vulnerable patients."

The National Governors Association, similarly, said the rule "will result in decreased access to care for many vulnerable Americans."

  • The National Association of State Medicaid Directors warned that the rule would have unintended consequences, like the destabilization of state budget cycles and "an environment of uncertainty for states."

Between the lines: The rule is deeply technical and wonky, but for some states, it could end up being a much bigger deal than the administration's Medicaid block grant and work requirement proposals simply because it's not optional.

  • That's true in both red and blue states.
  • "The proposed rule would collapse Texas’ already fragile rural health care infrastructure," the Texas Hospital Association wrote in its comment letter.

Go deeper

Updated 2 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Annelise Capossela/Axios

  1. Health: Fall and winter COVID surge "unlikely" if people get vaccinated.
  2. Politics: School boards are the next political battleground.
  3. Vaccines: Pfizer begins application for full FDA vaccine approval — Moderna says its COVID booster shot shows promise against variants.
  4. Economy: U.S. adds just 266,000 jobs in April, far below expectations.
  5. World: Asia faces massive new COVID surgeIndia records its deadliest day of the pandemic.
  6. Variant tracker: Where different strains are spreading.

Kevin McCarthy officially endorses Elise Stefanik to replace Liz Cheney

House Minority Leader Kevin McCarthy. Photo: Win McNamee/Getty Images

House Minority Leader Kevin McCarthy (R-Calif.) officially endorsed Rep. Elise Stefanik (R-N.Y.) to become the GOP's next House Republican conference chair during a Fox News appearance Sunday.

Why it matters: The GOP has been feuding internally over the fate of the current chair, Rep. Liz Cheney (R-Wyo.), because of her criticisms of former President Donald Trump, and her vote to impeach him for his role in the Jan. 6 Capitol riot.

Fauci: Vaccines could turn COVID-19 "surges" into "blips"

NIAID director Anthony Fauci told "Meet the Press" Sunday that if more Americans get vaccinated in accordance with the Biden administration's goals, COVID-19 surges may be replaced by "blips."

State of play: Last week President Joe Biden announced his goal to get 160 million Americans fully vaccinated by July 4, with at least 70% of Americans having at least one shot.