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Don't hold your breath for an imminent Medicaid deal

Illustration of a stethoscope with a clock attached.

Illustration: Shoshana Gordon/Axios

We broke the news last month that Congress was discussing an earlier rollback of the Medicaid continuous coverage provisions of the public health emergency as an offset in the omnibus.

  • So, let's check back in: How are the talks going on that? The answer from talking to aides and lobbyists: not particularly well.

What we're hearing: Democrats could be open to this offset if there are guardrails (like limiting the number of eligibility redeterminations that can be made each month) to help prevent people from losing coverage, and if the savings are reinvested back into other Medicaid priorities.

  • Those priorities include items like permanent 12 months postpartum Medicaid coverage in all states, 12-month continuous eligibility for children, permanent CHIP funding, and the "momnibus" package of maternal health bills.
  • Republicans, meanwhile, are interested in rolling back the Medicaid continuous coverage provisions because they point to the budgetary toll of so many enrollees right now, and it's far from clear they will agree to all of the Democratic asks.
  • In fact, the sides are still pretty far apart, and it's possible that no deal on Medicaid provisions comes together and the issue just drops out.

What they're saying: No one's giving up yet. Asked about a trade of allowing redeterminations of eligibility to begin in Medicaid in exchange for other Medicaid priorities, Senate Finance Chairman Ron Wyden did not directly answer.

  • "I mean every 20 minutes now there's another kind of offer being floated. I start with the proposition, too many Americans are falling through the health care cracks," he told Axios.
  • "I'm not going to disclose what I will or won't agree to, and all I can tell you is we're negotiating," said Sen. Mike Crapo, the top GOP member on Finance.
  • “We think it’s critical that Congress implement guardrails and coverage protections for vulnerable Medicaid beneficiaries as the PHE unwinds," said a Democratic aide.

The big picture: Making matters even more complicated, there's still no agreement on the topline numbers for the larger omnibus, which makes reaching a final deal on the health provisions tough to do.

  • A lot of health care pieces are still hanging in limbo until the broader situation is figured out. Democrats plan to unveil their own omnibus proposal Monday as a negotiating tactic, which is not a particularly hopeful sign for the state of the bipartisan talks.
  • Aides and lobbyists we talked to Thursday said it's up in the air what, if any, health care riders will be in that Democratic-only proposal (which is not going to become law but could indicate Democratic priorities).
  • Families USA, the health care consumer advocacy group, noted that since there are bipartisan talks on giving providers some relief from Medicare cuts, there should also be provisions in areas like improving postpartum and child coverage.
  • "Particularly as they are considering providing additional financial relief to health providers, [Congress] must not fail to invest in the people and families our health care system is supposed to serve," said Jen Taylor, the group's senior director of federal relations.
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