Spending bill would revamp pandemic response, Medicaid funding

A sweeping year-end $1.7 trillion congressional spending package would revamp the country’s pandemic response and make major changes to Medicaid policy, among other health provisions.

The legislation includes most of a bipartisan bill from Sens. Patty Murray (D-Wash.) and Richard Burr (R-N.C.) aimed at improving the U.S. preparedness for pandemics after the many shortcomings in the response to COVID-19.  

The bill includes changes aimed at improving public health communication and data collection, speeding up the development of vaccines and treatments, and bolstering oversight of health agencies.

It also would make the director of the Centers for Disease Control and Prevention a Senate-confirmed position.

“The COVID pandemic has taught our nation some painful lessons, and we owe it to our families and communities to make sure we never go through this again,” Murray said in a statement. “I’m glad we were able to get these critical policies into the end-of-year omnibus.”

But the spending bill notably excludes a measure that would have established a bipartisan task force modeled on the 9/11 Commission to examine the U.S. response to COVID-19 as well as the controversial subject of the origins of the pandemic. Partisan investigations are underway in both chambers, which has dismayed public health advocates who fear no answers will be gained without an independent probe.  

The spending bill also includes a provision that would save the government tens of billions of dollars by allowing states to begin kicking people off the pandemic-enhanced Medicaid coverage in April as the federal government phases out the extra funding states have received since the earliest days of the pandemic.

In normal times, states are allowed to redetermine whether a beneficiary remains eligible for Medicaid at least once a year and remove anyone who no longer qualifies. But during the public health emergency, anyone who was Medicaid-eligible was allowed to remain continuously enrolled. As a result, enrollment surged to record numbers. 

Removing Medicaid coverage from the public health emergency was a major priority for Republicans, but it would also give state health officials certainty. 

The public health emergency did not have a firm end date, so state Medicaid officials never knew when they would have to start going through their Medicaid rolls to figure out who was no longer eligible.

“That constant need to kind of go through all those exercises and constantly revise your assumptions … is creating a real, real friction between state Medicaid agencies and some of their trusted partners and decision makers,” said Jack Rollins, the director of federal policy for the National Association of Medicaid Directors.

“That advance notice is really important because we are looking at essentially nearly three years of no Medicaid program doing redeterminations, and that is going to be a significant amount of work when we have to start doing this again,” Rollins said.

Some of the money saved would go toward long-sought Democratic priorities, such as allowing states to permanently extend Medicaid coverage for new mothers for a full year, and to give a continuous year of eligibility for children on Medicaid or the Children’s Health Insurance Program.