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Provisions7
SEC. 2141. REPEAL OF HEALTH SUBTITLE CHANGES.8
Subtitle B of title VII of the Act titled ‘‘An Act to9
provide for reconciliation pursuant to title II of H. Con.10
Res. 14’’ (Public Law 119–21) is repealed and any law11
or regulation referred to in such subtitle shall be applied12
as if such subtitle and the amendments made by such sub-13
title had not been enacted.

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Originally posted by JEWELSTAITEFAN:
I am sorry. My mistake.
Sandy from Westchester was what highlighted the hypocrisy of her affluent childhood before she rebranded as poor struggling girl from the Bronx, AOC. I corrected it in the OP, to reduce confusion.

To confirm, I checked with a search engine. Humorous results, but all spot on. One hit credited Tucker Carlson as being the originator, but I can't imagine I ever heard him say it.
I've heard it mentioned several times on talk radio shows, I think by more than one person, not sure. I think Bill Cunningham is one I clearly recall. He does a radio show out of Cincinatti.

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Subtitle B--Health

Chapter 1--Medicaid

Subchapter A--Reducing Fraud and Improving Enrollment Processes

(Sec. 71101) This section delays until FY2035 implementation of certain provisions of the rule titled Streamlining Medicaid; Medicare Savings Program Eligibility Determination and Enrollment, which was issued by the Centers for Medicare & Medicaid Services (CMS) on September 21, 2023.

Specifically, the section delays provisions of the rule that (1) specify that individuals who must pay a premium to enroll in Medicare hospital services, reside in a group payer state, and enroll during a general enrollment period may qualify for Medicare Savings Programs (MSPs) as early as the month of their entitlement to Medicare hospital services; (2) require states to use certain data from the Social Security Administration (SSA) to facilitate the enrollment of qualifying individuals in both MSPs and the Low-Income Subsidy (LIS) program under the Medicare prescription drug benefit; and (3) align the definition of family size under MSPs with the definition under the LIS program.

(MSPs allow individuals to receive Medicare cost-sharing and premium assistance from state Medicaid programs if they meet certain income and resource criteria. The LIS program, also known as the Extra Help program, provides similar assistance with respect to cost-sharing for covered drugs under the Medicare prescription drug benefit.)

The section provides $1 million for FY2026 for the CMS to implement this section and Sec. 71102 of this act.

(Sec. 71102) This section delays until FY2035 implementation of certain provisions of the rule titled Medicaid Program; Streamlining the Medicaid, Children's Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes, which was issued by the CMS on April 2, 2024.

Specifically, the section delays provisions of the rule that, among other changes, (1) allow state Medicaid programs to verify an individual’s U.S. citizenship and identity through certain systems without additional proof of identity; (2) align certain Medicaid enrollment processes for those whose eligibility is not based on income with those that are based on income; and (3) establish additional timelines for Medicaid eligibility terminations, including when there is a change in an individual’s circumstances.

(Sec. 71103) This section requires the CMS to establish a centralized system for states to check whether enrollees are simultaneously enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) in multiple states.

Beginning no later than 2027, states must regularly obtain the addresses of Medicaid and CHIP enrollees from specified authorized sources. Beginning no later than FY2030, states must report on at least a monthly basis the Social Security numbers of enrollees to the CMS' newly established system. The CMS must notify states on at least a monthly basis of individuals who are enrolled in multiple states so that states may take appropriate action.

The section provides $10 million for FY2026 and $20 million for FY2029 for the CMS to establish and maintain the new system, respectively.

(Sec. 71104) This section requires state Medicaid programs to check, beginning in 2028, the SSA's Death Master File on at least a quarterly basis to determine whether Medicaid enrollees are deceased.

(Sec. 71105) This section provides statutory authority for the requirement that state Medicaid programs check, as part of the provider enrollment and reenrollment process, whether providers are deceased through the SSA's Death Master File. Beginning in 2028, the section requires states to continue to check this database on at least a quarterly basis after providers are enrolled.

(Sec. 71106) This section includes Medicaid payments to individuals for whom there is insufficient information as to their eligibility as erroneous excess payments that may ultimately reduce a state’s federal matching funds. These changes apply beginning in FY2030.

(Sec. 71107) This section requires state Medicaid programs to redetermine every six months, beginning with the first quarter after December 31, 2026, the eligibility of individuals who are enrolled in Medicaid as part of the Medicaid expansion population under the Patient Protection and Affordable Care Act. (That act allows states to extend Medicaid coverage to all adults under the age of 65 with incomes of up to 138% of the federal poverty level, including able-bodied adults without dependent children.)

The section provides $75 million for FY2026 for the CMS to implement these provisions.

(Sec. 71108) This section caps home equity limits for Medicaid nursing facility or other long-term care services beginning in 2028.

Currently, in order to qualify for such services, an individual’s home equity may not exceed certain limits, as set by states in accordance with federal standards and adjusted annually for inflation. For 2025, home equity limits set by states must be between $730,000 and $1,097,000.

The section caps the maximum home equity limit to $1 million, regardless of inflation. This limit does not apply to homes located on agricultural lots.

(Sec. 71109) This section generally restricts, beginning in FY2027, federal payment for Medicaid and CHIP to services for individuals who are U.S. residents and are either U.S. citizens, lawful permanent residents, Cuban-Haitian entrants, or Compact of Free Association migrants lawfully residing in the United States. The restrictions do not apply to certain mandatory emergency services provided to individuals who are not lawfully residing in the United States or to optional services provided to certain lawfully residing children and pregnant women.

Current law authorizes federal payment with respect to additional categories of individuals, including refugees; noncitizens granted parole for at least one year, asylum, or related relief; and Violence Against Women Act (VAWA) self-petitioners. The section excludes these individuals from eligibility.

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The section provides $15 million for FY2026 for the CMS to implement these provisions.

(Sec. 71110) This section reduces the Medicaid federal matching rate for emergency services provided to individuals who are not lawfully residing in the United States but who would otherwise qualify for Medicaid as part of the Medicaid expansion population in states that have expanded Medicaid. Specifically, the section limits, beginning in FY2027, the Medicaid federal matching rate for emergency services provided to individuals who are not lawfully residing in the United States to the same matching rate as would otherwise apply for such services (rather than the enhanced federal matching rate for states that have expanded Medicaid).

The section provides $1 million for FY2026 for the CMS to implement these provisions.

Subchapter B--Preventing Wasteful Spending

(Sec. 71111) This section delays until FY2035 implementation of certain provisions of the rule titled Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting, which was issued by the CMS on May 10, 2024.

Specifically, the section delays provisions of the rule that, among other changes, (1) establish minimum staffing standards for nurses in Medicare and Medicaid long-term care facilities, including requiring a nurse to be onsite 24/7 and requiring a minimum of 3.48 total nurse staffing hours per resident per day; and (2) require state Medicaid programs to report on payments to direct care workers and support staff of nursing facilities and intermediate care facilities for individuals with intellectual disabilities.

(Sec. 71112) This section shortens the window for retroactive Medicaid coverage. Specifically, the section specifies that, beginning with the first quarter after December 31, 2026, Medicaid coverage may begin retroactively (1) for individuals in the Medicaid expansion population, one month prior to the application filing date; and (2) for all other individuals, two months prior to the application filing date. Additionally, CHIP coverage may retroactively begin two months prior to the application filing date. (Currently, coverage may begin three months prior to the application filing date.)

The section provides $10 million for FY2026 for the CMS to implement these provisions.

(Sec. 71113) This section prohibits federal Medicaid payment for one year to nonprofit health care providers that serve predominantly low-income, medically underserved individuals (i.e., essential community providers) if the provider (1) primarily furnishes family planning services, reproductive health, and related care; (2) offers abortions in cases other than that of rape, incest, or life-threatening conditions for the woman; and (3) in FY2023, received federal and state Medicaid payments totaling more than $800,000.

The section provides $1 million for FY2026 for the CMS to implement these provisions.

Subchapter C--Stopping Abusive Financing Practices

(Sec. 71114) This section requires states that had not chosen to expand Medicaid pursuant to the Patient Protection and Affordable Care Act prior to March 11, 2021, to do so by January 1, 2026, in order to receive the corresponding enhanced federal matching rate.

(Sec. 71115) This section generally limits Medicaid provider taxes beginning in FY2027.

Under current law, states may impose a provider tax of up to 6% of net patient service revenues to potentially receive additional federal matching funds. The section precludes states that have not expanded Medicaid from increasing the rate of a provider tax beyond that currently in effect in order to qualify for federal matching funds. For states that have expanded Medicaid, a provider tax may not exceed the current rate or a specified rate, whichever is lower; the maximum rate gradually decreases from FY2028-FY2032, with a maximum rate of 3.5% beginning in FY2032 (these limits do not apply to nursing and intermediate care facilities, which are instead limited to current rates). The section additionally precludes states from imposing a new provider tax if there is not already one in effect.

The section provides $20 million for FY2026 for the CMS to implement these provisions.

(Sec. 71116) This section provides $7 million per fiscal year for FY2026-FY2033 for the CMS to revise regulations so as to limit state-directed payments for inpatient hospital services, outpatient hospital services, nursing facility services, and qualified practitioner services at an academic medical center under Medicaid managed care contracts to the payment rate for services under Medicare, rather than the average commercial rate. For states that cover the Medicaid expansion population, payment is limited to 100% of the Medicare rate; for other states, payment is limited to 110% of the Medicare rate.

Subchapter D--Increasing Personal Accountability

(Sec. 71119) This section requires, beginning not later than the first quarter after December 31, 2026 (or earlier, at the option of the state), individuals who are eligible for Medicaid as part of the Medicaid expansion population to engage in community service, work, or other activities in order to qualify for Medicaid.

Specifically, the section requires these individuals to, on a monthly basis, (1) work at least 80 hours, (2) complete at least 80 hours of community service, (3) participate in a work program for at least 80 hours, (4) be enrolled at least half-time in an educational program, or (5) engage in any combination thereof for a total of at least 80 hours. Individuals may also qualify if they have a monthly income (or, for seasonal workers, an average monthly income over six months) that is at least as much as the equivalent of minimum wage multiplied by 80 hours.

Individuals who are applying for Medicaid must demonstrate compliance with these requirements for one to three months (as determined by the state) consecutively and immediately prior to filing an application; individuals who are already enrolled in Medicaid must demonstrate compliance for one month or more (as determined by the state), whether or not consecutive, during the period between the individual’s last eligibility determination and the next scheduled eligibility determination.

States must verify an individual’s compliance upon a determination or redetermination of eligibility but may also choose to verify compliance more frequently. States may not waive the new requirements. However, states may choose to provide an exception for individuals experiencing short-term hardships (e.g., hospitalization).

The section excludes certain individuals from these requirements, including those with serious medical conditions or with dependent children aged 13 or younger.

Upon request, the CMS may exempt a state from fully implementing these requirements until December 31, 2028. States requesting an exemption must demonstrate good faith efforts to comply with the requirements and provide a detailed timeline for implementation.

The section provides $200 million to states and $200 million to the CMS for FY2026 to implement these requirements.

(Sec. 71120) This section requires, beginning in FY2029, states to institute cost-sharing requirements for individuals who are eligible for Medicaid as part of the Medicaid expansion population and whose family income exceeds the federal poverty line. Cost sharing may not exceed $35 for an item or service; total cost sharing for all individuals in a family may not exceed 5% of the family’s income.

The requirements do not apply to (1) services for which cost sharing is already prohibited (e.g., emergency services); (2) primary care, mental health, or substance use disorder services; or (3) services provided by federally qualified health centers, certified community behavioral health clinics, or rural health clinics. States may allow providers to condition the provision of services upon the payment of any required cost sharing.

The section provides $15 million for FY2026 for the CMS to implement these provisions.

Subchapter E--Expanding Access to Care

(Sec. 71121) This section authorizes additional home and community-based services (HCBS) waivers (also known as Section 1915(c) waivers) for state Medicaid programs beginning on July 1, 2028. States may seek waivers to provide HCBS to individuals without the need for certain determinations as to whether an individual requires hospital or institutional care (as is required for current waivers). States must establish other needs-based criteria for such services.

The section provides $50 million for FY2026 for the CMS to implement these provisions. It also provides $100 million for FY2027 to support state HCBS programs.

Chapter 2--Medicare

Subchapter A--Strengthening Eligibility Requirements

(Sec. 71201) This section generally restricts Medicare eligibility to U.S. citizens, lawful permanent residents, Cuban-Haitian entrants, and Compact of Free Association migrants lawfully residing in the United States. The SSA must identify Medicare enrollees who do not meet these requirements and terminate their enrollment within 18 months of this section’s enactment.

Current law authorizes additional categories of individuals who are lawfully present in the United States to qualify for Medicare, including refugees; noncitizens granted parole for at least one year, asylum, or related relief; noncitizens with Temporary Protected Status; and noncitizens with deferred action, including Deferred Action for Childhood Arrivals (DACA) recipients. The section excludes these individuals from eligibility.

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(Sec. 71202) This section increases payments under the Medicare physician fee schedule for services furnished between January 1, 2026, and January 1, 2027.

Subchapter B--Improving Services for Seniors

(Sec. 71203) This section modifies certain provisions under the Medicare Drug Price Negotiation Program with respect to orphan drugs, including by excluding additional orphan drugs from qualifying for negotiation.

The Medicare Drug Price Negotiation Program requires the CMS to negotiate the prices of certain prescription drugs under Medicare beginning in 2026. Among other requirements, drugs must have had market approval for at least 7 years (for drug products) or 11 years (for biologics) to qualify for negotiation. The program does not apply to orphan drugs that are approved to treat only one rare disease or condition.

The section modifies these provisions so as to exclude any period in which a drug was an orphan drug from market approval calculations. It also excludes orphan drugs that are approved to treat more than one rare disease or condition from the program. The changes take effect in 2028.

Chapter 3--Health Tax

Subchapter A-- Improving Eligibility Criteria

This subchapter modifies eligibility and verification requirements for the premium tax credit (which may be used to purchase health insurance on an exchange).

Below is a summary of the provisions in this subchapter.

(Sec. 71301) This section limits a lawfully-present alien’s eligibility for the premium tax credit to

an alien who is lawfully admitted for permanent residence;
an alien who has been granted the status of Cuban and Haitian entrant; or
an individual who is lawfully residing in the United States in accordance with the Compacts of Free Association between the United States and Micronesia, the Marshall Islands, and Palau.

(Sec. 71302) This section repeals the rule that allows certain lawfully-present aliens who have a household income of less than 100% of the federal poverty level and are ineligible for Medicaid (based on the individual’s alien status) to claim the premium tax credit.

Subchapter B--Preventing Waste, Fraud, and Abuse

This subchapter requires verification of certain information supplied by individuals for purposes of determining eligibility for the premium tax credit, limits use of the premium tax credit, and expands recapture of excess advance payments of the premium tax credit.

Below is a summary of the provisions of this subchapter.

(Sec. 71303) This section requires the verification, beginning in 2028, of certain information for an individual to enroll in a health insurance plan through a health insurance exchange and to generally qualify for the premium tax credit. (Under current law, eligible individuals are allowed a premium tax credit, which applies toward the cost of obtaining health insurance through health insurance exchanges.)

Specifically, under this section, a health insurance exchange must verify, using applicable enrollment information provided (or verified) by an individual, the following information:

household income and family size,
whether the individual is an eligible alien,
any health coverage status or eligibility for coverage,
place of residence, and
any other information required by the Department of the Treasury.

The verification requirements may be waived for individuals who enroll in a health insurance plan through a health insurance exchange during a special enrollment period due to a change in family size.

(Sec. 71304) This section provides that the premium tax credit is not allowed for any health insurance plan enrolled in through a health insurance exchange during a special enrollment period provided by such exchange (1) on the basis of the relationship between the individual’s expected household income to the federal poverty level, and (2) not in connection with with the occurrence of an event or change in circumstances specified by the Department of Health and Human Services for such purposes.

(Sec. 71305) This section eliminates the limit on the recapture of excess advance payments of the premium tax credit and, accordingly, allows the full amount of any such excess payments to be recaptured. (Under current law, individuals with incomes below 400% of the federal poverty level may be required to pay back only a portion of any excess advance payment of the premium tax credit.)

Subchapter C--Enhancing Choice for Patients

This subchapter expands health savings account (HSA) eligibility requirements.

As background, individuals may establish and contribute to an HSA if they are covered under a high-deductible health plan (HDHP) and not covered under a health plan that (1) is not an HDHP and (2) provides coverage for any benefits that is covered under the HDHP (subject to certain exceptions).

Below is a summary of the provisions in this subchapter.

(Sec. 71306) This section allows individuals to establish and make tax-deductible contributions to a health savings account (HSA) if covered by a health insurance plan that provides telehealth and other remote care services without requiring a deductible but otherwise meets the requirements of an HDHP.

(Sec. 71307) This section expands eligibility to make tax-deductible HSA contributions to include individuals who have a bronze-level or catastrophic health insurance plan through a health insurance exchange. (A bronze-level health insurance plan provided through a health insurance exchange may or may not qualify as a HDHP, depending on the specific plan features. Catastrophic health plans provided through a health insurance exchange generally do not meet the requirements of a HDHP.)

(Sec. 71308) This section expands eligibility to make tax-deductible HSA contributions to include individuals who have a direct primary care service arrangement with a fixed period fee that does not exceed $150 a month (or $300 a month if the arrangement covers more than one individual). The amounts are adjusted annually for inflation. (Some limitations apply.)

Chapter 4--Protecting Rural Hospitals and Providers

(Sec. 71401) This section provides $10 billion per fiscal year for FY2026-FY2030 for a program that supports the provision of health care in rural areas.

Under the program, states may apply for financial allotments to improve the access and quality of care of services in rural areas, such as through enhanced technology, strategic partnerships, and workforce training. States must submit detailed rural health transformation plans and certify that no funds will be used to finance the non-federal share of Medicaid or CHIP. The CMS must approve or deny applications by December 31, 2025; states that receive approval do not need to reapply each year. States are not required to contribute any matching funds with respect to program allotments.

The CMS must award allotments so that 50% of funds are awarded equally among all approved states. The remaining 50% of funds must be awarded based on certain considerations, including the proportion of rural health facilities in the state compared to the number of such facilities nationwide.

The section additionally provides $200 million for FY2025 for the CMS to impl

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Originally posted by JEWELSTAITEFAN:
Who are the people who did not have it before COVID, but will now?

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Originally posted by 6ixStringJack:

That's worse than debtor's prison. One might even argue it's worse than forcing an untested vaccination on people with the threat of taking their job away if they don't get it. It's in the same ballpark.

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