NABH Pushes for Changes to Senate Budget Reconciliation Bill

NABH has identified critical provisions to change in the budget reconciliation bill the Senate Finance Committee released on Monday evening, June 16.
 
The legislation would impose deeper Medicaid cuts than the House-passed bill, including:
 
Provider Taxes, Section 71120
 
The Senate Finance Committee’s bill would reduce the current 6% provider tax limit to 3.5% for states that expanded Medicaid under the Affordable Care Act (40 states and Washington, D.C.). This change would be phased in by lowering the limit by 0.5% each year between 2027 and 2031 and would not apply to taxes imposed on nursing or intermediate care facilities, and non-expansion states would still be held at the 6% threshold. This provision goes further than the House bill, which proposes to freeze provider taxes at the current levels. Similar language in the House bill about a moratorium for new provider taxes is in the Senate bill, and we continue to review new technical changes for what implications this would have on providers.
 
State Directed Payments, Section 71121
 
Changes to state directed payments (SDPs) would likewise be based on their Medicaid expansion status under the Senate budget reconciliation bill, with SDPs being limited to 100% of the Medicare payment rate in expansion states and 110% of the Medicare payment rate in non-expansion states. States would phase in this change by reducing their SDPs by 10% each year until they reach the permitted payment level. Meanwhile, the House bill would grandfather current SDPs while limiting future SDPS to the Medicare payment rate.
 
Additional Provisions
 
Other provisions, including work requirements and cost sharing, have behavioral health-focused exemptions that align with the House bill. However, NABH continues to have concerns with the work requirement exemption for people with a “disabling mental disorder,” because this language could imply the need for a formal disability determination. We are also concerned that the Senate bill excludes a provision to extend premium tax credits for Marketplace plans.  
 
The Senate may vote on the legislation next week before it adjourns for the Independence Day recess.
 
The NABH Government Affairs team is contacting senate offices to oppose the current draft and will send an Action Alert to NABH members urging them to contact their U.S. senators. Please respond to the Action Alert, share it with your colleagues, and urge them to do the same. This is a critical time to act and your voice can help effect change!