Senate budget recommendations even worse than House version
The Senate released a draft of their budget reconciliation recommendations, following the passage of H.R. 1 (the "One Big, Beautiful, Bill Act") in the House last month. The House version had countless concerning provisions that would lead to billions of dollars in Medicaid funding cuts and thousands of people losing services. (You can read a summary of the healthcare provisions in it courtesy of our partners at the National Council for Mental Wellbeing.) There was reason to hope the Senate would temper the impacts on Medicaid before approving a reconciliation package, since their original savings goal was lower and they have been receiving nationwide and local advocacy against draconian cuts for months.
Unfortunately, the Senate version only digs in deeper on the Medicaid cuts. Here is a full section-by-section summary of their recommendations, and I've highlighted a few pieces to note below.
Work or Community Engagement Requirements: the Senate version narrows the exemptions for individuals with dependent children proposed by the House -- parents, guardians, and caretakers of children 15 and older would not be exempt.
Provider Taxes: the Senate version lowers the maximum allowable rate of most provider taxes in Medicaid expansion states like New York, effectively lowering the dollars available to fund services.
State-Directed Payments: the House and Senate versions both require that state-directed payments (like the non-risk payments to managed care plans that went along with the rate floor for HCBS) be no higher than 100% of the Medicare rate for such services in Medicaid expansion states like New York. The House version had an exemption for payments that were approved before the bill's passage, but the Senate version adds conditions to lower all payments down to that 100% Medicare rate eventually.
The Senate Budget Committee will now compile the recommendations from various committees into a single package for a vote. There will likely be a long floor debate and attempts to add all kinds of amendments to the bill, and in the end, only a simple majority of 51 votes is needed to pass the bill. If you haven't already, please write to your legislators!