The agency can expand access to birth control under Medicaid if Roe v. Wade is canceled

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Chiquita Brooks-LaSure testifies before the Senate Finance Committee during her nomination hearing to be Administrator of the Centers for Medicare & Medicaid Services in Washington on Thursday, April 15, 2021.

Caroline Brehmann | CQ-Roll Call, Inc. | Getty Images

In her first year as Administrator of the Centers for Medicare and Medicaid Services, Chiquita Brooks-Lasure oversaw the expansion of government health coverage to a record number of Americans under Medicare Exchange Plans, Medicaid and Private Affordable Care Act.

Now she wants to keep them insured and expand access to services for women.

“We cover over 150 million people through all of the agency’s hard work to really enroll people in coverage. So we’re a huge payer and we’re helping dictate coverage in this country…and have a powerful opportunity. to advance health equity,” said Brooks-Lasure.

Over the coming year, one of the agency’s biggest challenges will be creating a smooth transition for millions of Medicaid members who may lose coverage when the Covid public health emergency ends. As part of the federal health emergency, states have suspended eligibility reviews for the past two years.

Loss of coverage

While the administration is expected to renew the current emergency designation next month, a Kaiser Family Foundation study estimated that between 5 million and 14 million people could be unenrolled when new determinations resume.

Brooks-Lasure says health insurers who administer state Medicaid programs will play an important role in helping those who lose eligibility transition to private exchange health plans, or Medicare if they have reached the age of 65.

“We have more plan participation, particularly in Medicaid coverage, than, say, 10 years ago. So they’re a key part of making sure that we — and by us, I also mean the states — transfer people to whatever type of coverage they are entitled to,” she said.

Even beyond the public health emergency, she wants health coverage to be more consistent between public and private programs.

“Because it’s about maternal health or you’re in the middle of cancer treatment…you want to stay focused on the disease itself rather than having to worry about what’s changed in your cover,” she said.

birth control

In a new report outlining the agency’s priorities, Brooks-Lasure says tackling health disparities is a central pillar of the agency’s mission. It has particularly focused on improving maternal health coverage; Medicaid programs now cover 40% of births in the United States. With funding from the American Rescue Plan Act, passed in 2021, the agency is working with states to extend Medicaid coverage to uninsured new mothers from 60 days to 12 months.

Regarding reproductive care, Brooks-Lasure said CMS will also prioritize improving access to contraception in Medicaid and ACA health plans over the coming year. If the Supreme Court overturns Roe v. Wade, as expected this month, the agency will be limited in its ability to provide abortion access to women on Medicaid under federal funding rules.

Brooks-Lasure said the agency focuses on areas over which it has authority, such as preventive care and contraception. She said CMS encourages states to use Medicaid to ensure both men and women have access to birth control, “in light of the Supreme Court’s ruling on broader services.”

Cancellation of health insurance premium

One of the most important decisions made by the CMS this year was to limit Medicare coverage for the Alzheimer’s disease treatment Aduhelm, after mixed data on the drug’s effectiveness. However, the move came after actuaries factored the expected high cost of the drug into Medicare premiums in 2022. Medicare beneficiaries can expect a rollback in 2023.

“Because the coverage is lower, we’re going to roll it into next year’s premium,” Brooks-Lasure said.

Medicare beneficiaries could also benefit from reduced drug plan premiums with the introduction of several biosimilar versions of AbbVie’s high-priced arthritis treatment, Humira, over the next year. Sales of Humira topped $20 billion in 2021. Amgen’s biosimilar version will be the first to go on sale in the United States in January.

Brooks-Lasure said CMS actuaries are calculating the potential impact of switching to Humira biosimilars and are expected to release their analysis in early September, in time to set 2023 premiums.

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