The uncertainty in several Medicare and Medicaid funding issues could cause confusion for patients and providers, and potentially hinder access to care. 

Amidst the looming government shutdown and controversy surrounding funding for several healthcare programs such as CHIP, and in the Continuing Resolution to keep the government funded by the January 19 deadline, several important Medicare and Medicaid funding issues have been swept aside under the rationale that they can wait to be addressed “in the near future.”

Among these programs is funding for the Medicare Dependent and Low Volume Hospital programs (sometimes referred to as the “rural extenders”), therapy cap policy changes, a delay in the Medicaid disproportionate share hospital (DSH) pay cuts, and the Maternal, Infant and Early Childhood Home Visiting Program. Providers, particularly worried about the failure to include funding of these programs in the current Continuing Resolution being debated prior to the January 19 deadline, pressured Congress on Thursday into pushing for a two-year delay of the Medicaid DSH cuts and five years of funding for the Medicare-Dependent Hospital and Low-volume Adjustment Programs (which requested package purports to include an exception allowing Medicare patients to exceed the annual cap on therapy services).

Failure to timely raise the current therapy cap ($2,010 for 2018 physical, occupational, and speech therapy), which went into effect on January 1, could jeopardize Medicare patients close to hitting their caps. The Centers for Medicare & Medicaid Services (CMS) has indicated that it would begin holding claims impacted by the therapy caps to attempt to delay the process of beneficiaries hitting the therapy caps “for a short period of time.” However, no one is quite certain what a “short period of time” is, or whether and how the delay would impact providers. All in all, congressional punting on these important issues is certain to cause confusion for patients and providers, and potentially hinder access to care.

Kathleen P. Rubinstein also contributed to this post.