The agency may expand access to birth control under Medicaid if Roe v. Wade is lifted

Chiquita Brooks-LaSure testifies before the Senate Finance Committee during her nomination hearing for 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 insurance to a record number of Americans under Affordable Care Act Medicare, Medicaid, and private exchange plans.

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

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

In the year ahead, one of the agency’s biggest challenges will be creating a smooth transition for millions of Medicaid members who could lose insurance coverage when the Covid public health emergency ends. As part of the federal public health emergency, states have put eligibility reassessments on hold for the past two years.

loss of cover

While the administration is expected to renew the current emergency designation next month, a Kaiser Family Foundation study estimates that between 5 million and 14 million people could be de-registered if the redesignations resume.

Brooks-Lasure says health insurers that administer state Medicaid programs will play an important role in helping those who lose eligibility to transition to private health plans or Medicare when they turn 65.

“We have more plan enrollments, particularly with Medicaid coverage, than we did 10 years ago, for example. So they’re a key component of making sure that we — and by us I mean States — move people to whatever type of coverage they’re entitled to,” she said.

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

“Because whether it’s maternal health or you’re in the middle of cancer treatment … you want to focus on the condition itself instead of worrying about what’s changed in your coverage,” 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 particularly focuses on improving maternal health care; Medicaid programs now cover 40% of US births. With funding from the American Rescue Plan Act, passed in 2021, the agency is working with states to expand Medicaid coverage from 60 days to 12 months for new mothers who are uninsured.

Regarding reproductive health, Brooks-Lasure said that CMS will also prioritize improving access to contraception in Medicaid and ACA health plans in the coming year. If the Supreme Court Roe v. Wade, as expected this month, will limit the agency’s ability to provide access to abortions to women on Medicaid under federal funding rules.

Brooks-Lasure said the agency is focused on areas where it has authority, such as screening and contraception. She said CMS encourages states to use Medicaid to ensure men and women have access to birth control “given what the Supreme Court’s decision is on broader services.”

Medicare premium rollback

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

“As coverage is less, we will factor that into next year’s premium,” Brooks-Lasure said.

Medicare beneficiaries could also get a break in drug plan premiums with the launch of several biosimilar versions of AbbVie’s high-priced arthritis drug Humira over the next year. Humira’s revenue exceeded $20 billion in 2021. Amgen’s biosimilar version will be the first to launch in the US in January.

According to Brooks-Lasure, CMS actuaries are calculating the potential impact of moving to Humira biosimilars and are expected to release their analysis in early September, in time for 2023 premiums to be determined.

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