July 17, 2025
Following are summary notes compiled by Reid, McNally and Savage – our fabulous government relations consultants, from the Governor’s Cabinet Meeting held earlier today. It is of course distressing to read SDoH Commissioner McDonald’s comments about the need to expand scope of practice to address workforce shortages in hospitals without his mentioning other areas of the public healthcare system that are in dire need of this kind of regulatory relief and flexibility. But do not despair! We will make absolutely sure the Governor and the Commissioner fully understand the magnitude of our needs and specifically the workforce shortages that are devastating ALL areas of healthcare beginning with mental health and substance use disorder shortages. The flexibility the Governor and the Commissioner seek from SED and the Legislature should extend across a very broad range of titles including those most in demand in our neck of the woods.
July 17, 2025
Governor’s 7/17/25 Cabinet Meeting Discussing the Impacts of President Trump’s “Big Beautiful Bill”
This afternoon, Governor Hochul convened a cabinet meeting to discuss the cuts imposed by the federal budget – “The Big Beautiful Bill” (BBB) – and direct state agency heads to prepare strategies to minimize the long-term damage to New York’s programs. Please find below a summary of the briefing including media questions answered by state leaders. Please find the related press release attached for more details and we will continue to keep you updated.
Devastating Impacts of the “Big Ugly Bill”:
There are still many unknowns, however we cannot mask the consequences as these cuts will destabilize our health insurance programs and broadly impact all individuals, not just those on Medicaid. Rural parts of the state will be particularly impacted if hospitals are forced to close: for example, there are only 5 hospitals in the North Country. Specifically, 1.5 million New Yorkers will lose health insurance, uncompensated care costs to hospitals and providers are estimated to increase to more than $ billion annually, and 3 million will have their food benefits jeopardized. This will also hurt farmers as people use their benefits to purchase food at farmers’ markets and other retailers.
The Governor stressed that this intentional infliction of pain on New Yorkers and the most vulnerable across the country will put lives at risk as hospitals face higher costs and greater pressure. She also emphasized that the most cynical part is that they postponed some of the pain until later, hoping New Yorkers will forget about what they have unleashed on their own districts when it comes election time next year. But she will not let people forget – she vowed that New Yorkers will know who voted yes for this bill. The 7 New York Republicans who voted against their districts knew the devastation that this would cause.
New York is looking at a $750 million hit in the fourth quarter of this year and a staggering $3 billion hit next year. She has directed her agencies to identify creative strategies to limit long-term damage to vital programs. Additionally, during this year’s budget process they anticipated that something would happen, so they stopped $400 million in spending that was anticipated. Further, the one-time $3 billion inflation rebate is now a $2 billion inflation rebate. She reiterated that things are still uncertain because we don’t have the full picture, but New York is prepared. She cares about families and she will make every New Yorker her priority.
Questions from the media –
- The biggest hit that New York will take is from providing healthcare for undocumented people. Is the Governor considering legislative action to change the State’s policy and stop covering those services?
- They’re having discussions internally with legislative leaders, but at this time they are not giving any definite answers.
- New York State Budget Director Blake Washington emphasized that many of these individuals are green card holders that have been here for longer than 5 years. It would cost $3 billion to continue to provide them.
- What impact are the ongoing ICE deportations having on farmers and the industry overall impact? Are farmers concerned?
- Farmers are shocked and betrayed, especially because many of them voted Republican. They are not in support of these people being ripped out of the country.
- The terror of unidentified people with guns is palpable and the Governor noted that it’s ironic that some ICE agents are immigrants themselves.
- Richard Ball, New York State Commissioner of Agriculture, shared that there is grave uncertainty over who will take care of crops and manage farms. He also noted that the guest worker program for agricultural jobs has been having issues for decades and farms have already been under immense pressure.
- Many farm workers are disappearing or not showing up to work, they are afraid to go to work, church, the grocery store, etc.
- Is there anything that the State can do to buoy North Country hospitals in danger of closing?
- The Governor stated that before anyone asks her, people should ask members of Congress who represent those areas what they are going to do about it.
- Talks about managing this issue are ongoing among the many other problems New York will face, but no she emphasized that no state can compensate for these cuts and no concrete decisions have been made yet.
- New York State Department of Health Commissioner Dr. James McDonald stated that to help hospitals lower costs, we should look at scope of practice of health care providers as they proposed in this year’s budget:
- Other states have medication aides in nursing homes, he needs the Legislature to help with that
- Other states don’t have nursing shortages like New York, we are doing a lot to get more people interested in health care but we need to figure out a solution
- For example, medical assistants should be able to give vaccines, they are able to everywhere else. He needs the Legislature to work and partner with them on this. Highly trained individuals should be allowed to take on more tasks
- In the “Big Beautiful Bill,” they expect states to charge people with incomes between 100% and 138% of the federal poverty level higher co-pays up to $35. These people simply can’t afford this.
- The Governor noted that scope of practice is an enormous source of frustration for her that they can’t get the Legislature and the Department of Education to sign onto what other states are doing. Highly trained individuals should be allowed to take on more tasks. There’s no reason why New York shouldn’t lean in on all the ways we can support healthcare. They will be taking this on once again.
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FISCAL POLICY INSTITUTE WEBINAR #2
Attached please find summary notes from today’s second Webinar hosted by the Fiscal Policy Institute looking at potential impacts of the OBBB on NYS.
Many thanks to our fabulous government relations consultants at Reid, McNally and Savage for compiling the notes!
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NONPROFIT CONTRACTING BILL
Reminder for those who are so inclined to sign-on to the letter at the link directly below which is now up to more than 500 signatures, encouraging Governor Hochul to sign the nonprofit contracting bill that passed in both houses of the NYS Legislature in June into law!
Read the letter, sign the form.
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Federal Update from the Congressional Progressive Caucus Center:
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This morning, at President Trump’s behest, the Senate clawed back federal funding Congress had previously approved on a bipartisan basis. This package of “rescissions” cuts $9 billion for foreign assistance, contributions to United Nations bodies like UNICEF, and funding for the Corporation for Public Broadcasting, which funds PBS and NPR. Every Senate Democrat opposed the cuts, while every Republican voted for them, with two exceptions: Sens. Susan Collins (R-ME) and Lisa Murkowski (R-AK). For more details on the White House-requested cuts, check out our July 11 update. Below, I’ll get into what’s changed since then, where things stand now, and what’s next. |
How did the Senate change the rescissions package? |
| The Senate changed the rescissions package that the White House asked for and that the House approved on June 12. Those changes include: |
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What about concerns for public broadcasting and emergency alerts? |
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I noted last week that clawing back funding for public broadcasting could shut down public radio and TV stations, threatening life-saving emergency broadcasts that rural communities in particular depend on during disasters, such as the recent flash floods in Texas. Public broadcasting alerts have been critical when cell and Internet service has gone down, such as during Hurricane Helene in North Carolina. Tribal broadcasters also appealed to senators to oppose the cuts. Despite some Republicans’ reported concerns that these cuts could endanger their constituents during emergencies, GOP senators voted down an amendment to block the cut to public broadcasting if it threatened emergency services. |
Now what happens in the House? |
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Because the Senate changed the package the House approved last month, the House has to vote on it again. Reminder: Congress has to approve a rescissions package no more than 45 days after the White House requests it in order to move it through the Senate with just a simple majority vote. That clock runs out tomorrow, July 18—so, the House wants to get this done today if possible. “Getting this done” means a Rules Committee meeting to set parameters for debate, House debate and a vote on that rule, then House debate and a vote on the final package before it can go to the President to become law. It’s doable, but a tall order. There is some debate as to whether the administration must release these funds if that clock runs out while Congress is actively considering the package. I’m not an expert on the Impoundment Control Act or an attorney, so I won’t speculate there… …that said, the administration is currently holding back an estimated $425 billion+ from the American people, including funding for teacher training, libraries, electric vehicle charger installations, and much more. I am skeptical that the same administration will hustle to get resources out the door if Congress narrowly misses this deadline, even though the law is clear—but, like much of the aforementioned funding, it could become another question for the courts. |
And if this does become law? |
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If these cuts do become law in the coming days, the next big question will be how all of this impacts efforts to fund the government before it shuts down at the end of the fiscal year (September 30). Senator Patty Murray (D-WA), the top Democrat on the Senate Appropriations Committee, said, “we have never, never before seen bipartisan investments slashed through a partisan rescissions package.” This begs the question, how do Democrats agree to a government funding deal in the next couple months, knowing Republicans could vote to walk that deal back shortly thereafter? We’ll keep you posted. |
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FOR IMMEDIATE RELEASE
July 17, 2025
Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries
CMS Finds 2.8 Million Americans Potentially Enrolled in Two or More Medicaid/ACA Exchange Plans
Unnecessary, Duplicate Enrollment Wasting $14 Billion Annually
The Centers for Medicare & Medicaid Services (CMS) continue to crush fraud, waste, and abuse in America’s healthcare programs by stopping duplicative enrollment in government health programs, with the potential to save taxpayers approximately $14 billion annually.
A recent analysis of 2024 enrollment data identified 2.8 million Americans either enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) in multiple states or simultaneously enrolled in both Medicaid/CHIP and a subsidized Affordable Care Act (ACA) Exchange plan.
CMS is taking action to ensure individuals are only enrolled in one program and to stop the federal government from paying multiple times for these individuals to receive health coverage. In addition, as a result of the One Big Beautiful Bill Act, CMS now has new tools to prevent the federal government from paying twice for the same person’s care—saving billions and restoring integrity to the system.
“HHS staff uncovered millions of Americans who were illegally or improperly enrolled in Medicaid and ACA plans,” said U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. “Under the Trump Administration, we will no longer tolerate waste, fraud, and abuse at the expense of our most vulnerable citizens. With the passage of the One Big Beautiful Bill, we now have the tools to strengthen these vital programs for generations to come.”
“The Biden Administration struggled to ensure that individuals were only enrolled in the single Medicaid or Exchange plan for which they were eligible, that ends today,” said CMS Administrator Dr. Mehmet Oz. “CMS is restarting these important checks to follow federal law. We are going to work with states to identify individuals enrolled in multiple programs and fix the duplicate enrollment problem to save taxpayers billions of dollars, while minimizing inappropriate coverage loss. This is exactly why we fought for stronger tools in the One Big Beautiful Bill Act—to go after this type of waste and finally put a stop to paying twice for the same person’s health coverage.”
Over the past several months, software engineers collaborated with CMS to examine historical program enrollment data and found that in 2024 an average of 1.2 million Americans each month were enrolled in Medicaid/CHIP in two or more states and an average of 1.6 million Americans each month were enrolled in both Medicaid/CHIP and a subsidized Exchange plan.
Federal regulations require Exchanges to periodically examine data for dual enrollments in Medicaid to guard against improper enrollments in subsidized Exchange plans through a process called Medicaid Periodic Data Matching (PDM). These essential examinations were strengthened under the first Trump Administration and increased to at least twice a year. These examinations were paused under the Biden Administration to ensure that continuous coverage was maintained during the PHE, in alignment with the statutory requirement on states to maintain continuous enrollment in Medicaid or CHIP throughout the COVID public health emergency.
CMS will partner with states to reduce duplicate enrollment through three initiatives:
- Individuals Enrolled in Two or More Medicaid Programs: CMS will provide states with a list of individuals who are enrolled in Medicaid or CHIP in two or more states and ask states to recheck Medicaid or CHIP eligibility for these individuals. CMS will work with states to prevent individuals from losing coverage inappropriately.
- Individuals Enrolled in Medicaid or CHIP + a Subsidized Federally-facilitated Exchange (FFE) Plan: CMS notified individuals enrolled in both Medicaid or CHIP and an FFE plan with a subsidy. These individuals are asked to take one of the following actions: 2) End their subsidy (with the option to end their coverage); or After 30 days, the FFE will end the subsidy for individuals who still appear to be enrolled in both Medicaid or CHIP and an Exchange plan with a subsidy.
- 3) Notify the Exchange that the data match is incorrect and submit supporting documentation to show they are not enrolled in both Medicaid/CHIP and subsidized Exchange coverage.
- 1) Disenroll from Medicaid or CHIP, if no longer eligible;
- Individuals Enrolled in Medicaid or CHIP + a Subsidized State-based Exchange (SBE) Plan: CMS will provide SBEs with a list of individuals who are potentially enrolled in the state’s Medicaid or CHIP and a subsidized Exchange plan and ask SBEs to determine whether these individuals are dually enrolled, and if so, to implement a process, similar to the federal Exchange, to recheck eligibility. CMS will work with states to prevent individuals from losing coverage inappropriately.
CMS will provide additional guidance to state Medicaid and CHIP agencies in early August with expectations for tackling concurrent enrollment. The agency will follow up with lists to each state of individuals concurrently enrolled in Medicaid or CHIP and ask states to make their best efforts to recheck eligibility by late fall. Going forward, CMS will continue to work with states to provide support for their existing Medicaid/CHIP and Exchange data matching processes and work to implement new requirements in the One Big Beautiful Bill Act designed to eliminate and prevent duplicate enrollment in Medicaid programs.
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Gift article from Modern Healthcare re: 1115 Waivers, Medicaid and CMS concerns regarding ‘continuous Medicaid enrollment’
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