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Lawsuit challenging Medicaid abortion restrictions in Pennsylvania dismissed

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A judge ruled that Planned Parenthood does not have legal standing in a case that claims women have a right to have Medicaid pay for their abortions.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



A general view of the Pennsylvania Judicial Center, home to the Commonwealth Court, is seen Friday, Nov. 6, 2020, in Harrisburg, Pa.

Julio Cortez / AP Photo

(The Center Square) – A state judge dismissed a lawsuit on Friday that challenged the constitutionality of Pennsylvania’s restrictions on Medicaid coverage for abortions.

Commonwealth Court President Judge Mary Hannah Leavitt said the petitioners – including seven reproductive health care centers that provide 95% of abortions across the state – lack standing because she “can ascertain no reason, and none is alleged, why women enrolled in Medical Assistance cannot assert the constitutional claims raised in the petition for review on their own behalf.”

Attorneys for Allegheny Reproductive Health Center, Allentown Women’s Center, Delaware County Women’s Center, Philadelphia Women’s Center, Planned Parenthood Keystone, Planned Parenthood Southeastern Pennsylvania and Planned Parenthood of Western Pennsylvania filed the legal challenge against state officials at the Department of Human Services in January 2019 that claimed Medicaid’s restrictive policies for covering abortions violated their patients’ constitutional rights.

Pennsylvania’s Medicaid program only pays for an abortion if it is the result of rape or incest or if it endangers the mother’s life. The reproductive centers said this narrow view left many women to choose between the “essentials of life” or paying for abortion, with many “forced to carry pregnancies to term against their will.”

The centers also complained that the restrictive Medicaid parameters diverted time and resources away from its other programs to help women find ways to afford the procedure.

The state asked for a dismissal based on the centers’ lack of standing – a position with which Leavitt ultimately agreed.

“We conclude that Reproductive Health Centers do not have standing to vindicate the constitutional rights of all women on Medical Assistance, some of whom may not be their patients, and who may or may not agree with the claims asserted on their behalf in the petition for review,” Leavitt wrote. “The interests of Reproductive Health Centers are not inextricably bound up with the equal protection interests of all women enrolled in Medical Assistance.”

House Republican leaders released a joint statement Friday applauding the ruling as “consistent” with their position, as well as state and federal law, that conclude “public funds cannot fund abortions.”

“We applaud the Commonwealth Court for making the right decision and not taking an action to rewrite existing law,” the statement read. “This case was brought forward by Planned Parenthood and other abortion providers who want to make abortions more prevalent in our communities. This ruling in our favor is a victory for all pro-life Pennsylvanians.”

The Center Square reached out to Planned Parenthood Keystone but did not receive an immediate response. The reproductive centers could still choose to appeal the case to the state Supreme Court.


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Medicaid And The American Rescue Plan: How It All Fits Together

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The new COVID relief bill includes funding and requirements around treating longer term impacts of COVID, as well as payments for vaccines and testing.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

In her recent Health Affairs Blog post, Katie Keith provides an inclusive overview of the insurance provisions in the landmark American Rescue Plan Act (the Act). The Kaiser Family Foundation also offers important information on the Act’s new incentives for states that have not expanded Medicaid—to cover all adults with incomes under 138 percent of the federal poverty level (FPL)—to do so. In this post, we take a closer look at the structure of and interactions between several key provisions of the Act, including the COVID coverage and treatment mandate, the postpartum Medicaid coverage option, and the expansion incentive and its relationship to § 1115 of the Social Security Act.

Mandatory Medicaid Coverage Of COVID-19 Testing, Treatment, And Vaccines (§ 9811)

The Act effectively establishes a new mandatory Medicaid COVID treatment bundle. The law classifies COVID-19 testing, treatment, and immunization as a required medical assistance benefit for multiple Medicaid eligibility groups. The new bundle covers not only COVID treatment but services needed for conditions that could complicate COVID treatment; it also includes a provision that appears to act as a legal override of otherwise applicable limits and exclusions on benefits covered under the state plan in cases in which COVID is the underlying diagnosis.

This is a coverage rule, of course, meaning that should eligibility cease during a period of extended coverage and no other basis of eligibility can be established, the entitlement to treatment will cease. But with the exception of early and periodic screening, diagnosis, and treatment (EPSDT) for children (which remains the broadest statement of Medicaid coverage ever drafted), the COVID coverage breadth has no real precedent in Medicaid. To be sure, Congress previously has designed certain special benefit packages for certain eligibility groups, such as coverage of pregnant women for pregnancy-related care, family planning coverage for individuals eligible for family planning and related services, and treatment for people diagnosed with breast or cervical cancer. But the COVID treatment amendment is singular in its reach.

The COVID mandate applies throughout the period covered by the public health emergency declaration under Section 1135 of the Social Security Act, and for a year after the emergency period’s end. The coverage mandate encompasses a broad group of people: individuals “diagnosed with or presumed to have” COVID-19.” It also guarantees a broad range of benefits: the benefits and services covered under the state Medicaid plan as well as “specialized equipment and therapies (including preventive therapies).”

A Benefit-Limit Override

Furthermore, the mandate applies not only to COVID treatment for people “diagnosed with or presumed to have COVID-19,” but also to “treatment of a condition that may seriously complicate the treatment of COVID-19, if otherwise covered under the state plan (or waiver of such plan)”. It appears, in other words, that coverage is mandatory in the case of underlying health conditions that could affect COVID treatment (presumably during both its acute and recovery stages), and treatment of these complicating conditions is covered regardless of limits that might otherwise apply to services covered under the state Medicaid plan.

Thus, the COVID coverage rule appears to act as a benefit-limit override, barring limits on state plan benefits and services when those limits would apply to treatments for COVID or complicating conditions. For example, in states covering case management only for targeted conditions, such a limit would appear to give way if case management is targeted on COVID or the management of conditions that could complicate COVID treatment and recovery.

Detailed guidance from the Centers for Medicare and Medicaid Services (CMS) will be essential here to clarify understanding of the scope and extent of the treatment mandate and benefit-limit override provision. Clarification will be key not only for state agencies but for the comprehensive managed care plans that administer Medicaid for some or all beneficiaries in 39 states and the District of Columbia. Many aspects of the mandate will require elucidation:

  • What constitutes a COVID-19 diagnosis or presumptive case?
  • What is meant by treatment and preventive therapies?
  • Must COVID-19 treatments and preventive theories be covered even in states whose plans do not include the benefit classes that correspond to such treatments and therapies?
  • What evidence is permissible when determining whether a condition could complicate COVID treatment?
  • Do conditions that could complicate COVID treatment include conditions that could complicate COVID recovery in the case of people experiencing long-haul COVID?
  • Which of Medicaid’s dozens of eligibility groups are, or are not, entitled to this expansive COVID medical assistance benefit?
  • How will states be expected to incorporate these rules into their managed care contracts and reprice their agreements?
  • What if any special rules must apply to utilization management and review?

Finally, it is worth noting that for Medicaid beneficiaries (and this is true obviously for millions of other insured Americans under various public and private coverage arrangements), a crucial issue down the line becomes cessation of insurance eligibility in the middle of COVID treatment, which, as the long-haul problem has demonstrated, could be quite lengthy.

Vaccines For Additional Eligibility Groups And Protections Against Cost Sharing

Along with the coverage mandate, the Act reinforces cost-sharing protections for COVID testing, treatment, and immunization, similarly overriding normal state cost-sharing rules (or cost-sharing designs applied under Medicaid managed care). Like the treatment mandate, the special cost-sharing rules apply to a broad range of eligibility groups, including groups normally entitled to more limited benefits. Guidance on the scope of the treatment mandate presumably will also deal with the cost-sharing rule, which also will affect managed care contracts and contract pricing.

Outpatient Prescription Drug Coverage

The Act clarifies that the Medicaid drug rebate program for outpatient prescription drugs applies to “any drug or biological product” associated with the extended coverage rules. The amendment reaches any product furnished as a Medicaid covered benefit for the “treatment or prevention of COVID-19.” Special guidance is needed here as well.

FMAP For Testing, Treatment, And Immunizations

The Act sets the federal medical assistance percentage (FMAP)—the percentage of the cost of care covered by a state Medicaid program paid for by the federal government—at 100 percent for immunizations (vaccines and their administration). The Act retains the normal FMAP rate (as enhanced during the pandemic emergency period) for the new COVID treatment standard.

Improving Postpartum Coverage For Women And Interaction With Pre-Existing Law (Section 9812)

Currently, states much provide full Medicaid coverage to all pregnant women with incomes below 138 percent FPL through 60 days after birth; states have the option of extending that coverage to higher income levels. The Act creates a new state option to increase Medicaid postpartum coverage from 60 days to 12 months.

Under current law, eligibility ends on the last day of the month in which the 60th postpartum day occurs; the Act would extend this period to the last day of the month in which the 12-month extension ends. The option sunsets after five years. Presumably the option either will be made permanent or will join the legion of Medicaid provisions that must be renewed periodically.

The postpartum option is likely to be highly popular given the serious maternal mortality problems facing women across the nation, the value of continuous health care following birth, and the very large percentage of women whose pregnancy is insured through Medicaid but who lose coverage entirely after the current postpartum period.

The new state option is an outgrowth of a multi-year effort to improve coverage for postpartum women, particularly in states that have not enacted the ACA Medicaid expansion and thus expose women to the Medicaid coverage gap at the end of the 60-day postpartum period. But the option also represents a key reform in expansion states. The option ensures 12 months of uninterrupted full-benefit Medicaid coverage (states taking the option also would be required to furnish full Medicaid coverage during pregnancy, not only coverage limited to pregnancy-related care) without the need for further review or reapplication, thus pushing out the date for renewal action until well after the critical newborn phase has passed.

States cannot adopt an amendment extending postpartum coverage to 12 months until one year after the Act’s enactment. But the new option’s presumed popularity means that both states and CMS likely will begin planning for adoption. In approaching implementation, detailed attention may be warranted with respect to various interactions across the new postpartum option, the COVID coverage rule, and the continuous enrollment protection established under the Families First Coronavirus Response Act (FFCRA).

The first such interaction involves postpartum women who at this point are protected by the special FFCRA continuous enrollment protection; continuous coverage is a condition of enhanced FMAP funding under FFCRA during the public health emergency. The public health emergency period is set to last through at least March 2022 and could, of course, go longer. But should the enhancement and associated FFFCRA continuous enrollment guarantee end before a state’s postpartum 12-month extension rule goes live, postpartum women shielded by the continuous enrollment rule may find themselves without a coverage pathway that lasts for the duration of the 12-month postpartum coverage period.

Special transition protocols will be needed to ensure that their eligibility is redetermined and women are moved from FFCRA continuous enrollment status into postpartum coverage. Alternatively, Congress could amend the law to provide that, in the case of postpartum women, continuous enrollment at the enhanced rate remains in place until their 12th month is reached, and that they can transition to another eligibility category, should one be applicable.

A second interaction issue is the relationship between the 12-month postpartum coverage option and the special COVID coverage standard and benefit limit override. This special coverage rule lasts for a full year beyond the end of the public health emergency, meaning that it would apply potentially to postpartum women transitioning from FFCRA continued eligibility to postpartum coverage depending on the state. States and plans will benefit from guidance on COVID treatment and aftercare (including the benefit-limit override rule) during the postpartum period, in particular, how complications during the postpartum period may complicate COVID treatment and recovery.

The New ACA Medicaid Expansion Incentive (§ 9814)

As has been extensively reported and analyzed, the new ACA Medicaid expansion option could heavily boost the amount of federal funding for which newly expanding states (states that did not cover the expansion population as of the date of enactment) would qualify. The new 5 percentage point FMAP increase would be on top of the current 6.2 FMAP percentage point increase under the public health emergency provision of FFCRA, which as noted, is set to last until at least March 2022, if not longer.

The new FMAP incentive, while generous, is also quite specific in the conditions it imposes on states that elect to move forward. Under the terms of the amendment, the enhancement is available for the eight- quarter period beginning with the first calendar quarter during which a qualifying State “expends amounts for all individuals [emphasis added] described in” the ACA expansion eligibility group. The adults who are the focus of the “all new individuals” expenditure targets are those whose incomes do not exceed 138 percent of the federal poverty level and are under age 65, not pregnant, not entitled to Medicare, and not eligible under one of Medicaid’s traditional mandatory eligibility groups. Furthermore, the law specifies that enhanced payments are not available in “any quarter (and each subsequent quarter) during such period during which the State ceases to provide medical assistance to any such individual under the State plan (or waiver of such plan).” [emphasis added].

This language could not be clearer. To qualify for enhanced federal funding, states must cover every individual described in the ACA expansion group. Furthermore, under the terms of the law, in any quarter in which a state covers fewer than all the individuals described in the expansion group, the special federal enhancement payment is not available.

The enhanced funding provision amends § 1905 of the Social Security Act rather than § 1902, which lays out state plan requirements. Section 1905 defines the scope of state activities that qualify for federal Medicaid funding, meaning that the definition of the funding enhancement is tied to the definition of the ACA expansion group.

The Rescue Plan Expansion Enhancement And The Future Of § 1115

Thus, a key question is how this new enhancement provision interacts with § 1115 of the Social Security Act, which authorizes the HHS Secretary to waive certain provisions of federal law in order to undertake “experimental, pilot, or demonstration project[s]” that are “likely to assist in promoting the objectives of” Medicaid. The Biden administration is expected to use § 1115 authority to seek to persuade the remaining states to expand. What leeway does the new enhancement provision offer in terms of the types of expansion demonstrations that states might develop with administration approval?

Under § 1115, the Secretary’s waiver power is confined to § 1902 of the Social Security Act, which lays out Medicaid’s state plan requirements, along with § 1903, which specifies the federal financial contribution rate for various types of state Medicaid expenditures. In the case of the new enhancement incentive however, the amendment is to § 1905, and thus outside the scope of what is waivable under § 1115. Because the Secretary cannot use § 1115 to waive the provisions of 1905, newly expanding states that wish to qualify for the new enhancement funding must cover “all individuals” described in the expansion group as a condition of enhancement funding.

This restriction on the availability of enhancement funding is consistent with a policy issued by the Obama administration in December 2012, in the wake of National Federation of Independent Business v Sebelius. (That case effectively converted the ACA Medicaid expansion into a state option.) The Obama administration concluded that because of the way in which the expansion group language was drafted, partial expansion (e.g., up to 100 percent of the federal poverty level) was legally permissible but would not qualify for the enhanced federal match the ACA provided for the expansion population. This latest iteration of an expansion enhancement appears to be structured to continue the same policy—to qualify for enhancement funds, states must expand to the entire ACA expansion group.

The dozen states that to date have not expanded may yet opt to respond to this latest incentive. The problem is an urgent one; in what may be the most singular example of health care inequity facing the nation, residents of 12 states—disproportionately Black—have been left to face a pandemic without access to either Medicaid or subsidized marketplace coverage, simply because their incomes are too low and their state is a nonexpansion state. Nothing in the American Rescue Plan extends even temporary marketplace coverage to the millions of impoverished people who are caught in this coverage gap. Therefore, how to use § 1115 to spur expansion remains an ongoing subject of extensive discussion and debate; indeed, strengthening Medicaid was a focus of one of the President’s earliest executive orders.

As has been discussed at length, the Obama administration used this special 1115 experimental authority to encourage states to adopt the Medicaid expansion population under terms that, in fact, differed from the eligibility rules applicable in states that covered the group through a simple state plan amendment. Most notably, several of the seven states that adopted the full ACA expansion at enhanced federal funding rates but on a § 1115 demonstration basis were in fact permitted to impose certain eligibility restrictions on the expansion population, such as elimination of retroactive eligibility. At least one state, Indiana, was permitted to lock out members of the eligibility group who failed to pay premiums owed, a sanction akin to the loss of eligibility. Otherwise, however, the Obama administration insisted on full expansion by demonstration states that sought to qualify for enhanced funding as part of their demonstrations.

The Trump administration, of course, took an entirely different view, allowing eligibility restrictions on a demonstration basis that have no place in the Medicaid program. Specifically, the administration used its authority to permit states to add an explicit eligibility restriction tied to compelled work; it continued to permit states pursuing work restrictions to nonetheless qualify for ACA enhancement funding. The legality of work restrictions as a permissible use of § 1115 is now before the United States Supreme Court in the Gresham and Philbrick cases. Whether the case is ever argued and decided is uncertain at this point—the Court has cancelled the March 29 oral argument but has not yet dismissed the case, even though the Biden administration is now in the process of ending work experiments.

The current administration has made clear that work as a condition of Medicaid eligibility is not an experiment it wishes to pursue, and a landmark study has documented the adverse impact of a work requirement on Medicaid coverage. But the Biden team might want to use § 1115 to reach those in the coverage gap, in nonexpansion states. For example, a number of states have sought permission to adopt a partial Medicaid expansion, up to 100 percent of the federal poverty level. Given the improvements in Marketplace subsidies, such a compromise might be more feasible.

However, as with the original ACA enhanced funding language, the new funding enhancement provision also seems to foreclose the HHS Secretary from pursuing such a direction. As the Obama administration did previously, the Secretary might once again allow restrictions that while not a complete elimination of eligibility, certainly constrain the reach of the expansion. The HHS Secretary also might permit other reforms, such using an Arkansas-type “private option” Medicaid buy-in, so that expansion takes the form of coverage through Marketplace health plans for some or most newly eligible beneficiaries. Similarly, the Secretary might revisit other limits allowed during the Obama years, such as more limited coverage and higher cost sharing for the expansion group.

Even as the Biden administration navigates the end of the work experiments and the pending Supreme Court cases, attention increasingly will turn to what types of deals administration officials are prepared to explore with nonexpansion states. This is particularly so in the case of Florida and Texas; these states, which together account for a high proportion of people caught in the coverage gap, only recently received lengthy extensions of their uncompensated care pool funding—seemingly a hefty financial award for rejecting insurance coverage.

Whether the administration will be able to move these two states off their pooling structures and into an insurance model ultimately may depend on whether the Biden administration is willing to honor the 10-year approval period—vastly beyond the five-year experimental coverage period normally allowed—as well as a federal investment of this magnitude without any coverage. This same question—whether the Biden administration will insist on changes to high-cost 1115 demonstrations approved during the Trump era that undermine coverage rather than enhance it, is also squarely on the table in the case of Tennessee; that state’s block grant approval in the waning days of the Trump administration represents an enormous investment of funding by the federal government without any coverage guarantee.

Partial expansion and eligibility restrictions on the expansion population are off the table, at least insofar as enhancement funding is concerned. But it remains to be seen whether the newest version of the funding enhancement, coupled with a more hard-nosed negotiation over the terms of approved 1115 demonstrations that award vast amounts of funding without the promise of coverage, might eventually be a door opener.


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Waiting Lists May Be Eliminated For Disability Services Provided By Medicaid

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There is draft federal legislation what would make HCBS mandatory in Medicaid for all who qualify, which could eliminate waiting lists for these services.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Marisol Ramos, left, wipes excess makeup off her daughter Naomi’s cheek as the family gets ready to go on a shopping trip in 2017. Naomi has intellectual disability and spent years on a waiting list before finally receiving government-funded services. (Michael Bryant/The Philadelphia Inquirer/TNS)

Work is underway on legislation that could fundamentally transform the nation’s system of home- and community-based services, eliminating waiting lists and allowing people with disabilities to move across state lines without forfeiting critical services and supports.

A draft bill unveiled this month known as the HCBS Access Act would require Medicaid to provide home- and community-based services to everyone who is eligible and establish a minimum set of services that states must offer. The bill is also designed to help states create a network of providers and workers to deliver such supports.

The plan is being put forth by U.S. Rep. Debbie Dingell, D-Mich., along with Sens. Maggie Hassan, D-N.H., Bob Casey, D-Pa., and Sherrod Brown, D-Ohio.

The lawmakers said the “discussion draft” is a “first step to creating HCBS support for all those who are eligible and choose HCBS” and they are seeking feedback in the coming weeks from stakeholders before moving forward with introducing a formal bill.

“The HCBS Access Act would be a huge paradigm shift,” said Nicole Jorwic, senior director of public policy at The Arc who’s advocating for the legislation. “It’s not an overstatement to say this would be a game changer for services and supports for people with disabilities.”

Since home- and community-based services originated in the early 1980s, they have been optional. States provide the services through Medicaid waivers, which vary greatly from one place to another and are limited meaning that people with disabilities often spend years on waiting lists before they can access supports. The waivers are tied to the state where a person lives, so if an individual moves, they often must start the waiting list process anew. By contrast, Medicaid guarantees institutional services to those who qualify.

Under the draft legislation, that would change. Home- and community-based services would be mandatory in the Medicaid program, much like institutional services already are.

“For the 850,000 people on waiting lists, this would be life changing,” Jorwic said. “When you pull that many people into this system, you’re not only helping the people getting the supports and services, you’re also helping family caregivers who are currently filling the gaps in the services system.”

The draft bill would send more federal funding to states and create a basic menu of required home- and community-based services nationwide that states could choose to enhance. Advocates say this would eliminate confusion for families and simplify things for states, which currently operate a range of waiver programs, each with their own target populations and rules.

The lawmakers have also indicated that they intend to include provisions in the bill to strengthen the workforce that provides support to people with disabilities in the community, but they are currently short on specifics about that piece of the plan.

The move comes after President Joe Biden proposed eliminating waiting lists for home- and community-based services and boosting the direct care workforce during his campaign last year.

“The current system is an artifact of a law that is over 55 years old and never envisioned community-based supports for older adults and people with disabilities,” reads a note to stakeholders from the offices of Hassan, Brown, Casey and Dingell. “It is time to establish a baseline criteria for the delivery of HCBS across the country and to make those foundational services an entitlement under Medicaid.”


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Senate confirms Xavier Becerra as HHS secretary

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Becerra has been confirmed to head HHS.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Key Points

  • The Senate confirmed Xavier Becerra as Health and Human Services secretary.
  • The California attorney general and former U.S. representative will have a major role in the Covid-19 vaccine rollout as the country tries to achieve a level of normalcy by the summer.
  • Becerra will also play a part in the Biden administration’s plans to create a Medicare-like public health-care option.
  • The confirmation vote was close, as Republicans have questioned Becerra’s health experience and previous support for “Medicare for All.”


Xavier Becerra, nominee for Secretary of Health and Human Services, answers questions during his Senate Finance Committee nomination hearing on Capitol Hill in Washington, DC, February 24, 2021.

Greg Nash | Pool | Reuters

The Senate confirmed Xavier Becerra as Health and Human Services secretary on Thursday as the U.S. aims to contain Covid-19 and achieve a semblance of normal life by summer.

Becerra, California’s attorney general, won approval by a narrow 50-49 margin in a Senate evenly split by party. Nearly all Republicans opposed the former U.S. representative’s nomination, questioning his health-care experience and past support for “Medicare for All.”

Becerra will be the first Latino to lead HHS. In a tweeted statement following his confirmation, Becerra said he is “honored and humbled by today’s vote” and “ready to get to work.”

The support of Sen. Susan Collins, a Maine Republican, removed the need for Vice President Kamala Harris to cast a tiebreaking vote.

Becerra will take a major role in one of the federal government’s most daunting undertakings ever. HHS will help to facilitate Covid-19 vaccinations and testing efforts as health officials hope widespread inoculation will beat back a mutating virus and allow businesses and schools to reopen.

While the virus’s spread has slowed in the U.S., the country is recording about 54,800 Covid-19 cases and at least 1,200 deaths every day, according to a seven-day average calculated by CNBC. About 15.5% of adults, and 37.6% of people over 65, are fully vaccinated, according to the Centers for Disease Control and Prevention.

Becerra will also have a prominent part to play if and when the Biden administration moves on to health-care reform. President Joe Biden has backed the creation of a Medicare-like public insurance option and changes to control the cost of drugs and care.

Ahead of the vote, Senate Majority Leader Chuck Schumer, D-N.Y., said Becerra “has decades of standing up for working-and middle-class Americans in Congress, fighting to protect and expand Medicare, Medicaid, and working to safeguard our health care system from attacks by the Trump administration.”

Becerra became the 20th member of the president’s Cabinet confirmed by the Senate. The chamber has turned its attention to filling out the executive branch since its passage of the $1.9 trillion coronavirus relief bill earlier this month.

Speaking at a Senate confirmation hearing last month, Becerra said he understands “the enormous challenges before us.” He said he would work not only to contain the virus but also to boost access to affordable health care.

Becerra touted his work as California’s attorney general to make Covid treatments more widely available and crack down on opioid manufacturers.

He succeeded Harris as the largest U.S. state’s top law enforcement official in 2017 after her election to the Senate the previous year. Becerra won a four-year term in 2018.

He represented California in the U.S. House from 1993 to 2017.


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Georgia vows to continue fight if feds kill Medicaid waiver plan

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Georgia plans to fight CMS reneging on its approved waiver.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Georgia Commissioner of Community Health Frank Berry wrote in a letter that if the federal government revokes the state’s Medicaid waiver plan, “Georgia will challenge the decision.” The Trump administration approved the plan last year, but the CMS in February raised questions about its work requirements. Federal courts have blocked similar requirements in other states. (HYOSUB SHIN / HYOSUB.SHIN@AJC.COM)

Georgia officials, as expected, have appealed the new federal position on the state’s Medicaid waiver plan, saying its possible revocation by the Biden administration would be ”an arbitrary and unlawful bait-and-switch.”

The commissioner of the state’s Department of Community Health, in a letter dated March 12, noted that federal health officials last year approved Georgia’s approach to require low-income adults to meet work or other eligibility standards to get Medicaid coverage.

Those requirements were at the center of the Biden administration’s criticism last month of the Georgia plan, which is scheduled to begin July 1.

If the feds revoke the Medicaid waiver plan, “Georgia will challenge the decision,” Commissioner of Community Health Frank Berry wrote in the conclusion of his letter to officials with the Centers for Medicare and Medicaid Services. He called the work and other eligibility requirements “core to the waiver.”

State Republican lawmakers have defended the waiver plan promoted by Gov. Brian Kemp.

The Berry letter comes as the federal government dangles new incentives for states to pursue a much larger enrollment increase in Medicaid through a regular expansion of the program under the Affordable Care Act, something most states have done already.

Medicaid provides health coverage to low-income and disabled residents, including about 2 million in Georgia.

Georgia’s waiver says that to get Medicaid coverage, a person is required to put 80 hours a month into a job, an education program, a volunteer organization or another qualifying activity.

A February letter from the CMS, though, criticized Georgia’s policies ”that condition health care coverage on meeting work or other community engagement requirements.”

The letter from the feds pointed to uncertainties related to the COVID-19 pandemic, including job training and other activities used to satisfy work and other requirements, along with access to transportation and affordable child care.

Twelve states received federal approval under the Trump administration to impose Medicaid work requirements. But federal courts have blocked work requirements in Arkansas, Kentucky and elsewhere, and the U.S. Supreme Court is expected to take up a related case this month.

Berry, in his letter, said state officials “worked with CMS in good faith to adopt an innovative program to deliver coverage to a new category of individuals while helping them build important skills and become more independent and self-reliant.”

The Berry letter said Georgia officials had agreed to allow virus-related exceptions to the requirements for coverage, and that the COVID-19 pandemic has now eased.

CMS officials could not be reached Wednesday for comment on the Georgia letter.

The Trump administration opposed the ACA, supporting lawsuits against it and congressional efforts to repeal it. CMS officials under Trump approved the Georgia waiver as an alternative to a standard Medicaid expansion.

President Joe Biden, however, is a staunch supporter of the ACA, which became law while he was vice president.

Sweetening the offer

Georgia is one of 12 states that so far have chosen not to expand their Medicaid programs as outlined by the ACA. But the newly approved COVID-19 relief legislation gives those states enhanced financial incentives to adopt expansion.

States that expand the program at this point would receive an additional 5-percentage-point increase in their regular federal Medicaid matching rate for two years. So over that time, even factoring in the costs of implementing expansion, Georgia would net $700 million under the new incentives, according to the Kaiser Family Foundation.

The Kemp waiver plan, as outlined now, is much less ambitious. It would cost $75 million for the first year and cover just 31,000 low-income adults, according to the consumer advocacy group Georgians for a Healthy Future. The federal match under the Kemp waiver plan would be the regular 67% of the cost.

A standard expansion would give Medicaid eligibility to 480,000 to 600,000 people in the state, said Laura Colbert, the group’s executive director.

“Medicaid expansion has always been the moral and cost-effective choice for Georgia,” she said recently. The new incentive package, she said, “just amplifies that choice.”

Democrats, including Georgia’s newly elected U.S. Sens. Jon Ossoff and Raphael Warnock, have pointed to the state’s potential gains under Medicaid expansion, including helping hospitals and other medical providers.

“If Georgia does not expand Medicaid,” Warnock recently told The Atlanta Journal-Constitution, “then we are literally leaving money on the table that could save the lives of Georgians.”

Andy Miller is editor and CEO of Georgia Health News.

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U.S. Supreme Court scraps arguments in Medicaid work case

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SCOTUS takes its orders from the Executive branch on state-approved Medicaid reforms.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


By Lawrence Hurley

WASHINGTON (Reuters) – At the request of President Joe Biden’s administration, the U.S. Supreme Court on Thursday canceled an upcoming oral argument on a policy introduced under his predecessor Donald Trump backing work requirements for people who receive healthcare under the Medicaid program for the poor.

The court granted a request made by Acting Solicitor General Elizabeth Prelogar on Feb. 22, who said the new administration has started the process of reversing the previous policy. The oral argument concerning pilot programs adopted by the states of Arkansas and New Hampshire had been scheduled for March 29.

Under Trump, the Department of Health and Human Services (HHS) in 2018 approved the pilot projects in those two states as part of a push to put a conservative stamp on Medicaid, a program that was expanded under the Affordable Care Act, also known as Obamacare, to provide medical coverage to millions more Americans.

Biden, a Democrat, succeeded Trump, a Republican, on Jan. 20. Under Biden, HHS made a preliminary finding that work requirements would be inconsistent with the objectives of Medicaid, which provides medical insurance for the poor, Prelogar told the court.

Biden’s Justice Department has reversed course in several cases originally filed by the Trump administration. In response to one such shift, the court on Tuesday dismissed an upcoming case on Trump’s policy barring immigrants deemed likely to need government benefits from legal permanent residency.

The Supreme Court on Feb. 3 canceled oral arguments in two other cases after Biden’s administration changed course from Trump policies. Both were appeals by Trump’s administration – one defending his funding of the U.S.-Mexico border wall and the other defending his so-called “remain in Mexico” asylum policy.


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Texas Judge Sides Against Planned Parenthood, Finalizing Cut From Medicaid Program | The Texan


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A judge has ruled that TX Medicaid has the right to determine whether a provider is qualified to provide services to its members.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



Planned Parenthood lost a last-minute bid yesterday to remain on the Medicaid program in Texas.

A Travis County district court judge ruled against the organization’s claim that Texas failed to provide proper notice before cutting it from the program, the latest loss for the company in a legal back-and-forth that began in 2015 and may leap up to a federal appeal.

Motivated by a series of undercover videos showing Planned Parenthood higher-ups discussing the sale of fetal remains, Texas decided to cut Planned Parenthood from the Medicaid program in October 2015. The Office of Inspector General sent a final notice of termination to Planned Parenthood in December 2016.

Planned Parenthood sued the Texas agency and found favor in court with a 2017 ruling that kept it on the Medicaid program. However, the company lost in late 2020 when an appeals court ruled that the state reserved the right to determine Medicaid providers.

“A state agency may determine that a Medicaid provider is unqualified and terminate its Medicaid provider agreement even if the provider is lawfully permitted to provide health services to the general public,” the ruling reads.

In response to Planned Parenthood’s request for a grace period to refer patients to new providers, the Texas Health and Human Services Commission (HHSC) gave the organization 30 days, beginning January 4 of this year. The decision that came yesterday ended a new tangent of litigation that began as that grace period came to a close, when Planned Parenthood successfully argued that the state didn’t send proper notice of termination.

The court kept the state on the Medicaid program with a temporary restraining order against the state before the fourteen-day renewal ended yesterday, when Judge Lora Livingston sided with Texas against Planned Parenthood.

The Austin American-Statesman
reports that Livingston treated the decision with gravity.

“This decision is not made lightly. In the light of the ongoing public health crisis, the risks of the individual losing health care and medical attention requires increased attention and scrutiny,” Livingston wrote.

Though Livingston sided against the company yesterday, a similar concern for harm to Planned Parenthood patients motivated the 2017 ruling at least in part.

“The Individual Plaintiffs have proven a substantial likelihood of success on their claim terminating the Provider Plaintiffs from Medicaid violates their right to their chosen provider and would cause irreparable harm,” Judge Sam Sparks wrote.

“If the termination were allowed to proceed, the Individual Plaintiffs would, at minimum, see their health care disrupted.”

The videos that prompted the state to cut Planned Parenthood from Medicaid show a range of personnel including abortion physicians discussing how best to harvest the organs from fetal remains for sale to researchers.

While federal money cannot fund abortions, Democrat lawmakers have proposed a bill that would let the state pay for them with taxpayer money in a program parallel to Medicaid, dispensed by the Texas Health and Human Services Commission.

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Medicaid expansion amendment dies in Kansas Senate

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The fight over expansion in KS now is tied to potential tax-payer funding for abortion.



The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.






TOPEKA, Kan. (WIBW) – Kansas Senate Republicans and Democrats battled over a Medicaid expansion amendment on Wednesday evening.

The Kansas Senate Republicans say they preserved Medicaid for Kansans that need it by rejecting an amendment by Democrats to alter the program. They said in doing so, they also prevented taxpayer-funded abortions.

According to the Senate Republicans, Democrats brought an amendment to SB 238, which handles community behavioral health clinics, that would expand Medicaid to include able-bodied, working-age adults.

“It is critically important to preserve Medicaid for the vulnerable Kansans for whom it was intended such as the elderly, the disabled, and other vulnerable communities,” said Senate President Ty Masterson (R-16th District). “Expanding Medicaid to include able-bodied adults would force tens of thousands of Kansans off their insurance and further destroy the private market, which as already been damaged by ObamaCare. The best way to improve access to health care is to create more choices for Kansans by removing barriers to competition and removing the regulations that drive up the cost of health care.”

Masterson said the rejection of the amendment also ensured taxpayers do not have to fund abortions.

Due to the Hodes decision, taxpayer-funded abortion would assuredly be a devastating consequence of expanding Medicaid,” said Masterson. “Senate Republicans made it clear today that we side with Kansans who do not want their hard-earned money going to fund abortion.”

However, Senate Democrats said the move would have helped low-income working families during the COVID-19 pandemic. It said the move would have also expanded Medicaid for 165,000 Kansans.

“In the midst of the worst public health crisis in a century, Republicans in the Kansas Senate don’t think low-income working families and vulnerable Kansans who have lost their jobs due to the COVID-19 pandemic deserve healthcare,” said Vicki Hiatt, Chairwoman of the Kansas Democratic Party. “Hardworking Kansans have felt the repercussions of Republican inaction and obstructionism on healthcare for years and will continue to do so as Republican legislators voted down an amendment to SB 238 yesterday, which would have expanded Medicaid for 165,000 Kansans.”

Hiatt said Kansas needs Medicaid expansion to overcome the repercussions of the COVID-19 pandemic. She also said the expansion would have enhanced the viability of rural hospitals.

“In contrast, Democratic leaders in the Kansas Senate are championing our state’s need for Medicaid expansion to overcome the economic and public health consequences caused by the COVID-19 pandemic and improve the lives of hardworking Kansans across the Sunflower state,” said Hiatt. “Expanding Medicaid in Kansas would cover 165,000 additional hardworking Kansans, spur economic development and new jobs, provide financial stability to low-income families and enhance the viability of rural hospitals and other healthcare providers.”

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Spending bill for Medicaid expansion raises questions about intent

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MO lawmakers are working to fund expansion costs separately from the normal Medicaid funding budget.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.




JEFFERSON CITY, Mo. — The $1.6 billion cost of expanding Medicaid to approximately 275,000 uninsured Missourians has been segregated from other spending in the upcoming budget year by moving it into a separate appropriation bill.

The move has Democrats wondering if House Republicans are looking for a way to avoid funding the new health care program and a leading Senate Republican suggesting it may be a path to renewing legal challenges to expansion.

Instead of adding expenses for the newly eligible to individual spending lines in appropriation bills for mental health, senior care, hospitalizations and other services, the bill filed by House Budget Committee Chairman Cody Smith, R-Carthage, would pay for all care needed by the expansion clients.

It appropriates $103.5 million in general revenue, $51.5 million in other state funds and $1.4 billion in federal matching funds to cover the cost.

Smith declined a request from the Independent for an interview and did not provide a promised statement about his bill by publication time.

The ranking Democrat on the budget committee, Rep. Peter Merideth of St. Louis, said he worries that Republicans intend to defeat the appropriation bill.

“I don’t have from the horse’s mouth the reason for it,” Merideth said, “but it does raise a lot of red flags.”

On the Senate side, which is awaiting House action on spending bills, Appropriations Committee Chairman Dan Hegeman, R-Cosby, said the bill could be part of a plan for court action to test the constitutionality of Medicaid expansion.

Hegeman noted that a court ruling on the ballot measure passed by voters in August as Amendment 2 stated that a challenge based on the need to spend money for the extra coverage wasn’t timely until voters had decided.

“That judicial decision allowed it to go on the ballot,” Hegeman noted. “But is there a mandate to fully fund it because of that previous decision? All of this convergence and conflict means there are lots of moving parts.”

August vote

Amendment 2, passed in August, added Missouri to the list of 36 states that have allowed individuals in households with income below 138% of the federal poverty guideline to receive care under the provisions of the Affordable Care Act. The program takes effect July 1, the first day of fiscal 2022.

Republicans in the Legislature have opposed expanding Medicaid since it was first proposed by Gov. Jay Nixon in 2013, arguing that it is too expensive and that the current program costs too much. Advocates have argued that it will add no net costs by combining savings in the current program with additional revenue from the extra medical spending.

Medicaid in Missouri cost $10.8 billion in fiscal 2020, which ended June 30, including $1.98 billion in general revenue.

Gov. Mike Parson’s proposed $34.1 billion budget for fiscal 2022 set the cost of Medicaid expansion at $1.9 billion, including $120 million in general revenue. That estimate included administrative costs.

Overall, the budget proposal calls for $14.1 billion for Medicaid, including $2.7 billion in general revenue, according to budget documents.

Missouri’s existing Medicaid program, called MO HealthNet, offers few services that are not required to participate in the program.

Adults with children and no other qualifying conditions such as a disability are covered only if their income is less than the family would receive in cash welfare benefits, $292 a month for a single-parent household with two children. No working-age adults without children are covered unless they qualify for another reason.

The cost of the existing program is shared with the federal government, and for the current year, Missouri’s stated share is about 35%.

Under the Affordable Care Act, every state pays 10% of the cost of the newly eligible and the federal share is 90%.

Ballot language

If lawmakers failed to pass Smith’s spending bill, it would not relieve the state of the obligation to provide services for the expansion clients, Merideth said.

“The department would have to go forward with expansion anyway,” he said. “It will just mean we will have a massive supplemental (spending bill) we will have to do later.”

The ballot language for Amendment 2 told voters that passage could cost as much as $200 million a year in state general revenue or result in savings from the existing program of up to $1 billion annually.

While the amendment mandated that the state offer the coverage, it did not mandate how much to spend or from which funds. and because of COVID-19, Missouri’s cost for the current Medicaid program will be substantially below 35% of the total for the foreseeable future.

The federal emergency declaration for the pandemic means the federal share of Medicaid increased by 7.62% for all states during 2020, and that is likely to continue until at least the end of this year.

In addition, states that expand Medicaid would get an additional 5% cut in their federal match rate for 24 months under the provisions of the $1.9 billion relief bill proposed by President Joe Biden and passed Friday in the U.S. House.

The two changes would reduce the state’s cost for the existing program by $2 billion or more over the next two years.

Opponents of expansion sued to keep it off the ballot. They argued that requiring the state to add people to Medicaid would mandate new appropriations from existing revenues, a violation of the Missouri Constitution.

The Western District Court of Appeals didn’t say the opponents were wrong. Instead, the court opinion found that whether it was true was yet to be seen. The job of the court before the election, Presiding Judge Mark Pfeiffer wrote, was to determine if it met the form required to be placed on the ballot.

The ballot language for Amendment 2 and the amendment itself did not direct the Legislature to appropriate any money, Pfeiffer wrote.

“The forecasts as to costs of the proposed measure go to what the proposed measure will or may do if approved by the voters and put into operation, not to whether the proposed measure is properly put before the voters,” he wrote.

Unnecessary bill?

Whether Smith’s bill is part of a plan to get Medicaid expansion back into court or just a way to highlight the spending, Merideth argues that it is unnecessary.

“It seems at the very least to be an effort to continue their message that Medicaid expansion is somehow bad for our state,” he said.

Lawmakers in 2019 appropriated more than $2.3 billion in general revenue for the Medicaid program in fiscal 2020, state budget office documents show. The actual cost was $344 million less than that amount, while the overall program cost, including federal share and other state funds, increased by $415 million.

Hegeman did not say whether he would put Medicaid expansion spending back into the bills where it has traditionally been appropriated or work from Smith’s bill. The Senate will receive the budget after work is completed in the Missouri House.

He heard about Smith’s bill on Feb. 25, he said, after it was filed.

“I will work with my House colleagues to do the best we can,” he said. “They told me. They didn’t ask me. But that is the purview of going first.”

The state constitution ranks the priority for eight types of spending. First is public debt, followed by education. Health and welfare programs are sixth, followed by “all other state purposes.” The General Assembly is eighth.

That raises the question of whether lawmakers can appropriate money for legislative operations if constitutionally mandated programs go unfunded, Merideth said.

“The constitution seems to say if we are going to cut expansion,” he said, “we need to cut our own budget.”


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Medicaid Work Rule Fight Threatens Push to Cover Social Needs

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The Biden position on work requirements before SCOTUS could have unintended consequences.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



The U.S. Supreme Court building stands in Washington, D.C., Jan. 22, 2019.

Photographer: Al Drago/Bloomberg via Getty Images

Medicaid’s ability to address housing, nutrition, transportation, and other social needs that impact people’s health will be in play in a Supreme Court case examining the program’s flexibility in another area: work requirements.

The court is scheduled to hear oral argument March 29 in a lawsuit reviewing the Trump-era Department of Health and Human Service’s approval of work requirements in the Medicaid programs in Arkansas and New Hampshire.

But a court ruling against work requirements could end up cutting back on the HHS’s authority under the Biden administration to let states experiment with Medicaid—undermining hopes of using it in a broader effort to address social conditions that lead to poor health outcomes. Many advocates see this issue as particularly urgent during the Covid-19 pandemic.

That effort could include using Medicaid funds for a wider range of non-medical expenses, such as buying an air conditioner for a beneficiary afflicted with asthma, having mold removed from an apartment, or providing transportation services to distant grocery stores for people who live in food deserts.

Medicaid currently addresses those issues in a limited fashion, typically focusing on referrals to existing services: helping beneficiaries connect with housing support, finding a food pantry, or getting access to transportation services.

“If a ruling narrowed the scope of the Medicaid program so that it was purely for health insurance, then that could leave us stuck at the status quo,” said Manik Bhat, CEO of Healthify, which works with private health plans and Medicaid managed care organizations to address the social determinants of health.

“Then you’d be leaning into the administrative tasks of delivering health insurance, rather than looking at these broader social needs.”


Tactical Dilemma

The Supreme Court case presents the Biden administration with a tactical dilemma, according to Nicholas Bagley, a professor at the University of Michigan School of Law.

The court could rule against requirements that Medicaid enrollees work as a condition of coverage, which would be, in effect, a policy win for the administration. But such a ruling could also hamstring the agency in developing future experiments with Medicaid.

That problem is already present in the U.S. Court of Appeals for the District of Columbia Circuit ruling against work requirements, he said.

“The circuit court ruling that is before the court on appeal is a good holding for Democrats who opposed work requirements,” Bagley said. “But it’s a ruling that circumscribes HHS’s discretion when it comes to future waivers.”

That problem may help explain why the Justice Department filed a motion Feb. 22 asking the high court to send the case back to the HHS without issuing a ruling, Bagley said.

The DOJ also asked the high court to vacate the circuit court ruling. That somewhat counterintuitive request suggests that those inside the Biden administration concerned with preserving the HHS’s wide discretion in administering Medicaid had prevailed over those concerned with the question of work requirements, he said.

“I can imagine them having two thoughts,” Bagley said. “On the one hand, they like the D.C. Circuit decision because it takes work requirements off the table for the future. But I can also see them thinking, this could be a problem for some of the waivers we’d like to do in coming years that might enable Medicaid programs to come up with creative uses of Medicaid money to help people get healthier, and to address needs that go beyond health care.”

Exaggerated Fears?

Some analysts caution against exaggerating the likelihood the court will significantly constrain Medicaid’s ability to address social needs.

The key problem with work requirements is that they act as a practical barrier to health coverage, and therefore fall outside the purposes of Medicaid, said Sara Rosenbaum, a professor at the George Washington University Law School.

But expanding the definition of benefits under Medicaid wouldn’t have the same effect, she said.

“What you do when you insure the poor under Medicaid is you entitle them to medical assistance,” Rosenbaum said. “It is a perfectly respectable experiment to expand the meaning of the term ‘medical assistance’ to include things we would not include in a conventional insurance plan.”

But using Medicaid to address social needs in a serious way will raise questions of the most appropriate use of limited funds.

Making such changes—such as systematically screening beneficiaries to determine their needs, developing networks of service providers, connecting beneficiaries with appropriate services, and managing the resulting data—would be very expensive, and could divert funds from more traditional uses, said Bhat, who favors expanded use of Medicaid funds to meet social needs.

“The question is, what do we want Medicaid to be?” Bhat said. “If we want it to be real support for families and their health, we need to start getting creative and go back to the drawing board on what is going to drive health. And that’s what we’re talking about: using our resources to have the biggest impact on health.”

Work Requirements Case

A lower court and the D.C. Circuit declared the HHS’s approvals of work requirements improper because, the courts said, the HHS failed to consider the impact of work and community-engagement requirements on the primary objective of Medicaid: providing access to medical care.

Work requirements first emerged as a policy option for able bodied adults in Medicaid during the Trump administration. Critics say they’re unnecessary because most adult Medicaid beneficiaries are already working, and the requirements cause people to leave Medicaid or not sign up in the first place.

Supporters say employment is important to health and acts as a stepping stone to independence. They also contend that experimenting with work requirements is valid under the Medicaid statute, which makes room for demonstration projects under the Section 1115 waiver authority.

The Biden administration signaled Feb. 12 that it intends to rescind the approval of work requirements in the 12 states that received approval from the Centers for Medicare & Medicaid Services during the Trump administration.

The case is Azar v. Gresham, U.S., Nos. 20-37 and 20-38, oral argument scheduled 3/29/21.


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