Reed Smith Client Alerts

The Build Back Better Act (H.R. 5376) is a wide-ranging bill that would have implications for an array of health care products, including Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), and Marketplace health care coverage under the Patient Protection and Affordable Care Act (ACA). The House passed the bill last week, and the Senate will likely work on the bill through the Thanksgiving recess before bringing it to the floor for a vote.

The provisions of the bill that may affect health payors include Section 30601, which addresses the affordability of Marketplace coverage for certain low-income populations, Section 30721, which addresses postpartum coverage, and Section 30741, which addresses coverage for children enrolled in Medicaid and CHIP and coverage for inmates prior to their release.

Section 30601 would amend the ACA to provide additional Marketplace cost-sharing reduction assistance to individuals with household incomes below 138 percent of the federal poverty line until 2025. Consistent with current law, individuals who qualify for government-sponsored insurance would not qualify for the temporary cost-sharing assistance. This change is estimated to reduce premiums for up to nine million individuals and increase Marketplace enrollments. It will also temporarily close the Medicaid gap in states that did not expand Medicaid, which will lead to four million uninsured people gaining coverage. This section would additionally provide $10 billion in annual funding from 2023 to 2025 for states to either establish an individual market reinsurance program, or reduce premiums and out-of-pocket costs for the Marketplace for Basic Health Program enrollees. States that have not expanded Medicaid would not be eligible to apply for this funding.

Section 30721 of the proposed legislation would amend the Social Security Act to require states to extend Medicaid eligibility up to 12 months postpartum for women who were enrolled in Medicaid while pregnant. Federal law currently only requires Medicaid eligibility to last for 60 days postpartum; beyond that, qualification for Medicaid is not guaranteed. While some states have already adopted a 12-month postpartum eligibility period, others (such as Kansas and Oregon) only provide for the minimum 60-day postpartum period. Section 30721 would require state Medicaid programs and Medicaid MCOs in all states to provide Medicaid coverage for 12 months postpartum.