Healthcare Highlights from the Presidential Proposed FY24 Budget

Author: Lisa McAndless Robinson

Mar 30, 2023 | Billing, CMS-OIG, Coding Compliance

President Biden released his proposed FY2024 budget at the beginning of March. Though the budget must still clear the hurdle of Congressional approval, its final version is likely to have significant impact on health care organizations. The proposed changes cast a wide net of initiatives and it remains clear that healthcare reform is still a main directive for the administration. Medicaid will see some of the largest changes, and the overall goal continues to be to achieve affordable healthcare for all Americans.

The budget aims to lower Medicaid costs by over $20 billion dollars. A main strategy to accomplish this is by addressing excessive payments to Medicaid Managed Care Organizations through a requirement on all states to pay back the excess funds they receive on patient care. If approved, insurance companies will have to pay these excess funds back to Medicaid. Additionally, the states that have not adopted Medicaid expansion under the Affordable Care Act would be required to provide Medicaid-like coverage to individuals including financial incentives to ensure continual health maintenance.

Under the proposed Department of Health and Human Services (HHS) budget increase of $14.8 billion (11.5% from the 2023 enacted level), Medicaid will realize significant enhancements. The solvency of the Medicare Trust Fund would extend by at least 25 years. The President has set his sight on controlling rising prescription drug cost and proposes to build upon the Inflation Reduction Act by giving Medicare more negotiating power, including bringing more drugs to the negotiating table. Medicare Part D would see limits for cost sharing for high-value generic drugs for certain chronic conditions. Consumers would directly realize benefits such as capped pricing on insulin products at $35 for a monthly prescription. Seniors’ out-of-pocket expenses would be capped at $2,000 a year.

Nursing home care would be under closer watch through a proposed investment of $150 billion over a 10-year period to expand Medicaid home and community-based services. The funds are aimed at improving the safety and quality of nursing home care, through increasing transparency of facility ownership, and expanding financial penalties on substandard facilities. Home and community-based services would see efforts to improve personal care services to allow older Americans and individuals with disabilities to remain in their homes.

From a workforce standpoint, employers would be required to provide employees a certain number of sick days, which could be used for health needs of the individual, their families, or to seek safety from domestic violence, dating violence, sexual assault, or stalking. Stiffer penalties would be imposed on employers who violate fair wage and rights to organize protections, and for not providing a safe and healthy workplace free from discrimination, promoting a heightened focus on workplace safety.

Behavioral Health will be expanded at lower cost for Medicare patients. Veterans Affairs (VA) and Indian Health Services (HIS) will see enhanced support with a focus on cancer treatment, expanding benefits, and behavioral health. Women’s healthcare, family planning, preventative and treatment options for HIV/AIDs and Hepatitis C will all see additional funding. A focus on increased access to healthcare in rural areas will result in workforce development, training, and improved access to Internet services for more access to telehealth services.

Significant budget increases will be enacted for HHS, and the CDC, at state, and local levels, to ensure better preparedness for future pandemics, including research, development in scientific and medical areas, technology, and core capabilities.

Some parts of the budget propose to increase the fight against identify theft, bad actors, and other areas of systemic fraud, and employment fraud. There is no doubt that healthcare could feel additional scrutiny as these efforts increase nationally. From increased enforcement on Fraud, Waste & Abuse, to access to telehealth, to safer work environments, to an increased number of people accessing healthcare, it is prudent for health organizations to be watchful as this proposed budget moves through the Congressional review and approval process.