The FAQ applies to consumers who were referred by the Marketplace as potentially eligible for Modified Adjusted Gross Income (MAGI)-based Medicaid/CHIP and were referred to their SMA, and who are waiting for their SMA to conduct a final MAGI-based Medicaid/CHIP eligibility determination. This can occur in households where all applicants are found by the Marketplace as potentially eligible for Medicaid/CHIP or in households where some applicants are found eligible for Marketplace coverage and others are potentially Medicaid/CHIP-eligible. Households in the latter scenario will have qualified health plan (QHP)-eligible applicants routed to enroll in coverage with the Marketplace, and applicants assessed as Medicaid/CHIP-eligible will have their application information securely electronically transferred to their SMA for final eligibility determinations and/or enrollment, if eligible. The FAQ can be used to assist consumers navigating these various scenarios.

See FAQs Consumers the FFM Refers to Medicaid and CHIP Agencies.pdf for frequently asked questions.

Following Wednesday’s article about Apexus (the 340B Prime Vendor), The New York Times published a second article about 340B this week, focusing on how drops in the sticker price for insulin have impacted CHCs and their low-income patients. The article explains how lower “sticker prices” caused 340B prices for insulin to skyrocket last year, and how this has affected CHCs patients and operations. While the human impacts of these changes can be devastating, the article clearly shows how CHCs are good stewards of the 340B program, using it to expand access to affordable medications and other important services to low-income patients. For this reason, we advise CHCs to keep this article handy to share with policymakers.

Federal Poverty Level (FPL) guidelines are issued each year by the U.S. Department of Health and Human Services (HHS) based on information gathered by the Census Bureau. The bureau uses that data to calculate the total cost of essential resources used by an average person in a year. FPLs are used to determine eligibility for certain programs and benefits, including savings on Marketplace health insurance and Medicaid and CHIP coverage. The 2025 guidelines establish $32,150 as the FPL for a family of four, a 3% increase from the previous FPL. View the full HHS chart.

Pennie, Pennsylvania’s Health Insurance Exchange, saw record-breaking enrollment of 496,661 customers for the 2025 Open Enrollment period. Nationally 24.2 million people have enrolled in coverage with a few state-based exchanges remaining open till the end of January. While this is remarkable, those currently enrolled may not be able to access extended enhanced premium tax credits in 2026 if Congress does not extend the tax credits for 2026 and beyond. Currently, 90% of Pennie enrollees could face substantial increases in their monthly premium should these credits not continue. Since 2021 these enhanced tax credits have not only reduced monthly premiums but improved access to preventive care for chronic conditions and provided some financial security for vulnerable populations.

The U.S. Drug Enforcement Administration (DEA) released three new rules impacting prescribing controlled substances via telehealth, including the long-awaited regulations regarding establishing a telehealth prescribing registration process that was first mandated by Congress in 2008. While the registration regulation is a proposed rule, the two additional rules regarding buprenorphine and Veterans Affairs providers are final rules:

·    Proposed Rule – Special Registrations for Telemedicine and Limited State Telemedicine Registrations

·    Final Rule – Expansion of Buprenorphine Treatment via Telemedicine Encounter

·    Final Rule – Continuity of Care via Telemedicine for Veterans Affairs Patients

Each of the rules seeks to create permanent exceptions to the existing in-person evaluation requirement related to the prescribing of controlled substances. Readers may recall that the DEA’s current permanent telehealth prescribing policies have been waived since the onset on the COVID-19 public health emergency (PHE) with the current temporary waiver currently slated to expire at the end of 2025. While these final and proposed regulations by the DEA would expand permanent policies, they will not be as broad as what has been seen during the temporary waiver period.

The U.S. Preventive Services Task Force released a final recommendation statement on screening for osteoporosis to prevent fractures. Screening for osteoporosis can help prevent fractures in women 65 and older and in younger women who have gone through menopause and are at increased risk. View the recommendation, the evidence on which it is based, and a summary for clinicians.

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced the selection of 15 additional drugs covered under Medicare Part D for price negotiations. In accordance with the Inflation Reduction Act, the negotiations with participating drug companies for these 15 drugs will occur in 2025 and any negotiated prices will become effective in 2027. Between November 2023 and October 2024, about 5.3 million people with Medicare Part D coverage used these drugs to treat a variety of conditions, such as cancer, type 2 diabetes, and asthma. These selected drugs accounted for about $41 billion in total gross covered prescription drug costs under Medicare Part D, or about 14%, during that period. When combined with the total gross covered prescription drug costs under Medicare Part D of the 10 drugs selected for the first cycle of negotiations over that same time, this represents over a third of total gross covered prescription drug costs under Medicare Part D. You can read more about the announcement and selected drugs in this HHS Press Release and CMS Factsheet.

President Trump ordered all executive departments and agencies to take the following steps:

·    Do not propose or issue any rule in any manner, including by sending a rule to the Office of the Federal Register (the OFR), until a department or agency head appointed or designated by the President after noon on Jan. 20, 2025, reviews and approves the rule.

·    Immediately withdraw any rules that have been sent to the OFR but not published in the Federal Register

·    Consistent with applicable law and subject to the exceptions described in paragraph one, consider postponing for 60 days from the date of the memorandum the effective date for any rules that have been published in the Federal Register.