A bill to help states fund integrated health homes for chronically ill children stalled in the Senate due to a lawmaker's opposition, despite pressure to pass it this week along with other Medicaid provisions.
The Advancing Care for Exceptional (ACE) Kids Act, championed by Senate Finance Chair Chuck Grassley (R-Iowa), passed in the U.S. House of Representatives on Monday as part of broader legislation that incorporated another Grassley-sponsored measure to require more transparency in Medicaid drug rebates.
The legislation also included Medicaid provisions such as a short extension of the eight-state excellence in mental health demonstration, expiring this weekend in Oregon and Oklahoma, and protections against impoverishment for spouses of people receiving Medicaid home and community-based care, which also expire this weekend.
Given these pending expirations, lawmakers hoped the package would clear the Senate with a vote of unanimous consent by the end of this week, although a Senate aide noted that Congress can retroactively fund the expired programs.
But ACE Kids, a key priority for the Children's Hospital Association, continues to be a stumbling block as it was last year when Sen. Mike Lee (R-Utah) blocked a December vote of unanimous consent on the package just before Congress recessed for the year.
Lee continues to oppose the bill, according to a Senate Democratic aide.
Despite years of tweaking, the legislation has been criticized. Medicaid managed-care plans view it as a threat to their own contracts if a federal funding boost encourages states to move chronically sick kids to provider-coordinated health homes.
Congressional conservatives who don't want to establish another program that will need continued funding have remained strong critics. In a bid to win over critics and ease passage given its previously sizable price tag, the bill's federal funding promise was significantly watered down before the end of last year.
For now, there's no clear path forward for the legislation unless the upper chamber can hold a unanimous consent vote. Grassley told Modern Healthcare that "one senator is holding it up, so I've got to convince that senator."
Meanwhile, Medicaid plans who fought ACE Kids for years have accepted that the measure will likely pass in some form, according to Alexander Shekhdar, who worked on the issue in a former role at the trade group Medicaid Health Plans of America. He is now a principal at Sycamore Creek Health Care Advisors.
"As a paradigm or model, it certainly threatens certain Medicaid state programs and managed care," he said, because managed care contracts for chronically ill kids bring high payment rates from the government.
"With integrated health homes, they would subsume those contracts," Shekhdar said.