On June 16, the Senate Finance Committee (SFC) released draft text of its proposals for the Senate’s version of the One Big Beautiful Bill (OBBB). SFC has jurisdiction over tax as well as Medicare, Medicaid, and the Affordable Care Act. LeadingAge is still evaluating the new text as it compares to the House version of the bill. Some topline changes of note: 

• Retroactive payments: In the House bill, retroactive eligibility for Medicaid was changed from 90 days to 30 days. In the SFC draft, they propose 30 days of retroactive coverage for the ACA population and 60 days for traditional Medicaid populations. LeadingAge had asked for 90 days particularly for those who are getting Medicaid due to age or disability. Ideally this would include those who are disabled getting coverage through the ACA expansion pathway. This change is a partial victory in that it gives more leeway for retroactive coverage for the populations that are mostly likely to need it; but we would prefer the changes go further. 

• Provider Taxes: The House policy froze provider taxes where they are across all classes of taxes. The Senate bill goes further. 

• The moratorium on new taxes remains for both expansion and non-expansion states. There is new language about when states can make changes relative to the date of enactment that we will analyze in the coming days. 

• Starting in 2027, for expansion states, the hold harmless threshold decreases by 0.5% a year until 2031 when the hold harmless threshold would be 3.5%. Nursing homes and intermediate care facilities are excluded from this provision. However, LeadingAge knows that nursing homes receive money from provider taxes that are levied on classes besides nursing homes (such as hospitals and managed care organizations). The drop in the hold harmless threshold for other classes also means that expansion states will be receiving fewer federal dollars (in some cases, significantly fewer), which will have a negative impact on home- and community-based services as well as nursing homes.  

• State directed payments: The House bill revised the payment limit for state directed payments (SDPs) to the Medicare rate for expansion states and 110% of Medicare for non-expansion states. The Senate version keeps this policy. It also adds a policy that existing SDPS would be reduced by 10% annually until the allowable Medicare-related payment rate is achieved. The House bill grandfathered in current SDPs without reductions. 

• The work requirements were adjusted to: 1) cap the look-back for demonstrating community engagement at three months; the House bill would have allowed an indefinite lookback; 2) limits the exemption for parents to parents of children 14 and under. It also adds family caregivers to the definition based on the definition in the RAISE Family Caregiver’s Act; and 3) allows the Secretary to exempt states from the requirements until Dec 31, 2028, if a state is demonstrating a good faith effort to comply. 

• The nursing home staffing standard elimination is in this bill but goes further than the House bill. It says that the rule can never be enforced as opposed to the House bill, which put a moratorium on enforcement until 2035. 

Overall, the SFC bill takes an even harder swing at states that chose to expand Medicaid and uses what will likely be increased federal cuts to Medicaid, compared to the House bill, to fund priorities like tax increases for the wealthiest Americans. We will continue to analyze the bill but the SFC’s attempts to protect long-term care, we believe, do not do nearly enough to counterbalance the devastating impacts of such large cuts. We will provide a more detailed summary in the coming days along with action items. Read the SFC text here.