A Message from the President & CEO Mark Parkinson: CONGRESS PASSES 2023 BUDGET

SNFs Left Alone; Wind Down of Enhanced FMAP to States

Congress today passed the FY 2023 budget, preventing government shutdown. The 4,000-plus page budget includes two areas in which I want to share an update due to the impact on skilled nursing and assisted living providers. 
  • SNFs and ALs have been left alone. There were attempts to include some of the onerous SNF regulatory provisions that Congress considered in mid-2021. We have been successful in thwarting those attempts in this legislation. We still have a battle on our hands with CMS, but the Congressional threat is close to over. There is nothing negative here.
  • The budget phases down the additional federal resources that states have been getting for Medicaid during the pandemic. This is the enhanced Federal Medicaid Assistance Percentage (FMAP) included in the Families First Coronavirus Response Act. Until now, states have been getting an additional 6.2% FMAP. The bill phases out the enhancement during 2023:
    • From April to June, the increased FMAP would be 5%. 
    • From July to September, it would be 2.5%. 
    • From October to December, it would be 1.5%. 
    • On December 31, 2023, the enhanced FMAP ends entirely.
In order to maintain the ability to draw down the enhanced FMAP in 2023, states must take certain steps towards redeterminations for beneficiaries to ensure continued Medicaid eligibility and, therefore, Medicaid payments to providers.

The phase down of the enhanced FMAP is both good and bad news for the states. Currently, the enhancement is tied to the COVID-19 Public Health Emergency (PHE). The prevailing thought has been that the PHE will end on April 11, which would mean the enhanced FMAP would go away all at once at the end of that quarter. With passage of this budget, a portion of it will continue through 2023. On the other hand, it is possible that HHS will keep the PHE going beyond April 11. If that's the case, this is less money to the states.  

There are states that continue to have enhancements tied to the PHE, and this should not impact those states. But as states receive less federal Medicaid dollars, it will be increasingly difficult to keep the state funds flowing. Of note, the 3-day stay waiver is not affected and remains tied to the PHE.

I've said it before, but I am truly thankful for everything you do and the amazing care you provide for the residents. We will continue to fight for you in D.C. in 2023. Have a wonderful holiday season.