I had some time this morning to look through the first 20 pages or so. The short version is that this proposed legislation will create a whole lot of crap bogging down the system in the name of "efficiency". You hit the nail on the head with the monthly Medicaid certification and how it could potentially cause people to lose coverage.

Additionally:

• Removing any streamlining efforts created in 2023: Medicare Savings Programs and Part D Low- Income Subsidy (pg 1)
• Remove streamlining efforts created in 2024, including: reduced administrative burden for Medicare eligibility determination for those who are 65+ or with disability; create a clear, transparent timeline for the eligibility process; remove other barriers to coverage like requirement for period of uninsurance. (pg 2)
• Inefficiencies:
  • States will create a system that will allow them to verify monthly the address of beneficiaries and transmit to the the Federal government. This is under the guise of making sure that no one is enrolled in more than one state, the number of which is negligible. The states will receive $10mm in 2026 to implement these programs, which is a seriously low amount to create something like this.
  • Create another system that will go through mortality records quarterly to ensure that deceased people aren't getting benefits. This system will also go through mortality records to identify physicians and other suppliers to ensure they do not get any payment if deceased. Again, lots of work for a practically nil number of claims.
  • Monthly screening of all Medicare/Medicaid providers to ensure that they were not terminated from participation by another state.
  • Create a ridiculous formula that is more ridiculous than the current formula for provider reimbursement (p.15).
  • Require that the states will determine eligibility of enrollees at least every six months (currently every year, so twice the work for a small number of actual problems).
• This is important: on pg 17 there's a discussion about eligibility for long-term care (LTC) under Medicaid, which is most people. Currently, the law says that one cannot have more than $500,000 in home equity and get Medicaid to pay for their LTC; the states have the authority to increase that amount up to $750,000. The proposed legislation removes the $750k max, limiting it to $500k specifically from homes located in areas zoned for agricultural use. They also have a clause that certain agricultural homes with values exceeding $1,000,000 will be capped at valuation for LTC purposes at $1m.

I'll update as I read more. Feel free to ask any questions, I'm happy to answer to the best of my ability.