The Centers for Medicare & Medicaid Services (CMS) wiped away the agency’s stated intentions for the future of Medicare Advantage (MA), underlining new uncertainty for the future of health-related social needs, CMS Innovation Center models and the federal health program.
In mid-December, the CMS announced it was discontinuing the Value-Based Insurance Design (VBID) model at the end of this year. Participating organizations would no longer use a hospice benefit through Medicare Part A starting Jan. 1, 2025.
The agency determined the model, which offered supplemental benefits to members with chronic conditions, is not economically viable due to increased risk score growth and Medicare Part D expenditures.
A frequently asked questions page gave further explanation, as did an executive summary of a report to be released in early 2025. The page included a section with the question, “What is CMS’ vision for the future of the MA program?” as of Feb. 22, archived versions of the web page shows.
But that question and answer was quietly deleted, and the page was last modified Feb. 26. It previously described how the VBID model helped health plans address health-related social needs and stressed health equity as an important cornerstone of its mission.
“Additionally, CMS will continue to make drugs more affordable for millions of Americans, by continuing to implement improvements to the Part D benefit through provisions included in the Inflation Reduction Act (IRA) and through the proposed Medicare $2 Drug List Model, which CMS aims to start in January 2027,” the deleted section read from the Biden administration’s CMS.
The $2 Drug List Model would cap out-of-pocket drugs at $2 a month, but it’s not certain the model will take effect under the Trump administration. Its exclusion from the VBID web page could further that line of thinking and highlights Republicans’ prior negative feelings toward the IRA.
CMS Innovation Centers models test out new ideas that are often incorporated in federal health programs down the road.
“Informed by the experience in the VBID model, CMS will also explore innovations that not only advance whole-person health, enhance transparency, and promote drug affordability but also address rising costs and protect the Medicare Trust Funds,” continued the deleted section.
The CMS did not immediately respond to a request for comment.
Many health policy prognosticators believe the Trump administration will be friendly to MA. CMS Administrator nominee Mehmet Oz, M.D., co-authored an op-ed calling for “Medicare Advantage for All.”
Still, it appears the Trump administration and Republican lawmakers are comfortable trying to crack down on the largest companies in the space in the name of waste, fraud and abuse. The Department of Justice (DOJ) is scrutinizing UnitedHealth Group’s billing practices in MA to see whether the company engages in upcoding. The Federal Trade Commission is also continuing its investigations and legal actions against pharmacy benefit managers.
Further, since Trump retook the White House, his administration has used executive orders to systematically root out all evidence of diversity, equity and inclusion—a mission that has extended into firing government employees working in health equity.
The Office of Civil Rights in the Department of Health and Human Services announced March 7 it is investigating four unnamed medical schools and hospitals under Title VI of the Civil Rights Act and Section 1557 of the Affordable Care Act after receiving allegations these programs discriminate based on race or sex.
An executive order Jan. 21 instructed agencies to “combat illegal private-sector DEI preferences, mandates, policies, programs and activities.” Another executive order directing agencies to freeze and block federal funding for equity-related grants has been blocked by the courts temporarily.
Earlier this month, the CMS pulled health equity guidance for the Medicaid and Children’s Health Insurance Program through Section 1115 waivers, which allowed states to better close coverage gaps through housing support, case management services, medically tailored meals, home modifications and more.
A Republican-led Congress is trying to pass a budget that will dramatically cut Medicaid through the reconciliation process. The Congressional Budget Office confirmed (PDF) March 5 that for the proposed budget to slash spending by the level Republicans desire, the bulk of cuts must come from the Medicaid program. Until 2034, 93% of non-Medicare spending, or $8.2 trillion, through the Energy and Commerce Committee comes from Medicaid.