CMS publishes final Medicaid work requirements rule

CMS on Monday published a final rule that will require most Medicaid beneficiaries between the ages of 19 and 64 to prove that they work or attend school, complete community service, or participate in a work program to qualify for benefits.

The work requirements were initially established as part of the One Big Beautiful Bill Act which was passed in July of last year. This final rule establishes the standards states are required to use to implement the work requirements, including those exempt from the requirements, how to verify those exemptions, and state reporting requirements.

The work requirements will apply to adults enrolled in Medicaid through the program's expansion and to those with lower incomes who are not also enrolled in Medicare. There are several exceptions to the requirements, including for those who are pregnant or postpartum, disabled or medically frail, and parents and caretakers of children under the age of 14.

Under the rule, those who aren't exempt must prove they spent at least 80 hours per month either working, performing community service, or engaged in education at least half of the time.

Initial estimates suggest the work requirements will reduce federal Medicaid spending by $326 billion and cost 5.3 million people Medicaid coverage. However, HHS on Monday published a research brief saying the rules will encourage more people to work and will reduce poverty by 1.6 million to 2.9 million people.

(Weixel, The Hill, 6/1; Wilkerson/Bannow, STAT+ [subscription required], 6/1)

U.S. plan to open Ebola quarantine unit in Kenya faces protests, delays

The Trump administration's plans to open an Ebola quarantine unit in Kenya for Americans exposed to the virus amid a growing outbreak centered in the Democratic Republic of the Congo has been met with violent protests and delays imposed by the country's high court.

The administration said that no U.S. citizens exposed to Ebola will return home for treatment and will instead be quarantined in Kenya, a proposal that has been supported by Kenyan President William Ruto, who said the plan to open a 50-bed quarantine facility at Laikipia Air Base "is neither unique nor exceptional, but part of a broader national preparedness system."

"When President Trump asked the government of Kenya to support them, I gave the OK because it was an agreement and a partnership with friends who have worked with Kenya for 30-40 years," Ruto said.

The U.S. has pledged to commit $13.5 million towards its partnership with Kenya, however violent protests throughout the country have so far led to two deaths, including in the town of Nanyuki, which is slated to house the quarantine unit.

In addition, Kenya's high court last week suspended plans for the facility after the Katiba Institute, a civil society group in Kenya, filed a petition challenging the constitutionality of the facility. The court then ruled that the next proceedings in the case will not take place until June 23, effectively delaying any action on the matter for three more weeks.

The court also ordered Kenya's government to provide full details of the terms of the agreement it struck with the U.S., including any financial arrangements and measures to protect the Kenyan population.

(Aggarwal, NBC News, 6/2; Bigg/Otieno, New York Times, 6/2; Malalo, Reuters, 6/2)

However, in March, a federal judge blocked HHS from implementing any decisions made by panelists on ACIP, ruling that Kennedy's reconstitution of the panel and changes made to the childhood vaccine schedule were likely illegal and that those changes violated the Administrative Procedure Act, which determines how agencies consider and implement policy changes.

In the executive order, Trump said CDC and ACIP should review the scientific assessment made by CDC that led to the schedule change, as well as the "latest clinical data" and then "take any appropriate steps to update the United States childhood and adolescent vaccine schedule."

"ACIP's review should consider ways to provide maximum flexibility to parents and doctors through recommendations for timing and sequencing of the administration of routine immunizations," the order states.

(Davis, The Hill, 5/30; Landi, Fierce Healthcare, 6/1)

RFK Jr. names Stephanie Haridopolos as temporary surgeon general

HHS last month picked Stephanie Haridopolos to temporarily serve as surgeon general while President Donald Trump's nominee for the role, Nicole Saphier, works through the congressional approval process.

Haridopolos, who is married to Rep. Mike Haridopolos (R-Fla.), is a family physician and top staffer in the Office of the Surgeon General (OSG) where she serves as director of national communications, chief of staff, and senior adviser.

"Assistant Secretary for Health Admiral Brian Christine, M.D. is using his delegation of authority powers to allow Dr. Haridopolos to begin carrying out many of the duties of the Surgeon General on behalf of the American people," a spokesperson for HHS said in a statement. "She will promote OSG public health actions, advisories, and guidance until the next Surgeon General is sworn into office."

The position of surgeon general has remained vacant for the entirety of Trump's second term. Trump initially nominated Janette Nesheiwat, a medical doctor and Fox News contributor, for the position but withdrew her nomination after several conservative figures, including far-right activist Laura Loomer, spoke out against Nesheiwat for comments she previously made online supporting COVID-19 vaccines and masking during the pandemic.

Trump then nominated Casey Means, a former Stanford Medical School-trained doctor who then became a functional medicine doctor and started health technology company Levels. However, Trump pulled Means' nomination following her testimony before the Senate Health, Education, Labor, and Pensions committee in February that drew into question whether her nomination would make it out of the committee.

Trump then nominated Saphier, a radiologist and practicing physician at the Memorial Sloan Kettering Cancer Center, who is awaiting Senate confirmation.

(Choi, The Hill, 5/20; Gooch, Becker's Hospital Review, 5/20)