Congress close to budget compromise

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House and Senate leaders say they are close to having a final budget bill. But there is still some resistance to Medicaid changes that could adversely affect low-income beneficiaries, including nursing home residents.

Although there has been some indication that Congressional negotiators are close to a compromise on Medicaid and Medicare provisions, Sen. Max Baucus (D-MT) said he plans to encourage the rejection of any Medicaid changes in the reconciliation bill that could negatively affect low-income beneficiaries. Baucus is the ranking member on the Senate Finance Committee.

The House and Senate budget reconciliation bills contain numerous Medicaid provisions, but only the Senate bill contains Medicare policy changes. Medicaid provisions in the House and Senate budget measures differ significantly.

In the Senate bill, which is favored by the American Health Care Association, among other providers, most of the Medicaid savings come from changes in how states and the federal government pay for prescription drugs -- without higher costs or reduced benefits for beneficiaries. The House version would give governors flexibility to increase cost-sharing and redesign benefits, and to make it harder for beneficiaries to qualify for Medicaid-paid nursing home coverage.

Senate Finance Committee Chairman Charles Grassley (R-IA) and House Ways and Means Committee Chairman William M. Thomas (R-CA) have said talks will wrap up by the end of this week.