Medicaid is the Hero in The HEROES Act

Medicaid is the Hero in The HEROES Act

Despite weeks of sheltering in place, coronavirus continues to ravage the country. Deaths continue to rise, testing is still in short supply, and the numbers of individuals filing for unemployment continue to rise

Medicaid has always served as the safety net for low-income and underserved individuals, providing comprehensive, affordable health care. It is needed now more than ever. The HEROES Act (Health and Economic Recovery Omnibus Emergency Solutions Act), introduced by Democrats in the House of Representatives earlier this week, includes a number of provisions to help Medicaid remains strong. Here’s a short discussion of the major Medicaid-related provisions.

Enhanced Medicaid Funding

The HEROES Act includes more Medicaid funding, beyond what Congress has already provided. The HEROES Act increases federal Medicaid payments for health care services by 14%. So if the federal government usually pays 60% of a state’s Medicaid costs, the state would get 74%. You can look at this chart to see what the federal government pays your state (the “FMAP”). That’s a big lifeline for states!

Maintenance of Effort

Previous COVID-related legislation says states getting extra Medicaid money can’t cut eligibility while receiving the money. This strong “Maintenance of Effort” requirement would apply to the new funding in the HEROES Act.

Unfortunately, the HEROES Act also includes an exemption for New York. This would especially hurt individuals getting home and community-based services. We don’t think even one state should get more federal funds but cut people off of Medicaid.

Home and Community-Based Services

The HEROES Act includes more money to pay for home and community-based services. Federal funding would increase by 10%, in addition to the increased 14% above. But no state could get more than 95% of its costs paid by the federal government. The bill lists specific uses for the increased funding so states could not just use it for existing costs.

Unfortunately, the definition of eligible services excludes most community mental health services. We hope this will be fixed as the bill moves forward.

Medicaid Fiscal Accountability Rule (MFAR)

The bill delays the Administration’s proposed MFAR. MFAR would drastically limit how states can fund their share of Medicaid costs. Our comments on the proposed rule explained how the changes could limit coverage and access to care for millions of people.

COVID-19 Treatment and Vaccinations

The bill adds payment for COVID-19 treatment and vaccinations in Medicaid and CHIP. A state would first have to choose to add Medicaid eligibility for the uninsured. And eligible people could not be charged any co-pays. The bill also amends the Pediatric Vaccines program to cover a COVID-19 vaccine for all children receiving vaccinations at no cost.

Health Equity

Medicaid serves as a critical program for people of color, people with disabilities, LGBTQ individuals, and others who are often left behind when it comes to health care access. People of color are disproportionately infected and dying from COVID-19 due to factors including structural racism, underlying health conditions and being more likely to be an essential worker.

The bill includes a strong nondiscrimination provision and data collection and reporting requirements. And it gives more funding to care for Native Americans and to Medicaid hospitals serving a large share of Medicaid and uninsured individuals. It also restores Medicaid eligibility to individuals under Compacts of Free Association (COFA).


In addition to the Medicaid provisions, NHeLP supports many of the other heath and non-health provisions in the HEROES Act. We are in unprecedented times, and we need this unprecedented response. We look forward to working with Congress to enact this important legislation.

For more information on these provisions, see Medicaid Needs to Remain the Hero: A Summary of the HEROES Act.



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