Health Announce: June 23, 2025

Topics for this week’s Health Announce:

1. HHS releases ACA Final Rule.
2. Reconciliation Bill Update – certain SNAP cuts found to violate the Byrd Rule.
3. State Senate passes FY 2025 Supplemental Appropriation.
4. Recent Supreme Court ruling a blow to transgender rights.
5. Reminder – HCWG this Wednesday!
6. Housing Authorities across the state freeze Section 8 vouchers.

🔥Heat Advisory! 🔥

Well, here it is: the first heat wave of the year. In parts of New England, temperatures are expected to reach extreme levels. As I write you from Amherst, the temperature is 99 degrees outside -- with a real feel of 114! Heat stroke is no joke: stay inside as much a possible and stay hydrated. Keep a look out for your community cooling centers, pools, or splash pads for some chilly relief!

Be well,

Health Law Unit
Massachusetts Law Reform Institute

1. HHS releases ACA Final Rule.

In March 2025, the US Department of Health and Human Services (HHS) released for comments a proposed rule affecting Marketplace coverage. Posted on MLS are the April 2025 comments filed by the Massachusetts Health Connector (our state-based Marketplace) and by MLRI. Virtually all the proposed changes would make it harder for eligible people to enroll or renew their health insurance coverage and make their coverage less affordable, along with other negative changes affecting eligibility and the scope of benefits.

On June 20, 2025, HHS released the final text of the rule in advance of its publication in the Federal Register. We are still going through its 500 pages, but many of the proposed rules were finalized to take effect only temporarily in Plan Year 2026. The preamble explains the reason for this as a concern with the issues raised by commenters, but most of the provisions of the proposed rule have been included in the pending version of the 2025 Reconciliation bill (the "One Big Beautiful Bill Act"). The Health Connector typically sends out preliminary eligibility notices for the following plan year in August--just two months away--making implementation of the final rules even more problematic.

The link below is the HHS press release & summary of the final rule.

https://www.cms.gov/newsroom/fact-sheets/2025-marketplace-integrity-and-affordability-final-rule

2. Reconciliation Bill Update – certain SNAP cuts found to violate the Byrd Rule.

Two harmful SNAP provisions have been ruled to violate the Byrd Rule. The Senate Parliamentarian has ruled that the following provisions should be stripped from OBBBA to comply with the rules of the reconciliation process:

• Language barring immigrants who are not citizens or lawful permanent residents from receiving SNAP benefits
• Language requiring states to pay for a certain percentage of food assistance, ranging from 5% to 15% of SNAP benefits, based on the state’s error rates in delivering aid

The Senate Parliamentarian, Elizabeth MacDonough, is tasked with reviewing the Senate’s version of the One Bill Beautiful Bill Act (OBBBA) for compliance with the Byrd Rule. This rule defines which provisions can legitimately be part of a budget reconciliation process and which are “extraneous.” Extraneous provisions violate the Byrd Rule if they have no budgetary effect (don’t add or subtract to the budget); fail to comply with a committee’s reconciliation target; fall outside of a committee’s jurisdiction; have a budgetary effect that is merely incidental to nonbudgetary elements of the provision; increase the deficit beyond the reconciliation window (typically 10 years); or recommend changes to Social Security.

The advantage to Senate Republicans of using the reconciliation process to pass this legislation is that they only need a simple majority. If they do not strike these provisions from the OBBBA, then they must meet the 60-vote threshold to pass it. The Senate Parliamentarian has found several other provisions of the Senate’s bill to violate the Byrd Rule, including language attempting to limit federal courts’ contempt powers.

3. State Senate passes FY 2025 Supplemental Appropriation.

On June 18, 2025, the Senate passed S2529, a Supplemental Appropriation for FY 2025.

The Senate includes $174 million for fiscally strained hospitals and $35 million for fiscally strained community health centers. This added funding reflects the large shortfall in the Health Safety Net Trust Fund that reimburses hospitals and health centers for treating the uninsured and underinsured. The Senate also calls for a task force to study the sustainability and resources of the health safety net. The House, in its version of the state budget, included a $230 million appropriation into the Health Safety Net Trust Fund.

From the Senate summary of S2529 --

Appropriates $532M in fiscal year 2025, including:

• $134.5M for the Medical Assistance Trust Fund
• $60M for Home Care Services
• $174M for payments to fiscally strained acute care hospitals (4000-1202)
• $35M for payments to fiscally strained community health centers (4000-1998)

Outside sections including:

• Section 6. Updates the composition of the MassHealth program advisory committee. (Amending 118E, Sec 6)
• Section 31. Updates the OneCare Program to align with the changes to the Duals Demonstration necessitated by federal authority (Amending 118E, Sec 9F)
• Section 32. Clarifies that the mandated coverage for applied behavior analysis services is available for treatment of Down Syndrome for individuals under the age of 21 (Clarifying 118E, Sec 10H1/2)
• Section 33. Allows the Executive Office of Health and Human Services to pay state agencies directly for Medicaid claims relating to healthcare programs, including correctional facilities (Amending 118E, Sec 87)
• Section 65. Sets up a Task Force to consider the funding and administration of the Health Safety Net and issue a report with its findings and recommendations by April 2, 2026

4. Recent Supreme Court ruling a blow to transgender rights.

On Wednesday, June 18, 2025, the US Supreme Court ruled 6-3 in US v. Skrmetti , 605 U.S. __ , No. 23-477 (2025), that Tennessee’s ban on puberty blockers and hormone therapy for transgendered individuals under 18 did not violate the Fourteenth Amendment’s equal protection clause. The lawsuit, brought by three parents of transgendered children and their Tennessee-based physician, sought to invalidate as unconstitutional the state’s law, SB1, because it violated the equal protection rights of their children in depriving them of certain medical care that was permitted for other groups of children. For example, children with early-onset puberty could be prescribed puberty blockers, but trans children seeking gender affirming care could not.

The plaintiffs argued that courts should review SB1’s sex-based discrimination under the heightened scrutiny standard, but the majority ruled that the law only required rational basis review. Accordingly, as
Chief Justice Roberts wrote, questions regarding the “wisdom, fairness, or logic” of a policy depriving trans children of needed medical interventions are left “to the people, their elected representatives, and the democratic process.” Skrmetti, No. 23-477, majority op. at 24.

Writing in dissent, Justice Sotomayor explained that the Constitution and settled precedent require that courts review a law that expressly classifies on the basis of sex and transgendered status – which Tennessee’s SB1 does – under the intermediate scrutiny standard. “By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgendered children and their families to political whims.” Skrmetti, No. 23-477, dissenting op. at 2.

While this decision does not cut off other avenues to challenging anti-trans laws across the country, it nonetheless is a devastating blow for the families of trans youth in Tennessee. Twenty-five states have
categorical bans on gender-affirming medical care for treating gender dysphoria in youth. If you know any families in states with such cruel anti-trans laws aimed at depriving youth of needed care, the Trans Youth Emergency Project can help those families access care.

5. Reminder – HCWG this Wednesday!

The Health Care Working Group (HCWG) meets this week: Wednesday, June 25, 2025, from 3 to 4:30 pm. Topics on the agenda include updates on the federal reconciliation process and the Senate's version of the "One Big Beautiful Bill Act," strategies for Medicaid and SNAP Defense, and the status of MassHealth initiatives for FY 2026. If you have any topics you’d like to discuss at the next meeting, please let Jeni (jkaplan@mlri.org) know.

6. Housing Authorities across the state freeze Section 8 vouchers.

The Boston Globe reports (paywall) that most Housing Authorities across the state are not issuing new Section 8 vouchers once a tenant gives them up. Additionally, some have closed already long waitlists to new applicants. Because of a combination of already high and rising rents and federal funding for Section 8 that has not kept pace and that the Trump regime has threatened to cut significantly, Housing Authorities are taking action now to avoid budgetary crises. However, in effect, Housing Authorities have frozen the state’s largest source of subsidized housing: currently, around 93,000 households rely on Section 8 vouchers to help pay their rents each month.