Jan. 13 Federal Update: Medicare’s $2,000 Cap on Prescription Drug Costs Takes Effect 

On Jan. 1, 2025, a new out-of-pocket cap on drug costs went into effect for Medicare Part D patients. The new cap is set at $2,000 per year for all prescriptions covered by Part D plans. 

The change was scheduled as part of the Inflation Reductions Act (IRA), which takes several steps to make health care more affordable and accessible.  

In addition to caps on drug costs, the IRA introduced other critical changes: 

• Insulin Costs: The cost of insulin is now capped at $35 per month for covered insulin products  

• Zero-Cost Vaccines: Medicare Part D patients can access recommended vaccines (like flu, shingles, COVID-19 and RSV) for free.  

• Pharmaceutical Negotiation: The law also allows Medicare to negotiate directly with drug companies each year to lower the prices of many of the most expensive and most commonly used prescription drugs 

More information about the IRA changes can be found from the Centers of Medicaid and Medicare services.

The Children’s Bureau Releases Program Instructions 

New guidance includes: 

• ACF-ACYF-CB-PI-24-10: State Requirements for Electing Title IV-E Prevention and Family Services and Programs: The program instruction informs state Title IV-E agencies of the Title IV-E prevention program requirements and flexibility agencies may provide to tribes with whom they have agreements. 

• ACYF-CB-PI-24-11: Tribal Title IV-E Agency Requirements for Electing Title IV-E Prevention and Family Services and Programs: The program instruction informs tribal Title IV-E agencies administering or supervising the administration of Title IV-E prevention program requirements. It additionally exempts tribal Title IV-E agencies from the evaluation waiver and continuous quality improvement requirements, extending flexibilities Title IV-E agencies offer. 

ACF Publishes Additions to the Child Welfare Policy Manual 

On Dec. 20, 2024, the Administration for Children and Families published two additions to the Child Welfare Policy Manual regarding access to services provided under Title IV-B of the Social Security Act and the Child Abuse Prevention and Treatment Act according to immigration status. 

The additions can be found in: 

• Question 3, 1 CAPTA, Assurances and Requirements: May a state agency deny access to services provided under CAPTA based solely on the immigration status of the child, parent, or family members? 

• Question 3, 1 TITLE IV-B, Citizenship/Alienage Requirements: May a Title IV-B agency deny access to services provided under Title IV-B based solely on the immigration status of the child, parent, or family members? 

President Biden Signs Key Legislation 

• H.R. 9076, Supporting America’s Children and Families Act: Introduced by Rep. Darin LaHood (R-Ill.), the bill reauthorizes, entirely for the first time in over 15 years, child welfare programs under Title IV-B of the Social Security Act that provide federal resources to states, tribes, and territories for family preservation and to promote the safety, permanence, and well-being of children in foster care. 

• H.R. 663, Native American Child Protection Act (NACPA): Introduced by U.S. Sens. Ben Ray Luján (D-N.M.) and Susan Collins (R-Maine), NACPA reauthorizes and reforms key programs related to the prevention, investigation, treatment, and prosecution of family violence, child abuse, and child neglect involving Indian children and families.  

• S. 1351, Stop Institutional Child Abuse Act: Introduced by Sen. Jeff Merkley (D-Ore.), the bill requires the National Academies of Sciences, Engineering, and Medicine to study and issue recommendations to improve coordination and the implementation of best practices regarding the health, safety, care, and treatment of youth in youth residential programs. 

• S. 1147, Jenna Quinn Law: Introduced by Sen. John Cornyn (R-Texas), the bill allows the Department of Health and Human Services (HHS) to provide grants for evidence-informed child sexual abuse awareness and prevention programs, which may be awarded for up to five years.  

• H.R. 7213, Autism Collaboration, Accountability, Research, Education, and Support (CARES) Act of 2024: Introduced by Rep. Chris Smith (R-N.J.), the bill reauthorizes several programs that support autism education, research, and resources.  

• H.R. 670, Think Differently Database Act: Introduced by Rep. Marcus Molinaro (R-N.Y.), the bill requires HHS to establish a website that provides information on resources available to individuals with a disability and their caregivers and families that is searchable by ZIP Code. 

• H.R. 5536, Grant Transparency Act of 2023: Introduced by Rep. Russell Fry (R-S.C.), the bill establishes transparency requirements for notices of funding opportunity in applications for competitive grants awarded by federal agencies, excluding the Government Accountability Office. 

• H.R. 1432, VSO Equal Tax Treatment Act: Introduced by Rep. Brad Wenstrup (R-Ohio), the bill expands the deductibility of charitable contributions to all federally chartered tax-exempt organizations serving current and former Armed Forces members. 

• S. 2513, Veterans Benefits Improvement Act of 2024: Introduced by Sen. Jon Tester (D-Mont.), the bill addresses specific requirements for medical disability benefit claims processes and personnel. 

• S. 141, the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act: Introduced by Sen. Jerry Moran (R-Kan.), the bill amends various Department of Veterans Affairs authorities related to health care, economic opportunity, disability and memorial affairs, veteran homelessness, and oversight and investigations. 

Sector Updates from the Judiciary 

Supreme Court Agrees to Hear a Lawsuit Surrounding Medicaid Patients’ Right to Provider Choice  

The U.S. Supreme Court has agreed to hear a lawsuit to determine whether Medicaid beneficiaries can sue  South Carolina for its decision to defund Planned Parenthood. Although Medicaid generally doesn’t cover abortion costs, Medicare patients were previously able to visit clinics that offered abortion care for other medical services, including screenings for cancer, high blood pressure, and cholesterol. 

 The lawsuit was brought by a patient with Medicaid who was diagnosed with diabetes and went to Planned Parenthood for birth control but wished to return to receive other care in the future. However, the patient was prevented from doing so due to a 2018 executive order issued by South Carolina Gov. Henry McMaster that ordered the state’s Department of Health and Human Services to stop abortion clinics from participating in the Medicaid program.  

The lawsuit argued that McMaster’s order violated a provision of the Medicaid Act that allows Medicaid patients to seek health care from any “qualified” provider. McMaster maintained that the “payment of taxpayer funds to abortion clinics, for any purpose, results in the subsidy of abortion and the denial of the right to life.” 

The initial ruling was issued in favor of Planned Parenthood, as the Fourth Circuit Court of Appeals determined that the case raises the larger question of whether Congress, through the Medicaid Act, grants individuals with Medicaid coverage the right to choose their health care provider freely.  

The Supreme Court will now hear the lawsuit. If the Supreme Court rules against Planned Parenthood and their Medicaid funding is revoked, similar family planning clinics that provide abortion care among other medical services will also lose federal funding. The closure of family planning clinics is expected to significantly reduce Medicaid patients’ access to and choice of affordable, quality family-planning care.   

Supreme Court Agrees to Hear a Lawsuit Surrounding Religious Exemptions for Unemployment Systems 

The Supreme Court agreed to hear a lawsuit filed by the Wisconsin chapter of Catholic Charities after the organization was disqualified from Wisconsin’s religious exemption. 

Wisconsin’s unemployment tax system reserves religious exemption for organizations “operated primarily for religious purposes.” The Wisconsin Supreme Court maintained Catholic Charities did not meet that requirement because it serves and employs individuals outside of the Catholic faith and provides services that secular organizations could offer.  

The Supreme Court decision is expected to broadly impact state unemployment systems, as 47 states have similar laws. It will also likely shape how organizations are determined to have a religious purpose, potentially affecting First Amendment religious protections.  

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