Several Prominent Medicaid Provisions in Senate's Budget Bill Deemed in Violation of Byrd Rule

Published in Government Relations on June 27, 2025

Senate Parliamentarian Elizabeth MacDonough advised this week that multiple Medicaid provisions in the Senate’s reconciliation bill would violate Senate procedure by violating the Byrd Rule. The Byrd Rule is a Senate-specific procedural process that allows Senators to prevent or block inclusion of extraneous provisions in reconciliation bills. Other provisions are still under review. 

Parliamentarian MacDonough has determined six Medicaid provisions to be in violation with others still under consideration. Of the six provisions determined to be in violation, these four are of note:

1. Limiting states’ ability to tax healthcare providers and use the money to finance Medicaid spending thereby increasing federal matching funds. 
2. Ending a practice called “silver-loading” whereby health insurer increase silver marketplace premiums to replace federal subsidies terminated in 2017. 
3. Prohibiting spread pricing by pharmacy benefit managers. 
4. Several sections that prohibit or limit health care access for immigrants. 

Among the several provisions still under review, the most notable for the DMEPOS industry include: 

1. Repeal of two Biden-era CMS rules that: 
   1. Aligned enrollment and renewal times for Medicaid and CHIP eligibility and enrollment. The rule also prohibited access barriers and created certain protections for eligibility determination timelines and returned mail. 
   2. Aligned Medicare Savings Program enrollment periods with federal programs and simplified the re-enrollment process. 
2. Repeal implementation of a final nursing home staffing rule. 

As usual, VGM will continue to monitor developments to this ever evolving and changing landscape and keep you updated.