The recently confirmed U.S. Department of Health & Human Services (HHS) Secretary Robert F. Kennedy, Jr. has outlined several priorities that dovetail with the largest challenges facing today’s palliative care patient populations.
Significant opportunities exist to improve serious illness care delivery for chronically ill and medically complex individuals across the country, according to Kennedy. Increased access will in part take innovative change in reimbursement models taking shape from the U.S. Centers for Medicare & Medicaid Services (CMS), he stated.
“I will work with Congress, CMS and stakeholders to ensure that the Innovation Center tests appropriate innovative models that improve the quality of care of patients and reduce costs for Medicare, Medicaid
and [Children’s Health Insurance Program (CHIP)] beneficiaries including those with chronic conditions,” Kennedy said in a recent Senate hearing.
Kennedy oversees all HHS programs, operating divisions and activities, including a nearly $2 trillion federal funding budget and a wide range of health and human service programs. HHS’ subagencies include CMS, the National Institutes of Health, the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Food & Drug Administration, among others.
Some of the most significant concerns to address in community-based palliative care include expanding access among chronically ill patient populations, ensuring “fair and sustainable” Medicare and Medicaid reimbursement avenues, protecting patient choice and independence, and addressing workforce shortages to meet growing demand, according to the National Alliance for Care at Home.
“Secretary Kennedy has long emphasized the importance of patient-centered care and tackling chronic illness through innovative, community-based solutions,” Alliance CEO Dr. Steve Landers said in a recent statement. “Care in the home is essential for addressing the challenges of an aging population and the epidemic of chronic disease. We look forward to working with Secretary Kennedy and HHS to expand access to high quality healthcare at home for the millions of Americans who need it.”
Competing palliative priorities, concerns
Health care for chronically ill children is among the key priorities to address, Kennedy stated in a Senate Finance Committee hearing.
While still under the Biden administration, CMS late last year released guidelines intended to better support state-based pediatric reimbursement systems and help improve equitable health access among youth populations. The guidance included best practices for state Medicaid programs and CHIP programs to implement and comply with early and periodic screening, diagnostic and treatment (EPSDT) coverage requirements.
CMS also recently expanded tribal health care reimbursement options in state-based and pediatric programs, which the agency cited as intended to improve culturally appropriate care delivery. CMS approved coverage amendments that allow certain state Medicaid programs and CHIP programs to cover traditional health care practices provided by tribal and Indian Health Service (IHS) facilities and urban Indian organizations (UIO). Impacted Medicaid state programs included Arizona, California, New Mexico and Oregon.
Provisions like these will be instrumental in providing resources for seriously ill pediatric populations, Kennedy indicated. He pledged a drive to work closely with agencies and the Trump administration to determine how best to meet the needs of tribal communities in both the Medicaid and Medicare reimbursement landscapes.
“Children are, and will continue to be, a high priority population within the Medicaid program,” Kennedy said in the hearing. “States are well-positioned to determine the most appropriate ways to ensure access to the highest quality care for children. If confirmed, I will work to see that the [HHS] Department is a helpful resource to states by providing transparent and clear communication regarding the flexibility available to them, technical assistance, and support as needed. Every state is unique in their specific approach to the provision of services, and we stand ready to assist states as they develop strategies to meet their particular goals. These populations deserve better health outcomes and quality of care.”
Kennedy indicated that looming Medicaid budget cut considerations would be also on the forefront to address. A recently introduced Congressional budget proposed nearly $880 billion in Medicaid funding reductions that could compromise access to palliative care.
Ensuring the right balance of state public funding for home- and community-based care options for seniors and seriously ill populations will be important, according to Kennedy.
A range of industry stakeholders have expressed concerns over Kennedy’s HHS Secretary appointment. The most pressing issue facing palliative and health care providers hinges on the ability for reimbursement programs to strengthen support for their services, according to David Lipschutz, codirector of law and policy at the Center for Medicare Advocacy.
“Mr. Kennedy’s lack of knowledge about Medicare and Medicaid make it more likely that he will rely on and defer to others to oversee the programs, including the incoming Administrator of the U.S. Centers for Medicare & Medicaid Services (CMS),” Lipschutz said in a statement. “With Mr. Kennedy’s confirmation, along with that of a Project 2025 ‘architect’ to lead the White House Office of Management and Budget, the stakes just got higher.”
Ensuring affordable access for seriously ill patients will take better management of chronic disease treatments and services, according to Kennedy. The HHS Secretary in the Senate hearing cited a focus on expanding public health initiatives related to rare diseases including efforts to better understand the trajectories of illnesses such as sickle cell disease, among others.
Developing new technologies and treatments that provide greater support for seriously ill populations is also on the horizon, Kennedy indicated. HHS’ Cell and Gene Therapy Access Model will play a key role in testing outcome-based payment arrangements for sickle cell and gene therapies. Payments will be tied to whether the therapy or treatment improves the health of the Medicaid beneficiary receiving it, Kennedy said during the hearing.
A large concern among seriously ill patients and their families is that new health care payment policies and competing regulatory priorities could impact their ability to make goal-concordant decisions about their care, according to Dr. Angela Chaudhari, obstetrician-gynecologist and associate professor at Northwestern University’s Feinberg School of Medicine.
“My biggest concern is for the long-term well-being of patients around the country — that people will make decisions that have a lifelong impact for themselves, and their families based on the rhetoric that has come out of this most recent election and the concern that this change will impact federal law,” Chaudhari told local news.
