Syrtis Solutions distributes a monthly Medicaid news summary to help you stay up-to-date. The monthly roundup focuses on developments, research, and legislation that relate to Medicaid program integrity, cost avoidance, coordination of benefits, improper payments, fraud, waste, and abuse. Below is a summary of last month’s Medicaid news.
Trump gives drugmakers 60 days to slash prescription drug prices NBC News, July 31
President Donald Trump sent letters to more than a dozen major drugmakers Thursday demanding that they lower the cost of prescription drugs in the U.S. within 60 days. In the letters — which Trump published on his social media platform Truth Social — the drugmakers were told to offer the “full portfolio” of their existing medications to Medicaid patients at the same prices paid abroad, also known as the “most favored nation” rule. read more
CMS FLAGS MILLIONS IN DUPLICATE COVERAGE: MEDICAID PLANS REQUIRE STRONGER TOOLS TO PREVENT WASTE
Syris Solutions LinkedIn, July 30
The Centers for Medicare & Medicaid Services (CMS) recently revealed that millions of individuals were dually enrolled in taxpayer-funded health programs in 2024, raising new concerns about overlapping coverage and underscoring the urgent need for improved data and technology to support Medicaid cost avoidance. Medicaid duplicate enrollment is costing the program valuable resources. read more
MHA Shares Recent Medicare and Medicaid Enrollment Analysis MHA, July 25
The MHA recently updated its analysis of Medicaid and Medicare enrollment based on June 2025 data. The analysis includes program enrollment as a percentage of each county’s total population and the split between fee-for-service and managed care organizations. More than 26% of Michigan’s total population is enrolled in Medicaid and 23% is enrolled in Medicare. read more
State retracts projected $500M impact of Trump budget bill on Medicaid program, citing carve-outs
Anchorage Daily News, July 22
The Alaska Department of Health on Monday projected that the state could see a reduction of up to $500 million in its annual $2.7 billion Medicaid budget because of the tax-and-spending law sought by President Donald Trump that includes massive cuts to social safety net programs. read more
State Waivers for Continuous Medicaid Eligibility to End Under CMS Guidance KFF, July 18
On Thursday, July 17, the Centers for Medicare and Medicaid Services (CMS) released guidance notifying states that it does not anticipate approving new state proposals or extending existing approvals for section 1115 waivers with continuous eligibility provisions for children and adults in Medicaid. Continuous eligibility generally allows individuals to remain enrolled for a specific period even if there are fluctuations in income. read more
Challenges Facing Managed Care Organizations under the Current Administration JDSupra, Mintz.com, July 18
Within the first six months of President Trump’s second term, his Administration and the GOP have already implemented significant policies that are reshaping health care in the United States. Through his Administration’s restructuring of the Department of Health and Human Services (HHS), promulgation of Marketplace Integrity and Affordability rules, sweeping RADV audit changes, and now the passage of the One Big Beautiful Bill Act (OBBA), entities throughout the health care industry—particularly managed care plans and sub-capitated providers—will need to readjust to the new paradigm. read more
Trump administration to end Medicaid waivers for continuous enrollment, workforce training
HealthcareDive, July 18
The waivers, called section 1115 demonstrations, allow states to shape the Medicaid program around their own priorities. Nearly all states have an active section 1115 waiver, while some states have multiple. Here, the CMS is targeting two types: those allowing continuous enrollment, which are currently in use in 17 states, and those using Medicaid funds for workforce initiatives, which are in five. read more
Medicaid Managed Care: Headwinds for the Big Five in the Budget Reconciliation Law
Georgetown University McCourt School of Public Policy, July 18
Early this week FitchRatings posted its take on the implications of the Budget Reconciliation Law (P.L. 119-21) for the “Big Five” insurers— Centene, CVSHealth/Aetna, Elevance Health, Molina Healthcare, and UnitedHealth Group—that together account for half of the Medicaid managed care market: U.S. health insurers managing coverage for state Medicaid programs will face revenue headwinds due to the One Big Beautiful Bill Act (OBBBA) that we expect to pressure earnings. read more
CMS Reinforces Medicaid and CHIP Integrity by Strengthening Eligibility Oversight and Limiting Certain Demonstration Authorities CMS.gov, July 17
The Centers for Medicare & Medicaid Services (CMS) is taking steps to restore accountability and safeguard the long-term integrity of Medicaid and the Children’s Health Insurance Program (CHIP). Through newly issued letters to states, CMS is emphasizing a clear shift away from policies that extend beyond statutory limits, specifically policies on continuous eligibility and workforce initiatives. read more
Thousands more could get Medicaid coverage under SC request for limited expansion South Carolina Daily Gazette, July 16
Thousands more people in South Carolina could get Medicaid coverage under a request from the state to expand the program to working low-income parents. While Gov. Henry McMaster wrote officials in January about the state’s impending request, the state’s Medicaid agency didn’t actually submit it until late last month, after gathering public comments and holding hearings. read more
Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State KFF, July 15
Section 1115 Medicaid demonstration waivers offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute, if [in the HHS Secretary’s view] the approach is likely to “promote the objectives of the Medicaid program.” They can provide states additional flexibility in how they operate their programs, beyond the considerable flexibility that is available under current law. read more
NY providers scrambling to avert $830M loss with managed care tax wind-down McKnights Long-Term Care News, July 15
New York nursing home advocates are pressing for a commitment from federal regulators to leave a managed care matching tax in place for at least two years. Late changes to the OBBBA budget bill signed into law July 4 mean that a tax on managed care organizations that brings hundreds of millions of dollars of funding to New York nursing homes is slated for extinction. read more
Medicaid, ACA enrollment expected to decrease under One Big Beautiful Bill Act Healthcare Finance, July 7
The American Hospital Association has called passage of the One Big Beautiful Bill Act “an extremely disappointing and very difficult day for healthcare in America.” President Donald Trump on Friday signed into law the One Big Beautiful Bill Act, meeting a self-imposed deadline of July 4. Congress has cut nearly a trillion dollars from Medicaid over a decade and has made enrollment in that program and in Affordable Care Act plans harder, according to AHA President and CEO Rick Pollack. read more
NM lawmakers presented with tough choices amid federal cuts to Medicaid, SNAP Source NM, July 2
A top budget adviser to New Mexico lawmakers Wednesday laid out the most detailed look he could muster on what the Senate budget reconciliation bill could mean for New Mexico, particularly when it comes to federal spending on health care and food aid here. Legislative Finance Committee Director Charles Sallee’s presentation was to a special state legislative committee grappling with expected federal cuts. read more
