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.
26 states sue CMS over final Medicaid work requirements rule
Fierce Healthcare, June 30
A coalition of 26 states is suing the Trump administration over its rollout of Medicaid work requirements. In the lawsuit—jointly led by California Attorney General Rob Bonta, Massachusetts Attorney General Andrea Joy Campbell, and New Jersey Attorney General Jennifer Davenport—the states seek to challenge provisions in the Centers for Medicare & Medicaid Services’ recently-finalized rule establishing guardrails for the work requirements implementation. read more
Fierce Healthcare, June 30
A coalition of 26 states is suing the Trump administration over its rollout of Medicaid work requirements. In the lawsuit—jointly led by California Attorney General Rob Bonta, Massachusetts Attorney General Andrea Joy Campbell, and New Jersey Attorney General Jennifer Davenport—the states seek to challenge provisions in the Centers for Medicare & Medicaid Services’ recently-finalized rule establishing guardrails for the work requirements implementation. read more
SYRTIS SOLUTIONS AUTOMATED ALGORITHMIC ANALYSIS AND INSURANCE DISCOVERY ENGINE HAS BECOME ESSENTIAL TO MODERN MEDICAID OPERATIONS
Syrtis Solutions, June 29
Automated algorithmic analysis and insurance discovery engines (AAAIDE) are becoming cornerstones of modern Medicaid operations. By identifying liable third-party coverage at the point of claim adjudication, these technologies reduce improper payments, strengthen payment accuracy, and improve coordination of benefits. This priority is now reflected in state policy. On June 10, 2026, Ohio passed Senate Bill 315, which requires the Ohio Department of Medicaid to use automated algorithmic analysis and insurance discovery engines before making any Medicaid payment. read more
Syrtis Solutions, June 29
Automated algorithmic analysis and insurance discovery engines (AAAIDE) are becoming cornerstones of modern Medicaid operations. By identifying liable third-party coverage at the point of claim adjudication, these technologies reduce improper payments, strengthen payment accuracy, and improve coordination of benefits. This priority is now reflected in state policy. On June 10, 2026, Ohio passed Senate Bill 315, which requires the Ohio Department of Medicaid to use automated algorithmic analysis and insurance discovery engines before making any Medicaid payment. read more
Chairman Joyce Delivers Opening Statement at Subcommittee on Oversight and Investigations Hearing with State Medicaid Directors Energy & Commerce, June 25
Congressman John Joyce, M.D. (PA-13), Chairman of the Subcommittee on Oversight and Investigations, delivered the following opening statement at today’s hearing titled State Medicaid Program Integrity: Examining Fraud Risks and Oversight Deficiencies.“Good morning, and welcome to today’s hearing titled, State Medicaid Program Integrity: Examining Fraud Risks and Oversight Deficiencies. Today’s hearing will examine Medicaid program integrity in four states: Minnesota, California, New York, and Ohio. read more
Congressman John Joyce, M.D. (PA-13), Chairman of the Subcommittee on Oversight and Investigations, delivered the following opening statement at today’s hearing titled State Medicaid Program Integrity: Examining Fraud Risks and Oversight Deficiencies.“Good morning, and welcome to today’s hearing titled, State Medicaid Program Integrity: Examining Fraud Risks and Oversight Deficiencies. Today’s hearing will examine Medicaid program integrity in four states: Minnesota, California, New York, and Ohio. read more
Medicaid Program Integrity: Tracking State-Specific and Nationwide Federal Action KFF, June 25
The Trump Administration and Congress continue to focus on rooting out fraud, waste, and abuse in federal programs, including Medicaid. Those efforts include 50-state initiatives and targeted actions that focus on issues in specific states. Given the quickly evolving Medicaid program integrity landscape, this page tracks emerging developments in the federal government’s approach to program integrity in Medicaid, along with the implications of those actions for different states. read more
The Trump Administration and Congress continue to focus on rooting out fraud, waste, and abuse in federal programs, including Medicaid. Those efforts include 50-state initiatives and targeted actions that focus on issues in specific states. Given the quickly evolving Medicaid program integrity landscape, this page tracks emerging developments in the federal government’s approach to program integrity in Medicaid, along with the implications of those actions for different states. read more
Key Facts about the Uninsured Population
KFF, June 16
The high cost of private insurance and limited availability of public coverage for some individuals with low income—particularly in states that have not expanded Medicaid under the Affordable Care Act (ACA)—continued to leave millions of people without health coverage in 2024. Our fragmented and complex health insurance system also means some people fall through the cracks of coverage when they experience a change in circumstances. read more
KFF, June 16
The high cost of private insurance and limited availability of public coverage for some individuals with low income—particularly in states that have not expanded Medicaid under the Affordable Care Act (ACA)—continued to leave millions of people without health coverage in 2024. Our fragmented and complex health insurance system also means some people fall through the cracks of coverage when they experience a change in circumstances. read more
MACPAC recommends improvements to oversight of Medicaid managed care organizations
American Hospital Association, June 15
The Medicaid and CHIP Payment and Access Commission June 15 released its June 2026 report to Congress. Among the topics discussed, chapter two focuses on automation in Medicaid prior authorization and makes recommendations to improve oversight and increase disclosure and transparency of managed care plans’ use of automation in PA. The third chapter includes recommendations to improve managed care plan accountability. read more
American Hospital Association, June 15
The Medicaid and CHIP Payment and Access Commission June 15 released its June 2026 report to Congress. Among the topics discussed, chapter two focuses on automation in Medicaid prior authorization and makes recommendations to improve oversight and increase disclosure and transparency of managed care plans’ use of automation in PA. The third chapter includes recommendations to improve managed care plan accountability. read more
Final Rules for Medicaid Work Requirements Are Out. Here’s What You Need To Know. KFF, June 12
The Trump administration has issued final rules on how states should ensure that millions of Medicaid enrollees prove they’re working or completing other activities, such as job training, volunteering, or being enrolled in an educational program. The Centers for Medicare & Medicaid Services released the rules on June 1. That deadline was set last year in the GOP tax-and-spending law known as the One Big Beautiful Bill Act, which established a work requirement for certain people enrolled in Medicaid, the state-federal health insurance program for people with low incomes or disabilities. read more
The Trump administration has issued final rules on how states should ensure that millions of Medicaid enrollees prove they’re working or completing other activities, such as job training, volunteering, or being enrolled in an educational program. The Centers for Medicare & Medicaid Services released the rules on June 1. That deadline was set last year in the GOP tax-and-spending law known as the One Big Beautiful Bill Act, which established a work requirement for certain people enrolled in Medicaid, the state-federal health insurance program for people with low incomes or disabilities. read more
CMS increases oversight of state Medicaid demonstrations
HealthcareDive, June 12
Medicaid waivers, called section 1115 demonstrations, allow states more flexibility to experiment with care delivery in the safety-net insurance program. Almost every state uses a demonstration waiver, while some states have multiple active waivers. The waivers have allowed states like Alabama to provide family planning services to people whose Medicaid eligibility for pregnancy had ended and Colorado to provide specialized care to people with brain injuries. read more
HealthcareDive, June 12
Medicaid waivers, called section 1115 demonstrations, allow states more flexibility to experiment with care delivery in the safety-net insurance program. Almost every state uses a demonstration waiver, while some states have multiple active waivers. The waivers have allowed states like Alabama to provide family planning services to people whose Medicaid eligibility for pregnancy had ended and Colorado to provide specialized care to people with brain injuries. read more
House Passes Ohio Medicaid Program Integrity and Fraud Prevention Act The Ohio House of Representatives, June 10
State Representatives Mike Dovilla (R-Berea), Jennifer Gross (R-West Chester), Josh Williams (R-Sylvania Twp.) and Brian Stewart (R-Ashville) today announced the passage of a comprehensive legislative package aimed at fighting fraud, waste and abuse within Ohio’s Medicaid program with the united goal of protecting taxpayer dollars. The Ohio Medicaid Program Integrity and Fraud Prevention Act works to strengthen oversight and accountability within the system, ensure transparency, target high-risk providers to ensure quality care, boost fraud reporting requirements, implement guardrails around home-health services, and enhance penalties for Medicaid fraud. read more
State Representatives Mike Dovilla (R-Berea), Jennifer Gross (R-West Chester), Josh Williams (R-Sylvania Twp.) and Brian Stewart (R-Ashville) today announced the passage of a comprehensive legislative package aimed at fighting fraud, waste and abuse within Ohio’s Medicaid program with the united goal of protecting taxpayer dollars. The Ohio Medicaid Program Integrity and Fraud Prevention Act works to strengthen oversight and accountability within the system, ensure transparency, target high-risk providers to ensure quality care, boost fraud reporting requirements, implement guardrails around home-health services, and enhance penalties for Medicaid fraud. read more
What to Know About Recent Federal Actions Involving State Medicaid Program Integrity KFF, June 9
The Trump Administration continues its focus on rooting out fraud, waste, and abuse in federal programs, including Medicaid. In March 2026, President Trump issued an Executive Order establishing the Task Force to Eliminate Fraud, chaired by Vice President J.D. Vance. In May 2026, the Centers for Medicare and Medicaid Services (CMS) announced a six-month nationwide moratoria (or pause) on the enrollment of new Medicare hospice and home health agency providers. The Department of Health and Human Services (HHS) has also taken nationwide and state-specific action in the Medicaid program, including: read more
The Trump Administration continues its focus on rooting out fraud, waste, and abuse in federal programs, including Medicaid. In March 2026, President Trump issued an Executive Order establishing the Task Force to Eliminate Fraud, chaired by Vice President J.D. Vance. In May 2026, the Centers for Medicare and Medicaid Services (CMS) announced a six-month nationwide moratoria (or pause) on the enrollment of new Medicare hospice and home health agency providers. The Department of Health and Human Services (HHS) has also taken nationwide and state-specific action in the Medicaid program, including: read more
High Improper Payment Rates Are Persistent at Some Agencies, Says GAO FEDweek, June 8
In the latest in a series of reports on improper payments by federal agencies the GAO has stressed that high rates are persistent in some agencies, recommending that OMB clarify its guidance to agencies on how to report annual information and that agencies improve their procedures for reporting. A report said that over fiscal years 2021-2024, agencies with improper payment rates above 10 percent each year included Agriculture, Labor, Treasury and VA, with HHS and the Corporation for National and Community Service above that level in three of the years and the Education Department for two. read more
In the latest in a series of reports on improper payments by federal agencies the GAO has stressed that high rates are persistent in some agencies, recommending that OMB clarify its guidance to agencies on how to report annual information and that agencies improve their procedures for reporting. A report said that over fiscal years 2021-2024, agencies with improper payment rates above 10 percent each year included Agriculture, Labor, Treasury and VA, with HHS and the Corporation for National and Community Service above that level in three of the years and the Education Department for two. read more
Trump’s Medicaid Work Rules Force States To Scrap Plans and Rework Systems KFF Health News, June 3
The Trump administration’s rollout of a federal mandate that millions of Americans on Medicaid must work or risk losing health benefits will force states to scrap months of preparation, according to advocates for Medicaid enrollees and consultants advising states. And they say an overhaul — less than seven months before states must start enforcing the requirement — will be costly. Regulations issued June 1 by the Centers for Medicare & Medicaid Services dictate many granular details about how the new work requirements will play out. read more
The Trump administration’s rollout of a federal mandate that millions of Americans on Medicaid must work or risk losing health benefits will force states to scrap months of preparation, according to advocates for Medicaid enrollees and consultants advising states. And they say an overhaul — less than seven months before states must start enforcing the requirement — will be costly. Regulations issued June 1 by the Centers for Medicare & Medicaid Services dictate many granular details about how the new work requirements will play out. read more
CMS releases Medicaid work requirements guidance for states
HealthcareDive, June 1
The Trump administration on Monday released long-awaited Medicaid work requirements guidance for states, finalizing a rule that will affect healthcare access for millions of Americans — and create a roadmap for the beleagured state officials looking to operationalize Congress’ bedrock changes to the safety-net insurance program. The CMS’ new interim final rule includes key definitions and standards that states have been waiting for, just seven months ahead of the deadline for Medicaid work requirements to go into effect. read more
HealthcareDive, June 1
The Trump administration on Monday released long-awaited Medicaid work requirements guidance for states, finalizing a rule that will affect healthcare access for millions of Americans — and create a roadmap for the beleagured state officials looking to operationalize Congress’ bedrock changes to the safety-net insurance program. The CMS’ new interim final rule includes key definitions and standards that states have been waiting for, just seven months ahead of the deadline for Medicaid work requirements to go into effect. read more
