MEDICAID NEWS RECAP – AUGUST 2021

Over the last 56 years, Medicaid has helped provide health services to the most vulnerable populations in the United States. As member enrollment surges, Medicaid TPL and fiscal responsibility have been problematic. To resolve these issues, several legislative efforts have occurred to curb fraud, waste, and abuse. Unfortunately, these measures have done little to protect program integrity and Medicaid’s improper payment rate continues to climb. The federal government’s initiatives to combat improper claims payments and improve TPL processes fall into three categories: assessing the risk of fraud, estimating the impact of TPL, requiring more reporting, and data sharing.  read more

Some Montana Medicaid recipients are pushing back against plans to end 12-month continuous coverage for certain people enrolled in public health insurance programs as the state’s public comment period on the new policy draws to a close. If successful, the change would likely alter two Medicaid programs in Montana in significant ways, both for enrollees who rely on the state for health care coverage and for officials tasked with operating the new system.  read more

Ohio pushed back its projected launch date of its revamped and reformed Medicaid managed care system to July 1 of next year,  the Ohio Department of Medicaid announced Wednesday. The initial timeline set the launch of the long-awaited system in January. “Our priority since the beginning of this administration has been on doing this right for the people we serve,” said Ohio Medicaid Director Maureen Corcoran.  read more

The New York Department of Health paid out more than $1.5 billion in improper Medicaid payments due to a billing system error. Reports by State Comptroller Thomas DiNapoli found a number of claims were paid without an appropriate National Provider Identifier. That number ensures the provider is properly qualified. DiNapoli said the e-Med-NY system that processes Medicaid claims is to blame. State auditors found $57 million dollars in payments for pharmacy claims that did not contain an appropriate prescriber number.  read more

A federal judge on Friday issued a ruling that keeps in place Texas’ Medicaid agreement, blocking an effort by the Biden administration to rescind it. Texas is one of only 12 states that have resisted expanding Medicaid coverage under a key provision of former President Barack Obama’s health care law. Instead, state Republican leaders negotiated waivers to provide billions of federal dollars in reimbursements to hospitals that serve the uninsured. Texas has the nation’s most uninsured residents.  read more

Errors in the state Department of Health (DOH) billing system cost the state more than $1.5 billion in improper Medicaid payments over severals years and exposed patients to underqualified health care providers, according to three reports released Tuesday by State Comptroller Thomas P. DiNapoli. “Troubling errors like the ones routinely identified by my auditors are extremely costly. They can also put patients at risk,” DiNapoli said.  read more

In a letter Friday, CMS said it is giving states a full year after the covid-19 public health emergency ends to finish redetermining eligibility for Medicaid beneficiaries. Also, CMS is so far refraining from penalizing providers who haven’t adjusted their price transparency rules, Bloomberg Law reports. Modern Healthcare: States Get Deadline Extension To Confirm Medicaid Enrollee Eligibility – CMS is now giving states a full year after the COVID-19 public health emergency ends to finish redetermining eligibility for Medicaid beneficiaries.  read more

Missouri is ready to start accepting applications for the close to a quarter-million residents who qualify for coverage under the expansion of Medicaid. A special enrollment session for government-assisted health care ends Aug. 15. Those wanting to enroll can go to healthcare.gov. Those who apply will get approved in October. In the last session, Missouri legislators did not approve monetary appropriations for the expansion, but the Missouri Supreme Court ruled that the measure, which was approved by voters, would need to be funded.  read more

The federal Centers for Medicare & Medicaid Services late Monday withdrew approval of a work requirement Ohio wanted to implement to determine Medicaid eligibility. It’s a step back for the Ohio Department of Medicaid and the state’s conservative politicians, who say such requirements are necessary for the governmental health insurance covering around 3 million low-income and disabled Ohioans.  read more

A Missouri judge on Tuesday ruled that Republican Gov. Mike Parson no longer can deny Medicaid health care to thousands more newly eligible adults. Cole County Judge Jon Beetem in his order said Parson’s administration must give Medicaid coverage to newly eligible adults, despite the governor’s resistance to doing so. Beetem also ordered that newly eligible adults won’t face any additional restrictions to get health care coverage through the program.  

Nearly 20 Senate Democrats reintroduced legislation Friday to create a new Medicaid-based public option, reinforcing their commitment to a key priority. But the legislation isn’t certain to become law, as it has not been added to a $3.5 trillion infrastructure package that includes other reforms on drug pricing and expanding Medicare benefits. Nevertheless, the legislation underscores the commitment among the chamber’s Democrats to the issue that also has gotten support from President Joe Biden.  read more

Federal health officials will likely reject Montana’s request to include work requirements for beneficiaries of its Medicaid expansion program, which insures 100,000 low-income Montana adults, state officials said.Federal health officials will likely reject Montana’s request to include work requirements for beneficiaries of its Medicaid expansion program, which insures 100,000 low-income Montana adults, state officials said.  read more

Louisiana’s government auditing agency cited the Department of Health for the single largest amount of waste in the watchdog’s recently released fourth-quarter report for fiscal year 2021. The Louisiana Legislative Auditor is tasked with identifying taxpayer-funded waste, fraud and abuse across state and local government agencies. It’s required to relay findings of $150,000 or more to the legislature’s Joint Legislative Committee on the Budget, composed of bipartisan members from both the House and Senate.  read more

With the economic impact of the COVID-19 Pandemic and provisions in the Families First Coronavirus Response Act (FFCRA), Medicaid enrollment grew substantially from December 2019 to 2020. Total Medicaid and Children’s Health Insurance Program (CHIP) enrollment was over 80 million as of December 2020 according to the Centers for Medicare & Medicaid Services (CMS) Monthly Medicaid & CHIP Application, Eligibility Determination, and Enrollment Reports & Data.  read more

More than 150,000 Oklahomans have qualified for Medicaid under an expansion of the program approved by voters, and state health officials say they suspect many more Oklahomans are eligible but haven’t yet applied. The Oklahoma Health Care Authority reported Monday that 154,316 Oklahomans have qualified for the additional health benefits. Of those, nearly 91,000 live in urban areas and about 63,000 in rural Oklahoma.  read more