04 Jun MEDICAID NEWS RECAP – MAY 2025
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 relates 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.
Allocating CBO’s Estimates of Federal Medicaid Spending Reductions and Enrollment Loss Across the States KFF, May 30
On May 22, the House passed a reconciliation bill, the One Big Beautiful Bill Act. The Congressional Budget Office’s (CBO) latest cost estimate shows that the bill would reduce federal Medicaid spending by $723 billion and that the Medicaid provisions would increase the number of uninsured people by 7.6 million. Earlier CBO estimates show that 10.3 million fewer people would be enrolled in Medicaid. read more
On May 22, the House passed a reconciliation bill, the One Big Beautiful Bill Act. The Congressional Budget Office’s (CBO) latest cost estimate shows that the bill would reduce federal Medicaid spending by $723 billion and that the Medicaid provisions would increase the number of uninsured people by 7.6 million. Earlier CBO estimates show that 10.3 million fewer people would be enrolled in Medicaid. read more
Syrtis Solutions, May 29
With the passing of the Trump administration’s spending bill in the House, Medicaid is at the center of the healthcare policy conversation. The program now consumes roughly one-third of most state budgets, placing enormous strain on state finances. Medicaid expansion and pandemic-era policies have driven enrollment to record highs, and with that, the cost of maintaining the program has surged. read more
With the passing of the Trump administration’s spending bill in the House, Medicaid is at the center of the healthcare policy conversation. The program now consumes roughly one-third of most state budgets, placing enormous strain on state finances. Medicaid expansion and pandemic-era policies have driven enrollment to record highs, and with that, the cost of maintaining the program has surged. read more
A bill to rein in Medicaid fraud could push out eligible Louisianans, critics warn
Louisiana Illuminator, May 27
A bill aimed at strengthening oversight of Louisiana’s Medicaid program unanimously passed the state’s senate Tuesday. Senate Bill 130, sponsored by Sen. Heather Cloud, R-Turkey Creek, seeks to implement a series of data-driven checks and technological tools to ensure that only eligible residents receive Medicaid benefits. The bill requires the Louisiana Department of Health (LDH) to conduct regular cross-checks with state and federal agencies, including the Department of Revenue and Social Security Administration. read more
Louisiana Illuminator, May 27
A bill aimed at strengthening oversight of Louisiana’s Medicaid program unanimously passed the state’s senate Tuesday. Senate Bill 130, sponsored by Sen. Heather Cloud, R-Turkey Creek, seeks to implement a series of data-driven checks and technological tools to ensure that only eligible residents receive Medicaid benefits. The bill requires the Louisiana Department of Health (LDH) to conduct regular cross-checks with state and federal agencies, including the Department of Revenue and Social Security Administration. read more
When Medicaid Cost Cutting Is Simply Cost Shifting
MedCityNews, May 27
With the “big, beautiful bill” to advance President Trump’s America First agenda passed by the U.S. House of Representatives on May 22nd, all eyes are on members of the U.S. Senate as they weigh in with their own ideas about what should be in the legislation. We can expect Medicaid cuts – passed to partially offset the revenue loss from tax deductions and higher spending for defense and border security — will continue to be a hotly contested issue. read more
MedCityNews, May 27
With the “big, beautiful bill” to advance President Trump’s America First agenda passed by the U.S. House of Representatives on May 22nd, all eyes are on members of the U.S. Senate as they weigh in with their own ideas about what should be in the legislation. We can expect Medicaid cuts – passed to partially offset the revenue loss from tax deductions and higher spending for defense and border security — will continue to be a hotly contested issue. read more
Health Provisions in the 2025 Federal Budget Reconciliation Bill
KFF, May 22
On May 22, the House passed a budget reconciliation bill that includes significant changes to the Medicaid program and the Affordable Care Act, as well as additional provisions related to Medicare and Health Savings Accounts. This resource summarizes the relevant sections of the House-passed bill and compares the changes to current law. It reflects the final changes to the House Rules Committee Print released on May 19 version. read more
KFF, May 22
On May 22, the House passed a budget reconciliation bill that includes significant changes to the Medicaid program and the Affordable Care Act, as well as additional provisions related to Medicare and Health Savings Accounts. This resource summarizes the relevant sections of the House-passed bill and compares the changes to current law. It reflects the final changes to the House Rules Committee Print released on May 19 version. read more
New Medicaid policy lab brings data to the debate
WashU, May 20
As Congress considers $715 billion in cuts to Medicaid over the next decade, a new resource from Washington University in St. Louis is helping ground the national debate in facts. Launched earlier this year, the Medicaid Policy Analysis Lab has begun releasing a series of timely policy briefs showing how policy decisions hit home — especially in Missouri, where Medicaid enrollment is among the highest in the nation. read more
WashU, May 20
As Congress considers $715 billion in cuts to Medicaid over the next decade, a new resource from Washington University in St. Louis is helping ground the national debate in facts. Launched earlier this year, the Medicaid Policy Analysis Lab has begun releasing a series of timely policy briefs showing how policy decisions hit home — especially in Missouri, where Medicaid enrollment is among the highest in the nation. read more
Medicaid State Fact Sheets KFF, May 20
Medicaid provides health and long-term care coverage to 83 million low-income children and adults in the United States. Medicaid is administered by states within broad federal rules and jointly funded by states and the federal government through a federal matching program. Because states have some flexibility to determine which populations and services to cover, how to deliver care and how much to reimburse providers, there is variation across states in program spending and the share of residents covered by the program. read more
Medicaid provides health and long-term care coverage to 83 million low-income children and adults in the United States. Medicaid is administered by states within broad federal rules and jointly funded by states and the federal government through a federal matching program. Because states have some flexibility to determine which populations and services to cover, how to deliver care and how much to reimburse providers, there is variation across states in program spending and the share of residents covered by the program. read more
How Will the 2025 Budget Reconciliation Affect the ACA, Medicaid, and the Uninsured Rate? KFF, May 13
Congressional Republicans are considering a budget reconciliation package that would make significant changes to Medicaid and the Affordable Care Act (ACA). For example, the Energy and Commerce Committee released legislative text that includes work and reporting requirements for certain Medicaid enrollees and codifying changes in a recent Trump Administration proposed rule on the ACA Marketplaces, among other policy changes. read more
Congressional Republicans are considering a budget reconciliation package that would make significant changes to Medicaid and the Affordable Care Act (ACA). For example, the Energy and Commerce Committee released legislative text that includes work and reporting requirements for certain Medicaid enrollees and codifying changes in a recent Trump Administration proposed rule on the ACA Marketplaces, among other policy changes. read more
Status of State Medicaid Expansion Decisions
KFF, May 9
The Affordable Care Act’s (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($21,597 for an individual in 2025) and provided states with an enhanced federal matching rate (FMAP) for their expansion populations. To date, 41 states (including DC) have adopted the Medicaid expansion and 10 states have not adopted the expansion. read more
KFF, May 9
The Affordable Care Act’s (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($21,597 for an individual in 2025) and provided states with an enhanced federal matching rate (FMAP) for their expansion populations. To date, 41 states (including DC) have adopted the Medicaid expansion and 10 states have not adopted the expansion. read more
Medicaid Cost Savings Could Include Lower Drug Prices Via Most Favored Nation Model Forbes, May 8
As Republican lawmakers try to identify ways to cut costs in public programs such as Medicaid, they’re finding it harder to achieve than perhaps originally envisaged. Acceptable options for Republicans include adding work requirements and rooting out waste, fraud and abuse. But to achieve planned cuts of $88 billion annually, they’ll need to go further. Politico reported last week that the White House and Republican lawmakers may attempt to meet Medicaid savings targets in the budget reconciliation bill by linking the prices the program pays for prescription drugs to international benchmarks. read more
As Republican lawmakers try to identify ways to cut costs in public programs such as Medicaid, they’re finding it harder to achieve than perhaps originally envisaged. Acceptable options for Republicans include adding work requirements and rooting out waste, fraud and abuse. But to achieve planned cuts of $88 billion annually, they’ll need to go further. Politico reported last week that the White House and Republican lawmakers may attempt to meet Medicaid savings targets in the budget reconciliation bill by linking the prices the program pays for prescription drugs to international benchmarks. read more
Maryland Department of Health tries wrangling millions of dollars in questionable Medicaid claims 2abc WMAR, May 6
A newly released legislative audit suggests the Maryland Department of Health is attempting to correct its mishandling of millions in questionable Medicaid claims. This comes as a follow-up to an initial audit back in November 2023. That audit revealed many Maryland recipients that already got Medicaid benefits in other states. Some didn’t even have complete social security numbers, yet their claims were still processed. read more
A newly released legislative audit suggests the Maryland Department of Health is attempting to correct its mishandling of millions in questionable Medicaid claims. This comes as a follow-up to an initial audit back in November 2023. That audit revealed many Maryland recipients that already got Medicaid benefits in other states. Some didn’t even have complete social security numbers, yet their claims were still processed. read more
The Current, May 3
The future oversight over Georgia’s multi-billion-dollar Medicaid program is in limbo as companies battle over new management contracts after a lengthy bidding process. The medical safety net covered 2.5 million children, pregnant woman, low-income adults, seniors and people with disabilities in Georgia last year. The program totals $17 billion, with $5 billion from the state and the rest mostly from the federal government. The total is slated to rise to nearly $18 billion next year in the budget that lawmakers sent to Gov. Brian Kemp last month.
The future oversight over Georgia’s multi-billion-dollar Medicaid program is in limbo as companies battle over new management contracts after a lengthy bidding process. The medical safety net covered 2.5 million children, pregnant woman, low-income adults, seniors and people with disabilities in Georgia last year. The program totals $17 billion, with $5 billion from the state and the rest mostly from the federal government. The total is slated to rise to nearly $18 billion next year in the budget that lawmakers sent to Gov. Brian Kemp last month.
Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State KFF, May 2
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
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