Syrtis Solutions publishes a monthly Medicaid news summary to help healthcare leaders stay informed. Each edition highlights key developments, research, and legislation related to Medicaid program integrity, cost avoidance, coordination of benefits, improper payments, and fraud, waste, and abuse. Below is a recap of last month’s Medicaid news.
May 2026: Medicaid and CHIP Eligibility Operations and Enrollment Snapshot CMS, August 28
To promote transparency and provide insights into states’ Medicaid and Children’s Health Insurance Program (CHIP) eligibility operations and enrollment, this Snapshot captures state reporting of Performance Indicator Data, Eligibility Processing Data,1 and Transformed Medicaid Statistical Information System (T-MSIS) data focusing on: • Medicaid and CHIP enrollment; • Total applications submitted to Medicaid, CHIP, Human Services agencies, and State-based Marketplaces; • Modified adjusted gross income (MAGI) application processing times; read more
To promote transparency and provide insights into states’ Medicaid and Children’s Health Insurance Program (CHIP) eligibility operations and enrollment, this Snapshot captures state reporting of Performance Indicator Data, Eligibility Processing Data,1 and Transformed Medicaid Statistical Information System (T-MSIS) data focusing on: • Medicaid and CHIP enrollment; • Total applications submitted to Medicaid, CHIP, Human Services agencies, and State-based Marketplaces; • Modified adjusted gross income (MAGI) application processing times; read more
HHS OIG REPORT UNDERSCORES CONTINUED MEDICAID PAYMENT INTEGRITY CHALLENGES
Syrtis Solutions, August 28
Medicaid payment integrity remains a significant challenge as federal oversight continues to focus on reducing improper payments and improving payment accuracy. An August 2026 report from the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) found that HHS did not fully comply with federal improper payment requirements for fiscal year 2025, highlighting the continued need for stronger controls across the Medicaid program. read more
Syrtis Solutions, August 28
Medicaid payment integrity remains a significant challenge as federal oversight continues to focus on reducing improper payments and improving payment accuracy. An August 2026 report from the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) found that HHS did not fully comply with federal improper payment requirements for fiscal year 2025, highlighting the continued need for stronger controls across the Medicaid program. read more
Medicaid/CHIP Monthly Enrollment Tracker
KFF, August 26
This tracker presents the most recent data on monthly Medicaid and Children’s Health Insurance Program (CHIP) enrollment reported by the Centers for Medicare & Medicaid Services (CMS) as part of the Performance Indicator Project. It includes data for Medicaid and CHIP and reports enrollment data for children and adults. The data are generally the most recent data available and are useful for reporting trends in Medicaid enrollment.
read more
KFF, August 26
This tracker presents the most recent data on monthly Medicaid and Children’s Health Insurance Program (CHIP) enrollment reported by the Centers for Medicare & Medicaid Services (CMS) as part of the Performance Indicator Project. It includes data for Medicaid and CHIP and reports enrollment data for children and adults. The data are generally the most recent data available and are useful for reporting trends in Medicaid enrollment.
read more
A New Federal Rule Could Rein in State Medicaid Innovation
Governing, August 18
About 200,000 low-income Arkansans could see major changes to their health coverage next year after the Trump administration recently informed state officials it will not renew a key Medicaid agreement with the federal government. The decision by federal officials, citing authority granted under President Donald Trump’s signature tax-and-spending law, suggests the GOP-led state’s predicament could foretell other repercussions in how states are allowed to run the program under federal waivers. read more
Governing, August 18
About 200,000 low-income Arkansans could see major changes to their health coverage next year after the Trump administration recently informed state officials it will not renew a key Medicaid agreement with the federal government. The decision by federal officials, citing authority granted under President Donald Trump’s signature tax-and-spending law, suggests the GOP-led state’s predicament could foretell other repercussions in how states are allowed to run the program under federal waivers. read more
MDHHS Accepting Comments on Medicaid Health Plan Common Formulary MSMS, August 18
The Michigan Department of Health and Human Services (MDHHS) is soliciting comments from the public on the Michigan Medicaid Health Plan Common Formulary. The Common Formulary applies to pharmacy claims paid by Medicaid Managed Care Organizations – it will not apply to claims paid through Fee-for-Service. The public may submit comments on the drugs included or not included on the Common Formulary, new drug products, prior authorization criteria, step therapy criteria and other topics related to drug coverage under the Common Formulary. read more
The Michigan Department of Health and Human Services (MDHHS) is soliciting comments from the public on the Michigan Medicaid Health Plan Common Formulary. The Common Formulary applies to pharmacy claims paid by Medicaid Managed Care Organizations – it will not apply to claims paid through Fee-for-Service. The public may submit comments on the drugs included or not included on the Common Formulary, new drug products, prior authorization criteria, step therapy criteria and other topics related to drug coverage under the Common Formulary. read more
New Jersey Calls on CMS to Simplify Medicaid Community Engagement Requirements to Protect Health Coverage
New Jersey Human Services, August 17
The New Jersey Department of Human Services has submitted comments to the Centers for Medicare & Medicaid Services (CMS) urging changes to the federal interim final rule implementing new Medicaid community engagement requirements imposed under H.R. 1. The Department’s comments identify significant operational and administrative challenges that could unnecessarily jeopardize health coverage for eligible New Jerseyans and create substantial implementation burdens for states. read more
New Jersey Human Services, August 17
The New Jersey Department of Human Services has submitted comments to the Centers for Medicare & Medicaid Services (CMS) urging changes to the federal interim final rule implementing new Medicaid community engagement requirements imposed under H.R. 1. The Department’s comments identify significant operational and administrative challenges that could unnecessarily jeopardize health coverage for eligible New Jerseyans and create substantial implementation burdens for states. read more
Colorado Department of Health Care Policy & Financing Deploys New AI-Enabled Technology to Strengthen Program Integrity
CO HCPF, August 17
The Colorado Department of Health Care Policy and Financing (HCPF) has received certification from the Centers for Medicare and Medicaid Service (CMS) on a new AI-enabled technology to enhance HCPF’s Program Integrity efforts to detect and combat fraud, waste and abuse (FWA) in Health First Colorado (Colorado’s Medicaid program). HCPF’s tool, the FWA Finder™ by Alivia, analyzes provider, member, claims, and financial data to identify outliers and anomalies across large data sets for potential fraud, waste or abuse. read more
CO HCPF, August 17
The Colorado Department of Health Care Policy and Financing (HCPF) has received certification from the Centers for Medicare and Medicaid Service (CMS) on a new AI-enabled technology to enhance HCPF’s Program Integrity efforts to detect and combat fraud, waste and abuse (FWA) in Health First Colorado (Colorado’s Medicaid program). HCPF’s tool, the FWA Finder™ by Alivia, analyzes provider, member, claims, and financial data to identify outliers and anomalies across large data sets for potential fraud, waste or abuse. read more
How states are preparing for Medicaid eligibility changes
Route Fifty, August 7
States have less than five months to comply with recent changes to Medicaid’s eligibility requirements that go into effect next year, and they’re turning to various policy and legislative initiatives to get the job done. On Jan. 1, 2027, Medicaid enrollment will look different for millions of Americans. Under President Donald Trump’s H.R. 1 and final interim rules issued by the Centers for Medicare and Medicaid Services in June, enrollees face more stringent work and community engagement requirements. read more
Route Fifty, August 7
States have less than five months to comply with recent changes to Medicaid’s eligibility requirements that go into effect next year, and they’re turning to various policy and legislative initiatives to get the job done. On Jan. 1, 2027, Medicaid enrollment will look different for millions of Americans. Under President Donald Trump’s H.R. 1 and final interim rules issued by the Centers for Medicare and Medicaid Services in June, enrollees face more stringent work and community engagement requirements. read more
New York State Department of Health Announces Improvements to Medicaid Provider Revalidation Process and New Digital Portal To Ensure Integrity and Accuracy of the State’s Medicaid Program New York State, August 4
The New York State Department of Health today announced the State has received approval from the Centers for Medicare and Medicaid Services (CMS) to implement a plan to improve Medicaid oversight and modernize New York’s provider enrollment and revalidation process. The plan includes an updated provider revalidation schedule and reflects Governor Hochul’s commitment to working with our federal partners to address waste, fraud and abuse and ensure program integrity. read more
The New York State Department of Health today announced the State has received approval from the Centers for Medicare and Medicaid Services (CMS) to implement a plan to improve Medicaid oversight and modernize New York’s provider enrollment and revalidation process. The plan includes an updated provider revalidation schedule and reflects Governor Hochul’s commitment to working with our federal partners to address waste, fraud and abuse and ensure program integrity. read more
Tracking Implementation of the 2025 Reconciliation Law: Medicaid Work Requirements
KFF, August 3
The 2025 reconciliation law, once called the “One Big Beautiful Bill,” signed by President Trump on July 4, 2025, requires 44 states (including DC) to condition Medicaid eligibility for adults in the Affordable Care Act (ACA) Medicaid expansion group and certain enrollees in 1115 waiver programs on meeting work requirements starting January 1, 2027. Currently, 41 states (including DC) have expanded their Medicaid programs under the ACA to nearly all adults with income up to 138% FPL ($21,597 for an individual in 2025). read more
KFF, August 3
The 2025 reconciliation law, once called the “One Big Beautiful Bill,” signed by President Trump on July 4, 2025, requires 44 states (including DC) to condition Medicaid eligibility for adults in the Affordable Care Act (ACA) Medicaid expansion group and certain enrollees in 1115 waiver programs on meeting work requirements starting January 1, 2027. Currently, 41 states (including DC) have expanded their Medicaid programs under the ACA to nearly all adults with income up to 138% FPL ($21,597 for an individual in 2025). read more
