Last year, there were multiple attempts to reform the Medicaid program. While efforts at the federal level met resistance, multiple reform initiatives took place at the state level. These measures included legislation, program expansion, demonstration waivers, eligibility restrictions, and work requirements. Some of these changes...
California’s newly elected governor; Gavin Newsom (D) has recently made a legislative step to address skyrocketing drug prices. Shortly after he was sworn in last week, Newsom signed an executive order making the state responsible for negotiating drug prices directly with pharmaceutical companies. In addition,...
The future of the Affordable Care Act (ACA) is in jeopardy after a federal district court judge ruled the law unconstitutional. On Friday, Judge Reed C. O’Connor (TX) sided with twenty Republican legislators and ruled the law unconstitutional after congress passed the December 2017 tax bill. Last years...
Medicare and Medicaid accounted for $40 billion dollars in improper payments last year and the Medicaid program has been on the GAO’s High Risk List since 2003 due to inadequate fiscal oversight. However, last month CMS announced that the agency achieved the lowest improper payment...
Medicaid expansion was an important issue in the 2018 midterm elections. Three states – Idaho, Nebraska, and Utah - successfully passed ballot initiatives to expand their Medicaid programs, while Kansas and Maine elected pro-expansion governors. As a result, almost 500,000 additional low-income citizens will be...
Of the $4 trillion spent by the government in 2017, nearly $141 billion were improper payments. These are payments made in error either to the wrong recipient, in the incorrect amount, or for a service that is not legitimate. Fraud, antiquated data systems, and methodologies...
Over the last year, there has been a wave of PBM and healthcare provider mega-mergers. These acquisitions have undergone intense review and the approvals suggest that government regulators are more comfortable with vertical integration as opposed to horizontal. Here is an overview of these mergers. CVS...
In August, the GAO submitted a report to Congress that focused on what CMS would need in order to better target risks and improve Medicaid oversight. The review determined that one of the critical problems the agency is facing is the failure to implement new...
In 2017, improper payments within the Medicaid program reached a total of $37 billion, according to CMS. That equals 10 percent of the federal dollars spent on the program. Moreover, 99.2 percent of the payments made were overpayments. To make matters worse, under the current...
Support for Medicaid expansion is on the rise as states approach general elections this fall. Advocates for expansion have been busy in recent months as they look to expand their programs by way of ballot initiatives. In May we reviewed a number of states considering...
