Over the past three decades, Medi-Cal, California’s Medicaid program, has undergone significant changes and expansion. By 2016, the program provided coverage to more than one in three Californians, and as of January 2024, eligibility has been expanded to include all residents with incomes below certain...
In January 2020, DHHS declared the Coronavirus a public health emergency. Since then, the Public Health Emergency (PHE) has been renewed nine times, but it is set to expire this August unless it is extended again. Its expiration will have a significant impact on Medicaid,...
Since its passage in 1965, the Medicaid program has expanded to become the single largest payer for health care in the United States, costing $671.2 billion in 2020. Due to surges in enrollment from the pandemic and the current administration's priorities, spending is only expected to...
Under the Payment Integrity Information Act of 2019, the Centers for Medicare & Medicaid Services (CMS) was required to review federal programs at risk of improper payments. The bill tasked CMS to assess what programs are at risk, estimate the number of improper payments, and report...
Dependence on the Medicaid program has increased exponentially over time. Currently, it is the single largest insurer in the United States, and in FY 2019, it accounted for more than half of all federal funds distributed to states. Unfortunately, as the safety net program has...
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,...
Wisconsin Pharmacy Carve-Out Last year, the Wisconsin Department of Health Services carved out prescription drugs from the Family Care Partnership Program and transitioned to a Fee-for-Service (FFS) delivery model. The carve-out ensured compliance with the 2020 Medicaid and CHIP Managed Care Final Rule and eliminated the...
Medicaid payers of last resort face the challenging task of recovering claims payments made in error when program beneficiaries fail to report primary coverage information at the time services are provided. Plan members do not share other coverage information for a multitude of reasons, but...
Improper payments, fraud, and waste cost the Medicaid program billions of dollars every year. In 2020 alone, Medicaid improper payments reached $86.49 billion. These payments account for more than twenty percent of federal Medicaid expenditures, and one out of every four Medicaid dollars is spent...
The Coronavirus pandemic and the consequential economic recession accentuated the importance of the Medicaid program last year. By February, the Medicaid enrollment rate increased to 7.4 percent, and 76.5 million people were enrolled in the jointly funded program. In 2021, the new administration, economy, and...