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

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

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,

Medicaid is the single largest payer of health care in the United States. As the program has grown in size and scope, it has struggled with fraud, waste, abuse, and improper payments. Over the years, there have been a number

The Medicaid Managed Care Final Rule, CMS-2408-F, was finalized this November. The new rule implements proposals from the Notice of Proposed Rule Making from last year. Provisions from the rule will begin taking effect as early as December 14, 2020.  

Data from the federal government indicates that more than 4 million people enrolled in the Medicaid program this spring due to the pandemic driven economic downturn. The 5.7% spike came after the surge in unemployment and the loss of corresponding

In addition to the pandemic driven economic downturn and the consequential surge in Medicaid enrollment, rising prescription drug costs in the Medicaid program have caused tremendous fiscal pressure on state budgets over the years. In 2017, pharmaceuticals accounted for 5.1 percent of Medicaid

The Coronavirus pandemic has had a devastating impact on the nation’s economy. As of June, the U.S. Bureau of Labor Statistics reported that the national unemployment rate reached 11.1 percent which translates to 17.8 million unemployed people. Many Americans that

Medicaid has been designated as a high-risk government program by the GAO since 2003. The Medicaid program has struggled over the past seventeen years due to poor fiscal oversight and other administrative issues. These challenges will be exasperated as the

Improper payments in the Medicaid universe are payments full or partial claims payments paid in error or payments made to the wrong party. Improper payments have been a major problem for Medicaid in recent years and have cost the program's valuable resources.  Across