13 Feb MEDICAID 2024 – A YEAR IN REVIEW
Syrtis Solutions publishes an annual Medicaid review to help you stay informed. The annual recap focuses on developments, research, and legislation that relates to Medicaid integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Here is a summary of significant Medicaid developments in 2022.
Syrtis Solutions, December 31
The reported government-wide improper payment rate of 3.97% in 2024 marks the lowest level in over a decade. But beneath the surface lies a complex reality that reveals systemic flaws in how improper payments are calculated and managed. These numbers, far from representing genuine progress, underscore the urgent need for meaningful reform and solutions. Calculating the Rate – Improper payment rates are often used as a headline metric to signal success or failure. read more
The reported government-wide improper payment rate of 3.97% in 2024 marks the lowest level in over a decade. But beneath the surface lies a complex reality that reveals systemic flaws in how improper payments are calculated and managed. These numbers, far from representing genuine progress, underscore the urgent need for meaningful reform and solutions. Calculating the Rate – Improper payment rates are often used as a headline metric to signal success or failure. read more
Syrtis Solutions, November 27
Improper payments and fraud remain persistent and costly challenges for Medicaid and other government-funded programs. The GAO defines improper payments as payments that should not have been made or that were made in an incorrect amount (including overpayments and underpayments) under statutory, contractual, administrative, or other legally applicable requirements. According to GAO estimates, the federal government loses between $233 billion and $521 billion annually to fraud alone. read more
Improper payments and fraud remain persistent and costly challenges for Medicaid and other government-funded programs. The GAO defines improper payments as payments that should not have been made or that were made in an incorrect amount (including overpayments and underpayments) under statutory, contractual, administrative, or other legally applicable requirements. According to GAO estimates, the federal government loses between $233 billion and $521 billion annually to fraud alone. read more
Pew, September 12
In fiscal year 2022, states spent 12.9 cents of every state-generated dollar on Medicaid for low-income Americans—2.7 cents less than the 15-year average. As was the case in fiscal 2021, surging tax revenue and a temporary increase in federal funding contributed to the decreased share. But the share of state revenue dedicated to Medicaid is likely to show a rise for fiscal 2023 and beyond as federal pandemic aid expires and spending pressures grow. read more
In fiscal year 2022, states spent 12.9 cents of every state-generated dollar on Medicaid for low-income Americans—2.7 cents less than the 15-year average. As was the case in fiscal 2021, surging tax revenue and a temporary increase in federal funding contributed to the decreased share. But the share of state revenue dedicated to Medicaid is likely to show a rise for fiscal 2023 and beyond as federal pandemic aid expires and spending pressures grow. read more
Syrtis Solutions, August 30
During the pandemic, Medicaid enrollment surged due to federal measures that required states to maintain coverage for individuals, even if they gained other insurance. This policy, implemented in March 2020, lasted three years and added over 23.3 million people to Medicaid, pushing the total number of beneficiaries to 95 million at its peak. Private insurers managing Medicaid plans greatly benefited from this influx, as roughly 75% of Medicaid enrollees were under their care. read more
During the pandemic, Medicaid enrollment surged due to federal measures that required states to maintain coverage for individuals, even if they gained other insurance. This policy, implemented in March 2020, lasted three years and added over 23.3 million people to Medicaid, pushing the total number of beneficiaries to 95 million at its peak. Private insurers managing Medicaid plans greatly benefited from this influx, as roughly 75% of Medicaid enrollees were under their care. read more
Syrtis Solutions, August 29
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 thresholds. In 1990, Medi-Cal served about one in eight Californians, with eligibility limited to specific low-income groups like children, parents or caretakers of dependent children, and people with disabilities. read more
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 thresholds. In 1990, Medi-Cal served about one in eight Californians, with eligibility limited to specific low-income groups like children, parents or caretakers of dependent children, and people with disabilities. read more
Syrtis Solutions, July 31
Proposition 35 is a proposed ballot measure in California that seeks to impose a permanent tax on managed care organizations (MCOs) that provide healthcare services to vulnerable populations. The ballot also outlines specific ways the tax revenue must be used. Context and Background – The proposal comes amid recent expansions to California’s Medicaid program, Medi-Cal. Lawmakers have broadened Medi-Cal eligibility to include individuals who meet income requirements, regardless of immigration status. read more
Proposition 35 is a proposed ballot measure in California that seeks to impose a permanent tax on managed care organizations (MCOs) that provide healthcare services to vulnerable populations. The ballot also outlines specific ways the tax revenue must be used. Context and Background – The proposal comes amid recent expansions to California’s Medicaid program, Medi-Cal. Lawmakers have broadened Medi-Cal eligibility to include individuals who meet income requirements, regardless of immigration status. read more
IMPROVING PAYMENT INTEGRITY AND REDUCING ABRASION
Syrtis Solutions, June 28
Payment integrity programs are designed to ensure accurate claims processing, adherence to contractual rates, and compliance with payment rules. These efforts are vital for maintaining the financial stability of healthcare systems and ensuring that patients receive proper care. However, they can create friction between payers and providers, stemming from disputes over claim denials, reduced reimbursements, and the administrative burden associated with claims adjudication. read more
Syrtis Solutions, June 28
Payment integrity programs are designed to ensure accurate claims processing, adherence to contractual rates, and compliance with payment rules. These efforts are vital for maintaining the financial stability of healthcare systems and ensuring that patients receive proper care. However, they can create friction between payers and providers, stemming from disputes over claim denials, reduced reimbursements, and the administrative burden associated with claims adjudication. read more
Projected total Medicaid enrollment from 2020 to 2027
Statista, May 22
Medicaid is an important public health insurance for individuals with a low income, those that are pregnant, disabled or are children. It was projected that by 2020 there would be approximately 76.7 million Medicaid enrollees. By 2027 that number is expected to increase to 82 million individuals covered. Medicaid in the focus – Medicaid has recently been in the news for several reasons. A proposed Medicaid expansion was announced with the implementation of the Affordable Care Act in 2010. read more
Statista, May 22
Medicaid is an important public health insurance for individuals with a low income, those that are pregnant, disabled or are children. It was projected that by 2020 there would be approximately 76.7 million Medicaid enrollees. By 2027 that number is expected to increase to 82 million individuals covered. Medicaid in the focus – Medicaid has recently been in the news for several reasons. A proposed Medicaid expansion was announced with the implementation of the Affordable Care Act in 2010. read more
IMPROPER PAYMENTS WEAKEN MEDICAID AND MEDICARE
Syrtis Solutions, April 29
America’s most vulnerable populations rely on Medicaid and Medicare for essential healthcare services. Unfortunately, these programs lose billions of dollars annually due to improper payments. Recently, the Subcommittee on Oversight and Investigations delved into this pressing issue in a pivotal hearing titled “Examining How Improper Payments Cost Taxpayers Billions and Weaken Medicare and Medicaid.” The findings shed light on the far-reaching consequences of these errors and underscored the urgent need for reform.
read more
Syrtis Solutions, April 29
America’s most vulnerable populations rely on Medicaid and Medicare for essential healthcare services. Unfortunately, these programs lose billions of dollars annually due to improper payments. Recently, the Subcommittee on Oversight and Investigations delved into this pressing issue in a pivotal hearing titled “Examining How Improper Payments Cost Taxpayers Billions and Weaken Medicare and Medicaid.” The findings shed light on the far-reaching consequences of these errors and underscored the urgent need for reform.
read more
Syrtis Solutions, March 29
A recent audit by the U.S. Government Accountability Office reveals that the federal government suffered a staggering loss of $236 billion in 2023 due to improper payments. Medicaid and Medicare alone accounted for 43% of these payments, with Medicaid’s improper payments reaching $50.3 billion. These findings underscore the urgent need to address improper payments, which often stem from eligibility errors and outdated data systems, not rampant fraud and abuse. read more
A recent audit by the U.S. Government Accountability Office reveals that the federal government suffered a staggering loss of $236 billion in 2023 due to improper payments. Medicaid and Medicare alone accounted for 43% of these payments, with Medicaid’s improper payments reaching $50.3 billion. These findings underscore the urgent need to address improper payments, which often stem from eligibility errors and outdated data systems, not rampant fraud and abuse. read more
Syrtis Solutions, February 26
Medicaid enrollment is being significantly impacted due to the expiration of the continuous enrollment condition authorized by the Families First Coronavirus Response Act. Since April, millions of individuals have been disenrolled from the program. Simultaneously, millions of others have either re-enrolled or enrolled in the program for the first time. State data indicates that approximately 9.5 million individuals have been removed from Medicaid since enrollment peaked last April. read more
Medicaid enrollment is being significantly impacted due to the expiration of the continuous enrollment condition authorized by the Families First Coronavirus Response Act. Since April, millions of individuals have been disenrolled from the program. Simultaneously, millions of others have either re-enrolled or enrolled in the program for the first time. State data indicates that approximately 9.5 million individuals have been removed from Medicaid since enrollment peaked last April. read more
KFF, January 30
Ten months into the unwinding of the Medicaid continuous enrollment provision, states are continuing to reverify the eligibility of the roughly 94 million enrollees in the program. KFF tracking shows that states have reported outcomes for roughly half of the people expected to undergo renewals during the unwinding period. This policy watch examines the latest data and key issues to watch during the next phase of the unwinding. read more
Ten months into the unwinding of the Medicaid continuous enrollment provision, states are continuing to reverify the eligibility of the roughly 94 million enrollees in the program. KFF tracking shows that states have reported outcomes for roughly half of the people expected to undergo renewals during the unwinding period. This policy watch examines the latest data and key issues to watch during the next phase of the unwinding. read more