Syrtis Solutions publishes an annual Medicaid review to help you stay informed. The annual recap focuses on developments, research, and legislation that relate 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 2025.
CMS Announces $50 Billion in Awards to Strengthen Rural Health in All 50 States
U.S. Department of Health and Human Services, December 29
The Centers for Medicare & Medicaid Services (CMS) today announced that all 50 states will receive awards under the Rural Health Transformation Program, a $50 billion initiative established under President Trump’s Working Families Tax Cuts legislation (Public Law 119-21) to strengthen and modernize health care in rural communities across the country. In 2026, states will receive first-year awards from CMS averaging $200 million within a range of $147 million to $281 million. read more
U.S. Department of Health and Human Services, December 29
The Centers for Medicare & Medicaid Services (CMS) today announced that all 50 states will receive awards under the Rural Health Transformation Program, a $50 billion initiative established under President Trump’s Working Families Tax Cuts legislation (Public Law 119-21) to strengthen and modernize health care in rural communities across the country. In 2026, states will receive first-year awards from CMS averaging $200 million within a range of $147 million to $281 million. read more
MEDICAID IMPROPER PAYMENTS & UNKNOWN COMMERCIAL COVERAGE: THE BUDGET CRISIS STATES ARE FACING
Syrtis Solutions, November 30
In 2024, Medicaid improper payments surged to $31.1 billion, placing enormous pressure on state budgets and threatening the program’s stability. A disproportionate share of these losses came from claims Medicaid should never have paid in the first place—claims that were the responsibility of commercial insurers. At any given time, roughly 1 in 10 Medicaid beneficiaries have unreported commercial coverage. read more
Syrtis Solutions, November 30
In 2024, Medicaid improper payments surged to $31.1 billion, placing enormous pressure on state budgets and threatening the program’s stability. A disproportionate share of these losses came from claims Medicaid should never have paid in the first place—claims that were the responsibility of commercial insurers. At any given time, roughly 1 in 10 Medicaid beneficiaries have unreported commercial coverage. read more
MEDICAID AT THE CROSSROADS: PROTECTING MEMBER BENEFITS THROUGH REAL-TIME COB AND THIRD-PARTY LIABILITY Syrtis Solutions, October 31
Medicaid COB has never been more critical as states confront mounting fiscal pressure and federal funding cuts. Many states have already begun reducing their Medicaid budgets — even before the most significant federal reductions take effect. According to the Medicare Rights Center, states like North Carolina are slashing provider payments, while others such as Nevada are struggling to manage Medicaid programs that consume nearly a quarter of total state spending. read more
Medicaid COB has never been more critical as states confront mounting fiscal pressure and federal funding cuts. Many states have already begun reducing their Medicaid budgets — even before the most significant federal reductions take effect. According to the Medicare Rights Center, states like North Carolina are slashing provider payments, while others such as Nevada are struggling to manage Medicaid programs that consume nearly a quarter of total state spending. read more
Medicaid Enrollment and Unwinding Tracker KFF, September 30
The Medicaid Enrollment and Unwinding Tracker presents the most recent data on monthly Medicaid/CHIP enrollment reported by the Centers for Medicare & Medicaid Services (CMS) as part of the Performance Indicator Project as well as archived data on renewal outcomes reported by states during the unwinding of the Medicaid continuous enrollment provision. read more
The Medicaid Enrollment and Unwinding Tracker presents the most recent data on monthly Medicaid/CHIP enrollment reported by the Centers for Medicare & Medicaid Services (CMS) as part of the Performance Indicator Project as well as archived data on renewal outcomes reported by states during the unwinding of the Medicaid continuous enrollment provision. read more
GAO HIGHLIGHTS IMPROPER PAYMENTS IN MEDICAID: BILLIONS STILL AT RISK
Syrtis Solutions, August 29
The Government Accountability Office (GAO) released report GAO-25-108067 in August 2025, identifying 32 open priority recommendations for the Department of the Treasury. At the forefront of these recommendations is the reduction of fraud and improper payments, an issue that continues to plague federal programs, especially Medicaid. GAO estimates that the federal government loses $233 to $521 billion annually to fraud. read more
Syrtis Solutions, August 29
The Government Accountability Office (GAO) released report GAO-25-108067 in August 2025, identifying 32 open priority recommendations for the Department of the Treasury. At the forefront of these recommendations is the reduction of fraud and improper payments, an issue that continues to plague federal programs, especially Medicaid. GAO estimates that the federal government loses $233 to $521 billion annually to fraud. read more
Trump gives drugmakers 60 days to slash prescription drug prices NBC News, July 31
President Donald Trump sent letters to more than a dozen major drugmakers Thursday demanding that they lower the cost of prescription drugs in the U.S. within 60 days. In the letters — which Trump published on his social media platform Truth Social — the drugmakers were told to offer the “full portfolio” of their existing medications to Medicaid patients at the same prices paid abroad, also known as the “most favored nation” rule. read more
President Donald Trump sent letters to more than a dozen major drugmakers Thursday demanding that they lower the cost of prescription drugs in the U.S. within 60 days. In the letters — which Trump published on his social media platform Truth Social — the drugmakers were told to offer the “full portfolio” of their existing medications to Medicaid patients at the same prices paid abroad, also known as the “most favored nation” rule. read more
National Health Care Fraud Takedown Results in 324 Defendants Charged in Connection with Over $14.6 Billion in Alleged Fraud Office of Public Affairs DOJ, June 30
The Justice Department today announced the results of its 2025 National Health Care Fraud Takedown, which resulted in criminal charges against 324 defendants, including 96 doctors, nurse practitioners, pharmacists, and other licensed medical professionals, in 50 federal districts and 12 State Attorneys General’s Offices across the United States, for their alleged participation in various health care fraud schemes involving over $14.6 billion in intended loss. read more
The Justice Department today announced the results of its 2025 National Health Care Fraud Takedown, which resulted in criminal charges against 324 defendants, including 96 doctors, nurse practitioners, pharmacists, and other licensed medical professionals, in 50 federal districts and 12 State Attorneys General’s Offices across the United States, for their alleged participation in various health care fraud schemes involving over $14.6 billion in intended loss. read more
Allocating CBO’s Estimates of Federal Medicaid Spending Reductions and Enrollment Loss Across the States
KFF, May 30
On May 22, the House passed a reconciliation bill, the One Big Beautiful Bill Act. The Congressional Budget Office’s (CBO) latest cost estimate shows that the bill would reduce federal Medicaid spending by $723 billion and that the Medicaid provisions would increase the number of uninsured people by 7.6 million. Earlier CBO estimates show that 10.3 million fewer people would be enrolled in Medicaid. read more
KFF, May 30
On May 22, the House passed a reconciliation bill, the One Big Beautiful Bill Act. The Congressional Budget Office’s (CBO) latest cost estimate shows that the bill would reduce federal Medicaid spending by $723 billion and that the Medicaid provisions would increase the number of uninsured people by 7.6 million. Earlier CBO estimates show that 10.3 million fewer people would be enrolled in Medicaid. read more
Status of State Medicaid Expansion Decisions
KFF, April 30
The Affordable Care Act’s (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($21,597 for an individual in 2025) and provided states with an enhanced federal matching rate (FMAP) for their expansion populations. To date, 41 states (including DC) have adopted the Medicaid expansion and 10 states have not adopted the expansion. read more
KFF, April 30
The Affordable Care Act’s (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($21,597 for an individual in 2025) and provided states with an enhanced federal matching rate (FMAP) for their expansion populations. To date, 41 states (including DC) have adopted the Medicaid expansion and 10 states have not adopted the expansion. read more
Recent Medicaid Managed Care Policies And Safety Net Accountable Care HealthAffiars, March 28
Accountable care can be a useful tool for providing safety-net providers with more sustainable and flexible financing for meeting their patients’ needs. However, most safety-net organizations face multiple existing barriers to advancing accountable care in the safety net. Further, accountable care is at an inflection point, and several health policy proposals may affect accountable care. read more
Accountable care can be a useful tool for providing safety-net providers with more sustainable and flexible financing for meeting their patients’ needs. However, most safety-net organizations face multiple existing barriers to advancing accountable care in the safety net. Further, accountable care is at an inflection point, and several health policy proposals may affect accountable care. read more
POTENTIAL FEDERAL BUDGET CUTS AND THEIR IMPACT ON MEDICAID: HOW STATES SHOULD PREPARE
Syrtis Solutions, February 28
With the passing of the recent budget proposal in Congress, Medicaid remains a prime target for potential budget cuts. If funding reductions move forward, states will be left scrambling to fill gaps, likely leading to fewer benefits, stricter eligibility requirements, and financial strain on healthcare providers. Given that Medicaid supports millions of low-income individuals, families, and people with disabilities, any significant changes could have severe consequences for access to care and the broader healthcare system.
read more
Syrtis Solutions, February 28
With the passing of the recent budget proposal in Congress, Medicaid remains a prime target for potential budget cuts. If funding reductions move forward, states will be left scrambling to fill gaps, likely leading to fewer benefits, stricter eligibility requirements, and financial strain on healthcare providers. Given that Medicaid supports millions of low-income individuals, families, and people with disabilities, any significant changes could have severe consequences for access to care and the broader healthcare system.
read more
MILLIONS SPENT ON DUPLICATE MEDICAID ENROLLMENTS
Syrtis Solutions, January 31
A recent audit by the Washington State Auditor’s Office revealed that Washington state is overspending on Medicaid premiums—an estimated $8.6 million annually—due to individuals being enrolled in Medicaid programs in multiple states. The audit focused on seven states but suggested that the financial impact from duplicate Medicaid enrollments is likely even higher nationwide. read more
Syrtis Solutions, January 31
A recent audit by the Washington State Auditor’s Office revealed that Washington state is overspending on Medicaid premiums—an estimated $8.6 million annually—due to individuals being enrolled in Medicaid programs in multiple states. The audit focused on seven states but suggested that the financial impact from duplicate Medicaid enrollments is likely even higher nationwide. read more
