Syrtis Solutions distributes a monthly Medicaid news summary to help you stay up-to-date. The monthly roundup focuses on developments, research, and legislation that relates to Medicaid program integrity, cost avoidance, coordination of benefits, improper payments, fraud, waste, and abuse. Below is a summary of last month’s Medicaid news.

Syrtis Solutions Blog, April 29 
The federal government doled out close to $100 billion in “improper” Medicaid payments in 2021– accounting for about one-fifth of all Medicaid payments, according to estimates. The figure represents Washington’s current accounting of payments that didn’t meet the numerous criteria for the Medicaid program, which the federal government manages jointly with the states and allows millions of low-income people access to healthcare. The numbers were also high in 2020, with approximately $86.5 billion in Medicaid payments deemed improper, or just over 21%.  read more


New Reports Show Record 35 Million People Enrolled in Coverage Related to the Affordable Care Act, with Historic 21 Million People Enrolled in Medicaid Expansion Coverage, April 29 
Today, the U.S. Department of Health and Human Services, through the Office of the Secretary for Planning and Evaluation (ASPE), released a report showing new estimates for coverage related to the Affordable Care Act (ACA), concluding that the total enrollment for Medicaid expansion, Marketplace coverage, and the Basic Health Program in participating states has reached an all-time high of more than 35 million people as of early 2022.  read more


California Expands Medi-Cal to All Eligible Adults 50 Years of Age and Older, April 29 
Starting on May 1, Medi-Cal, California’s health coverage program for low-income individuals and families, is extending eligibility for full coverage to more than 185,000 individuals who are 50 years of age or older, regardless of immigration status. “We’re delivering concrete results for Californians, continuing to fulfill the promise of a Healthy California for All, and I encourage all those eligible to take advantage of these essential health services,” said Governor Newsom.  read more


Fierce Healthcare, April 22 
The Biden administration will drop its efforts to rescind a major waiver for Texas’ Medicaid program following a loss in court. In a letter (PDF) issued Friday, the Centers for Medicare & Medicaid Services (CMS) said it does not want to expend further resources to continue fighting the changes. “CMS is withdrawing the April 2021 letter, as CMS has concluded that it is not the best use of the federal government’s limited resources to continue to litigate this matter,” CMS Administrator Chiquita Brooks-LaSure wrote.  read more


Former Alabama Governor Urges State Lawmakers To Expand Medicaid   
Patch, April 22 
Tuscaloosa dermatologist and former Alabama Republican Governor Dr. Robert Bentley is urging Gov. Kay Ivey and the Alabama Legislature to expand Medicaid and accept additional federal funding to extend Medicaid health insurance coverage for more Alabamians living in rural and underserved areas. In a lengthy letter submitted to Patch, Bentley said at the start of the 2022 Alabama Legislative Session, he reached out to Ivey and legislative leadership to voice his concerns from the perspective of both a practicing physician and former elected official.  read more


Whats next for Medicaid expansion efforts in Mississippi without a ballot initiative process?  WLOX 13, April 20 
Mississippi lawmakers left Jackson without getting resolutions on two big issues: ballot initiatives and Medicaid expansion. There are 38 states that have expanded Medicaid. Some Mississippians got tired of not joining that list and started a ballot initiative to make it happen. Now that that process is derailed, what does that mean for expansion chances? Advocates admit the most likely avenue to get Medicaid expansion in Mississippi is no longer available.  read more


Medicaid Program – Improper Payments for Services Related to Ordering, Prescribing, Referring, or Attending Providers No Longer Participating in the Medicaid Program  NYS Comprtroller, April 19
To determine whether the Department of Health (Department) made improper payments for claims in violation of federal and State requirements related to ordering, prescribing, referring, or attending (OPRA) providers who were no longer participating in the Medicaid program. The audit covered the period from January 2015 through December 2019.  read more


Supreme Court throws out Medicaid work requirement cases 
HealthcareDive, April 19 
The lawsuits challenging Medicaid work requirements have been on hold since the nation’s highest court previously canceled arguments planned for March 2021. On Monday, the Supreme Court said the requirements were now moot, given the Biden administration’s dismissal of the policies, and sent them back to the trial court, instructing that court to dismiss its prior judgments. Republicans saw instituting work requirements as a way to incentivize work, while eventually shifting Medicaid beneficiaries to more comprehensive private coverage and hopefully saving states money.  read more


Senate committee approves bill that could overturn Missouri Medicaid expansion  Missouri Independent, April 13 
A constitutional amendment asking Missourians to let lawmakers decide year-to-year whether the state will offer Medicaid to working-age adults moved closer to passage on Wednesday. By an 8-5 vote, the Senate Appropriations Committee sent the House-passed proposal to the full Senate for debate. Only Sen. Lincoln Hough, R-Springfield, voted with Democrats to oppose the measure, which is seen by critics as an effort to roll back voter-approved Medicaid expansion. If approved in the Senate, the measure would appear on the August or November election ballot.  read more


HHS extends COVID-19 public health emergency for another 90 days  
Fierce Healthcare, April 13 
The Department of Health and Human Services (HHS) has extended the COVID-19 public health emergency for another 90 days and potentially for the final time. The PHE, which gives key flexibilities to providers and states, will not expire in July. The PHE was originally expected to expire April 16. It remains unclear whether HHS will extend the emergency for a second time this summer, but providers will likely know the answer in a month.  read more


Audit finds Kansas paid $193 million for residents in program who have not filed  WBIW 13, April 13 
A recent report from the Kansas Medicaid Inspector General found the state is paying an excess of $193 million to health care providers for nearly 3,000 Kansans enrolled in a program who have not filed in over a year. Kansas Attorney General Derek Schmidt says Kansas Medicaid Inspector General Steven D. Anderson released a report on Wednesday, April 13, which examines the Kansas Medicaid program.  read more


House lawmakers aim to tackle improper payments with better data, IT 
Federal News Network, April 12 
Addressing a record-high number of improper payments in federal spending is a priority for House lawmakers on the House Oversight and Reform Committee’s Subcommittee on Government Operations. Rep. Gerry Connolly (D-Va.), the subcommittee’s chairman, said he plans to introduce legislation to tackle improper payments, which last year reached their highest rate in nearly two decades. The prospective bill would create a program integrity office to oversee agencies’ efforts to track fraud, waste and abuse in their program spending.  


Rick Scott, Tim Scott Want GAO to Review Medicaid Recovery Audit Contractor Program  Florida Daily, April 11 
Last week, U.S. Sens. Rick Scott, R-Fla., and Tim Scott, R-SC, wrote a letter to the U.S. Government Accountability Office (GAO) requesting a review of the Medicaid Recovery Audit Contractor (RAC) program, which was created to eliminate improper Medicaid payments. “Over the last decade, there has been little oversight of this program and a review is needed to ensure it is working effectively and in the best interest of American taxpayers,” Rick Scott’s office noted. The letter is below.  read more


The End of the Covid Emergency Could Mean a Huge Loss of Health Insurance 
KHN, April 6 
If there has been a silver lining to this terrible covid-19 pandemic, it is that the rate of Americans without health insurance dropped to a near-historic low, in response to various federal initiatives connected to the government-declared public health emergency. Now, as the pandemic’s acute phase seemingly draws to an end, millions of low-income and middle-income Americans are at risk of losing health insurance. The United States might see one of the steepest increases in the country’s uninsured rate in years.  read more


Georgia Medicaid Fraud Division Obtains Recoveries in Excess of $85 Million in Enforcement Efforts  AllOnGeorgia, April 6 
Attorney General Chris Carr announced that the office’s Medicaid Fraud Division has obtained civil recoveries totaling more than $68 million since November 2016. Over this same time period, the Attorney General’s Medicaid Fraud Division has prosecuted more than 60 people for Medicaid fraud and the abuse, neglect and exploitation of older adults, resulting in $17 million in restitution orders in criminal matters. “Our Medicaid Fraud Division works hard each day to preserve the integrity of our Medicaid program and to protect taxpayer dollars no matter the amount,” said Carr.  read more


HealthAffairs, April 6
On April 5, 2022, President Biden signed a new executive order on continuing to improve access to affordable, quality health coverage. His stated priorities include further expanding the availability of affordable health insurance, improving the quality of coverage, strengthening benefits, and helping more Americans enroll in quality coverage. President Biden issued the executive order on the same day as a proposed rule to fix the family glitch was issued and was joined at the signing ceremony by Vice President Harris, former President Obama, members of Congress, and several Cabinet officials.  read more


Executive Order on Continuing to Strengthen Americans’ Access to Affordable, Quality Health Coverage  The Whitehouse, April 5 
By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows: Section 1. Policy. On January 28, 2021, I signed Executive Order 14009 (Strengthening Medicaid and the Affordable Care Act), establishing that it is the policy of my Administration to protect and strengthen Medicaid and the Affordable Care Act (ACA) and to make high-quality healthcare accessible and affordable for every American.  read more