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, 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.”  read more
Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State  KFF, April 23 
This page tracks approved and pending Section 1115 Medicaid demonstration waivers, which offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute. Key themes in current approved and pending waivers include targeted eligibility expansions, benefit expansions (particularly in the area of behavioral health, such as coverage of services provided in IMDs), and provisions related to social determinants of health.
West Virginia Department of Human Services Provides Update on Completion of Medicaid Unwinding, April 23 
The West Virginia Department of Human Services (DoHS), Bureau for Medical Services (BMS) today released updated data following the completion of the State’s Medicaid unwinding period. “Completing the Medicaid unwinding process represents a significant milestone for West Virginia’s health care system,” said Cynthia Beane, DoHS Bureau for Medical Services Commissioner.  read more
Medicaid final rules improve care access for managed care, FFS beneficiaries  Health Payer Intelligence, April 23
CMS has finalized policies to improve access to Medicaid and the Children’s Health Insurance Program (CHIP) managed care and boost coverage quality. The Medicaid and Children’s Health Insurance Program Managed Care Access, Finance, and Quality Final Rule and the Ensuring Access to Medicaid Services Final Rule address state payments, medical loss ratios, home- and community-based services (HCBS) payments, and more.  read more
Why haven’t Kansas and Alabama — among other holdouts — expanded access to Medicaid?  npr, April 22 
From Nebraska to North Carolina, states with Republican-led legislatures have slowly moved toward expanding access to Medicaid for thousands of their residents. But some are still holding out. Medicaid provides health care to some 80 million Americans living on low-incomes. But millions more fall into the so-called “coverage gap” where they make too much money for Medicaid but not enough to get their own insurance.  read more
Proposed changes to state Medicaid plans could shake up health coverage for 1.8 million low-income Texans  The Texas Tribune, April 18 
Texas health officials are poised to drop the state’s three largest nonprofit children’s health plans from multibillion-dollar Medicaid and children’s health insurance contracts — threatening the future of plans run by legacy children’s hospitals in Fort Worth and South Texas and shaking up health care coverage for low-income families throughout the state. Some 1.8 million Texans who receive Medicaid coverage from six managed care organizations across the state would lose their current health plans and be shifted to new insurers next year if Texas Health and Human Services stands by a recent decision to redistribute the contracts after a competitive bidding process.  read more
Advocates push for full Medicaid expansion as Mississippi legislators enter negotiations  AP, April 16
A coalition of advocates rallied for full Medicaid expansion Tuesday at the Mississippi Capitol as lawmakers prepare to negotiate a final plan that could extend health care coverage to tens of thousands of residents in one of the poorest states in the U.S. Members of Working Together Mississippi — a coalition of religious and nonprofit groups — said lawmakers face an economic and moral imperative to ensure more citizens gain access to health care coverage.  read more
Health News Florida, April 15
The state Agency for Health Care Administration on Friday announced plans to award contracts to five health plans to take part in the Medicaid managed-care program. The contracts will involve tens of billions of dollars in the coming years, with about 3.45 million people receiving health care through the managed-care system as of February, according to data posted on the agency’s website. The five health plans are Florida Community Care, Humana Medical Plan, Simply Healthcare Plans, Sunshine State Health Plan and South Florida Community Care Network, which does business as Community Care Plan.  read more
Newsweek, April 15
Millions of New Yorkers have been removed from their Medicaid coverage after the federal government ended its continuous coverage policy during the pandemic. According to a Kaiser Family Foundation report, 1.4 million New Yorkers were taken off Medicaid coverage as the government required recipients to reapply for coverage this year. Of those who were on Medicaid previously, 3.3 million were approved. This follows a national trend as states grapple with renewing Medicaid coverage since the government stopped offering continuous coverage through the pandemic.  read more
Kansas Medicaid expansion debate to be revived when Legislature returns  Kansas Reflector, April 9 
In three weeks, senators will decide whether to give Medicaid expansion a full floor debate or block discussion of health insurance coverage for low-income Kansans for another year. Lawmakers rushed to hammer out myriad policy pieces ranging from the tax code to K-12 education funding during a late-night marathon session before adjourning Saturday for three weeks. During the frenzied process, Senate Minority Leader Dinah Sykes, a Lenexa Democrat, introduced a motion to pull Senate Bill 355 to the floor for consideration.  read more
Idaho Medicaid waiver approval bill could immediately disrupt services, governor says Idaho  Capital Sun, April 9 
Without additional action by the Legislature, Idaho Gov. Brad Little worries a new bill requiring legislative approval for Medicaid waivers could disrupt health care services, including by halting millions of dollars in payments to medical providers across the state. Little’s office received 118 emails from providers asking for a trailer bill to House Bill 398, said spokesperson Madison Hardy. Little, in a letter to lawmakers Monday, called for imminent action by the Idaho Legislature.  read more
KFF, April 8
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 ($20,783 for an individual in 2024) 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
Experience of the Five Largest Publicly Traded Companies Operating Medicaid Managed Care Plans During Unwinding  KFF, April 3 
At the start of the “unwinding” period, in April 2023, Medicaid enrollment peaked at 94.5 million, an increase of 23 million or 32% from before the pandemic. As of December 2023, Medicaid enrollment declined by more than 9% across states, a decline of over 9 million people. The Centers for Medicare and Medicaid Services (CMS) continues to highlight the role managed care organizations (MCOs) can play in helping people eligible for Medicaid use and keep their coverage, as nearly three-quarters of Medicaid beneficiaries are enrolled in a managed care plan.  read more
KFF Health News, April 3 
Work requirements in Medicaid expansion programs are back on the agenda in many statehouses — despite their lackluster track record. In Mississippi, the idea has momentum from GOP lawmakers advancing legislation to expand Medicaid. In Kansas, the Democratic governor proposed work requirements to try to soften Republican opposition to expansion. (She’s had little luck, so far.) The controversial policy even has fresh traction in states that expanded Medicaid years ago, including Idaho and Louisiana.  read more