15 May MEDICAID NEWS RECAP – APRIL 2025
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.
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
Trump Administration Issues Drug Pricing Executive Order
Mintz, April 30
On April 15, 2025, President Trump issued an Executive Order instructing federal agencies to implement a variety of drug pricing reforms. The Executive Order addresses drug pricing from several different angles, including pharmacy benefit manager (PBM) competition and transparency, Medicare and Medicaid drug pricing, international importation, and drug manufacturer competition (Executive Order). read more
Mintz, April 30
On April 15, 2025, President Trump issued an Executive Order instructing federal agencies to implement a variety of drug pricing reforms. The Executive Order addresses drug pricing from several different angles, including pharmacy benefit manager (PBM) competition and transparency, Medicare and Medicaid drug pricing, international importation, and drug manufacturer competition (Executive Order). read more
5 Key Facts About Medicaid Expansion
KFF, April 25
Congress has passed a budget resolution that targets up to $880 billion or more in federal spending cuts from Medicaid over ten years. While specific proposals are not yet known, policies under discussion could limit financing and coverage for the Affordable Care Act (ACA) expansion group. Recent KFF polling shows there is little support for cuts to federal Medicaid spending overall, and a majority of adults (59%) oppose eliminating the enhanced federal match rate for adults covered under Medicaid expansion specifically. read more
KFF, April 25
Congress has passed a budget resolution that targets up to $880 billion or more in federal spending cuts from Medicaid over ten years. While specific proposals are not yet known, policies under discussion could limit financing and coverage for the Affordable Care Act (ACA) expansion group. Recent KFF polling shows there is little support for cuts to federal Medicaid spending overall, and a majority of adults (59%) oppose eliminating the enhanced federal match rate for adults covered under Medicaid expansion specifically. read more
Molina Healthcare sees opportunities for more acquisitions
Fierce Healthcare, April 24
Molina Healthcare surpassed analyst earnings expectations for the first quarter and detailed a mergers and acquisition environment that may lead to deals in the future. The company recorded an adjusted earnings per share of $6.08 and $11.15 billion in revenue, with premium revenues of $10.63 billion. CEO Joe Zubretsky said the insurer is “actively engaged” in seeking out more acquisitions, like its purchase of ConnectiCare, a Connecticut-based health plan from EmblemHealth, last year. read more
Fierce Healthcare, April 24
Molina Healthcare surpassed analyst earnings expectations for the first quarter and detailed a mergers and acquisition environment that may lead to deals in the future. The company recorded an adjusted earnings per share of $6.08 and $11.15 billion in revenue, with premium revenues of $10.63 billion. CEO Joe Zubretsky said the insurer is “actively engaged” in seeking out more acquisitions, like its purchase of ConnectiCare, a Connecticut-based health plan from EmblemHealth, last year. read more
KFF, April 24
As Congress considers ways to help pay for extending tax cuts, some lawmakers have suggested that hundreds of billions of dollars in federal savings could be achieved by addressing fraud, waste and abuse in the Medicaid program. They often cite data about improper payments in Medicaid, which accounted for 5.1 percent of total Medicaid outlays in 2024. read more
As Congress considers ways to help pay for extending tax cuts, some lawmakers have suggested that hundreds of billions of dollars in federal savings could be achieved by addressing fraud, waste and abuse in the Medicaid program. They often cite data about improper payments in Medicaid, which accounted for 5.1 percent of total Medicaid outlays in 2024. read more
HealthcareDive, April 23
The full text of the CMS’ proposal isn’t yet available, but its abstract says the rule would “update existing regulations that govern the process for States to obtain a waiver of the statutory requirements that health care-related taxes are broad based and uniform to ensure that taxes passing the statistical test are generally redistributive.” read more
The full text of the CMS’ proposal isn’t yet available, but its abstract says the rule would “update existing regulations that govern the process for States to obtain a waiver of the statutory requirements that health care-related taxes are broad based and uniform to ensure that taxes passing the statistical test are generally redistributive.” read more
Louisiana Illuminator, April 22
On his first day on the job Monday, Louisiana Department of Health Secretary Bruce Greenstein announced the launch of two initiatives – one to target Medicaid fraud and another to reduce the number of overdose deaths during pregnancy. The University of Louisiana at Lafayette is developing an artificial intelligence and data analysis tool the Louisiana Department of Health will use to fight “fraud, waste and abuse,” state officials said. read more
On his first day on the job Monday, Louisiana Department of Health Secretary Bruce Greenstein announced the launch of two initiatives – one to target Medicaid fraud and another to reduce the number of overdose deaths during pregnancy. The University of Louisiana at Lafayette is developing an artificial intelligence and data analysis tool the Louisiana Department of Health will use to fight “fraud, waste and abuse,” state officials said. read more
California OKs $2.8B to close Medicaid funding gap after expanding immigrant coverage AP, April 14
California Gov. Gavin Newsom signed legislation Monday to close a $2.8 billion budget gap in the state’s Medicaid services and ensure coverage through June for 15 million people, including immigrants, who receive health care via the program. The legislation is part of the state’s solution to solve the $6.2 billion hole in the state’s Medicaid budget. read more
California Gov. Gavin Newsom signed legislation Monday to close a $2.8 billion budget gap in the state’s Medicaid services and ensure coverage through June for 15 million people, including immigrants, who receive health care via the program. The legislation is part of the state’s solution to solve the $6.2 billion hole in the state’s Medicaid budget. read more
Final Budget Resolution Codifies Unreconciled Differences on Medicaid Cuts in House and Senate Reconciliation KFF, April 10
Republicans in Congress are hoping to use reconciliation to extend expiring tax cuts and make major changes to federal spending on programs including Medicaid. The first step in that process is for the House and Senate to pass a concurrent budget resolution, providing Congressional committees with reconciliation instructions, which happened on April 10.
Republicans in Congress are hoping to use reconciliation to extend expiring tax cuts and make major changes to federal spending on programs including Medicaid. The first step in that process is for the House and Senate to pass a concurrent budget resolution, providing Congressional committees with reconciliation instructions, which happened on April 10.
The Rubber is About to Hit the Road on Medicaid Cuts
KFF, April 10
The House and the Senate have now passed a budget resolution that implies big, but unspecified, cuts to Medicaid. The House Energy and Commerce Committee is expected to produce proposals to cut federal spending by at least $880 billion over a decade, and the math is inescapable that the vast majority of those cuts would come from Medicaid. read more
KFF, April 10
The House and the Senate have now passed a budget resolution that implies big, but unspecified, cuts to Medicaid. The House Energy and Commerce Committee is expected to produce proposals to cut federal spending by at least $880 billion over a decade, and the math is inescapable that the vast majority of those cuts would come from Medicaid. read more