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 relate 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.
An Early Look at State Approaches to Implementing Medicaid Work Requirements KFF, April 30
Starting January 1, 2027, federal law will require that adults enrolled in the Affordable Care Act (ACA) Medicaid expansion and enrollees in partial expansion waiver programs in Georgia and Wisconsin meet new work requirements. On April 30, 2026 , KFF hosted an hour-long interactive virtual briefing focused on states’ efforts to implement these new Medicaid work and community engagement requirements, which have created new administrative demands on states at a time of federal funding cuts, slowing revenue growth, and increasing spending demands. read more
Starting January 1, 2027, federal law will require that adults enrolled in the Affordable Care Act (ACA) Medicaid expansion and enrollees in partial expansion waiver programs in Georgia and Wisconsin meet new work requirements. On April 30, 2026 , KFF hosted an hour-long interactive virtual briefing focused on states’ efforts to implement these new Medicaid work and community engagement requirements, which have created new administrative demands on states at a time of federal funding cuts, slowing revenue growth, and increasing spending demands. read more
Comer Raises Concerns Over Complex Federal Billing System Potentially Fueling Improper Payments and Rising Healthcare Costs Committee On Oversight, April 30
The House Committee on Oversight and Government Reform is continuing to investigate drivers of rising healthcare costs in federal programs, including systemic issues that may enable significant waste, fraud, and abuse of taxpayer funds. In a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz, Chairman James Comer (R-Ky.) highlighted that the federally mandated Current Procedural Terminology (CPT) code system, used as the standard for billing Medicare and Medicaid, plays a central role in directing how billions of taxpayer dollars are spent each year. read more
The House Committee on Oversight and Government Reform is continuing to investigate drivers of rising healthcare costs in federal programs, including systemic issues that may enable significant waste, fraud, and abuse of taxpayer funds. In a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz, Chairman James Comer (R-Ky.) highlighted that the federally mandated Current Procedural Terminology (CPT) code system, used as the standard for billing Medicare and Medicaid, plays a central role in directing how billions of taxpayer dollars are spent each year. read more
Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies as States Prepare for Major Medicaid Policy Changes
KFF, April 30
By the beginning of 2025, states had largely resumed more routine Medicaid enrollment operations following the unwinding of pandemic-era continuous enrollment provisions but with numerous reforms in place to streamline renewal processes and bolster enrollee communications. However, the passage of the 2025 reconciliation law in July 2025 introduced significant Medicaid eligibility and enrollment changes. read more
KFF, April 30
By the beginning of 2025, states had largely resumed more routine Medicaid enrollment operations following the unwinding of pandemic-era continuous enrollment provisions but with numerous reforms in place to streamline renewal processes and bolster enrollee communications. However, the passage of the 2025 reconciliation law in July 2025 introduced significant Medicaid eligibility and enrollment changes. read more
CMS extends application deadlines for Medicaid drug pricing model Reuters, April 29
The U.S. Centers for Medicare & Medicaid Services said on Wednesday it has extended key application deadlines for drugmakers and states to join the payment model, which aims to negotiate lower prices on their prescription medicines for the U.S. Medicaid program for low-income Americans.Drug manufacturers now have until June 11, instead of April 30, to apply, giving companies more time to prepare applications. read more
The U.S. Centers for Medicare & Medicaid Services said on Wednesday it has extended key application deadlines for drugmakers and states to join the payment model, which aims to negotiate lower prices on their prescription medicines for the U.S. Medicaid program for low-income Americans.Drug manufacturers now have until June 11, instead of April 30, to apply, giving companies more time to prepare applications. read more
REDUCING IMPROPER MEDICAID PAYMENTS BEFORE THEY OCCUR Syrtis Solutions, April 28
Stephen Konsin Jr. from Syrtis Solutions, a solution provider at the Marcus Evans Value-Based Care Summit 2026, discusses the growing need for proactive Medicaid payment accuracy and cost avoidance strategies. Interview with: Stephen Konsin Jr., Vice President of Sales, Syrtis Solutions “The window for demonstrating proactive prevention of improper payments before the 2030 mandatory Federal Medical Assistance Percentage (FMAP) reductions is narrowing with each fiscal quarter. read more
Stephen Konsin Jr. from Syrtis Solutions, a solution provider at the Marcus Evans Value-Based Care Summit 2026, discusses the growing need for proactive Medicaid payment accuracy and cost avoidance strategies. Interview with: Stephen Konsin Jr., Vice President of Sales, Syrtis Solutions “The window for demonstrating proactive prevention of improper payments before the 2030 mandatory Federal Medical Assistance Percentage (FMAP) reductions is narrowing with each fiscal quarter. read more
Nebraska is becoming the first state to implement a Medicaid work requirement signed by Trump
AP, April 28
Nebraska on Friday will become the first state to enforce work, volunteer or education requirements for new Medicaid applicants, eight months before the federally mandated requirements kick in. Advocates worry that the state is launching so rapidly that key details remain unresolved and some people who are eligible for coverage will lose it. State officials say they’re prepared, training staff and sending letters, emails and texts to people who could be impacted. read more
AP, April 28
Nebraska on Friday will become the first state to enforce work, volunteer or education requirements for new Medicaid applicants, eight months before the federally mandated requirements kick in. Advocates worry that the state is launching so rapidly that key details remain unresolved and some people who are eligible for coverage will lose it. State officials say they’re prepared, training staff and sending letters, emails and texts to people who could be impacted. read more
Medicaid Fraud, Waste, and Abuse Prevention Updates
GA Department of Community Health, April 28
The Georgia Department of Community Health (DCH) is highly committed to administering the Medicaid program with integrity. Through the realignment of DCH’s fraud, waste, and abuse prevention system to better fit DCH’s current health care delivery models (fee-for-service and managed care), DCH hopes to increase cost avoidance and recovery of state and federal funds. DCH will gather information from vendors and revise processes and procedures for high-risk service categories to enhance program integrity. read more
GA Department of Community Health, April 28
The Georgia Department of Community Health (DCH) is highly committed to administering the Medicaid program with integrity. Through the realignment of DCH’s fraud, waste, and abuse prevention system to better fit DCH’s current health care delivery models (fee-for-service and managed care), DCH hopes to increase cost avoidance and recovery of state and federal funds. DCH will gather information from vendors and revise processes and procedures for high-risk service categories to enhance program integrity. read more
GAO Reports Improper Payments Rose to an Estimated $186 billion Across the Federal Government in Fiscal Year 2025
The GAO, April 27
GAO today issued its report on federal agencies’ improper payments estimates for fiscal year 2025, reporting that agencies identified $186 billion in payment errors. A longstanding, government-wide issue, improper payments are a result of overpayments, fraud, or other causes. Overpayments accounted for $153 billion of this year’s improper payments estimate, or roughly 82 percent. Today’s report shows a $24 billion increase in improper payments from the previous fiscal year, and GAO continues to make recommendations aimed at reducing these payment errors and safeguarding federal funds. read more
The GAO, April 27
GAO today issued its report on federal agencies’ improper payments estimates for fiscal year 2025, reporting that agencies identified $186 billion in payment errors. A longstanding, government-wide issue, improper payments are a result of overpayments, fraud, or other causes. Overpayments accounted for $153 billion of this year’s improper payments estimate, or roughly 82 percent. Today’s report shows a $24 billion increase in improper payments from the previous fiscal year, and GAO continues to make recommendations aimed at reducing these payment errors and safeguarding federal funds. read more
Medicaid Enrollment and Unwinding Tracker
KFF, April 24
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. The unwinding data were pulled from state websites, where available, and from CMS. read more
KFF, April 24
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. The unwinding data were pulled from state websites, where available, and from CMS. read more
NC House, Senate reach deal to fund state Medicaid program for rest of this year WUNC, April 21
Both chambers of the N.C. General Assembly expect this week to take up legislation fully funding the state’s Medicaid program for the remainder of this fiscal year. The bill will send $319 million to Medicaid, funding that Democratic Gov. Josh Stein and N.C. Department of Health and Human Services Secretary Dev Sangvai have been asking for since last summer. read more
Both chambers of the N.C. General Assembly expect this week to take up legislation fully funding the state’s Medicaid program for the remainder of this fiscal year. The bill will send $319 million to Medicaid, funding that Democratic Gov. Josh Stein and N.C. Department of Health and Human Services Secretary Dev Sangvai have been asking for since last summer. read more
Oz previews new plan to push states toward revalidating Medicaid providers Fierce Healthcare, April 21
CMS Administrator Mehmet Oz, M.D., on Tuesday previewed the agency’s next steps in its effort to root out fraud, waste and abuse in Medicaid. The head of the Centers for Medicare & Medicaid Services said during a session at Politico’s Health Care Summit that later this week, the agency will require every state to formulate a plan to revalidate participating Medicaid providers, particularly those in “high-risk” areas. Oz said that, for example, there may be a state where 5,000 providers are listed as offering services, but fewer than a fifth of that number actually respond to queries about their identities and whether they’re licensed to offer that care. read more
CMS Administrator Mehmet Oz, M.D., on Tuesday previewed the agency’s next steps in its effort to root out fraud, waste and abuse in Medicaid. The head of the Centers for Medicare & Medicaid Services said during a session at Politico’s Health Care Summit that later this week, the agency will require every state to formulate a plan to revalidate participating Medicaid providers, particularly those in “high-risk” areas. Oz said that, for example, there may be a state where 5,000 providers are listed as offering services, but fewer than a fifth of that number actually respond to queries about their identities and whether they’re licensed to offer that care. read more
MACPAC April 2026 Public Meeting
MACPAC, April 9
The April 2026 MACPAC meeting began with a staff presentation on a draft chapter for the June 2026 report to Congress describing findings from the Commission’s analytic work on considerations for implementing community engagement requirements in Medicaid. The draft chapter begins with background on community engagement requirements in Medicaid and an overview of the statutory requirement in the 2025 Budget Reconciliation Act (P.L. 119-21). read more
MACPAC, April 9
The April 2026 MACPAC meeting began with a staff presentation on a draft chapter for the June 2026 report to Congress describing findings from the Commission’s analytic work on considerations for implementing community engagement requirements in Medicaid. The draft chapter begins with background on community engagement requirements in Medicaid and an overview of the statutory requirement in the 2025 Budget Reconciliation Act (P.L. 119-21). read more
