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.
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
Status of State Medicaid Expansion Decisions KFF, August 26
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. Current status for each state is based on KFF tracking and analysis of state expansion activity. read more
CMS Launches Nationwide Push to Remove Ineligible Medicaid Enrollees, Uphold Citizenship Requirements CMS.gov, August 19
The Centers for Medicare & Medicaid Services (CMS) today launched an oversight initiative to ensure that enrollees in Medicaid and the Children’s Health Insurance Program (CHIP) are U.S. citizens, U.S. nationals, or have a satisfactory immigration status. CMS will begin providing states with monthly enrollment reports identifying individuals whose citizenship or immigration status could not be confirmed through federal databases, including the Department of Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) program. read more
Crushing Fraud Chili Cook-Off Competition CMS.gov, August 19
CMS is excited to announce the Crushing Fraud Chili Cook-Off Competition – a market-based research challenge aimed at harnessing explainable artificial intelligence (AI), specifically machine learning (ML) models, to detect anomalies and trends in Medicare claims data that can be translated into novel indicators of fraud. This challenge also seeks innovative, scalable technologies that reduce labor-intensive processes while keeping humans meaningfully in the loop to ensure effective oversight and interoperability. read more
Pay and Chase Construct is Tempting for Medicaid Fraudsters, Expert Says Healthcare Innovation, August 18
Some lawmakers argue that a significant portion of Medicaid spending is lost due to fraud, waste, and abuse, which is provided as one of the reasons for budget cuts. The 2024 DOJ report on healthcare fraud and abuse lists providers like ambulances, pain clinics, pharmacies, physicians, and more as common fraudsters; however, beneficiaries are not on this list. Fraud Control Units (FCUs) struggle with resources to fight the scale and volume of cases coming their way. read more
North Carolina to cut Medicaid rates by 3% across all providers in October NC Newsline, August 13
The North Carolina Department of Health and Human Services will slash Medicaid spending by $319 million effective Oct. 1, Secretary Devdutta “Dev” Sangvai wrote in a letter to General Assembly leaders Monday. That reduction — coming in response to a shortfall in the state budget and changes to Medicaid policy in the One Big Beautiful Bill Act — means the state will reduce rates by 3% to all medical providers, as well as cuts of 8% to 10% for inpatient and residential services and 10% for behavioral therapy and analysis for patients with autism. read more
Louisiana Medicaid audit reveals $9.6 million in payments for deceased beneficiaries WAFB9, August 11
Medicaid in Louisiana, one of the state’s largest expenses, provides healthcare for more than 1.6 million people. Typically, when a beneficiary dies, they are removed from the Medicaid rolls. However, from February 2019 to March 2025, the state paid $9.6 million for 1,072 people who were deceased. The Louisiana Legislative Auditor’s Office uncovered this issue by cross-referencing the federal Social Security database. read more
Fixing Duplicate Medicaid Enrollments through Smart Government IT Foundation for American Innovation, August 5
Section 71103 of the recently passed reconciliation bill presents a rare opportunity to improve Medicaid’s efficiency without sacrificing access to care. The provision directs the Centers for Medicare & Medicaid Services (CMS) to build a national database that allows states to detect when someone is enrolled in Medicaid or Children’s Health Insurance Program (CHIP) in more than one state at the same time—a situation that occurs far more often than people realize. read more
‘More paperwork for everyone’: NM Medicaid program braces for more churn Source NM, August 5
New Mexico Medicaid Director Dana Flannery told the state Medicaid Advisory Committee on Monday the New Mexico Health Care Authority will need more staff to comply with the federal One Big Beautiful Bill Act, which Congress passed and President Donald Trump signed into law last month. By Dec. 31, 2026, states must renew Medicaid recipients’ paperwork at least every six months. New Mexico currently confirms eligibility annually. read more
States Work to Overhaul Medicaid Systems Amid Funding Concerns Government Technology, August
When it comes to providing health-care services for the most vulnerable residents, Medicaid is at the center of the discussion, as it provides coverage for 83.1 million residents — 21 percent of the U.S. population — according to health-care news organization KFF, accounting for 20 percent of all health-care spending in the country. In fiscal year 2023, Medicaid spending totaled $880 billion, with the federal government paying 69 percent of that staggering sum. read more
