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.

The California Department of Health Care Services (DHCS) announced today that it has the go-ahead to launch its long-term commitment to transform and strengthen Medi-Cal. The federal Centers for Medicare & Medicaid Services (CMS) has approved the California Advancing and Innovating Medi-Cal (CalAIM) proposal that will launch January 1, 2022, and make Medi-Cal more equitable, coordinated, and person-centered to help people maximize their health and life trajectory.  read more


As we near the end of the second pandemic year, the desire for quality and affordable health care has never been more top of mind. The pandemic raised new concerns about medication access and supply, both of which drove utilization and costs upward. Centers for Medicare & Medicaid Services (CMS) projects prescription spend for commercial plans will grow an average of 5% annually, meanwhile, plan sponsors continue to battle budget pressures and ambiguity over their spend.  read more


Health Payer Intelligence, December 28
CMS has released the latest 2022 enrollment data for the Affordable Care Act marketplace and the most recent 2021 public payer enrollment data for Medicare, Medicaid and Children’s Health Insurance Program (CHIP). In 2020 and 2021, public payer and Affordable Care Act marketplaces experienced major disruptions and changes that continue to have ripple effects. The year that the pandemic struck, Medicaid and CHIP enrollment escalated for the first time in two years.  read more


New York Post, December 26
It’s New York’s Medicaid for All program. The number of state residents who received government-funded Medicaid health insurance has skyrocketed to historic highs during the COVID-19 pandemic, new state data reveal. The soaring enrollment — spurred by job and income loss — exploded by nearly 1.5 million claimants statewide since the pandemic hit, the figures show. In January 2020, about 6.1 million of the state’s 19.8 million residents were enrolled in the program.  read more


KHN, December 23
A record 13.6 million Americans have signed up for health coverage for 2022 on the Affordable Care Act marketplaces, with nearly a month remaining to enroll in most states, the Biden administration announced Wednesday. President Joe Biden’s top health advisers credited the increased government subsidies, which lowered out-of-pocket costs, for the surge in enrollment. They also said enhanced personal assistance and outreach helped connect more people to health insurance plans.  read more


The New York Times, December 23
The Biden administration on Thursday rejected work requirements for Medicaid recipients in Georgia, the last state to have a federal waiver for such restrictions, as it extended its rollback of a signature health policy of the Trump administration. The announcement from the Centers for Medicare & Medicaid Services, delivered in a 79-page letter to Georgia’s health agency, also reversed a federal waiver allowing the state to charge premiums for the health insurance program for the poor.  read more


Fox Business, December 23
The federal government’s health emergency declaration is set to expire in January, which could cause up to 15 million Americans — including 6 million children — to lose Medicaid coverage, according to a new analysis from the Urban Institute. The U.S. public health emergency declared on April 21, 2020, by former Secretary of the Department of Health and Human Services Alex Azar is set to expire on Jan. 15, 2022.  read more


The Centers for Medicare and Medicaid are directing Montana to end the state’s requirement that people covered by Medicaid expansion pay monthly premiums beyond what’s authorized by the federal government. In a Tuesday letter, CMS gave Montana a year to wind down the additional premiums created in 2019 legislation, saying they could reduce the ability for people earning lower incomes to gain health care coverage.  read more


State of Reform, December 22
Over 1.4 million people under Maryland Medicaid, or the Health Choice program, will continue to receive care under the state’s 1115 waiver. The Centers for Medicare and Medicaid Services (CMS) approved the waiver’s extension last week for an additional five years, from Jan. 1, 2022 through Dec. 31, 2026. The current waiver, in place since 2016, will expire at the end of this year. In a letter to Maryland Department of Health (MDH) Secretary Dennis Schrader, CMS Deputy Administrator and Director Daniel Tsai outlined new programs approved for Medicaid beneficiaries, as well as additions to existing benefits.  read more


Becker’s Payer Issues, December 22
Arkansas Gov. Asa Hutchinson received federal approval to begin its Medicaid expansion redesign, dubbed ARHOME. The plan aims to cover 300,000 residents who make 138 percent below the federal poverty line, according to Talk Business & Politics. Arkansas’ current program, Arkansas Works, expires at the end of 2021, and the new plan aims to cut down on state spending.  read more


Becker’s Payer Issues, December 16
An audit conducted by the Oregon Health Authority found that Oregon Health Plan, the state’s Medicaid program, improperly issued claims to providers for in-home care and transportation despite patients being hospitalized at the time, according to The Lund Report. According to the audit, the authority found more than $52,000 in improper payments and about $1.6 million in payments that had a high probability of being improper.  read more


The Build Back Better Act (BBBA) includes several prescription drug provisions; while much of the focus has been on Medicare and private insurance, the bill includes a number of provisions with implications for Medicaid prescription drug spending. Before the pandemic, Medicaid outpatient prescription drug utilization, measured in terms of the number of prescriptions, was decreasing while Medicaid gross spending on prescription drugs was increasing.   read more


Since the state of Michigan created the Healthy Michigan Plan in 2014, expanding Medicaid coverage to all households with incomes up to 133% of the federal poverty level, the number of uninsured Michiganders has plummeted by 53%. Now, with the University of Michigan’s (U-M) help, the state is looking back to examine how that change has improved health for Michigan residents who otherwise could not afford health insurance.  read more


U.S. News, December 7
In a sign that the expansion of Medicaid has really worked, new research finds that death rates have declined in states that expanded the public health insurance program. Medicaid expansion began in 2014 as part of the Affordable Care Act (also known as “Obamacare”) and has provided health coverage for an additional 12 million Americans. Expansion is optional, and nearly one-quarter of states have not yet expanded access to Medicaid.  read more


Louisiana’s latest search for contractors to manage the health care services of nearly 1.6 million Medicaid patients is taking longer than expected, blowing past an early November timeline for announcing the contract awards. The last bid process started by Gov. John Bel Edwards’ administration for the multibillion-dollar Medicaid managed care contracts was derailed two years ago in a legal dispute.  read more


Temp worker James Dickerson applied for Medicaid because it will be cheaper than his current health plan. Home health aide Sharon Coleman looks forward to having coverage that will cover a hospital stay. Incoming medical student Danielle Gaddis no longer worries a trip to the doctor will leave her in debt. All three are among the roughly 490,000 people newly eligible for Medicaid after Oklahoma and Missouri voters in 2020 approved expanding the federal-state public health insurance program for people with low incomes.  read more