13 Feb MEDICAID NEWS RECAP – DECEMBER 2024
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, December 31
The reported government-wide improper payment rate of 3.97% in 2024 marks the lowest level in over a decade. But beneath the surface lies a complex reality that reveals systemic flaws in how improper payments are calculated and managed. These numbers, far from representing genuine progress, underscore the urgent need for meaningful reform and solutions.
The reported government-wide improper payment rate of 3.97% in 2024 marks the lowest level in over a decade. But beneath the surface lies a complex reality that reveals systemic flaws in how improper payments are calculated and managed. These numbers, far from representing genuine progress, underscore the urgent need for meaningful reform and solutions.
Fox59, December 20
Indiana leaders are calling for “urgent” reforms after a federal audit revealed the state has made at least $56 million in improper Medicaid payments for Hoosiers with autism. A recently published audit from the U.S. Office of the Inspector General is aptly titled “Indiana Made at Least $56 Million in Improper Fee-for-Service Medicaid Payments.” The 45-page report explains how many of Indiana’s Applied Behavioral Analysis (ABA) payments over the last several years did not comply with State or Federal guidelines. read more
Indiana leaders are calling for “urgent” reforms after a federal audit revealed the state has made at least $56 million in improper Medicaid payments for Hoosiers with autism. A recently published audit from the U.S. Office of the Inspector General is aptly titled “Indiana Made at Least $56 Million in Improper Fee-for-Service Medicaid Payments.” The 45-page report explains how many of Indiana’s Applied Behavioral Analysis (ABA) payments over the last several years did not comply with State or Federal guidelines. read more
Yale unites scholars, policymakers to improve Medicaid
Yale News, December 20
Researchers from universities across the northeastern United States recently gathered at Yale’s Tobin Center for Economic Policy to share their work examining aspects of Medicaid, a government program that roughly a fifth of all Americans rely on for access to free or low-cost health care. The one-day symposium — which linked state and federal policymakers with scholars from Yale, Harvard, Brown, Cornell, and Boston University… read more
Yale News, December 20
Researchers from universities across the northeastern United States recently gathered at Yale’s Tobin Center for Economic Policy to share their work examining aspects of Medicaid, a government program that roughly a fifth of all Americans rely on for access to free or low-cost health care. The one-day symposium — which linked state and federal policymakers with scholars from Yale, Harvard, Brown, Cornell, and Boston University… read more
Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State KFF, December 19
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),… read more
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),… read more
Making Sense of Medicaid Work Requirements
KFF, December 17
Among the health policy changes likely to be enacted during the second Trump administration, Medicaid work requirements are near the top of the list. Adding work requirements to Medicaid would cut federal health spending modestly at a time when Republicans will be scrambling to pay for tax cuts. And on the surface, the idea of promoting work is popular, even though the one thing Medicaid work requirements don’t deliver is, well, work. read more
KFF, December 17
Among the health policy changes likely to be enacted during the second Trump administration, Medicaid work requirements are near the top of the list. Adding work requirements to Medicaid would cut federal health spending modestly at a time when Republicans will be scrambling to pay for tax cuts. And on the surface, the idea of promoting work is popular, even though the one thing Medicaid work requirements don’t deliver is, well, work. read more
Repeal or reform: The Idaho Legislature’s plans for Medicaid expansion in 2025 Idaho Capital Sun, December 17
For years, Idaho Republican lawmakers have said the rising budget for Idaho’s largest government program, Medicaid, needs to be controlled. Some think 2025 may finally be the year for big changes in Idaho Medicaid expansion, which made more lower income earners eligible for the health insurance assistance program. Idaho voters widely approved the policy in 2018. But many Republican lawmakers say expansion is a key driver behind Medicaid’s budget growth. read more
For years, Idaho Republican lawmakers have said the rising budget for Idaho’s largest government program, Medicaid, needs to be controlled. Some think 2025 may finally be the year for big changes in Idaho Medicaid expansion, which made more lower income earners eligible for the health insurance assistance program. Idaho voters widely approved the policy in 2018. But many Republican lawmakers say expansion is a key driver behind Medicaid’s budget growth. read more
WMKY, December 17
During the latest meeting of the Kentucky Interim Joint Committee on Appropriations and Revenue officials from Medicaid Services reported an increase in expenditures. Representatives from the department told the committee there was an increase of around $1.9 billion in 2024. Medicaid Services Chief Financial Officer Steve Bechtel said this year the department spent 9.8% more than fiscal year ‘23, despite a decrease in enrollment of around 274,000 people. read more
During the latest meeting of the Kentucky Interim Joint Committee on Appropriations and Revenue officials from Medicaid Services reported an increase in expenditures. Representatives from the department told the committee there was an increase of around $1.9 billion in 2024. Medicaid Services Chief Financial Officer Steve Bechtel said this year the department spent 9.8% more than fiscal year ‘23, despite a decrease in enrollment of around 274,000 people. read more
Medicaid Threats in the Upcoming Congress
Center On Budget and Policy Priorities, December 13
Deeply damaging health coverage proposals recently advanced by Republican congressional leaders and conservative think tanks could gain traction in Congress next year.[1] Cutting Medicaid would harm enrollees — including the millions of children, people with disabilities, and elderly people with low incomes who are covered by Medicaid — and increase health inequities. About 72 million people receive health coverage through Medicaid.[2] It pays for 2 in 5 births in the U.S.[3] and is the nation’s largest payer both of behavioral health services, which include mental health and substance use disorder treatment,.. read more
Center On Budget and Policy Priorities, December 13
Deeply damaging health coverage proposals recently advanced by Republican congressional leaders and conservative think tanks could gain traction in Congress next year.[1] Cutting Medicaid would harm enrollees — including the millions of children, people with disabilities, and elderly people with low incomes who are covered by Medicaid — and increase health inequities. About 72 million people receive health coverage through Medicaid.[2] It pays for 2 in 5 births in the U.S.[3] and is the nation’s largest payer both of behavioral health services, which include mental health and substance use disorder treatment,.. read more
BCBS of Alabama proposes state insurance program using Medicaid expansion funds Alabama Reflector, December 12
The state’s dominant health insurer Wednesday pitched a health care plan to county commissioners that would use Medicaid expansion money to pay for private insurance plans for Alabamians without health coverage. The ALLHealth plan — presented by Blue Cross and Blue Shield of Alabama (BCBS of Alabama) at the Association of County Commissions of Alabama’s legislative conference Wednesday — would provide private health insurance to up to 330,000 eligible Alabamians… read more
The state’s dominant health insurer Wednesday pitched a health care plan to county commissioners that would use Medicaid expansion money to pay for private insurance plans for Alabamians without health coverage. The ALLHealth plan — presented by Blue Cross and Blue Shield of Alabama (BCBS of Alabama) at the Association of County Commissions of Alabama’s legislative conference Wednesday — would provide private health insurance to up to 330,000 eligible Alabamians… read more
November in Review: CMS Issues Medicaid and CHIP Eligibility and Enrollment Guidance to States Manatt, December 11
Throughout the month of November, the Centers for Medicare & Medicaid Services (CMS) issued a series of sub-regulatory guidance and accompanying resources to support states’ compliance with federal Medicaid and Children’s Health Insurance Program (CHIP) application and renewal requirements. The suite of guidance lays out federal requirements and various state options, and offers illustrative scenarios in anticipation of state questions… read more
Throughout the month of November, the Centers for Medicare & Medicaid Services (CMS) issued a series of sub-regulatory guidance and accompanying resources to support states’ compliance with federal Medicaid and Children’s Health Insurance Program (CHIP) application and renewal requirements. The suite of guidance lays out federal requirements and various state options, and offers illustrative scenarios in anticipation of state questions… read more
Minnesota DHS overpaid $40M to Medicaid providers, audit finds
WCCO News, December 10
The Minnesota Department of Human Services’ “internal control weakness” has led to more than $40 million in overpayments to Medicaid providers, according to a report released on Tuesday by state auditors. The Office of the Legislative Auditor’s Financial Audit Division says the discovery was made in a performance audit focused on department data between October 2006 and June 2023. read more
WCCO News, December 10
The Minnesota Department of Human Services’ “internal control weakness” has led to more than $40 million in overpayments to Medicaid providers, according to a report released on Tuesday by state auditors. The Office of the Legislative Auditor’s Financial Audit Division says the discovery was made in a performance audit focused on department data between October 2006 and June 2023. read more
Unwinding Watch: Tracking Medicaid Coverage as Pandemic Protections End Center On Budget and Policy Priorities, December 5
Our “Unwinding Watch” highlights key developments as states resume determinations on people’s Medicaid eligibility. Previously, the pandemic-related “continuous coverage” requirement safeguarded this coverage for millions of people. As of April 1, 2023, states may begin ending coverage for people found ineligible or whose redetermination can’t be completed for procedural reasons. read more
Our “Unwinding Watch” highlights key developments as states resume determinations on people’s Medicaid eligibility. Previously, the pandemic-related “continuous coverage” requirement safeguarded this coverage for millions of people. As of April 1, 2023, states may begin ending coverage for people found ineligible or whose redetermination can’t be completed for procedural reasons. read more
New York Medicaid Enrollment Drops by Nearly 50,000 People
Newsweek, December 5
New York’s Medicaid enrollment declined by nearly 50,000 people in the span of just one month this year. The state’s total Medicaid enrollment was roughly 6.05 million in July, but a month later, New York recorded only around 6 million, showing a net loss of around 50,000, according to Data.Medicaid.gov. “The drop we’re seeing in New York is similar to some other states, and while it’s not exactly clear the exact reasons for the falloff in enrollment… read more
Newsweek, December 5
New York’s Medicaid enrollment declined by nearly 50,000 people in the span of just one month this year. The state’s total Medicaid enrollment was roughly 6.05 million in July, but a month later, New York recorded only around 6 million, showing a net loss of around 50,000, according to Data.Medicaid.gov. “The drop we’re seeing in New York is similar to some other states, and while it’s not exactly clear the exact reasons for the falloff in enrollment… read more
9 States Poised To End Coverage for Millions if Trump Cuts Medicaid Funding KFF Health News, December 4
With Donald Trump’s return to the White House and Republicans taking full control of Congress in 2025, the Affordable Care Act’s Medicaid expansion is back on the chopping block. More than 3 million adults in nine states would be at immediate risk of losing their health coverage should the GOP reduce the extra federal Medicaid funding that’s enabled states to widen eligibility, according to KFF, a health information nonprofit that includes KFF Health News… read more
With Donald Trump’s return to the White House and Republicans taking full control of Congress in 2025, the Affordable Care Act’s Medicaid expansion is back on the chopping block. More than 3 million adults in nine states would be at immediate risk of losing their health coverage should the GOP reduce the extra federal Medicaid funding that’s enabled states to widen eligibility, according to KFF, a health information nonprofit that includes KFF Health News… read more