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 noteworthy Medicaid news.

The New York Times, February 27
Ever since the Affordable Care Act became law in 2010 — a big deal, in the (sanitized) words of Vice President Joseph R. Biden Jr. — Democrats have itched to fix its flaws. But Republicans united against the law and, for the next decade, blocked nearly all efforts to buttress it or to make the kinds of technical corrections that are common in the years after a major piece of legislation. Now the Biden administration and a Democratic Congress hope to engineer the first major repair job and expansion of the Affordable Care Act since its passage.  read more


Syrtis Solutions Blog, February 23
Improper payments, fraud, and waste cost the Medicaid program billions of dollars every year. In 2020 alone, Medicaid improper payments reached $86.49 billion. These payments account for more than twenty percent of federal Medicaid expenditures, and one out of every four Medicaid dollars is spent improperly. Since its introduction in 1965, Medicaid has provided healthcare to the country’s most vulnerable populations. In 2010, the ACA expanded program eligibility and increased the federal government’s match percentage.  read more


American Action Forum, February 19
The Weekly Checkup has already considered the American Recovery Plan’s COBRA subsidy and premium tax credit expansion, so this week let’s turn to its changes to Medicaid. As I detailed recently, congressional Democrats and the White House are working to include as much of the president’s broader agenda as possible in the reconciliation legislation because it is not subject to a filibuster in the Senate and thus can be passed on a party-line vote. As a result, a package that is touted as a response to the pandemic includes myriad provisions unrelated to COVID-19.  read more, February 18
A trial court judge said Thursday that he’ll leave in place another judge’s decision that rejected arguments from an unsuccessful bidder for North Carolina’s upcoming managed-care initiative for Medicaid. Wake Superior Court Judge Michael O’Foghludha said at the close of online arguments that he would uphold an administrative law judge’s previous decision affirming how the Department of Health and Human Services conducted the process that led to contract awards in 2019.  read more


President Joe Biden will nominate seasoned Democratic health policy broker Chiquita Brooks-LaSure to helm the trillion-dollar Medicare and Medicaid agency, according to four sources familiar with the selection. Brooks-LaSure, an Obama administration veteran who oversaw implementation of Obamacare, if confirmed will play a leading role in crafting Biden’s plans to expand on the health care law – and unwind much of the Trump administration’s efforts to minimize it.  read more


KHN, February 17
President Joe Biden has an unexpected opening to cut deals with red states to expand Medicaid, raising the prospect that the new administration could extend health protections to millions of uninsured Americans and reach a goal that has eluded Democrats for a decade. The opportunity emerges as the covid-19 pandemic saps state budgets and strains safety nets. That may help break the Medicaid deadlock in some of the 12 states that have rejected federal funding made available by the Affordable Care Act, health officials, patient advocates and political observers say.  read more February 17
Most Alabama voters now support expanding Medicaid to cover low-income adults under the Affordable Care Act, including 50.6 percent of Republicans, according to a poll released Wednesday by Cover Alabama. Cover Alabama is a coalition of 90 organizations that support Medicaid expansion. The poll included 700 likely 2022 voters, and 69 percent said they strongly or somewhat supported expansion. Jane Adams, director of Cover Alabama, said the organization conducted the poll to measure support for different sources of funding for Medicaid expansion.   read more


Bloomberg Law, February 17
The Trump administration’s eleventh-hour attempt to preserve Medicaid work requirements and circumvent President Joe Biden’s plan to rescind them hinges on the question of whether the effort amounted to guidance or binding contracts, legal analysts say. At issue are letters former Centers for Medicare & Medicaid Services Administrator Seema Verma sent to states in January to keep Medicaid waivers in effect for nine months after any government movement to rescind them.  read more


C&M Health Law, February 16
On November 13, 2020, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule, demonstrating long-awaited efforts to streamline the regulatory framework governing the Medicaid and Children’s Health Insurance Program (“CHIP”) managed care programs. According to CMS, the purpose of the final rule is to relax certain administrative burdens imposed by the Medicaid managed care rule promulgated by the Obama Administration in 2016. The 2016 rule (the “Mega Reg”), reflecting efforts to modernize the Medicaid and CHIP managed care programs and frustrate widespread fraud and abuse, was the first update to Medicaid managed care regulations in more than a decade.   read more, February 10
Democrats are reviving efforts to expand Medicaid in the latest $1.9 trillion Covid-19 relief package, which could benefit about 4 million Americans at a time when health care is critical. Late on Tuesday, the House Energy and Commerce Committee released the details of the legislative recommendations for the budget reconciliation process that Democrats have undertaken to pass the latest relief package. Among the provisions is a new incentive for states that have not yet expanded their Medicaid programs, which provides health care to low-income Americans.  read more


Revcycle Intelligence, February 8
Healthcare remains one of the top priorities for the Biden administration as it inherits an ongoing pandemic and the unstable future of the Affordable Care Act. But the President is already unveiling his plans for the next four years of healthcare, starting with who he believes should lead his healthcare team. The Department of Health and Human Services (HHS) plays a major role in executing the president’s healthcare strategy and the HHS Secretary is at the head of that execution.  read more


JD Supra, February 5
The Biden Administration is just two weeks old, and President Biden has already issued more than two dozen Executive Orders on racial justice, health equity, strengthening Medicaid and the Affordable Care Act (ACA), the COVID-19 pandemic, immigration, and other topics. Importantly, in nearly all cases agencies must issue guidance, undertake new rulemaking, or take other actions to bring these Executive Orders to life. For example, following President Biden’s Executive Order on Strengthening Medicaid and the Affordable Care Act, the Department of Health and Human Services (HHS) announced that it will open an ACA Marketplace special enrollment period from February 15 through May 15.  read more


The Center Square, February 3
There is bipartisan support in the Florida Legislature to impose transparency requirements and restrict pharmacy benefit managers’ (PBMs) role in prescription drug costs. Nevertheless, bills seeking to do so have failed the last few years, including in 2020. A December audit commissioned by Florida’s Agency for Health Care Administration (AHCA) may spur that effort in 2021 after documenting “prescription markups” by PBMs cost Florida’s Medicaid system $113.3 million in 2020.  read more