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.

Crain’s Detroit Business, February 28 
As many of us anxiously await a resolution to the Major League Baseball lockout, I am confident there will be an overabundance of prospective players trying out for the Detroit Tigers at spring training this year. Unfortunately, the quantity of prospective players wanting to play for the Tigers has never been the problem. The challenge has always been identifying and assembling quality players to make for a winning team. For decades, under both government and commercial sponsored health care, providers like hospitals and physicians were paid for simply showing up at tryouts.  read more


Syrtis Solutions Blog, February 28 
Since its passage in 1965, the Medicaid program has expanded to become the single largest payer for health care in the United States, costing $671.2 billion in 2020 alone. Due to surges in enrollment from the pandemic and the current administration’s priorities, spending is only expected to increase. Considering that Medicaid improper payments now account for more than twenty percent of federal Medicaid expenditures, this is a problem.  read more


The National Law Review, February 25 
The Families First Coronavirus Response Act (FFCRA), passed in response to the COVID-19 pandemic, offered states the option to expand Medicaid eligibility for coverage of COVID-19 testing and treatment.1 FFCRA also increased federal financial participation for state Medicaid programs by 6.2% – on the condition that states must maintain beneficiaries’ Medicaid enrollment status until the end of the month following the end of the COVID-19 public health emergency (PHE).  read more


Prescription drugs: Another potential legislative change that Medicaid insurers face  Georgia Health News, February 25 
One House bill would make Georgia’s Medicaid managed care insurers face stricter requirements on how they spend their government dollars. There’s a second bill that has also captured their attention – an attempt to wrest control of patients’ prescription drugs from those health plans. House Bill 1351 would remove the function of the three managed care companies — Peach State, Amerigroup and CareSource — to oversee the dispensing of medication, instead placing it under state supervision. The goal of the bill is to improve care for patients and save the state money, said its lead sponsor, Rep. David Knight, a Griffin Republican. The bill was approved unanimously this week by the House Special Committee on Access to Quality Health Care. The legislation now goes to the House Rules Committee.  


Fierce Healthcare, February 24 
The Department of Justice has filed suit to intervene in UnitedHealth Group’s acquisition of Change Healthcare, just days shy of the company’s planned consummation date of Feb. 27. In an announcement, the DOJ says that the deal would harm competition in commercial health markets as well as the market for technology that insurers use to process claims and reduce healthcare costs. The deal is valued at $8 billion in cash and $5 billion in debt.  


Sublette Examiner, February 24 
The full Wyoming Senate wasn’t able to vote on a Medicaid expansion amendment to the budget bill Wednesday night after the Rules Committee declared it unconstitutional. Medicaid expansion has been a long-term effort by advocates such as Better Wyoming and the Healthy Wyoming Coalition, which made arguments in support of passing legislation so 24,000 residents could gain access to medical insurance.  read more


Fierce Healthcare, February 23
Michigan Gov. Gretchen Whitmer signed a series of pharmacy benefit management reforms into law on Wednesday, including bills that don’t discriminate against pharmacies they don’t have a relationship with. The signing of the three bills Wednesday comes less than a week after the Federal Trade Commission (FTC) was deadlocked on whether to investigate PBM contracting practices.  read more


Single-Payer Healthcare Fails in California, Look to Texas 
RealClear Health, February 23
A California lawmaker has pulled down his own bill that would have created a single-payer healthcare system in the Golden State—even before a vote was scheduled. Even with the Democrats’ supermajority in the California capitol, he couldn’t round up the votes. According to the Sacramento Bee, the bill by San Jose Assemblyman Ash Kalra “threatened the existence of private insurance companies and would have overhauled the healthcare system, prompting fierce push-back from many parts of the industry.”  read more


Aetna Better Health selected to continue serving Louisiana Medicaid program  CVSHealth, February 22 
Aetna Better Health of Louisiana, a CVS Health® company (NYSE: CVS), today announced that the Louisiana Department of Health intends to award the company a new statewide Medicaid contract through the Louisiana Medicaid Managed Care Program. Aetna Better Health has served Medicaid enrollees in Louisiana for more than seven years.  read more


CISION PRWeb, February 22
A recent Foundation for Government Accountability (FGA) report shows that conditions included in exchange for increased federal Medicaid funding have led to unsustainable Medicaid enrollment growth that is now costing states more than they are receiving from the increased funding. By agreeing to not strengthen program eligibility standards, adjust the enrollment processes, or remove individuals from their Medicaid rolls even when they become ineligible for the program, states are spending more than they are receiving from the federal funding increase.  read more


Payment failures to Florida’s sickest children could spur Medicaid managed care reform push  The Capitolist, February 22 
Software glitches that arose during the merger of the two largest Medicaid managed care providers in Florida are being blamed for payment stoppages to some of the state’s sickest children. But the political fallout from the payment failures could also be enough to spur state lawmakers into adopting wide-ranging changes to the state’s Medicaid managed care program – and supporters say the changes are badly needed to help prevent future failures through increased competition.  read more, February 17 
As part of the Biden-Harris Administration’s work to advance health equity and reduce health disparities, the Centers for Medicare & Medicaid Services (CMS) is seeking feedback on topics related to health care access, such as enrolling in and maintaining coverage, accessing health care services and supports, and ensuring adequate provider payment rates to encourage provider availability and quality.  read more


businesswire, February 15 
Anthem Blue Cross and Blue Shield in Ohio today announced the completion of the transaction to acquire the Medicaid contract held by Paramount Advantage that currently serves 257,000 Ohio Medicaid enrollees. “We’re pleased to complete the transaction with Paramount Advantage as we work to serve more Medicaid individuals with personalized, high-quality healthcare they’ve come to know and trust,” said Greg LaManna, Anthem Blue Cross and Blue Shield’s Medicaid Plan President in Ohio.  read more


Medicaid expansion to be discussed by North Carolina lawmakers on Friday. It’s the first of series of meetings.  Winston-Salem Journal, February 14 
A key committee is scheduled to begin discussing expanding the state’s Medicaid program on Friday. The Joint Legislative Oversight Committee on Access to Healthcare and Medicaid Expansion is scheduled to meet at 10 a.m. Friday. However, there is a possibility the meeting could be postponed to allow legislators to focus on the next attempt at redistricting maps.  read more


Why Millions on Medicaid Are at Risk of Losing Coverage in the Months Ahead  KHN, February 14 
The Biden administration and state officials are bracing for a great unwinding: millions of people losing their Medicaid benefits when the pandemic health emergency ends. Some might sign up for different insurance. Many others are bound to get lost in the transition. State Medicaid agencies for months have been preparing for the end of a federal mandate that anyone enrolled in Medicaid cannot lose coverage during the pandemic.  read more


CISION, February 14
Centene Corporation (NYSE: CNC) announced today its subsidiary Louisiana Healthcare Connections was selected by the Louisiana Department of Health to continue administering quality, integrated healthcare services to Medicaid enrollees across the state. The new statewide contract is anticipated to begin July 1, 2022. “We are honored by the opportunity to continue working with our state partners to help build a healthier Louisiana,” said Brent Layton, Centene’s President and Chief Operating Officer.  read more


U.S. News, February 14 
The Mississippi House decided Monday not to have a second debate on a bill that could force the state’s Medicaid program to end a contract with health care giant Centene. House Bill 658 moves to the Senate for more work. Centene settled a lawsuit last year that accused one of its subsidiaries of overcharging the Mississippi Division of Medicaid millions of dollars for pharmacy benefits management. Centene agreed to pay the state $55.5 million but did not admit fault.  read more


The Sun Times, February 8 
Two months ago, things were looking dire for Empower Healthcare Solutions, a managed care organization that serves roughly 20,000 Arkansas Medicaid beneficiaries with developmental disabilities, severe behavioral health disorders and other complex needs. The attorney general’s office was investigating the company for suspected Medicaid fraud. The state Department of Human Services, which oversees Medicaid in Arkansas, suspended new enrollments to Empower in November due to alleged “misrepresentations” to DHS.  read more