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, February 28 
In March 2020, under former Governor Andrew Cuomo’s administration, the New York Medicaid Redesign Team recommended that the state carve-out pharmacy benefits from the Medicaid program due to concerns regarding pharmacy spend and provider transparency. The reform essentially transitions prescription drug reimbursement from a managed care model to a fee-for-service model, making the state responsible for the pharmacy benefit rather than managed care organizations and pharmacy benefit managers.  read more


Federal audit: Missouri must refund $34.2M for bad Medicaid reimbursements  The Heartlander, February 28 
The U.S. Department of Health and Human Services’ inspector general found the state of Missouri must refund $34.2 million to the federal government due to unqualified reimbursements for personal care assistance. A 36-page audit by the HHS’ inspector general found Missouri didn’t always ensure consumer-directed personal care assistance services complied with federal and state Medicaid reimbursement requirements. The audit reviewed fiscal years 2018 and 2019. The audit found 17 of a sample of 150 items had a variety of errors.  read more


Why one state’s plan to unwind a Covid-era Medicaid rule is raising red flags  Politico, February 27 
President Joe Biden is giving states a year to check whether millions of low-income Americans are still eligible to receive health insurance through their government’s Medicaid program. Arkansas is planning to do it in half that time. GOP Gov. Sarah Huckabee Sanders, former President Donald Trump’s press secretary, is pushing to remove people from “government dependency,” and this month her Medicaid agency started sending letters to tens of thousands of Medicaid recipients asking for proof of income and a host of other details to show they are still eligible for the insurance program.  read more


Missourinet, February 27 
President Joe Biden announced in January that the COVID-19 public health emergency will expire in May. The shift back to pre-pandemic times will mean Missouri will begin checking whether Medicaid participants are still eligible for their benefits. Missouri has about 200,000 job openings. During an event with reporters Thursday, Gov. Mike Parson said he expects a shift in the number of job vacancies over the next six months. “When that declaration comes off, we’ll be able to go back in there and say, ‘Okay, do you belong? Do you not belong?  read more


Axios, February 26 
Millions of people who rely on Medicaid coverage may be removed from the program over the next year. The big picture: Under the COVID public health emergency, the federal government required state Medicaid agencies to provide coverage, even if an individual’s eligibility changed. Enrollment in Medicaid and the Children’s Health Insurance Program increased in every state since the start of the pandemic, per the Kaiser Family Foundation. Total Medicaid and CHIP enrollment increased by 20.2 million people from enrollment in February 2020, the Kaiser Family Foundation found.  read more


WV Public Broadcasting, February 17 
After federal and state level changes to Medicaid, many Americans will be left without health insurance coverage by the end of the year. To remedy the financial strain on West Virginia families, lawmakers are considering a bill to create a high-quality, low-cost health insurance plan for low income residents to pay a low monthly premium based on a sliding scale. House Bill 3274 would create the Affordable Medicaid Buy-in Program to help alleviate financial strain on recipients of Medicaid who start a job that disqualifies them from receiving their benefits.  read more


U.S. DHHS OIG, February 16 
Florida pays managed care organizations to make services available to eligible Medicaid enrollees in return for a monthly fixed payment (capitation payment) for each enrollee. Previous OIG audits found that State Medicaid agencies had improperly made capitation payments on behalf of enrollees who were residing and enrolled in Medicaid in another State. We are concerned that the concurrent Medicaid enrollment identified in our previous audits could be an issue that negatively impacts Florida’s Medicaid program.


U.S. proposes Medicare, Medicaid programs to cut drug costs, including $2 generics  Reuters, February 14
The U.S. health department proposed on Tuesday three new pilot projects aimed at lowering prescription drug prices for people enrolled in government health insurance plans, including offering some essential generic drugs for $2 a month. The Centers for Medicare and Medicaid (CMS) said it would test the models in the Medicare health program for people age 65 or over and the disabled and the Medicaid program for the poor.  read more


Fayetteville Flyer, February 15
Arkansas will ask the federal government to allow the state to require people on its expanded Medicaid program to work, Gov. Sarah Huckabee Sanders said Wednesday, trying to reinstate a requirement that was blocked by the courts and opposed by President Joe Biden’s administration. Unlike the previous requirement, Sanders said, the latest proposal won’t cut off coverage to people who don’t comply. Instead, it will move them from the private insurance used for Arkansas’ expansion to the traditional fee-for-service Medicaid program.  read more


Medicaid expansion bill glides through committees in the state House of Representatives  NC Health News, February 15
Often legislative committee hearings are sleepy affairs, attended by lawmakers, lobbyists and the occasional person interested in the intricacies of government. That was not the case Tuesday on the sixth floor of the legislative office building. The size and excitement of the crowd looked more like someone had a small stash of Taylor Swift tickets or the hottest new iPhone for sale. Lobbyists and advocates of expanding the state’s Medicaid program were jammed into a hallway, hoping to get inside the room where something, after more than a decade of waiting, might start to happen.  read more


KFF, February 13 
At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a requirement that Medicaid programs keep people continuously enrolled through the end of the COVID-19 public health emergency (PHE) in exchange for enhanced federal funding. Primarily due to the continuous enrollment provision, Medicaid enrollment has grown substantially compared to before the pandemic.  read more


LAO, February 10 
Governor’s Budget Includes Major Increase to Medi‑Cal General Fund Spending. The Governor’s budget includes $38.7 billion General Fund spending on Medi‑Cal, the state’s Medicaid program, in 2023‑24. This amount reflects a $6.4 billion (20 percent) net increase over the revised 2022‑23 level. The net increase primarily is driven by current law and policy adjustments as opposed to new budget proposals. The Governor’s budget also includes several proposals that would require a change in state law, new authorization from the federal government, or both.  read more


Spectrum News 1, February 9 
Lawmakers and labor unions are working to amend a longtime bill that would establish a single-payer health care system in New York as budget talks get under way. About 1 million New York adults, or about 1 in 6, lack health insurance, according to the New York City Health Department. Lawmakers have debated the best way to ensure every New Yorker has access to health coverage for decades, including replacing existing coverage through private insurance companies and implementing socialized health care in the state.  read more


The Lewiston Tribune, February 8 
The Idaho Legislature and state Division of Medicaid will have a number of potential downstream impacts to consider when weighing cost-saving recommendations for Medicaid. The state hired the consulting firm Sellers Dorsey to create a report of recommended cost reductions to Idaho’s Medicaid program. Michael Heifetz, director at the firm, told House and Senate Health and Welfare committee members Monday that his firm’s initial report only included possible short-term savings for the state, and it wasn’t charged with doing a long-term economic analysis of the impact of those recommendations — which include decreasing provider reimbursement rates, eliminating the primary care case management program and eliminating the dental benefit.  read more


Section 1115 Waiver Watch: How California Will Expand Medicaid Pre-Release Services for Incarcerated Populations  KFF, February 7
On January 26, the Centers for Medicare and Medicaid Services (CMS) approved California’s Section 1115 request to cover a package of reentry services for certain groups of incarcerated individuals 90 days prior to release. This approval is the first to include a partial waiver of the statutory Medicaid inmate exclusion policy, which prohibits Medicaid from paying for services provided during incarceration (except for inpatient services). Justice-involved individuals are disproportionately low-income and often have complex and/or chronic conditions, including behavioral health needs (mental health conditions and/or substance use disorder (SUD)).


Dayton Daily News, February 6
The Ohio Department of Medicaid recently launched its Next Generation managed care plans, following an overhauling process that began in 2019 when the state and Gov. Mike DeWine decided to rebid the managed care plans. Structural changes include expanding from five to seven managed care plans and renegotiating requirements for those Medicaid managed care insurance companies through the procurement process, which were the first changes to take place since the Centers for Medicare and Medicaid Services approved Ohio’s program in 2005.  read more


Kaiser Family Foundation Reports on Medicare-Medicaid Enrollment and Spending  Medicare Rights Center, February 2
This week, the Kaiser Family Foundation (KFF) released a brief examining national and state-level data on enrollment and spending for people enrolled in both Medicare and Medicaid, sometimes called dually enrolled individuals or duals. KFF used the 2019 and 2020 Medicare Beneficiary Summary Files and the 2019 Transformed Medicaid Statistical Information System to identify trends and patterns in enrollment across states and programs and spending in Medicaid and traditional Medicare, as spending data for individuals enrolled in Medicare Advantage is not publicly available.  read more


Comer Opens Hearing Investigating Billions Lost to Waste, Fraud, and Abuse in Pandemic Programs  Committee On Oversight and Accountability, February 1
House Committee on Oversight and Accountability Chairman James Comer (R-Ky.) today delivered opening remarks at a hearing titled “Federal Pandemic Spending: A Prescription for Waste, Fraud, and Abuse.” After spending trillions of dollars under the name of COVID with no guardrails or protections, billions of taxpayer dollars were lost to waste, fraud, abuse, and mismanagement. Chairman Comer emphasized that Republicans will identify where this money went, how much ended up in the hands of fraudsters or ineligible participants, and what should be done to ensure it never happens again.  read more