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 26 
Medicaid enrollment is being significantly impacted due to the expiration of the continuous enrollment condition authorized by the Families First Coronavirus Response Act. Since April, millions of individuals have been disenrolled from the program. Simultaneously, millions of others have either re-enrolled or enrolled in the program for the first time.  read more
How Many Uninsured Are in the Coverage Gap and How Many Could be Eligible if All States Adopted the Medicaid Expansion?  KFF, February 26
Ten years after the implementation of the Affordable Care Act’s (ACA) coverage options, ten states have not adopted the Medicaid expansion, leaving 1.5 million uninsured people without an affordable coverage option. The unwinding of the Medicaid continuous enrollment provision along with ongoing financial…  read more
Single-payer healthcare is a ‘tough, tough sell’ as California faces massive budget shortfall  Los Angeles Times, February 21
California Assembly Speaker Robert Rivas cast doubt on the latest proposal to create a state-run single-payer healthcare system, saying he likes the idea but isn’t convinced the state can afford it in the face of a budget shortfall of at least $38 billion. “The concept of single-payer and expanding access and affordability are good ideas,” Rivas, a Democrat from Hollister, told reporters at the state Capitol on Tuesday.  read more
Massachusetts 1115 waiver success can translate to New York: experts
Fierce Healthcare, February 21
The blueprint set forth by Massachusetts accountable care organizations to improve population health metrics and reduce costs can be applied to New York, after Centers for Medicare & Medicaid Services (CMS) approved its amended section 1115 demonstration in January. That’s according to Kim Prendergast, vice president of policy at MassHealth ACO Community Care Cooperative (C3), and Suzanne Wogelius, vice president of product management…  read more
Medicaid Managed Care: Results of the PHE Unwinding for the Big Five in Q4 2023  Georgetown University CCF, February 14
Q4 2023 was also the third quarter of the PHE “unwinding”—the redetermination of eligibility for all 86.7 million Medicaid enrollees following the expiration of the Public Health Emergency continuous coverage provision in March 2023. These redeterminations have resulted in the disenrollment of over 16 million Medicaid enrollees as of January 2024, which translates into a net decline of nearly 10 million enrollees…  read more
How Payers and Pharmacy Benefit Managers Work Together to Lower Costs
Health Payer Intelligence, February 14
As prescription drug spending rises in the United States, healthcare stakeholders and policymakers constantly look for ways to curb costs. Many payers turn to pharmacy benefit managers (PBMs), which aim to negotiate lower drug prices with pharmaceutical manufacturers. PBMs are third-party entities that act as intermediaries between health insurers and drug companies.  read more
More than 2 million people dropped from Medicaid in Texas  
Axios, February 13
More than 2 million people have been removed from Texas’ Medicaid program since federal pandemic-era coverage protections were lifted last April, new state data shows. The big picture: That’s the most of any state and nearly equivalent to all of Houston — Texas’ most populous city, with 2.3 million residents — losing coverage in less than a year. Zoom in: More than 16.4 million people have lost Medicaid coverage nationwide since eligibility checks…  read more
KFF, February 7
The Affordable Care Act’s (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($20,783 for an individual in 2024) and provided states with an enhanced federal matching rate (FMAP) for their expansion populations. To date, 41 states (including DC) have adopted the Medicaid expansion and 10 states have not adopted the expansion.  read more
Minnesota Medicaid Revisits the Question: Managed Care or Fee-for-Service?
Georgetown University CCF, February 6
In the beginning, there was fee-for-service (FFS). In this case, the beginning was 1965, when Medicaid (and Medicare) were enacted. FFS was the way that these public programs, as well as almost all private insurers, purchased health care. Fast forward to today. Propelled by an interest in budget predictability and federal policy changes giving them greater flexibility…  
Policy Update: CMS Approves New York 1115 Medicaid Redesign Waiver
JD Supra, February 2
On January 9, 2024, the Centers for Medicare and Medicaid Services (CMS) approved the New York State (NY) 1115 Medicaid waiver “Medicaid Redesign Team” (MRT). The MRT is a long-standing waiver in NY that has continuously evolved to improve the administration, structure and financing of the NY Medicaid program; enhance Medicaid beneficiaries’ access to services; and…  read more