MEDICAID NEWS RECAP – JANUARY 2025

MILLIONS SPENT ON DUPLICATE MEDICAID ENROLLMENTS
Syrtis Solutions, January 31
A recent audit by the Washington State Auditor’s Office revealed that Washington state is overspending on Medicaid premiums—an estimated $8.6 million annually—due to individuals being enrolled in Medicaid programs in multiple states. The audit focused on seven states but suggested that the financial impact from duplicate Medicaid enrollments is likely even higher nationwide.  read more

CMS Statement on Lowering the Cost of Prescription Drugs
CMS.gov, January 29
Lowering the cost of prescription drugs for Americans is a top priority of President Trump and his Administration. In accordance with the statutory requirements of the Inflation Reduction Act, the Centers for Medicare and Medicaid Services (CMS) released the list of 15 drugs selected for the second cycle of the Medicare Drug Price Negotiation Program on January 17, 2025.  

Arkansas again seeks Medicaid work requirement waiver
Arkansas Advocate, January 28
Arkansas is again seeking a Medicaid work requirement that state officials say incorporates lessons learned from previous attempts. Republican Gov. Sarah Huckabee Sanders on Tuesday shared a letter to U.S. Department of Health and Human Services Secretary-Designate, Robert F. Kennedy Jr. and a waiver request to the Centers for Medicare and Medicaid Services (CMS) requesting the implementation of a work requirement for “able-bodied, working-age recipients” of the state’s Medicaid expansion program — Arkansas Health and Opportunity for Me (ARHOME).  read more

KOMO News, January 27
The federal government issued $161.5 billion in improper payments during fiscal year 2024, according to a report by the U.S. Government Accountability Office. These payments were either made in error or incorrect amounts, contributing to a long-standing issue that has accumulated to $2.8 trillion since 2003. “I put the fall to Congress here is not really cracking down and doing what it needs to do to reduce these erroneous and fraudulent payments,” said Chris Edwards, the Kilts Family Chair in Fiscal Studies at the Cato Institute.  read more

Sen. Jordan Rasmusson chairs human services hearing on waste, fraud and abuse  Echo Press, January 25
On Wednesday, Jan. 22, Senator Jordan Rasmusson, R-Fergus Falls, the Republican chair of the Senate Human Services Committee, led a hearing on program integrity and fraud prevention within the Minnesota Department of Human Services (DHS). The committee focused on understanding ways for the agency to strengthen oversight, ensure taxpayer dollars are spent wisely, and guarantee state services only reach their intended purposes.  read more

Hundreds of thousands in Vt. taxpayer Medicaid dollars are unaccounted for  WCAX3, January 24  
The Department of Vermont Health Access’s efforts to stop fraud is reported to have fallen short of its duties. Auditor Doug Hoffer’s team found the Department of Vermont Health Access special investigative unit identified $1.2 million of improper payments in just a sample of 2024′s claims. The auditor says in most of these cases, the special investigative unit was able to retrieve the erroneous payments. However, $517,000 will not be recovered due to what they say is the Department of Vermont Health Access’s management problem.  read more

House committee introduces Medicaid expansion repeal bill
Idaho Capital Sun, January 24
Idaho Republican lawmakers on Friday introduced a bill to repeal a voter-passed law to expand Medicaid. Idaho House Health and Welfare Committee Chairman John Vander Woude, R-Nampa, presented the bill — House Bill 58 — which lists Idaho House Assistant Majority Leader Josh Tanner, R-Eagle, as a sponsor. “We’re on a trajectory that I just don’t think we can afford to continue,” Vander Woude told the committee. “And I do think we need to take a closer look.”  read more

AJMC, January 22
In his first hours as the 47th president of the United States, Donald Trump initiated an effort to rescind Biden administration policies, ranging from scaling back Affordable Care Act (ACA) provisions to withdrawing from the World Health Organization (WHO) and rescinding drug pricing initiatives. These executive orders reflect a sharp pivot in federal health policy, with the president’s swift policy reversals raising concerns among public health experts and advocates about the future of pandemic preparedness, health care equity, and cost-saving reforms.  

South Carolina Daily Gazette, January 21
Gov. Henry McMaster asked federal officials Tuesday to quickly approve his request that would expand Medicaid eligibility for poor parents who are working or going to school. If the Trump administration agrees, more South Carolina adults would qualify for the government-paid health insurance if they can prove they’re either working, training for a job, going to school or volunteering for at least 80 hours each month.  read more

CMS announces updated Medicaid eligibility standards for 2025
McKnights Senior Living, January 17  
The Centers for Medicare & Medicaid Services on Friday released an informational bulletin with updated federal poverty level standards applied to eligibility criteria for Medicaid. The 2025 guidelines reflect a 2.9% price increase between calendar years 2023 and 2024, the agency said. For 2025, the poverty guideline in all states except Alaska and Hawaii is $15,650 for a one-person family/household and $21,150 for a two-person family/household.  read more

Braun administration quick to make Medicaid changes related to eligibility checks, advertisements  WFYI, January 16
Indiana Gov. Mike Braun was sworn in on Monday and his administration has already made changes to the Medicaid program. The most significant change involves how often the Family and Social Services Administration checks whether people are still eligible. Mitch Roob, the new secretary of FSSA, said the Braun administration will begin checking eligibility once a quarter instead of once a year. When asked about the legality of this change, he said it wasn’t a concern.  read more

 

Medicaid Work Requirements Could Put 36 Million People at Risk of Losing Health Coverage  Center On Budget and Policy Priorities, January 16
Recent proposals from Republican congressional leaders and conservative think tanks would cut Medicaid by taking coverage away from people who don’t meet unnecessary and burdensome work requirements.[1] We estimate that 36 million Medicaid enrollees — including people in every state — could be at risk of losing their coverage under various proposals.While not all of those at risk would lose coverage, many would.  read more

Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State  KFF, January 14
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), and provisions related to social determinants of health.  

Peter G. Peterson Foundation, January 3
President-elect Trump has announced the creation of an advisory committee known as Department of Government Efficiency (DOGE), promising that “as the first order of business, this commission will develop an action plan to totally eliminate fraud and improper payments within six months.” The Government Accountability Office (GAO) has tried to quantify the extent of improper payments and estimates that they totaled $236 billion in 2023.  read more