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 relate 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.
MHA Shares Recent Medicare and Medicaid Enrollment Analysis MHA, January 30
The MHA recently updated its analysis of Medicaid and Medicare enrollment based on December 2025 data. The analysis includes program enrollment as a percentage of each county’s total population and the split between fee-for-service and managed care organization . Just over 25% of Michigan’s total population is enrolled in Medicaid and 23% is enrolled in Medicare. Roughly two-thirds of Michigan’s 2.5 million Medicaid beneficiaries are enrolled in one of nine managed care plans. read more
The MHA recently updated its analysis of Medicaid and Medicare enrollment based on December 2025 data. The analysis includes program enrollment as a percentage of each county’s total population and the split between fee-for-service and managed care organization . Just over 25% of Michigan’s total population is enrolled in Medicaid and 23% is enrolled in Medicare. Roughly two-thirds of Michigan’s 2.5 million Medicaid beneficiaries are enrolled in one of nine managed care plans. read more
Gov. Stitt suggests Medicaid cuts to curb health care costs
Oklahoma’s News 4, January 30
On Thursday, the Oklahoma Healthcare Authority asked for nearly half a billion more in its budget. Healthcare Authority Director Clay Bullard told lawmakers that a remedy for high agency costs could be taking the Medicaid Expansion out of the state constitution. OHCA stated that the extra cost to maintain the Oklahoma Medicaid Program (SoonerCare) at the current level would be $354,212,545 for Fiscal Year 2027. “There is no cash reserve at this point; it is at a dangerous level,” said Bullard on Thursday. Bullard told lawmakers that there were a lot of reasons why their budget is tight. read more
Oklahoma’s News 4, January 30
On Thursday, the Oklahoma Healthcare Authority asked for nearly half a billion more in its budget. Healthcare Authority Director Clay Bullard told lawmakers that a remedy for high agency costs could be taking the Medicaid Expansion out of the state constitution. OHCA stated that the extra cost to maintain the Oklahoma Medicaid Program (SoonerCare) at the current level would be $354,212,545 for Fiscal Year 2027. “There is no cash reserve at this point; it is at a dangerous level,” said Bullard on Thursday. Bullard told lawmakers that there were a lot of reasons why their budget is tight. read more
PREPARING FOR MEDICAID BUDGET REDUCTIONS WITHOUT CUTTING BENEFITS Syrtis Solutions, January 30
As states begin planning their fiscal year (FY) 2027 budgets, many Medicaid programs are preparing for tougher financial conditions. State revenue growth has slowed while health care spending pressures continue, and recent federal policy changes under the 2025 budget reconciliation law add uncertainty to future funding streams. Even as enrollment stabilizes, costs tied to provider payments, higher needs among beneficiaries, and expanding long-term care, pharmacy, and behavioral health utilization are contributing to rising spending. read more
As states begin planning their fiscal year (FY) 2027 budgets, many Medicaid programs are preparing for tougher financial conditions. State revenue growth has slowed while health care spending pressures continue, and recent federal policy changes under the 2025 budget reconciliation law add uncertainty to future funding streams. Even as enrollment stabilizes, costs tied to provider payments, higher needs among beneficiaries, and expanding long-term care, pharmacy, and behavioral health utilization are contributing to rising spending. read more
Health official warns that future Medicaid cuts could lead to $2.7 billion loss in federal funding Maryland Matters, January 29
Cuts and changes to Medicaid under the Trump administration could amount to almost $3 billion in lost federal dollars annually, Maryland health care officials told the Senate Finance Committee Thursday. Much of that loss comes from the anticipated drop in Medicaid coverage due to eligibility changes under HR 1, the federal budget reconciliation bill passed in 2025 known as the “One Big Beautiful Bill Act.” Deputy Health Secretary Perrie Briskin, in charge of health care financing and state Medicaid director, told senators that “with all provisions implemented” in the bill, the state could lose out on $2.7 billion in federal funding, a loss that would account for almost 20% of current Medicaid funding in the state — numbers that elicited a small gasp from one of the lawmakers on the committee. read more
Cuts and changes to Medicaid under the Trump administration could amount to almost $3 billion in lost federal dollars annually, Maryland health care officials told the Senate Finance Committee Thursday. Much of that loss comes from the anticipated drop in Medicaid coverage due to eligibility changes under HR 1, the federal budget reconciliation bill passed in 2025 known as the “One Big Beautiful Bill Act.” Deputy Health Secretary Perrie Briskin, in charge of health care financing and state Medicaid director, told senators that “with all provisions implemented” in the bill, the state could lose out on $2.7 billion in federal funding, a loss that would account for almost 20% of current Medicaid funding in the state — numbers that elicited a small gasp from one of the lawmakers on the committee. read more
CMS Shuts Down Massive Medicaid Tax Loophole, Saving Billions for Federal Taxpayers and Restoring the Federal-State Partnership CMS.gov, January 29
CMS Shuts Down Massive Medicaid Tax Loophole, Saving Billions for Federal Taxpayers and Restoring the Federal-State Partnership. New Policy Delivers Major Program Integrity Win by Halting State Schemes that Previously Shifted Medicaid Costs onto Federal Taxpayers. The Centers for Medicare & Medicaid Services (CMS) is taking decisive action – through the Preserving Medicaid Funding for Vulnerable Populations—Closing a Health Care-Related Tax Loophole Final Rule – to implement and enforce statutory changes that closed a Medicaid financing gimmick. read more
CMS Shuts Down Massive Medicaid Tax Loophole, Saving Billions for Federal Taxpayers and Restoring the Federal-State Partnership. New Policy Delivers Major Program Integrity Win by Halting State Schemes that Previously Shifted Medicaid Costs onto Federal Taxpayers. The Centers for Medicare & Medicaid Services (CMS) is taking decisive action – through the Preserving Medicaid Funding for Vulnerable Populations—Closing a Health Care-Related Tax Loophole Final Rule – to implement and enforce statutory changes that closed a Medicaid financing gimmick. read more
If Idaho cuts Medicaid, ripple effects on the budget are likely. Will they drive up costs elsewhere? Idaho Capital Sun, January 26
As Idaho lawmakers consider cutting Medicaid to balance the state’s budget, some lawmakers worry cuts could drive up costs elsewhere. But just how much is difficult to know. An internal budget document suggests that the Idaho Department of Health and Welfare doesn’t know if the governor’s proposed $22 million cuts would create “new potential costs.” And those cuts could also result in the state losing over $100 million dollars in federal matching funds that Idaho Medicaid would get. read more
As Idaho lawmakers consider cutting Medicaid to balance the state’s budget, some lawmakers worry cuts could drive up costs elsewhere. But just how much is difficult to know. An internal budget document suggests that the Idaho Department of Health and Welfare doesn’t know if the governor’s proposed $22 million cuts would create “new potential costs.” And those cuts could also result in the state losing over $100 million dollars in federal matching funds that Idaho Medicaid would get. read more
Medicaid: What to Watch in 2026 KFF, January 23
At the start of 2026, many issues are at play that could affect Medicaid coverage, financing, and access to care. Medicaid, which is administered by states within broad federal rules, provides comprehensive health and long-term care coverage to one in five low-income Americans. A more tenuous fiscal climate in 2026 coupled with implementation of the 2025 reconciliation law will put pressure on state Medicaid programs. While major legislative changes to Medicaid at the federal level are unlikely in 2026, key areas to watch include federal policy actions such as new regulations or guidance related to work requirements, implementation guidance for other components of the 2025 reconciliation law, and states’ policy actions in response to federal policy changes and state budget pressures. read more
At the start of 2026, many issues are at play that could affect Medicaid coverage, financing, and access to care. Medicaid, which is administered by states within broad federal rules, provides comprehensive health and long-term care coverage to one in five low-income Americans. A more tenuous fiscal climate in 2026 coupled with implementation of the 2025 reconciliation law will put pressure on state Medicaid programs. While major legislative changes to Medicaid at the federal level are unlikely in 2026, key areas to watch include federal policy actions such as new regulations or guidance related to work requirements, implementation guidance for other components of the 2025 reconciliation law, and states’ policy actions in response to federal policy changes and state budget pressures. read more
Medicaid and Upcoming State Budget Debates
KFF, January 23
As states begin budget debates for state fiscal year (FY) 2027, many states are facing a more tenuous fiscal climate. Slowing revenue growth and heightened spending demands coupled with anticipated federal Medicaid cuts under the 2025 reconciliation law, changes to the Affordable Care Act (ACA) enhanced Marketplace subsidies, and economic changes are contributing to tighter budget conditions and fiscal uncertainty for states. Medicaid is often central to state fiscal decisions as it is simultaneously a significant spending item as well as the largest source of federal revenues for states. read more
KFF, January 23
As states begin budget debates for state fiscal year (FY) 2027, many states are facing a more tenuous fiscal climate. Slowing revenue growth and heightened spending demands coupled with anticipated federal Medicaid cuts under the 2025 reconciliation law, changes to the Affordable Care Act (ACA) enhanced Marketplace subsidies, and economic changes are contributing to tighter budget conditions and fiscal uncertainty for states. Medicaid is often central to state fiscal decisions as it is simultaneously a significant spending item as well as the largest source of federal revenues for states. read more
Medicaid Work Requirements Spark Debate as States Prepare for Federal Changes NCSL, January 21
State lawmakers are weighing the impact of newly enacted federal Medicaid work requirements, a policy shift supporters say will encourage engagement but critics warn could strip health care from hundreds of thousands of low-income Americans. The One Big, Beautiful Bill reconciliation package signed July 4, 2025, adds a nationwide requirement that many Medicaid recipients work or participate in qualifying activities for 80 hours per month, unless they meet exemptions for disability, pregnancy, caregiving, school enrollment or other circumstances. read more
State lawmakers are weighing the impact of newly enacted federal Medicaid work requirements, a policy shift supporters say will encourage engagement but critics warn could strip health care from hundreds of thousands of low-income Americans. The One Big, Beautiful Bill reconciliation package signed July 4, 2025, adds a nationwide requirement that many Medicaid recipients work or participate in qualifying activities for 80 hours per month, unless they meet exemptions for disability, pregnancy, caregiving, school enrollment or other circumstances. read more
Illinois Medicaid program faces looming funding crisis due to federal changes
Capitol News Illinois, January 19
A multibillion-dollar budget crisis will hit the state’s Medicaid program in the next few years unless state lawmakers and Gov. JB Pritzker act to prevent it, budget analysts both inside and outside state government warn. The crisis comes from changes in federal Medicaid policy that were enacted last year as part of President Donald Trump’s sweeping domestic policy agenda, known officially as H.R. 1, or the “One Big Beautiful Bill Act,” which, among many other things, slashes one of the main funding tools many states have used for four decades to fund their share of the cost of Medicaid. read more
Capitol News Illinois, January 19
A multibillion-dollar budget crisis will hit the state’s Medicaid program in the next few years unless state lawmakers and Gov. JB Pritzker act to prevent it, budget analysts both inside and outside state government warn. The crisis comes from changes in federal Medicaid policy that were enacted last year as part of President Donald Trump’s sweeping domestic policy agenda, known officially as H.R. 1, or the “One Big Beautiful Bill Act,” which, among many other things, slashes one of the main funding tools many states have used for four decades to fund their share of the cost of Medicaid. read more
Fiscal Year 2025 Improper Payments Fact Sheet
CMS.gov, January 15
The Centers for Medicare & Medicaid Services (CMS) is committed to being a responsible steward of public funds and to promoting the sustainability of its programs for future generations. While CMS’ improper payment reporting programs are designed to protect the integrity of CMS programs, improper payment measurement is not a measure of fraud, and not all improper payments are attributable to fraud or abuse. Rather, it is important to understand that improper payments are payments that do not meet CMS program payment requirements. read more
CMS.gov, January 15
The Centers for Medicare & Medicaid Services (CMS) is committed to being a responsible steward of public funds and to promoting the sustainability of its programs for future generations. While CMS’ improper payment reporting programs are designed to protect the integrity of CMS programs, improper payment measurement is not a measure of fraud, and not all improper payments are attributable to fraud or abuse. Rather, it is important to understand that improper payments are payments that do not meet CMS program payment requirements. read more
Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State KFF, January 14
Section 1115 Medicaid demonstration waivers offer states an avenue to test new approaches in Medicaid that difer from what is required by federal statute, if [in the HHS Secretary’s view] the approach is likely to “promote the objectives of the Medicaid program.” They can provide states additional flexibility in how they operate their programs, beyond the considerable flexibility that is available under current law. Waivers generally reflect priorities identified by states as well as changing priorities from one presidential administration to another. read more
Section 1115 Medicaid demonstration waivers offer states an avenue to test new approaches in Medicaid that difer from what is required by federal statute, if [in the HHS Secretary’s view] the approach is likely to “promote the objectives of the Medicaid program.” They can provide states additional flexibility in how they operate their programs, beyond the considerable flexibility that is available under current law. Waivers generally reflect priorities identified by states as well as changing priorities from one presidential administration to another. read more
To cut Medicaid budget, governor says Idaho could remove disability, dental services Idaho Capital Sun, January 14
To balance the state’s budget, Idaho Gov. Brad Little’s plan says the state could cut Medicaid services for dental care and people with disabilities. As part of the governor’s recommendation for $22 million in extra Medicaid cuts, he says the state could remove Medicaid dental coverage for adults, and home and community-based services, which are meant to help people with developmental disabilities live outside of institutional settings. read more
To balance the state’s budget, Idaho Gov. Brad Little’s plan says the state could cut Medicaid services for dental care and people with disabilities. As part of the governor’s recommendation for $22 million in extra Medicaid cuts, he says the state could remove Medicaid dental coverage for adults, and home and community-based services, which are meant to help people with developmental disabilities live outside of institutional settings. read more
New Federal Medicaid Policies Compound State Budget Pressures Pew, January 13
This is one in a series of five articles examining key debates that will unfold in the nation’s statehouses in the year ahead. Medicaid—the health care provider for roughly 1 in 5 Americans and the largest single source of federal funding for state governments—is entering a period of major change that could reshape state budgets for years to come. read more
This is one in a series of five articles examining key debates that will unfold in the nation’s statehouses in the year ahead. Medicaid—the health care provider for roughly 1 in 5 Americans and the largest single source of federal funding for state governments—is entering a period of major change that could reshape state budgets for years to come. read more
