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.

Medicaid expansion breakthrough within reach in N. Carolina  abc News, July 31  After a decade of vigorous opposition, most North Carolina Republicans have now embraced the idea of expanding the state’s Medicaid program to cover hundreds of thousands of additional low-income adults. Legislative approval finally appears within reach. During the General Assembly session that ended July 1, the GOP-controlled House and Senate passed separate, bipartisan measures by wide margins that would put the state on the path to Medicaid expansion.  read more


Statement by HHS Secretary Xavier Becerra, CMS Administrator Chiquita Brooks-LaSure on the 57th Anniversary of Medicare and Medicaid, July 30 Today, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra and Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure released the following statements to mark the 57th anniversary of Medicare and Medicaid on July 30, 2022: Secretary Xavier Becerra: “On the 57th anniversary of Medicare and Medicaid, we celebrate the peace of mind that these critical programs have offered Americans for decades.  read more


House Democrats push for legislation to close Medicaid coverage gap in Senate package  Fierce Healthcare, July 29  Several House Democrats believe there is a big hole in the Senate’s healthcare reconciliation package: legislation to close the Medicaid coverage gap. A group of 50 House Democrats wrote to Senate leadership Thursday calling for closing the coverage gap as part of the Inflation Reduction Act, which includes legislation to lower drug prices and extend Affordable Care Act subsidies.   read more


COST AVOIDANCE MAKES MORE SENSE THAN “PAY AND CHASE”  Syrtis Solutions Blog, July 28  Medicaid has evolved to become an integral safety net program that provides access to health care for millions of Americans. Payment for this health care is either delegated to Medicaid or other third party insurance coverage. In 2012, 7.6 million people on Medicaid had other private coverage, and 10.6 million had other public coverage. Medicaid is considered the “payer of last resort”: if the Medicaid recipient has additional insurance, that third party insurance is responsible for primary payment.  read more


States mixed on how to improve Medicaid unwinding with PHE end date unknown  HealthcareDive, July 28  States are mixed on how to address Medicaid uncertainty once the COVID-19 public health emergency expires, according to a panel that advises Congress on the program. During the PHE, states that received a 6.2 percentage point increase in federal funding for Medicaid were forbidden from disenrolling beneficiaries from the safety-net program.  read more


MACPAC: States press for exact date for ending of COVID-19 public health emergency Fierce Healthcare, July 27  Some states surveyed by a congressional advisory group want an exact date when the COVID-19 public health emergency expires and with it a requirement to not drop anyone from Medicaid’s rolls. The Medicaid and CHIP Payment and Access Commission (MACPAC) released a report during a meeting Wednesday based on surveys of five states who are preparing for the unwinding of the PHE, which now runs through October. “The unwinding will likely be challenging for all states,” said Martha Heberlein, a staffer with MACPAC.  read more


Federal Government Extends PHE, Medicaid Eligibility Reviews on Pause Until Mid-October  AllOnGeorgia, July 25  According to the Georgia Department of Human Services(DHS), the Biden Administration recently announced the official extension of the federal public health emergency (PHE) through October 13, 2022. During the PHE, state Medicaid agencies are required to continue health care coverage for all medical assistance programs, even if someone’s eligibility changes.  read more


Tennessee drops Medicaid drug change over federal concerns  AP, July 22  Tennessee is abandoning plans for a major change to its Medicaid program’s pharmacy benefits after federal health officials raised concerns. TennCare, Tennessee’s Medicaid program, said it will abandon a proposal to impose limits on some prescription drugs following pressure from the federal government. The state last year received approval from former President Donald Trump’s administration for a TennCare overhaul that included the change.  read more


Colorado has added nearly 500,000 people to its Medicaid rolls since 2020. What happens when the emergency order ends? The Colorado Sun, July 20  In normal times, about 35,000 people drop off the government health insurance plan for the needy each month, usually because someone in their household got a new job and they no longer qualify. But since the coronavirus pandemic, and a federal public health emergency declaration more than two years ago, no one has lost their Medicaid benefits. Colorado has added nearly 500,000 people to its Medicaid rolls since early 2020, an increase of 32%.  read more


Medicaid expansion discussions return as Mississippi hospitals face financial struggles wlox13, July 20  More Mississippi organizations have come out in favor of Medicaid expansion in recent months. But state leaders haven’t shown any interest in changing course. Still, it’s part of conversations on how to keep hospitals up and running. It’s not a new explanation about why the Mississippi Hospital Association believes Medicaid expansion is needed for the healthcare system to thrive. “The challenge is simply the revenue,” described Richard Roberson, Mississippi Hospital Association General Counsel and Vice President of Policy and State Advocacy.   read more


With Medicaid Waiver Plan, Washington State Envisions 10 Community Hubs  healthcare innovation, July 19 In its request for an extension of its Section 1115 Medicaid demonstration waiver, Washington state said it plans to develop a“Taking Action for Healthier Communities (TAHC)” program that will create 10 “Community Hubs” to further invest in multi-sector, community-based partnerships and approaches to better support individuals and families. The state’s initial waiver, called the Medicaid Transformation Project (MTP), was approved in January 2017.  read more


HHS Announces Historic Investment of Over $49 Million to Increase Health Care Coverage for Children, Parents, and Families, July 19 Awards to 36 grantees support President Biden’s Executive Orders on Strengthening Medicaid and the Affordable Care Act, and represent the largest outreach and enrollment investment ever made through Connecting Kids to Coverage program. The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), today awarded $49 million to organizations on the frontlines of reducing uninsured rates and connecting more children, parents, and families to health care coverage.  read more


Delaware Adds Centene Plan to Medicaid Managed Care Offerings   healthcare innovation, July 19  The Delaware Department of Health and Social Services (DHSS) has expanded its Medicaid managed care program by adding a Centene health plan. Centene’s Delaware Health First will join Highmark Health Options Blue Cross Blue Shield, which began operating in Delaware in 2015, and AmeriHealth Caritas, which began in 2018.  read more


Molina to acquire Wisconsin Medicaid plan in $150M deal  Fierce Healthcare, July 14 Healthcare will acquire My Choice Wisconsin, a Medicaid plan, for about $150 million. The Medicaid managed care organization has offered services in the state for 22 years and, as of May, covered 44,000 Medicaid and managed long-term services and supports (MLTSS) members. That accounts for about $1 billion in premium revenue in the 12 months ending March 31. MCW represents a “strong strategic fit” with Molina’s existing Medicaid portfolio, the insurer said in an announcement.  read more


Federal audit forces New Hampshire to repay $7.9M Medicaid funds  The Center Square, July 12  A majority of Medicaid-funded treatments for New Hampshire opioid addicts don’t meet quality standards, according to a new audit, which will require the state to pay back nearly $8 million to the federal government. The audit, conducted for the U.S. Department of Health and Human Services, found that more than 90% of the state’s methadone treatment programs that billed the Medicaid program for services didn’t provide the required follow-up counseling or long-term recovery plans, and in many cases didn’t require follow-up with tests for illegal drugs.  read more


HHS Provides States with Additional Resources to Improve Oversight and Ensure Access to Quality Care in Medicaid and CHIP Managed Care Programs, July 6  Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS) unveiled a suite of new resources to improve CMS and state oversight of Medicaid and Children’s Health Insurance Program (CHIP) managed care programs. These programs provide people with health benefits and additional services through contracted arrangements with managed care plans.  read more