Syrtis Solutions publishes a monthly Medicaid news summary to help healthcare leaders stay informed. Each edition highlights key developments, research, and legislation related to Medicaid program integrity, cost avoidance, coordination of benefits, improper payments, and fraud, waste, and abuse. Below is a recap of last month’s Medicaid news.
HHS Defers More Than $1 Billion in Medicaid Payments to California, Minnesota Pending Review of High-Risk Claims in Crackdown on Fraud USDHHS, July 21
The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) today deferred more than $1 billion in federal Medicaid payments to California and Minnesota as the states submit additional documentation supporting certain high-risk Medicaid claims. The action advances the Trump administration’s effort to combat fraud, waste, and abuse in Medicaid and safeguard federal taxpayer dollars.“Medicaid exists to serve vulnerable Americans — not to bankroll unsupported claims,” said HHS Secretary Robert F. Kennedy, Jr. “Under President Trump’s leadership, we are restoring accountability across our public programs and protecting taxpayer dollars. read more
The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) today deferred more than $1 billion in federal Medicaid payments to California and Minnesota as the states submit additional documentation supporting certain high-risk Medicaid claims. The action advances the Trump administration’s effort to combat fraud, waste, and abuse in Medicaid and safeguard federal taxpayer dollars.“Medicaid exists to serve vulnerable Americans — not to bankroll unsupported claims,” said HHS Secretary Robert F. Kennedy, Jr. “Under President Trump’s leadership, we are restoring accountability across our public programs and protecting taxpayer dollars. read more
Judge rejects states’ bid to pause Medicaid work requirements
HealthcareDive, July 31
The lawsuit from the states, which includes Massachusetts, California, New Jersey, Colorado and New York, came weeks after the CMS finalized a rule detailing how to set up Medicaid work requirements, one of the largest changes to the safety-net insurance program enacted in the “Big Beautiful Bill” passed last summer. Under the law, beneficiaries enrolled through Medicaid expansion will have to work, volunteer or go to school for 80 hours each month to stay enrolled in coverage. The states argue putting the work requirements in place by Jan. 1 will create expensive and complex administrative hurdles, potentially disrupting their beneficiaries’ access to care, according to the lawsuit, filed in late June. read more
HealthcareDive, July 31
The lawsuit from the states, which includes Massachusetts, California, New Jersey, Colorado and New York, came weeks after the CMS finalized a rule detailing how to set up Medicaid work requirements, one of the largest changes to the safety-net insurance program enacted in the “Big Beautiful Bill” passed last summer. Under the law, beneficiaries enrolled through Medicaid expansion will have to work, volunteer or go to school for 80 hours each month to stay enrolled in coverage. The states argue putting the work requirements in place by Jan. 1 will create expensive and complex administrative hurdles, potentially disrupting their beneficiaries’ access to care, according to the lawsuit, filed in late June. read more
CMS Administrator Oz Joins Governors and NGA to Advance Rural Health Transformation and Address Medicaid Program Integrity National Governors Association, July 31
The National Governors Association (NGA) today welcomed Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz for discussion to advance the Rural Health Transformation Program (RHTP) and address Medicaid program integrity in states across the country. Tennessee Gov. Bill Lee facilitated the wide-ranging conversation during NGA’s annual Summer Meeting in Oklahoma City. “With the Rural Health Transformation Program, we want people thinking there’s a future out there, getting excited about it, and the fact that Congress thought this was wise enough to do it and then give it away immediately, I think, is real testimony to the power governors have in this country,” said CMS Administration Dr. Mehmet Oz. read more
The National Governors Association (NGA) today welcomed Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz for discussion to advance the Rural Health Transformation Program (RHTP) and address Medicaid program integrity in states across the country. Tennessee Gov. Bill Lee facilitated the wide-ranging conversation during NGA’s annual Summer Meeting in Oklahoma City. “With the Rural Health Transformation Program, we want people thinking there’s a future out there, getting excited about it, and the fact that Congress thought this was wise enough to do it and then give it away immediately, I think, is real testimony to the power governors have in this country,” said CMS Administration Dr. Mehmet Oz. read more
H.R. 1 SIGNALS A SHIFT TOWARD PAYMENT PREVENTION IN MEDICAID Syrtis Solutions, July 31
Payment Prevention is becoming the defining principle of modern Medicaid program integrity. Federal agencies have intensified efforts to combat Medicaid fraud, highlighted by the March 2026 announcement of a new Task Force to Eliminate Fraud. At the same time, Congress has taken another significant step through the One Big Beautiful Bill Act (H.R. 1), which increases financial accountability for Medicaid erroneous payments. Together, these initiatives reflect a broader trend toward placing greater emphasis on preventing improper payments before they occur while maintaining strong post-payment oversight. read more
Payment Prevention is becoming the defining principle of modern Medicaid program integrity. Federal agencies have intensified efforts to combat Medicaid fraud, highlighted by the March 2026 announcement of a new Task Force to Eliminate Fraud. At the same time, Congress has taken another significant step through the One Big Beautiful Bill Act (H.R. 1), which increases financial accountability for Medicaid erroneous payments. Together, these initiatives reflect a broader trend toward placing greater emphasis on preventing improper payments before they occur while maintaining strong post-payment oversight. read more
How Many Uninsured Are in the Coverage Gap and How Many Could be Eligible if All States Adopted the Medicaid Expansion? KFF, July 27
While millions of people have gained health coverage through Medicaid expansion under the Affordable Care Act (ACA) over the last decade, state decisions not to expand Medicaid continue to leave many without an affordable coverage option. In the 41 states including the District of Columbia that have adopted the expansion, adults with incomes up to 138% of the federal poverty level (FPL) are eligible for Medicaid. Medicaid expansion has led to significant coverage gains, particularly as more states adopted the expansion over the years. read more
While millions of people have gained health coverage through Medicaid expansion under the Affordable Care Act (ACA) over the last decade, state decisions not to expand Medicaid continue to leave many without an affordable coverage option. In the 41 states including the District of Columbia that have adopted the expansion, adults with incomes up to 138% of the federal poverty level (FPL) are eligible for Medicaid. Medicaid expansion has led to significant coverage gains, particularly as more states adopted the expansion over the years. read more
Idaho Department of Health and Welfare announces work requirements for Medicaid expansion recipients
IDHW, July 23
The Idaho Department of Health and Welfare (DHW) is issuing this update about the implementation of new reporting requirements for the state’s Medicaid expansion population, effective Jan. 1, 2027. Last year, H.R. 1 was approved by the U.S. Congress and President Trump, directing states to implement new work requirements for Medicaid recipients in the expansion category to qualify for Medicaid and keep their coverage. These changes require Medicaid expansion enrollees to report on their participation in work or community engagement activities. Key policy changes and requirements: 80-hour work requirement: Enrollees are required to document at least 80 hours per month of employment, community service, or approved educational/training activities. read more
IDHW, July 23
The Idaho Department of Health and Welfare (DHW) is issuing this update about the implementation of new reporting requirements for the state’s Medicaid expansion population, effective Jan. 1, 2027. Last year, H.R. 1 was approved by the U.S. Congress and President Trump, directing states to implement new work requirements for Medicaid recipients in the expansion category to qualify for Medicaid and keep their coverage. These changes require Medicaid expansion enrollees to report on their participation in work or community engagement activities. Key policy changes and requirements: 80-hour work requirement: Enrollees are required to document at least 80 hours per month of employment, community service, or approved educational/training activities. read more
KY Gov. Beshear to tap $255M in surplus funds to reverse Medicaid cuts Lexington Herald Leader, July 22
Gov. Andy Beshear announced Wednesday the state will use $255 million generated from savings and surpluses to reverse a proposed cut to Medicaid, the state-federal healthcare program for the poor and disabled. In addition, Beshear said the state will use $4 million to restore some funding to a senior meals program, which Beshear said the General Assembly underfunded in the two-year budget. Beshear also said he has allocated $18 million to the state’s road fund to offset revenue losses when he declared a state of emergency and suspended the state’s 10-cent gas tax in May when gas prices surged. Some had criticized the move, saying it would deplete the road fund, which funds many paving and other road projects. read more
Gov. Andy Beshear announced Wednesday the state will use $255 million generated from savings and surpluses to reverse a proposed cut to Medicaid, the state-federal healthcare program for the poor and disabled. In addition, Beshear said the state will use $4 million to restore some funding to a senior meals program, which Beshear said the General Assembly underfunded in the two-year budget. Beshear also said he has allocated $18 million to the state’s road fund to offset revenue losses when he declared a state of emergency and suspended the state’s 10-cent gas tax in May when gas prices surged. Some had criticized the move, saying it would deplete the road fund, which funds many paving and other road projects. read more
HHS preparing to implement federal work requirements and other changes to Medicaid program NDDHHS, July 21
North Dakota Health and Human Services (HHS) is preparing to implement several federally required changes to the state’s Medicaid program over the next two years, including work requirements for some Medicaid Expansion members. These new requirements are a result of the federal Working Families Tax Cut Act passed by Congress and signed into law on July 4, 2025. Starting Jan. 1, 2027, adults ages 19 to 64 enrolled in Medicaid Expansion will be required to participate in work, an approved work or training program, volunteer or be enrolled in an education program for at least 80 hours per month to maintain their coverage, unless they qualify for an exclusion. read more
North Dakota Health and Human Services (HHS) is preparing to implement several federally required changes to the state’s Medicaid program over the next two years, including work requirements for some Medicaid Expansion members. These new requirements are a result of the federal Working Families Tax Cut Act passed by Congress and signed into law on July 4, 2025. Starting Jan. 1, 2027, adults ages 19 to 64 enrolled in Medicaid Expansion will be required to participate in work, an approved work or training program, volunteer or be enrolled in an education program for at least 80 hours per month to maintain their coverage, unless they qualify for an exclusion. read more
Oregon eyes $421 million in Medicaid cuts, including fewer benefits and limits on treatments OPB, July 8
Major cuts are coming to the Oregon Health Plan, the state’s free healthcare program covering 1.4 million children and low-income adults. But the group of experts Gov. Tina Kotek charged with minimizing the harm of those cuts has given her no definitive recommendations. Instead, this week they gave the governor a report listing more than 40 different options for reducing spending on the program, with no consensus on which to choose. That means Kotek still has no clear path to plugging a $421 million hole in the state’s upcoming two-year budget, with five months left before her budget plan is due to the state legislature. read more
Major cuts are coming to the Oregon Health Plan, the state’s free healthcare program covering 1.4 million children and low-income adults. But the group of experts Gov. Tina Kotek charged with minimizing the harm of those cuts has given her no definitive recommendations. Instead, this week they gave the governor a report listing more than 40 different options for reducing spending on the program, with no consensus on which to choose. That means Kotek still has no clear path to plugging a $421 million hole in the state’s upcoming two-year budget, with five months left before her budget plan is due to the state legislature. read more
Healthcare faces congressional oversight heading into 2026 midterms and beyond HealthcareDive, July 7
With congressional Democrats eyeing potential majorities in the 120th Congress, future investigations are already a top priority. In addition to oversight of the Trump administration, much of the focus will be on consumer-facing issues with an emphasis on affordability. Although healthcare has historically been a bipartisan oversight target, a potential shift in congressional control would likely expand investigations beyond longstanding concerns such as affordability, consolidation and fraud to include inquiries tied directly to the Trump administration, federal contracting, regulatory decision-making and relationships between industry and political appointees. read more
With congressional Democrats eyeing potential majorities in the 120th Congress, future investigations are already a top priority. In addition to oversight of the Trump administration, much of the focus will be on consumer-facing issues with an emphasis on affordability. Although healthcare has historically been a bipartisan oversight target, a potential shift in congressional control would likely expand investigations beyond longstanding concerns such as affordability, consolidation and fraud to include inquiries tied directly to the Trump administration, federal contracting, regulatory decision-making and relationships between industry and political appointees. read more
Modernizing Program Integrity in Medicaid Self-Directed Care
MedCity News, July 5
Medicaid programs are in a period of heightened scrutiny, as states confront growing complexity in how these programs are administered and sustained. A recent Kaiser Family Foundation analysis highlights how states are grappling with rising program costs and tough tradeoffs, with total Medicaid spending projected to increase by 7.9% in FY 2026. In this environment, ensuring program integrity is no longer just about compliance, it’s central to sustaining access to care. Nowhere is that imperative more apparent than in self-directed care programs, where rapid growth and increased visibility have raised the stakes for getting oversight right. read more
MedCity News, July 5
Medicaid programs are in a period of heightened scrutiny, as states confront growing complexity in how these programs are administered and sustained. A recent Kaiser Family Foundation analysis highlights how states are grappling with rising program costs and tough tradeoffs, with total Medicaid spending projected to increase by 7.9% in FY 2026. In this environment, ensuring program integrity is no longer just about compliance, it’s central to sustaining access to care. Nowhere is that imperative more apparent than in self-directed care programs, where rapid growth and increased visibility have raised the stakes for getting oversight right. read more
How H.R. 1 Cuts and Changes to Medicaid Played out in 2026 State Legislative Sessions (Part 2)
Georgetown University Center for Children and Families, July 2
It’s been nearly a year since H.R.1 was signed into law, enacting the largest Medicaid cuts in history and setting off a scramble in state capitals to respond. Back in March, we took a look at how ten state legislatures were grappling with the impending budget holes and policies created by H.R.1. Now that most 2026 state legislative sessions have wrapped up, we’re taking another look at how state lawmakers responded. Attempts by state legislatures to codify provisions of H.R. 1 in state code has perhaps been the most prolific response we’ve seen across states. In many of these codification bills, state legislators also took the opportunity to go further than the already harmful provisions of H.R. 1.
read more
Georgetown University Center for Children and Families, July 2
It’s been nearly a year since H.R.1 was signed into law, enacting the largest Medicaid cuts in history and setting off a scramble in state capitals to respond. Back in March, we took a look at how ten state legislatures were grappling with the impending budget holes and policies created by H.R.1. Now that most 2026 state legislative sessions have wrapped up, we’re taking another look at how state lawmakers responded. Attempts by state legislatures to codify provisions of H.R. 1 in state code has perhaps been the most prolific response we’ve seen across states. In many of these codification bills, state legislators also took the opportunity to go further than the already harmful provisions of H.R. 1.
read more
Feds suspend $60M in Medicaid fraud funding for New York
News10, July 2
The federal government suspended funding for New York’s Medicaid Fraud Control Unit, accusing the state agency of doing a bad job with criminal enforcement. State officials called the move a political attack—pointing out that the MFCU has recovered hundreds of millions—and called attention to high-profile arrests announced as recently as June 24, June 29, and July 1.The federal government is withholding between $53 million and $60 million in annual grant funding through at least September 30. That’s according to a June 30 letter from the U.S. Department of Health and Human Services Office of Inspector General to Democratic Attorney General Letitia James and MFCU Director Amy Held, which you can read at the bottom of this story. read more
News10, July 2
The federal government suspended funding for New York’s Medicaid Fraud Control Unit, accusing the state agency of doing a bad job with criminal enforcement. State officials called the move a political attack—pointing out that the MFCU has recovered hundreds of millions—and called attention to high-profile arrests announced as recently as June 24, June 29, and July 1.The federal government is withholding between $53 million and $60 million in annual grant funding through at least September 30. That’s according to a June 30 letter from the U.S. Department of Health and Human Services Office of Inspector General to Democratic Attorney General Letitia James and MFCU Director Amy Held, which you can read at the bottom of this story. read more
