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.

The clock is ticking for North Carolina legislators hoping to wrap up the session before the July 4 long weekend. It’s been a busy short session at the General Assembly, with debates on hemp and medical marijuana, a new state budget and sports gambling. One of the biggest surprises of the session was a Republican proposal to expand Medicaid in North Carolina, which the GOP-led legislature has resisted for more than a decade.  read more


AP News, June 30
California on Thursday became the first state to guarantee free health care for all low-income immigrants living in the country illegally, a move that will provide coverage for an additional 764,000 people at an eventual cost of about $2.7 billion a year. Gov. Gavin Newsom signed a $307.9 billion operating budget that pledges to make all low-income adults eligible for the state’s Medicaid program by 2024 regardless of their immigration status. It’s a long-sought victory for health care and immigration activists, who have been asking for the change for more than a decade.  read more


The Maryland Medicaid Administration under the Department of Health (MDH) provided an update on its preparations for the unwinding of the federal public health emergency (PHE) to members of the Maryland Medicaid Advisory Committee (MMAC) at its June meeting. MMAC also discussed recent changes to its 1915(c) waiver reports and upcoming applications. Although states have yet to receive a 60-day notice from CMS signifying the end of the PHE, Maryland has worked to develop a plan to return to normal Medicaid eligibility and enrollment operations. read more, June 28 
The federal government and states share responsibility for financing Medicaid payments for care provided to Medicaid beneficiaries. One way states may provide Medicaid services is under a managed care model. Generally, managed care plans determine how they pay providers. In 2016, the Centers for Medicare & Medicaid Services (CMS), which oversees Medicaid, began allowing states to direct payments to providers in Medicaid managed care under certain circumstances and generally contingent upon CMS approval.  read more


Syrtis Solutions Blog, June 27 
In January 2020, DHHS declared the Coronavirus a public health emergency. Since then, the Public Health Emergency (PHE) has been renewed nine times, but it is set to expire this August unless it is extended again. Its expiration will have a significant impact on Medicaid, when one considers that millions of beneficiaries will lose the coverage that the PHE and corresponding legislation provided. Shortly after the PHE was declared, Congress passed the Families First Coronavirus Response Act (FFCRA).  read more


Colorado Newsline, June 23 
Federal approval of a state waiver application means it’s full steam ahead for the “Colorado Option”: a heavily regulated, lower-cost health insurance plan that private carriers must offer starting next year. “I’m thrilled that Colorado’s waiver has been approved — allowing us to move forward with this historic money-saving and forward-thinking program in Colorado,” Gov. Jared Polis, a Democrat, said in a written statement Thursday. “Saving people money on health care couldn’t come at a better moment.”  read more


Health Payer Intelligence, June 22
Consumer experience and access to care are set to become major focal points for payers. The federal government is preparing to implement more rigorous benchmarks for health plan quality ratings based increasingly on how members perceive their interactions with the healthcare system. For payers, this requires a shift in thinking about data. Consider the highly competitive Medicare Advantage space. Analysis by McKinsey & Company shows that the steady growth of MA plans will only continue, pushing the number of lives covered by the program to 34 million by 2023.  read more


Insurance Newsnet, June 16 
Ahead of a congressional subcommittee hearing being held Tuesday, the Select Subcommittee on the Coronavirus Crisis announced that over $10 billion worth of fraudulent payments made through federal pandemic relief programs has been recovered and returned to the federal government. “These relief programs were vital to helping Americans in need during the economic crisis brought on by the coronavirus pandemic,” U.S. Rep. James Clyburn, D-S.C., chairman of the subcommittee, said.  read more


MTFP, June 15 
The newly hired official tasked with running Montana’s Medicaid program got a grilling on Wednesday in his first public appearance before lawmakers, some of whom expressed concerns about the state potentially privatizing the system that handles health coverage for hundreds of thousands of low-income Montanans. Montana is one of 11 states with an entirely government-run Medicaid system, which helps administer a range of healthcare benefits to more than 280,000 Montana adults and children.  read more


Clayton, June 13 
Georgia is seeking input from individuals and organizations about what it should look for when it awards new multibillion-dollar contracts for the state’s Medicaid program. The Georgia Department of Community Health’s request for information is the first step in the process of awarding the new health care contracts, which are expected to take effect by July 1, 2024. Georgia’s Medicaid program contracts with private health insurers to provide health care services to around 1.7 million Georgians, most of them low-income children and pregnant women.  read more


11 recent CMS actions  Becker’s Hospital CFO Report, June 10 
CMS recently imposed its first fines for price transparency violations, cited hospitals for not complying with the COVID-19 vaccine mandate and called out payers for cutting agents’ commissions amid record ACA enrollment. Becker’s has reported on the following 11 CMS moves in the last month. Finance 1. Atlanta system 1st in US to face CMS fines for price transparency violations Atlanta-based Northside Hospital is the first health system in the nation to be fined by CMS for violating federal price transparency laws, CMS told Becker’s.  


Forbes, June 8 
South Dakota voters Tuesday overwhelmingly rejected a measure that would have required certain ballot initiatives like Medicaid expansion to pass with 60% support instead of a simple majority. The overwhelming defeat of “Constitutional Amendment C” by a 2 to 1 margin in South Dakota comes ahead of a November referendum on expanding Medicaid health insurance for the poor in the state. With 88% of precincts reporting, the measure initiated by Republicans in the South Dakota state legislature had only 32% support with nearly 68% of South Dakota voters, or more than 110,000 voting “no” compared to less than 53,000 who supported the measure.  read more


Bloomberg Law, June 6
States can take money Medicaid beneficiaries win in personal injury litigation for future medical expenses to recoup payments the program made for their prior care, the U.S. Supreme Court ruled Monday. In a 7-2 decision, the court’s majority said the Medicaid Act permits a state to seek reimbursement from settlement amounts that are allocated for future medical expenses. In delivering the court’s ruling, Justice Clarence Thomas said the plain text of the statute decided this case.  read more


NCDOJ.Gov, June 1
Attorney General Josh Stein today announced that Healthkeeperz, Inc., a Pembroke behavioral health care provider, will pay $2.1 million to resolve allegations that the company violated the False Claims Act by billing claims that were not reimbursable to Medicaid programs. “When health care providers cheat the Medicaid program, they waste taxpayers’ health care resources,” said Attorney General Josh Stein. “I will hold accountable health care providers when they break the law, and I’m pleased that this defendant will be reimbursing the Medicaid program.  read more


Missouri Independent, June 1
Missouri officials vowed again Wednesday to lower the number of days it takes to process Medicaid applications – which was an average of 101 days in April — and come into federal compliance with the maximum of 45 days. “We’ll get to a place where we should be processing in under 45 days by the end of July,” Kim Evans, director of the Family Support Division, told MOHealthNet Oversight Committee on Wednesday. And by the end of August, it will be 30 days, she said.   read more