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.
National Health Care Fraud Takedown Results in 324 Defendants Charged in Connection with Over $14.6 Billion in Alleged Fraud
Office of Public Affair DOJ,June 30
The Justice Department today announced the results of its 2025 National Health Care Fraud Takedown, which resulted in criminal charges against 324 defendants, including 96 doctors, nurse practitioners, pharmacists, and other licensed medical professionals, in 50 federal districts and 12 State Attorneys General’s Offices across the United States, for their alleged participation in various health care fraud schemes involving over $14.6 billion in intended loss. read more
Medicaid Managed Care: Improper Payment Estimate
GAO, June 26
State Medicaid programs predominantly rely on managed care to provide coverage. In 2022, just over 75 percent of Medicaid beneficiaries (about 74 million beneficiaries) received coverage through managed care. Under Medicaid managed care, states contract with managed care plans and generally pay them a fixed monthly amount per beneficiary (i.e., a capitation payment) to provide a set of covered services. read more
GAO, June 26
State Medicaid programs predominantly rely on managed care to provide coverage. In 2022, just over 75 percent of Medicaid beneficiaries (about 74 million beneficiaries) received coverage through managed care. Under Medicaid managed care, states contract with managed care plans and generally pay them a fixed monthly amount per beneficiary (i.e., a capitation payment) to provide a set of covered services. read more
MSN, June 23
Kentucky’s newly established Medicaid Oversight and Advisory Board convenes for its first meeting today. Lawmakers established the board, which includes citizens, during the 2025 legislative session. Experts say educating the public on Medicaid is critical amid ongoing threats to cut federal funding for the program. Dr. Sheila Schuster, licensed psychologist and executive director of the Advocacy Action Network, said Medicaid is the largest source of health care in Kentucky, but few know how it works. read more
Kentucky’s newly established Medicaid Oversight and Advisory Board convenes for its first meeting today. Lawmakers established the board, which includes citizens, during the 2025 legislative session. Experts say educating the public on Medicaid is critical amid ongoing threats to cut federal funding for the program. Dr. Sheila Schuster, licensed psychologist and executive director of the Advocacy Action Network, said Medicaid is the largest source of health care in Kentucky, but few know how it works. read more
Senate Finance Language Would Further Cut Federal Spending for Medicaid Expansion States KFF, June 20
The House passed budget reconciliation package, the One Big Beautiful Bill Act, is estimated to reduce federal Medicaid spending by $793 billion, decrease Medicaid enrollment by 10.3 million people, and increase the number of uninsured people by 7.8 million. While the debate has not centered on repeal and replace of the Affordable Care Act (ACA) like the debate in 2017, several provisions in the House-passed reconciliation bill specifically target states that have adopted the ACA Medicaid expansion in various ways. read more
The House passed budget reconciliation package, the One Big Beautiful Bill Act, is estimated to reduce federal Medicaid spending by $793 billion, decrease Medicaid enrollment by 10.3 million people, and increase the number of uninsured people by 7.8 million. While the debate has not centered on repeal and replace of the Affordable Care Act (ACA) like the debate in 2017, several provisions in the House-passed reconciliation bill specifically target states that have adopted the ACA Medicaid expansion in various ways. read more
MHA Shares Recent Medicare and Medicaid Enrollment Analysis
MHA, June 18
The MHA recently updated its analysis of Medicaid and Medicare enrollment based on May 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 organizations. Just over 26% of Michigan’s total population is enrolled in Medicaid and 23% is enrolled in Medicare. Roughly two-thirds of Michigan’s 2.63 million Medicaid beneficiaries, are enrolled in one of nine managed care plans. read more
MHA, June 18
The MHA recently updated its analysis of Medicaid and Medicare enrollment based on May 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 organizations. Just over 26% of Michigan’s total population is enrolled in Medicaid and 23% is enrolled in Medicare. Roughly two-thirds of Michigan’s 2.63 million Medicaid beneficiaries, are enrolled in one of nine managed care plans. read more
What Are ‘Improper’ Medicaid Payments, and Are They as High as a Trump Official Said? KFF Health News, June 11
Responding to charges that President Donald Trump’s tax and spending bill would cut Medicaid coverage for millions of Americans, Trump administration officials misleadingly counter that it targets only waste, fraud, and abuse. During an interview on CNN’s “State of the Union,” Russell Vought, the administration’s director of the Office of Management and Budget, framed Medicaid as sagging under the weight of improper payments. read more
Responding to charges that President Donald Trump’s tax and spending bill would cut Medicaid coverage for millions of Americans, Trump administration officials misleadingly counter that it targets only waste, fraud, and abuse. During an interview on CNN’s “State of the Union,” Russell Vought, the administration’s director of the Office of Management and Budget, framed Medicaid as sagging under the weight of improper payments. read more
MACPAC Releases June 2025 Report to Congress
MACPAC, June 11
The Medicaid and CHIP Payment and Access Commission (MACPAC) released its June 2025 Report to Congress on Medicaid and CHIP today, with recommendations on improving transitions from pediatric to adult care for Medicaid-covered children and youth with special health care needs (CYSHCN). read more
MACPAC, June 11
The Medicaid and CHIP Payment and Access Commission (MACPAC) released its June 2025 Report to Congress on Medicaid and CHIP today, with recommendations on improving transitions from pediatric to adult care for Medicaid-covered children and youth with special health care needs (CYSHCN). read more
How Will the 2025 Budget Reconciliation Affect the ACA, Medicaid, and the Uninsured Rate? KFF, MAY 13
Congressional Republicans are considering a budget reconciliation package that would make significant changes to Medicaid and the Affordable Care Act (ACA). For example, the Energy and Commerce Committee released legislative text that includes work and reporting requirements for certain Medicaid enrollees and codifying changes in a recent Trump Administration proposed rule on the ACA Marketplaces, among other policy changes. read more
New Jersey Medicaid Saves About $102 Million By Curbing Wasteful Lab Tests New Jersey Office of the State Comptroller, June 10
The Office of the State Comptroller reports that New Jersey Medicaid has saved roughly $102 million in the last four years due to policy changes that have reduced wasteful lab tests. Audits by OSC’s Medicaid Fraud Division revealed that independent clinical laboratories routinely billed and were paid for excessive and often medically unnecessary drug tests. read more
The Office of the State Comptroller reports that New Jersey Medicaid has saved roughly $102 million in the last four years due to policy changes that have reduced wasteful lab tests. Audits by OSC’s Medicaid Fraud Division revealed that independent clinical laboratories routinely billed and were paid for excessive and often medically unnecessary drug tests. read more
Eliminating Waste, Fraud, and Abuse in Medicaid
The White House, June 6
My Administration has been relentlessly committed to rooting out waste, fraud, and abuse in Government programs to preserve and protect them for those who rely most on them. The Medicaid program was designed to be a program to compassionately provide taxpayer dollars to healthcare providers who offer care to the most vulnerable Americans. To keep payments reasonable, billable costs for such care were historically capped at the same level that healthcare providers could receive from Medicare. read more
The White House, June 6
My Administration has been relentlessly committed to rooting out waste, fraud, and abuse in Government programs to preserve and protect them for those who rely most on them. The Medicaid program was designed to be a program to compassionately provide taxpayer dollars to healthcare providers who offer care to the most vulnerable Americans. To keep payments reasonable, billable costs for such care were historically capped at the same level that healthcare providers could receive from Medicare. read more
Allocating CBO’s Estimates of Federal Medicaid Spending Reductions and Enrollment Loss Across the States: House Reconciliation Bill KFF, June 4
On May 22, the House passed a reconciliation bill, the One Big Beautiful Bill Act. The Congressional Budget Office’s (CBO) latest cost estimate shows that the bill would reduce federal Medicaid spending by $793 billion and that the Medicaid provisions would increase the number of uninsured people by 7.8 million. Previous CBO estimates show that 10.3 million fewer people would be enrolled in Medicaid. read more
On May 22, the House passed a reconciliation bill, the One Big Beautiful Bill Act. The Congressional Budget Office’s (CBO) latest cost estimate shows that the bill would reduce federal Medicaid spending by $793 billion and that the Medicaid provisions would increase the number of uninsured people by 7.8 million. Previous CBO estimates show that 10.3 million fewer people would be enrolled in Medicaid. read more
Medicaid cuts 2025: Who will lose coverage?
FingerLakes1, June 3
A new Republican-led tax and spending package could slash Medicaid by more than $700 billion over the next decade, raising alarms from patient advocates, state leaders, and healthcare experts. The White House says the changes will only impact those “who shouldn’t have had coverage to begin with,” but analysts warn that millions of low-income Americans could lose access to health care. read more
FingerLakes1, June 3
A new Republican-led tax and spending package could slash Medicaid by more than $700 billion over the next decade, raising alarms from patient advocates, state leaders, and healthcare experts. The White House says the changes will only impact those “who shouldn’t have had coverage to begin with,” but analysts warn that millions of low-income Americans could lose access to health care. read more
WAFB, June 2
The Louisiana Legislative Auditor (LLA) has been closely watching the state’s Medicaid program. About two years ago, an audit found that millions of dollars were lost because the Louisiana Department of Health (LDH) paid out Medicaid benefits for people who no longer lived in the state. At that time, the auditor recommended that the health department use data from the Office of Motor Vehicles (OMV) to make sure recipients were still in the state. read more
The Louisiana Legislative Auditor (LLA) has been closely watching the state’s Medicaid program. About two years ago, an audit found that millions of dollars were lost because the Louisiana Department of Health (LDH) paid out Medicaid benefits for people who no longer lived in the state. At that time, the auditor recommended that the health department use data from the Office of Motor Vehicles (OMV) to make sure recipients were still in the state. read more
Idaho Capital Sun, June 2
Idaho health officials say it’ll take years to switch all Idaho Medicaid benefits to being managed by private companies. Through a sweeping bill meant to cut Medicaid costs, the Idaho Legislature this year directed the Idaho Department of Health and Welfare to change a range of Medicaid policies — including to pursue switching Medicaid benefits to being run by private companies. That model, called managed care, is used widely across the country. read more
Idaho health officials say it’ll take years to switch all Idaho Medicaid benefits to being managed by private companies. Through a sweeping bill meant to cut Medicaid costs, the Idaho Legislature this year directed the Idaho Department of Health and Welfare to change a range of Medicaid policies — including to pursue switching Medicaid benefits to being run by private companies. That model, called managed care, is used widely across the country. read more
