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.

Syrtis Solutions, March 30 
To reign in prescription drug costs and increase Medicaid program transparency, New York’s Governor, Kathy Hochul, and the New York Medicaid Redesign Team announced earlier this year that the state would carve-out the prescription drug benefit from the Medicaid program. After being delayed for two years, the carve-out is set to go into effect on April 1. However, legislators in the New York State Senate repealed the transition in the one-house budget resolution this month. Since the state’s announcement to transition to a fee-for-service model, there has been an ongoing clash between safety net providers and pharmacists.  read more


The Center Square, March 30
The federal government reported an estimated $247 billion in payment errors in fiscal year 2022, with the majority coming from five federal programs, including Medicaid and Medicare. Improper payments include overpayments or payments that should not have been made. Examples include payments to people who have died and payments to those no longer eligible for government programs. The $247 billion in estimated improper payments in 2022, was down from an estimated $281 billion in improper payments in fiscal year 2021, but remained above the estimated $206 billion for fiscal year 2020.  read more


WellCare of Kentucky Encourages Medicaid Beneficiaries to Act Early to Confirm Eligibility  Benzinga, March 30 
As a leading Medicaid managed care provider in Kentucky, WellCare of Kentucky is committed to ensuring Kentucky residents have access to high-quality, affordable health coverage. In line with its mission, WellCare is providing its Medicaid members with information and resources to help them understand upcoming redetermination deadlines while encouraging them to act quickly and update their eligibility information to maintain their current health coverage.  


Louisiana plans to spend $196 million to check Medicaid enrollees’ status  Louisiana Illuminator, March 29 
Gov. John Bel Edwards’ administration has proposed spending $195.8 million to reach out to Medicaid enrollees and check whether they meet the qualifications for the public health insurance program during a massive Medicaid disenrollment over the next year. The state plans to spend $106.6 million of federal funding in the current budget cycle that ends June 30 to verify the income status of hundreds of thousands of Medicaid enrollees, according to budget documents.  read more


Rochester healthcare workers call on Albany lawmakers to close Medicaid coverage cap  News 10, March 22 
Thousands of caregivers and healthcare workers are calling on Gov. Kathy Hochul and legislators to reverse healthcare cuts and close the Medicaid coverage gap. Those workers held a rally in Albany on Tuesday. Members of the United Health Care Workers East Union are calling for at least a $2.5 billion investment in the new New York State Budget. The money would go towards an increase in Medicaid reimbursement rates, restoring safety net funding, and raising the minimum wage for these workers.  read more


Becker’s Payer Issues, March 20 
While state approaches to Medicaid redeterminations can vary widely, most states are adopting a few key strategies to promote continuity of coverage, according to a report from Kaiser Family Foundation. The foundation published results of a survey of all 50 state Medicaid agencies, and the District of Columbia. Not every state agency responded to every question. Beginning April 1, states can disenroll Medicaid members who are no longer eligible for the program for the first time since the beginning of the COVID-19 public health emergency in 2020. Kaiser Family Foundation estimates around 15 million people will lose their Medicaid coverage during redeterminations.  read more


MACPAC calls for states to have power to restrict Medicaid coverage of some accelerated approval drugs  Fierce Healthcare, March 20 
Congress should give states the power to not pay full price under Medicaid for drugs approved under the Food and Drug Administration’s accelerated approval pathway, a key advisory panel said. The Medicaid and CHIP Payment and Access Commission (MACPAC) released proposals for Congress as part of its March report last week (PDF). One of the key recommendations is to limit state coverage under Medicaid of drugs cleared via accelerated approval that have not completed a confirmatory trial.  read more


How states approach Medicaid eligibility redetermination will have big implications for enrollees: KFF analysis  Fierce Healthcare, March 16 
Most states plan to take a year to 14 months to complete Medicaid eligibility checks and disenrollment as pandemic-era protections for Medicaid enrollees will expire March 31. At the start of the pandemic, Congress boosted the federal matching rate for state Medicaid payments. However, states had to agree to not drop anyone off the Medicaid rolls for the duration of the public health emergency. States have been preparing for a while for when they must start redetermining the eligibility of Medicaid recipients.  read more


AP News, March 15
A bipartisan agreement to expand Medicaid coverage to more low-income adults while loosening or ending several regulatory hurdles to building more health care facilities could get its final votes next week after clearing the Senate on Wednesday. Senators voted 44-2 to complete its approval of legislation that would direct state health officials to accept Medicaid coverage provided for in the Affordable Care Act. The margin was nearly identical to Tuesday’s initial vote in the chamber. The measure now moves to the House, where it will be voted on next week at the earliest, said Rep. Donny Lambeth, a Forsyth County Republican and negotiator on the expansion agreement between House and Senate Republicans two weeks ago.  read more


FACT SHEET: The President’s Budget Cuts Wasteful Spending on Big Pharma, Big Oil, and Other Special Interests, Cracks Down on Systemic Fraud, and Makes Programs More Cost Effective  The White House, March 9 
The President’s FY 2024 Budget lays out President Biden’s plan to invest in America, lower costs for families, protect and strengthen Social Security and Medicare, and reduce the deficit. Alongside major reforms to the individual and corporate tax codes to ensure that the wealthy and big corporations pay their fair share, the Budget cuts wasteful spending on Big Pharma, Big Oil, and other special interests, cracks down on systemic fraud and identity theft, and makes programs more efficient and cost-effective—saving taxpayers hundreds of billions of dollars.  read more


Medicaid managed care bidding bill passed
The Weirton Daily Times, March 8
The West Virginia House of Delegates approved a bill Tuesday that will open up competition for the state lucrative Medicaid managed care program, but opponents see the bill as a way to re-open old wounds from a 2015 lawsuit. Senate Bill 476, exempting managed care contracts from purchasing requirements, passed the House in an 80-17 vote. The bill now returns to the state Senate to concur with changes the House made to the bill. SB 476 would exempt the Department of Health and Human Resource’s Bureau of Medical Services from all Purchasing Division requirements.  read more


As States Prepare to Resume Disenrollments, Medicaid/CHIP Enrollment Will Reach Nearly 95 million in March, and the Pandemic-Era Enrollment Growth of 23 million Accounts for 1 in 4 Enrollees  KFF, March 2
A new KFF analysis estimates that enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) will have grown by 23.3 million enrollees, to nearly 95 million, by the end of March. That is when the federal continuous enrollment provision expires, and states can resume disenrollments, which have been paused since February 2020. Millions of beneficiaries are expected to be disenrolled over the next year, and the new estimates illustrate the extent to which enrollment could decline and who will be most affected.  read more


Medicaid Enrollment Growth: Estimates by State and Eligibility Group Show Who may be at Risk as Continuous Enrollment Ends  KFF, March 2
In the Consolidated Appropriations Act, 2023, signed into law at the end of 2022, Congress set an end to the Medicaid continuous enrollment provision on March 31, 2023 and phased down the enhanced federal Medicaid matching funds through December 2023. At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act, which included a requirement that Medicaid programs keep people continuously enrolled during the COVID-19 public health emergency in exchange for enhanced federal funding.  read more


Erie News Now, March 2
This week, Republicans in the state House announced legislation to target wasteful spending and fraud. They say ineligible recipients for some state programs are costing taxpayers hundreds of millions of dollars each year. “Pennsylvania is facing a structural deficit,” said House Appropriations Committee Republican Chair Seth Grove (R-York), adding that the state is also experiencing a demographic crisis. “Our population continues to age and workforce continues to shrink.”  read more


Finding members where they’re at: How Aetna is approaching Medicaid determinations  Becker’s Payer Issues, March 2
States can begin disenrolling members from Medicaid April 1, the first time states have redetermined who is eligible for the program since 2020. Up to 18 million people nationwide could lose their coverage during redeterminations, according to estimates from the Robert Wood Johnson Foundation. Some Medicaid members will lose coverage because they make too much income to qualify for the program, while others may be dropped for administrative reasons.  read more


Audit: Florida made Medicaid payments for patients also enrolled in other states  The Center Square, March 1 
A recent report from the U.S Department of Health and Human Services’ Office of the Inspector General showed that Florida had made Medicaid payments on behalf of thousands of residents who were also enrolled in Medicaid programs in other states. Managed care organizations in Florida are paid by the state for services they make available to eligible Medicaid enrollees, an expense that is paid monthly by the state at a fixed rate. Previous audits by OIG had found that state Medicaid agencies had made improper capitation payments, this prompted concern about the future of Florida’s Medicaid program being negatively impacted and this concern was the catalyst for the latest report.  read more