16 Apr MEDICAID NEWS RECAP – MARCH 2024
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 29
A recent audit by the U.S. Government Accountability Office reveals that the federal government suffered a staggering loss of $236 billion in 2023 due to improper payments. Medicaid and Medicare alone accounted for 43% of these payments, with Medicaid’s improper payments reaching $50.3 billion. These findings underscore the urgent need to address improper payments, which often stem from eligibility errors and outdated data systems, not rampant fraud and abuse. read more
A recent audit by the U.S. Government Accountability Office reveals that the federal government suffered a staggering loss of $236 billion in 2023 due to improper payments. Medicaid and Medicare alone accounted for 43% of these payments, with Medicaid’s improper payments reaching $50.3 billion. These findings underscore the urgent need to address improper payments, which often stem from eligibility errors and outdated data systems, not rampant fraud and abuse. read more
WLBT, March 28
Medicaid expansion is one step closer to going to the governor’s desk. On Thursday, the Mississippi Senate passed H.B. 1725, a bill that would expand Medicaid coverage under the more than decade-old Affordable Care Act. The bill will now be returned to the House for concurrence. If the House does not concur, it will go to a conference committee for a final version to be hammered out. It passed on a 36-16 vote, with 16 Republicans voting against it. read more
Medicaid expansion is one step closer to going to the governor’s desk. On Thursday, the Mississippi Senate passed H.B. 1725, a bill that would expand Medicaid coverage under the more than decade-old Affordable Care Act. The bill will now be returned to the House for concurrence. If the House does not concur, it will go to a conference committee for a final version to be hammered out. It passed on a 36-16 vote, with 16 Republicans voting against it. read more
Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State KFF, March 28
This page tracks approved and pending Section 1115 Medicaid demonstration waivers, which offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute. Key themes in current approved and pending waivers include targeted eligibility expansions, benefit expansions (particularly in the area of behavioral health, such as coverage of services provided in IMDs), and provisions related to social determinants of health.
This page tracks approved and pending Section 1115 Medicaid demonstration waivers, which offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute. Key themes in current approved and pending waivers include targeted eligibility expansions, benefit expansions (particularly in the area of behavioral health, such as coverage of services provided in IMDs), and provisions related to social determinants of health.
RI Medicaid paid $38M for out-of-state residents, audit discovers
WPRI12, March 28
Rhode Island paid health insurers more than $38 million to cover Medicaid recipients living in nine other states and Puerto Rico over three years, according to a newly released audit. The R.I. Office of the Auditor General released the report this week, concluding poor oversight of eligibility by the state’s Medicaid office led officials to disburse the funds for ineligible recipients from 2019 through 2021. State money made up about $16.5 million — or 43% — of the total. read more
WPRI12, March 28
Rhode Island paid health insurers more than $38 million to cover Medicaid recipients living in nine other states and Puerto Rico over three years, according to a newly released audit. The R.I. Office of the Auditor General released the report this week, concluding poor oversight of eligibility by the state’s Medicaid office led officials to disburse the funds for ineligible recipients from 2019 through 2021. State money made up about $16.5 million — or 43% — of the total. read more
Health Payer Intelligence, March 27
A new CMS final rule, the “Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes” rule, aims to modernize and optimize the Medicaid enrollment process, according to a press release from CMS. The rule was proposed in September 2022 in response to Executive Orders from President Joe Biden. read more
A new CMS final rule, the “Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes” rule, aims to modernize and optimize the Medicaid enrollment process, according to a press release from CMS. The rule was proposed in September 2022 in response to Executive Orders from President Joe Biden. read more
More than 124,000 people were enrolled under Medicaid in multiple states, report shows Dayton Daily News, March 27
More than 2 million people have been removed from Texas’ Medicaid program since federal More than 124,000 people enrolled in Ohio Medicaid were simultaneously enrolled in Medicaid programs in other states for at least three months at a time from 2019 through 2022, Ohio Auditor of State Keith Faber says. Over the four-year period examined, Ohio paid managed care organizations more than $1 billion to provide services to individuals enrolled in multiple states’ Medicaid programs, the state auditor’s office says. read more
More than 2 million people have been removed from Texas’ Medicaid program since federal More than 124,000 people enrolled in Ohio Medicaid were simultaneously enrolled in Medicaid programs in other states for at least three months at a time from 2019 through 2022, Ohio Auditor of State Keith Faber says. Over the four-year period examined, Ohio paid managed care organizations more than $1 billion to provide services to individuals enrolled in multiple states’ Medicaid programs, the state auditor’s office says. read more
Nebraska auditor finds DHHS potentially misspent or unaccounted for tens of millions of federal dollars 1011NOW, March 26
Nearly a month after Nebraska’s top auditor released a report detailing “longstanding fraud and abuse” in a program overseen by the Department of Health and Human Services (DHHS), a new investigation into the department’s finances has uncovered tens of millions of potentially misspent or unaccounted for federal dollars from additional programs. In Auditor Mike Foley’s Feb. 28 report, he uncovered “longstanding fraud and abuse” in a Medicaid-funded “personal assistance services” (PAS) program overseen by DHHS. read more
Nearly a month after Nebraska’s top auditor released a report detailing “longstanding fraud and abuse” in a program overseen by the Department of Health and Human Services (DHHS), a new investigation into the department’s finances has uncovered tens of millions of potentially misspent or unaccounted for federal dollars from additional programs. In Auditor Mike Foley’s Feb. 28 report, he uncovered “longstanding fraud and abuse” in a Medicaid-funded “personal assistance services” (PAS) program overseen by DHHS. read more
Georgia’s Medicaid Work Requirements Costing Taxpayers Millions Despite Low Enrollment KFF Health News, March 20
Georgia Gov. Brian Kemp’s plan for a conservative alternative to Obamacare’s Medicaid expansion has cost taxpayers at least $26 million so far, with more than 90% going toward administrative and consulting costs rather than medical care for low-income people. Kemp’s Georgia Pathways to Coverage offers government health insurance to people earning up to the federal poverty level — $15,060 for an individual adult — if they can document that they’re working, in school, or performing other qualifying activities. Since July, when the program began, about 3,500 people have signed up, according to state officials. read more
Georgia Gov. Brian Kemp’s plan for a conservative alternative to Obamacare’s Medicaid expansion has cost taxpayers at least $26 million so far, with more than 90% going toward administrative and consulting costs rather than medical care for low-income people. Kemp’s Georgia Pathways to Coverage offers government health insurance to people earning up to the federal poverty level — $15,060 for an individual adult — if they can document that they’re working, in school, or performing other qualifying activities. Since July, when the program began, about 3,500 people have signed up, according to state officials. read more
The HIPAA Journal, March 18
Audits conducted by the Department of Health and Human Services Office of Inspector General (HHS-OIG) of states that claim Medicaid school-based costs with the assistance of contractors have revealed some states have claimed unallowable federal funds due to their contractors improperly conducting random moment time studies (RMTSs). Pennsylvania is the latest state to be audited by HHS-OIG, which found that approximately $590 million was claimed in federal Medicaid payments for school-based services between July 1, 2015, and June 30, 2019, $551.4 million of which was improperly claimed. read more
Audits conducted by the Department of Health and Human Services Office of Inspector General (HHS-OIG) of states that claim Medicaid school-based costs with the assistance of contractors have revealed some states have claimed unallowable federal funds due to their contractors improperly conducting random moment time studies (RMTSs). Pennsylvania is the latest state to be audited by HHS-OIG, which found that approximately $590 million was claimed in federal Medicaid payments for school-based services between July 1, 2015, and June 30, 2019, $551.4 million of which was improperly claimed. read more
Kentucky Supreme Court tie vote leaves Medicaid managed care contracts in place Kentucky Lantern, March 14
In a quick turnaround, the Kentucky Supreme Court has upheld a lower court ruling that five insurance companies will retain the right to oversee most of the state’s $15 billion annual Medicaid business, appearing to end a long-running court fight. Anthem Kentucky, which had challenged the contract award, will be excluded, according to a Supreme Court order issued Thursday. The decision comes just one week after the Supreme Court heard arguments on the complex contract dispute and is the result of a tie vote among the six justices who heard the case. read more
In a quick turnaround, the Kentucky Supreme Court has upheld a lower court ruling that five insurance companies will retain the right to oversee most of the state’s $15 billion annual Medicaid business, appearing to end a long-running court fight. Anthem Kentucky, which had challenged the contract award, will be excluded, according to a Supreme Court order issued Thursday. The decision comes just one week after the Supreme Court heard arguments on the complex contract dispute and is the result of a tie vote among the six justices who heard the case. read more
A Closer Look at Medicaid Expansion Efforts in Mississippi
KFF, March 12
Following implementation of Medicaid expansion under the Affordable Care Act (ACA) in North Carolina and South Dakota in 2023, there has been a recent surge in expansion activity early in 2024 among several of the ten states that have not yet adopted Medicaid expansion. While activity in Alabama, Georgia, and Kansas may have stalled, there continues to be growing potential for action in Mississippi. read more
KFF, March 12
Following implementation of Medicaid expansion under the Affordable Care Act (ACA) in North Carolina and South Dakota in 2023, there has been a recent surge in expansion activity early in 2024 among several of the ten states that have not yet adopted Medicaid expansion. While activity in Alabama, Georgia, and Kansas may have stalled, there continues to be growing potential for action in Mississippi. read more
New York’s post-pandemic Medicaid binge
Empire Center, March 7
As state budget preparations head into their final weeks, a confrontation is brewing over Medicaid, the state-run health plan for the low-income and disabled. Governor Hochul has proposed holding the state’s $36 billion share of Medicaid funding essentially flat, arguing for restraint after three years of double-digit growth. Yet hospitals, nursing homes and other provider groups are clamoring for further increases to address what they portray as a broad crisis in the health-care system. read more
Empire Center, March 7
As state budget preparations head into their final weeks, a confrontation is brewing over Medicaid, the state-run health plan for the low-income and disabled. Governor Hochul has proposed holding the state’s $36 billion share of Medicaid funding essentially flat, arguing for restraint after three years of double-digit growth. Yet hospitals, nursing homes and other provider groups are clamoring for further increases to address what they portray as a broad crisis in the health-care system. read more
Florida Gets the OK. But Will Drug Importation from Canada Actually Happen? Managed Healthcare Executive, March 5
Florida has become the first state to receive approval from the FDA to import certain prescription drugs from Canada, with the aim of lowering costs. However, some experts are skeptical that the medications will ever make it across the border. “I don’t think Canada has any interest in this occurring,” says Randy Hatton, Pharm.D., a clinical professor at the University of Florida College of Pharmacy in Gainesville. It’s likely in Canada’s “best interest to maintain their own pharmaceutical supply chain,” he adds. read more
Florida has become the first state to receive approval from the FDA to import certain prescription drugs from Canada, with the aim of lowering costs. However, some experts are skeptical that the medications will ever make it across the border. “I don’t think Canada has any interest in this occurring,” says Randy Hatton, Pharm.D., a clinical professor at the University of Florida College of Pharmacy in Gainesville. It’s likely in Canada’s “best interest to maintain their own pharmaceutical supply chain,” he adds. read more
Instead of Medicaid expansion, GOP legislators try for higher reimbursement rates Kansas Reflector, March 4
House Republicans who oppose Medicaid expansion are pushing a one-time influx of cash for local hospitals as a way to save the state’s teetering rural health care system. House Republican leadership said increasing the state’s medical reimbursement rates would increase access to care for the state’s “truly needy.” “By increasing shockingly low Medicaid reimbursement rates, we’re strengthening Kansas health care from within,” said House Speaker Dan Hawkins, R-Wichita. read more
House Republicans who oppose Medicaid expansion are pushing a one-time influx of cash for local hospitals as a way to save the state’s teetering rural health care system. House Republican leadership said increasing the state’s medical reimbursement rates would increase access to care for the state’s “truly needy.” “By increasing shockingly low Medicaid reimbursement rates, we’re strengthening Kansas health care from within,” said House Speaker Dan Hawkins, R-Wichita. read more