24 Apr MEDICAID NEWS RECAP – MARCH 2025
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.
Recent Medicaid Managed Care Policies And Safety Net Accountable Care HealthAffiars, March 28
Accountable care can be a useful tool for providing safety-net providers with more sustainable and flexible financing for meeting their patients’ needs. However, most safety-net organizations face multiple existing barriers to advancing accountable care in the safety net. Further, accountable care is at an inflection point, and several health policy proposals may affect accountable care. read more
Accountable care can be a useful tool for providing safety-net providers with more sustainable and flexible financing for meeting their patients’ needs. However, most safety-net organizations face multiple existing barriers to advancing accountable care in the safety net. Further, accountable care is at an inflection point, and several health policy proposals may affect accountable care. read more
HHS Announces Transformation to Make America Healthy Again
HHS, March 27
Today, the U.S. Department of Health and Human Services (HHS) announced a dramatic restructuring in accordance with President Trump’s Executive Order, “Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.” The restructuring will address this and serve multiple goals without impacting critical services. First, it will save taxpayers $1.8 billion per year through a reduction in workforce of about 10,000 full-time employees who are part of this most recent transformation. read more
HHS, March 27
Today, the U.S. Department of Health and Human Services (HHS) announced a dramatic restructuring in accordance with President Trump’s Executive Order, “Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.” The restructuring will address this and serve multiple goals without impacting critical services. First, it will save taxpayers $1.8 billion per year through a reduction in workforce of about 10,000 full-time employees who are part of this most recent transformation. read more
Federal improper payments have become a universal constant
Federal News Network, March 26
Federal improper payments went on unabated last year. They reached $162 billion. Most, but not all, were overpayments. Medicare and Medicaid produced about half the overpayments. The Director of Financial Assurance at the Government Accountability Office, Hannah Padilla, shared more with the Federal Drive with Tom Temin. read more
Federal News Network, March 26
Federal improper payments went on unabated last year. They reached $162 billion. Most, but not all, were overpayments. Medicare and Medicaid produced about half the overpayments. The Director of Financial Assurance at the Government Accountability Office, Hannah Padilla, shared more with the Federal Drive with Tom Temin. read more
In legislature’s final hour, lawmakers OK’d Medicaid work requirements. What happens next? Courier Journal, March 25
Speakers at a roundtable forum last week in Louisville over potential federal Medicaid cuts had plenty to say — the event ran nearly an hour over its scheduled time as attendees shared grave concerns over the future of their health care plans. One message many of them echoed: Work requirements, like those included in an eleventh-hour bill approved earlier this month by the Kentucky legislature, don’t work. “We know they don’t work. Everybody knows they don’t work,” Family Health Centers CEO Dr. Bart Irwin said. read more
Speakers at a roundtable forum last week in Louisville over potential federal Medicaid cuts had plenty to say — the event ran nearly an hour over its scheduled time as attendees shared grave concerns over the future of their health care plans. One message many of them echoed: Work requirements, like those included in an eleventh-hour bill approved earlier this month by the Kentucky legislature, don’t work. “We know they don’t work. Everybody knows they don’t work,” Family Health Centers CEO Dr. Bart Irwin said. read more
Iowa Senate approves bill setting expanded Medicaid work requirements
Iowa Capital Dispatch, March 25
The Iowa Senate passed legislation Tuesday setting work requirements for Iowans on the state’s expanded Medicaid program. Senate File 615, passed by the Senate in a 33-15 vote, would make work requirements mandatory for the continued existence of the Iowa Health and Wellness Plan, also known as IHAWP, the Medicaid coverage available for low-income, able-bodied adults from ages 19 to 64. read more
Iowa Capital Dispatch, March 25
The Iowa Senate passed legislation Tuesday setting work requirements for Iowans on the state’s expanded Medicaid program. Senate File 615, passed by the Senate in a 33-15 vote, would make work requirements mandatory for the continued existence of the Iowa Health and Wellness Plan, also known as IHAWP, the Medicaid coverage available for low-income, able-bodied adults from ages 19 to 64. read more
Putting $880 Billion in Potential Federal Medicaid Cuts in Context of State Budgets and Coverage KFF, March 24
Medicaid is jointly financed by states and the federal government but administered by states within broad federal rules. Medicaid accounts for a large share of state budgets and can be central to state fiscal decisions. Following years of robust revenue growth, states are now contending with weakening tax revenues, budget shortfalls, and uncertainty in their long-term fiscal outlook, leaving some states with difficult budget decisions. read more
Medicaid is jointly financed by states and the federal government but administered by states within broad federal rules. Medicaid accounts for a large share of state budgets and can be central to state fiscal decisions. Following years of robust revenue growth, states are now contending with weakening tax revenues, budget shortfalls, and uncertainty in their long-term fiscal outlook, leaving some states with difficult budget decisions. read more
Medicaid Improper Payments Estimate: $1.1 Trillion
The Heartland Institute, March 24
Medicaid issued approximately $1.1 trillion in improper payments over the past decade, double the agency’s stated amount, the Paragon Health Institute estimates. “Cracking down on improper payments is a necessary first step that could provide hundreds of billions of dollars in Medicaid savings for federal taxpayers,” states the March 3 policy brief based on examination of eligibility checks from government audits. read more
The Heartland Institute, March 24
Medicaid issued approximately $1.1 trillion in improper payments over the past decade, double the agency’s stated amount, the Paragon Health Institute estimates. “Cracking down on improper payments is a necessary first step that could provide hundreds of billions of dollars in Medicaid savings for federal taxpayers,” states the March 3 policy brief based on examination of eligibility checks from government audits. read more
MEDICAID AND MCOs BRACE FOR $880B BUDGET CUTS: CHALLENGES AND STRATEGIC ADJUSTMENTS Syrtis Solutions, March 21
As of March 18th, Medicaid Managed Care Organizations are confronting significant challenges due to proposed federal budget cuts totaling $880 billion over the next decade. These reductions threaten to reshape Medicaid funding, potentially leading to coverage losses and stricter eligibility requirements. Consequently, MCOs may experience enrollment declines and reimbursement challenges, necessitating strategic adjustments to maintain service quality and financial sustainability. read more
As of March 18th, Medicaid Managed Care Organizations are confronting significant challenges due to proposed federal budget cuts totaling $880 billion over the next decade. These reductions threaten to reshape Medicaid funding, potentially leading to coverage losses and stricter eligibility requirements. Consequently, MCOs may experience enrollment declines and reimbursement challenges, necessitating strategic adjustments to maintain service quality and financial sustainability. read more
Medicaid and CHIP Rules on Chopping Block
Georgetown University McCourt School of Public Policy, March 21
As my colleague Edwin Park has written, the House Budget Committee “menu” of Medicaid cuts includes rescinding regulations promulgated by the Biden Administration. Of particular interest to readers of SayAhhh!, the menu includes rescinding the Medicaid and CHIP eligibility and enrollment rule and the two companion rules on improving access to care in fee-for-service and managed care delivery systems. read more
Georgetown University McCourt School of Public Policy, March 21
As my colleague Edwin Park has written, the House Budget Committee “menu” of Medicaid cuts includes rescinding regulations promulgated by the Biden Administration. Of particular interest to readers of SayAhhh!, the menu includes rescinding the Medicaid and CHIP eligibility and enrollment rule and the two companion rules on improving access to care in fee-for-service and managed care delivery systems. read more
5 Key Facts About Medicaid Program Integrity – Fraud, Waste, Abuse and Improper Payments KFF, March 18
Medicaid is the primary program providing comprehensive coverage of health and long-term care to 83 million low-income people in the United States and accounts for one-fifth of health care spending. Medicaid is jointly financed by states and the federal government but administered by states within federal rules. The recently passed House budget resolution targets cuts to Medicaid of up to $880 billion or more over a decade. read more
Medicaid is the primary program providing comprehensive coverage of health and long-term care to 83 million low-income people in the United States and accounts for one-fifth of health care spending. Medicaid is jointly financed by states and the federal government but administered by states within federal rules. The recently passed House budget resolution targets cuts to Medicaid of up to $880 billion or more over a decade. read more
What to do about $1.1 trillion in improper Medicaid payments
The Hill, March 16
As the 119th Congress seeks to reduce government spending through reconciliation, talk of Medicaid reductions has raised concerns about vulnerable populations losing Medicaid coverage. But simply following the law and paying only for what Medicaid allows would save hundreds of billions of dollars without ending coverage for any of Medicaid’s intended recipients. read more
The Hill, March 16
As the 119th Congress seeks to reduce government spending through reconciliation, talk of Medicaid reductions has raised concerns about vulnerable populations losing Medicaid coverage. But simply following the law and paying only for what Medicaid allows would save hundreds of billions of dollars without ending coverage for any of Medicaid’s intended recipients. read more
Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State KFF, March 14
Section 1115 Medicaid demonstration waivers offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute, if [in the HHS Secretary’s view] the approach is likely to “promote the objectives of the Medicaid program.” They can provide states additional flexibility in how they operate their programs, beyond the considerable flexibility that is available under current law. read more
Section 1115 Medicaid demonstration waivers offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute, if [in the HHS Secretary’s view] the approach is likely to “promote the objectives of the Medicaid program.” They can provide states additional flexibility in how they operate their programs, beyond the considerable flexibility that is available under current law. read more
Idaho Capital Sun, March 10
The Idaho Senate Health and Welfare Committee on Monday advanced a bill that proposes sweeping policy changes to control Medicaid costs. House Bill 345 calls for Idaho to seek work requirements for able-bodied Idahoans on Medicaid, and to give Idahoans eligible for Medicaid expansion access to tax credits to buy insurance on Idaho’s health care exchange. read more
The Idaho Senate Health and Welfare Committee on Monday advanced a bill that proposes sweeping policy changes to control Medicaid costs. House Bill 345 calls for Idaho to seek work requirements for able-bodied Idahoans on Medicaid, and to give Idahoans eligible for Medicaid expansion access to tax credits to buy insurance on Idaho’s health care exchange. read more