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.

Pro-unionization language dropped from Pennsylvania multi-billion dollar Medicaid contracts  The Center Square, May 31 
After a months-long controversy over unionization language in Medicaid contracts that sparked a lawsuit, the Pennsylvania Department of Human Services has removed the provision in question, citing concerns about “misinformation” and “confusion.” Since March, DHS has been criticized by Republican state legislators and hospital groups over its proposed HealthChoices Medicaid Managed Care agreements, as The Center Square has previously reported.  read more


NC General Assembly could take up Medicaid expansion bill this week
Blue Ridge Public Radio, May 31
A Medicaid expansion bill could be on the floor this week in the North Carolina General Assembly. BPR talked with one Western North Carolina senator who helped write the bill. Republican Senator Kevin Corbin who represents the westernmost counties in the state has been a part of the discussion about Medicaid expansion for years. “It will be voted on the floor this week,” said Corbin. He remembers when the House recently advocated for some expansion but now it seems like it’s the Senate’s turn.  read more


Gov. Pritzker signs Medicaid omnibus providing continuous eligibility for enrolled adults  KFVS12, May 27
Governor JB Pritzker signed a Medicaid omnibus that includes a variety of measures aimed at increasing access to health care, preserving coverage, and creating a more equitable health care system in Illinois. “This legislation sends a clear message: in Illinois, healthcare is a right—not a privilege,” said Governor JB Pritzker. “Throughout my administration, it has been our priority to create the most equitable healthcare system in the nation. Today, we continue to make that idea a reality.  read more


Rollback of pandemic protections to test Medicaid managed care organizations 
HealthcareDive, May 26
Millions of Americans are at risk of losing health coverage when pandemic-era protections are peeled back. Yet one-third of those estimated to lose coverage — nearly 3 million adults — may still have access to subsidized coverage through the Affordable Care Act marketplace. The impending rollback will test the strategies of insurers who have made offering marketplace plans a key piece of their business model to insure low-income Americans. The question is whether insurers will be able to shift Medicaid members who lose coverage to subsidized marketplace plans.  
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Oklahoma Medicaid managed care bill passes  
Insurance Newsnet, May 24
Oklahoma legislators on Friday approved plans to revamp the state’s Medicaid program into a value-based health care model that incentivizes providers to improve patient health. The plan includes some elements of the Medicaid managed care plan the Stitt administration tried to implement last year, but lawmakers were directly involved in crafting the details this time. The Oklahoma Supreme Court last year ruled the Oklahoma Health Care Authority, which oversees the state’s Medicaid program, exceeded its authority in trying to implement managed care.  read more


Virginia poised to review eligibility of 2 million in Medicaid ‘safe haven’
Richmond Times-Dispatch, May 16
Virginia is poised to begin an exhaustive 12-month review of more than 2 million people in its Medicaid program for the elderly, disabled and low-income families — it’s just a question of when. The federal-state program, supercharged by Virginia’s expansion of eligibility in 2019 under the Affordable Care Act, has added more than a half-million people since the COVID-19 pandemic began, relying on more than $1 billion in additional federal funding to provide health care for people who can’t afford to pay.  read more


KS Gov. Kelly rejects bill blocking her administration from negotiating KanCare contracts  The Kansas City Star, May 13
Touting the need for a “transparent, competitive bidding process,” Kansas Gov. Laura Kelly vetoed legislation aimed at barring her administration from seeking new contractors to run the state’s Medicaid program. Contracts for the three insurance companies that administer KanCare, Kansas’ privatized Medicaid system, are up at the end of next year. Kelly’s administration was set to put requests for proposals out this fall to begin the process of negotiating new contracts, but Kansas Republicans passed a bill blocking the RFP from going out until January, when the winner of the 2022 election will be in office.  read more


UnitedHealthcare Selected by State of Missouri to Serve Medicaid Beneficiaries
UnitedHealth Group, May 12
The state of Missouri has selected UnitedHealthcare Community Plan of Missouri as one of three managed care organizations to administer its MO HealthNet Managed Care Program for Medicaid members in Temporary Assistance for Needy Families (TANF) and the Children’s Health Insurance Program (CHIP). UnitedHealthcare is committed to working closely with the Missouri Department of Social Services and its MO HealthNet Division, which administer the state’s Medicaid program, toward the shared goal of improving the overall health and well-being of members.  read more


House Committee Approves Bill That Could Require More Fraud Reporting
Biz New Orleans, May 12 
The House and Governmental Affairs Committee approved legislation to require state agencies to annually report progress on eliminating fraud, waste and abuse to the Legislature. The committee voted unanimously on Tuesday to approve Senate Bill 259, sponsored by Sen. Sharon Hewitt, R-Slidell, to require the departments of Children and Family Services, Education, Health, and the Louisiana Workforce Commission to report to the legislature annually regarding policies and processes for identifying and eliminating fraud, waste, and abuse of certain government-funded programs.  read more


States receive billions in extra federal Medicaid funds to cover more Americans during the pandemic  CNN, May 10
States are expected to receive a total of more than $100 billion in extra federal Medicaid funds to help them get through the Covid-19 pandemic, according to a Kaiser Family Foundation analysis released Tuesday. That’s more than double what they are projected to spend on the growth in Medicaid enrollees. The expanded funding stems from a coronavirus relief measure Congress approved in March 2020. It provides states with a 6.2 percentage point increase in their federal match rate for most enrollees.  read more


KFF: Up to 14M enrollees could lose Medicaid coverage as states restart eligibility checks
Fierce Healthcare, May 10
Between 5.3 million and 14.2 million enrollees could lose Medicaid coverage next year as the Biden administration is expected to roll back the program’s continuous coverage provision, a new analysis finds. The analysis, released Tuesday by the Kaiser Family Foundation, explores how much enrollment in Medicaid changed during the pandemic, including the impact of a requirement that could go away that prevented states from disenrolling recipients.
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Fiscal and Enrollment Implications of Medicaid Continuous Coverage Requirement During and After the PHE Ends  KFF, May 10
Early in the pandemic, Congress passed the Families First Coronavirus Response Act (FFCRA), which authorized a 6.2 percentage point increase in the federal Medicaid match rate (“FMAP”) for states that meet certain “maintenance of eligibility” (MOE) requirements, with the goal of providing broad fiscal relief to states while preventing coverage losses during the pandemic. The additional funds were retroactively available to states beginning January 1, 2020 and continue through the quarter in which the Public Health Emergency (PHE) period ends.  read more


Department of Health and Human Services Met Many Requirements, but It Did Not Fully Comply With the Payment Integrity Information and Applicable Improper Payment Guidance 
HHS Office of Inspector General, May 9
The Office of Inspector General (OIG) must review the Department of Health and Human Services (HHS) compliance with the Payment Integrity Information Act of 2019 (PIIA, P.L. No. 116-117) and related applicable improper payment guidance. Ernst & Young (EY), LLP, under its contract with the HHS OIG, audited the fiscal year 2021 HHS improper payment information reported in the Agency Financial Report (AFR) to determine compliance with PIIA and related guidance from the Office of Management and Budget (OMB).  read more


Anthem closes acquisition of Integra Managed Care  Fierce Healthcare, May 9
Anthem has closed its acquisition of New York-based Integra Managed Care. The insurer announced plans to acquire Integra, a long-term care plan, in November. The plan will bring more than 40,000 Medicaid members into the Anthem fold and offers coverage to assist with managing long-term care needs and disabilities in the home. “We’re pleased to complete this acquisition and work alongside our new colleagues as we continue to grow our Medicaid business and enhance the healthcare experience for all of our members,” said Felicia Norwood, executive vice president of Anthem’s government business division, in a statement.  read more


An Overview of Medicaid Work Requirements: What Happened Under the Trump and Biden Administrations?  KFF, May 3
The Trump Administration aimed to reshape the Medicaid program by newly approving Section 1115 demonstration waivers that imposed work and reporting requirements as a condition of Medicaid eligibility. However, courts struck down many of these approvals and the Supreme Court recently dismissed pending challenges in these cases. The Court dismissed pending litigation in Arkansas and New Hampshire due to the expiration of Arkansas’ waiver as well as the Biden Administration’s earlier withdrawals of these approved work requirement waivers.  read more


ACA-related coverage enrollment tops record at nearly 36M  HealthcareDive, May 2
The decline in the U.S. uninsured rate corresponds with about 4.9 million Americans gaining health coverage since the end of 2020. A record 14.5 million people signed up for coverage through the ACA exchanges for 2022. Of the more than 35 million people with ACA-related insurance in early 2022, about 21 million obtained coverage due to the expansion of Medicaid to low-income adults aged 65 and under in more than 40 states and territories. Minnesota and New York also implemented the Basic Health Program option under the ACA to cover people with incomes between 138% and 200% of the federal poverty level.  read more