MEDICAID NEWS RECAP – MAY 2023

The Government Accountability Office recently published its updated High-Risk List. The update is part of the biennial High-Risk Series started in 1990 that identifies government operations vulnerable to fraud, waste, abuse, and mismanagement. The recent report marks the twentieth consecutive year that the Medicaid program has made the cut. According to the GAO, the Centers for Medicare and Medicaid Services must strengthen fiscal oversight of program expenditures to mitigate improper payments and ensure that resources are spent appropriately.  read more

The debt-ceiling deal negotiated by President Joe Biden House Speaker Kevin McCarthy does not include the Medicaid work requirements that many Democrats were prepared to fight. But the agreement does include clawing back $30 billion in unspent COVID-19 relief funds favored by many Republicans. The debt-ceiling bill passed by House Republicans in late April included Medicaid work requirements. The Kaiser Family Foundation estimated that if the requirements became law and had been implemented next year, up to 1.7 Medicaid enrollees might have lost coverage for failing to meet the requirements.  read more

Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies, and analyses; and other health policy news. This week, CMS issued a proposed rule to implement policies in the Medicaid Drug Rebate Program (MDRP) and CBO released health insurance coverage projections for 2023 to 2033.  read more

On May 23, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule entitled Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program (Proposed Rule). The title belies the significant nature of many of the Proposed Rule’s provisions, which include: A new drug price verification survey of manufacturers and wholesalers that would require the IRA-like disclosures of manufacturer cost and pricing data, The material modification of numerous Medicaid Drug Rebate Program (MDRP) requirements that could have significant implications for manufacturers, and Increased transparency between Medicaid managed care plans and pharmacy benefit managers (PBMs) as to prices PBMs pay pharmacies.  read more

CMS has finalized or proposed several policy changes in 2023, including stricter audits of Medicare Advantage plans, changes to prior authorization and regulations aimed at drug prices. Here are seven key policies from the agency to note from the first half of 2023: CMS is proposing a new rule for drug manufacturers, pharmaceutical benefit managers and managed care plans to increase drug price transparency in Medicaid.  read more

As described in an earlier Forefront article by Laura Keohane and Ann Hwang, 2022 was a year of renewed congressional interest in advancing Medicare and Medicaid integration for dual-eligible individuals. Several bipartisan bills were introduced that would support the development of state integrated care strategies, as recommended by the Medicaid and CHIP Payment and Access Commission in its June 2022 report to Congress, or that would provide states with the option of creating a wholly new program for dual-eligible individuals that would combine Medicare and Medicaid funding, care delivery, and program rules into a single program, as described in the Comprehensive Care for Dual Eligible Individuals Act of 2022.  read more

About 1 in 4 Medicaid enrollees don’t know where to look for other coverage if they drop off the safety net program’s rolls, and 15% say they’ll be uninsured, according to a new KFF survey. Why it matters: The findings begin to quantify how unprepared many enrollees are for the eligibility renewal process that’s begun in states with the end of the COVID-19 public health emergency. 65% of recipients say they didn’t have a change in income or other change that would make them ineligible for the program, underscoring the importance of navigating the renewal process and not getting lost in bureaucratic churn.  read more

As flexibilities rolled out during the COVID-19 pandemic wind down, there will be plenty of factors at play that could impact uninsured rates in the coming years. Analysts at the Congressional Budget Office (CBO) project that while the rate will increase from current levels, it will decline over the next decade from pre-pandemic levels. They estimate that 10.1% of people will be uninsured in 2033, down from 12% in 2019, according to a new study published in Health Affair.  read more

During the COVID-19 pandemic, states kept people continuously enrolled in Medicaid in exchange for enhanced federal funding. Continuous enrollment in Medicaid ended on March 31, 2023, and over the coming months, states will redetermine eligibility for people enrolled in Medicaid and will disenroll those who are either no longer eligible or who are unable to complete the renewal process.  read more

Negotiations on a debt ceiling deal continue in Washington, and Medicaid work requirements have emerged as a key issue in the discussions. House Speaker Kevin McCarthy, R-Calif., described work requirements as a “red line” in the negotiations with President Joe Biden on a deal to avoid default on federal loans, according to a report from ABC News. Work requirements in Medicaid and other federal assistance programs have been a long-time Republican talking point.  read more

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that aims to increase the transparency of prescription drug costs in Medicaid. “This proposed rule prioritizes CMS’ role as a good steward of Medicaid dollars while also strengthening program integrity and the management of pharmacy benefits for people with Medicaid coverage,” CMS Administrator Chiquita Brooks-LaSure said in the press release.   read more

The Centers for Medicare & Medicaid Services’ (CMS’) proposed rule seeks to advance policies to promote efficient operation of the Medicaid Drug Rebate Program (MDRP). This includes proposed policies to implement new statutory authorities included in the Medicaid Services Investment and Accountability Act of 2019 (MSIAA) to address situations in which manufacturers incorrectly report or misclassify their drugs in the MDRP.  read more

States are finding innovative ways to partner with and leverage their Managed Care Organizations to ensure that their Medicaid redetermination processes are as effective as possible, according to an AHIP issue brief. In February 2023, states began the process of redetermining whether each of the more than 90 million Americans currently enrolled in Medicaid are still eligible for the program, with eligibility coverage decisions starting April 1.  read more

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 2022 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

Republican lawmakers are trying to reverse a provision in New York’s $229 billion state budget that shifted $1 billion in Medicaid funding away from county governments. County leaders have warned that without the combined $1 billion from federal medical assistance percentage funds, they could be forced to consider property tax increases. State Sen. Mark Walczyk on Monday announced he was backing the measure meant to reverse the budget provision.  read more

Today, Paragon Health Institute released a new report, Pandemic Unwinding: How States Should Clean Up Their Medicaid Rolls. Medicaid is a welfare program for low-income Americans. But, because of policies related to the COVID public health emergency, more than 20% of Medicaid enrollees no longer meet the criteria for program eligibility. States have not conducted redeterminations of Medicaid enrollees’ eligibility in more than three years. States have an obligation to move as quickly and smartly as possible to begin cleaning up their Medicaid rolls.  read more

The state will start to withhold federal aid from New York localities to help pay for Medicaid over the next three years under changes included in the next budget, pushing county leaders to be concerned they’ll be forced to increase property taxes and cut local services to afford the difference. The state will gradually shift Federal Medicaid Assistance Percentage payments to its coffers.  read more