06 Jun MEDICAID NEWS RECAP – MAY 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.
At one-year mark, more than 1.6 million Michigan residents have Medicaid coverage renewed State of Michigan DHHS, May 24
As the redetermination process reaches the one-year mark, the Michigan Department of Health and Human Services (MDHHS) renewed Medicaid and Healthy Michigan Plan coverage for an additional 137,685 people whose eligibility was up for renewal in April, bringing the total to more than 1.6 million residents who have retained insurance coverage. The department is continuing its efforts to maintain Medicaid coverage for eligible Michiganders. read more
As the redetermination process reaches the one-year mark, the Michigan Department of Health and Human Services (MDHHS) renewed Medicaid and Healthy Michigan Plan coverage for an additional 137,685 people whose eligibility was up for renewal in April, bringing the total to more than 1.6 million residents who have retained insurance coverage. The department is continuing its efforts to maintain Medicaid coverage for eligible Michiganders. read more
Managed Care USDHHS OIG, May 23
The OIG has designated oversight of managed care as a priority area. OIG has developed a strategy to align its audits, evaluations, investigations, and enforcement of managed care. The HHS-OIG Strategic Plan for Oversight of Managed Care for Medicare and Medicaid has three goals: Promote access to care for people enrolled in managed care, Provide comprehensive financial oversight, Promote data accuracy and encourage data-driven decisions. read more
The OIG has designated oversight of managed care as a priority area. OIG has developed a strategy to align its audits, evaluations, investigations, and enforcement of managed care. The HHS-OIG Strategic Plan for Oversight of Managed Care for Medicare and Medicaid has three goals: Promote access to care for people enrolled in managed care, Provide comprehensive financial oversight, Promote data accuracy and encourage data-driven decisions. read more
South Dakota Medicaid-expansion enrollments slowing
SIOUXLAND Proud, May 22
The number of South Dakotans who have enrolled for Medicaid still hasn’t come close to the level predicted two years ago when voters were preparing to say yes or no to expanding income eligibility for the government-subsidized healthcare services. South Dakota Social Services Secretary Matt Althoff met Tuesday with the Legislature’s Appropriations Committee that sets the spending levels for state government, including the Medicaid program. read more
SIOUXLAND Proud, May 22
The number of South Dakotans who have enrolled for Medicaid still hasn’t come close to the level predicted two years ago when voters were preparing to say yes or no to expanding income eligibility for the government-subsidized healthcare services. South Dakota Social Services Secretary Matt Althoff met Tuesday with the Legislature’s Appropriations Committee that sets the spending levels for state government, including the Medicaid program. read more
Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State KFF, May 22
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.
Subcommittee Chair Guthrie Opening Remarks at Health Subcommittee Markup of 23 Legislative Proposals to Strengthen the American Health Care System Energy & Commerce Chair Rodgers, May 16
House Energy and Commerce Subcommittee on Health Chair Brett Guthrie (R-KY) delivered the following opening remarks at today’s markup of 23 legislative proposals to extend Americans’ access to telehealth services, strengthen and preserve Medicaid, and encourage innovation to help children with rare diseases. “Over the past several weeks, the Health Subcommittee has led the way bringing forward solutions to address some of the biggest challenges facing patients and our health care system. read more
House Energy and Commerce Subcommittee on Health Chair Brett Guthrie (R-KY) delivered the following opening remarks at today’s markup of 23 legislative proposals to extend Americans’ access to telehealth services, strengthen and preserve Medicaid, and encourage innovation to help children with rare diseases. “Over the past several weeks, the Health Subcommittee has led the way bringing forward solutions to address some of the biggest challenges facing patients and our health care system. read more
As Medicaid redeterminations restart, about 73% of state’s recipients remain enrolled The Times Weekly, May 15
More than 660,000 disenrolled following expiration of COVID-era rule, state reports. About 73 percent of Illinois’ Medicaid recipients remain on the rolls after the first redetermination cycle following the COVID-19 pandemic, while approximately 660,000 recipients have been disenrolled. Speaking at a news conference in Chicago, Gov. JB Pritzker celebrated the fact that 2.6 million Illinoisans remained on the rolls despite redeterminations beginning anew, saying “this is what good government looks like. read more
More than 660,000 disenrolled following expiration of COVID-era rule, state reports. About 73 percent of Illinois’ Medicaid recipients remain on the rolls after the first redetermination cycle following the COVID-19 pandemic, while approximately 660,000 recipients have been disenrolled. Speaking at a news conference in Chicago, Gov. JB Pritzker celebrated the fact that 2.6 million Illinoisans remained on the rolls despite redeterminations beginning anew, saying “this is what good government looks like. read more
Indiana Medicaid rolls higher than pre-pandemic enrollment as unwinding concludes Daily Journal, May 15
Medicaid rolls in the Hoosier State are higher today than they were in February of 2020, more than four years after the emergence of COVID-19 and accompanying federal health coverage protections. But outcomes for disenrolled Hoosiers are still unknown. With 11 of 12 months posted — and the last due to publish in the coming days — the Family and Social Services Administration (FSSA) wrapped up the yearlong redetermination process in April. Nearly 2 million Hoosiers rely upon Medicaid for their health coverage, compared to 1.5 million in February 2020. read more
Medicaid rolls in the Hoosier State are higher today than they were in February of 2020, more than four years after the emergence of COVID-19 and accompanying federal health coverage protections. But outcomes for disenrolled Hoosiers are still unknown. With 11 of 12 months posted — and the last due to publish in the coming days — the Family and Social Services Administration (FSSA) wrapped up the yearlong redetermination process in April. Nearly 2 million Hoosiers rely upon Medicaid for their health coverage, compared to 1.5 million in February 2020. read more
KFF, May 8
The Affordable Care Act’s (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($20,783 for an individual in 2024) and provided states with an enhanced federal matching rate (FMAP) for their expansion populations. To date, 41 states (including DC) have adopted the Medicaid expansion and 10 states have not adopted the expansion. read more
The Affordable Care Act’s (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($20,783 for an individual in 2024) and provided states with an enhanced federal matching rate (FMAP) for their expansion populations. To date, 41 states (including DC) have adopted the Medicaid expansion and 10 states have not adopted the expansion. read more
New Rules Will Help Adults and Children Enroll — and Stay Enrolled in — Medicaid and CHIP The Commonwealth Fund, May 7
On April 2, the Centers for Medicare and Medicaid Services (CMS) published the most significant set of eligibility regulations since the initial rule implementing the Affordable Care Act (ACA). The new rule will help eligible individuals enroll in Medicaid and Children’s Health Insurance Program (CHIP) coverage and stay enrolled as long as they remain eligible. Many of the provisions address issues that contributed to coverage losses during the unwinding of the continuous enrollment provision that has resulted in at least 13.7 million people losing Medicaid coverage, mostly for procedural reasons. read more
On April 2, the Centers for Medicare and Medicaid Services (CMS) published the most significant set of eligibility regulations since the initial rule implementing the Affordable Care Act (ACA). The new rule will help eligible individuals enroll in Medicaid and Children’s Health Insurance Program (CHIP) coverage and stay enrolled as long as they remain eligible. Many of the provisions address issues that contributed to coverage losses during the unwinding of the continuous enrollment provision that has resulted in at least 13.7 million people losing Medicaid coverage, mostly for procedural reasons. read more
Medicaid enrollment soars in North Carolina after expansion
Axios Charlotte, May 5
We’re nearing the six-month mark since North Carolina opened up enrollment to its expanded Medicaid program. Since December, 448,242 North Carolinians have been added to the rolls for full coverage, the state Department of Health and Human Services tells Axios. Why it matters: The expansion meant that another 600,000 residents — nearly 6% of the state’s population — became eligible for coverage they previously might not have been able to afford, from maternity care to prescription drugs. read more
Axios Charlotte, May 5
We’re nearing the six-month mark since North Carolina opened up enrollment to its expanded Medicaid program. Since December, 448,242 North Carolinians have been added to the rolls for full coverage, the state Department of Health and Human Services tells Axios. Why it matters: The expansion meant that another 600,000 residents — nearly 6% of the state’s population — became eligible for coverage they previously might not have been able to afford, from maternity care to prescription drugs. read more
Missouri Senate filibuster ends with vote on multibillion-dollar Medicaid program AP, May 2
A dayslong filibuster in the Missouri Senate ended Thursday after a Republican faction allowed a vote on a more than $4 billion Medicaid program they had been holding hostage. Senators gave initial approval in a voice vote to a bill that will renew a longstanding tax on hospitals and other medical providers. The measure needs a second vote of approval in the Senate. Money from the tax is used to draw down $2.9 billion in federal funding, which is then given to providers to care for low-income residents on Medicaid health care. read more
A dayslong filibuster in the Missouri Senate ended Thursday after a Republican faction allowed a vote on a more than $4 billion Medicaid program they had been holding hostage. Senators gave initial approval in a voice vote to a bill that will renew a longstanding tax on hospitals and other medical providers. The measure needs a second vote of approval in the Senate. Money from the tax is used to draw down $2.9 billion in federal funding, which is then given to providers to care for low-income residents on Medicaid health care. read more
Restraining Medicaid’s Budget-Busting Waivers
Manhattan Institute, May 2
For decades, federal officials have tried to let states make Medicaid more cost-effective by waiving some of the program’s standard terms and conditions. But waivers have not led to savings for taxpayers. Instead, Medicaid spending has surged, from $205 billion in 2000 to $683 billion in 2019—with 75% of that spending now under a waiver. Waivers provide no incentive for states to reduce the program’s overall expenditures, because waiver funding is contingent on states spending any purported savings that are generated. read more
Manhattan Institute, May 2
For decades, federal officials have tried to let states make Medicaid more cost-effective by waiving some of the program’s standard terms and conditions. But waivers have not led to savings for taxpayers. Instead, Medicaid spending has surged, from $205 billion in 2000 to $683 billion in 2019—with 75% of that spending now under a waiver. Waivers provide no incentive for states to reduce the program’s overall expenditures, because waiver funding is contingent on states spending any purported savings that are generated. read more
Medicaid expansion effort collapses in Republican-led Mississippi Legislature AP, May 2
Medicaid expansion efforts fizzled and died Thursday in Republican-led Mississippi because top lawmakers could not agree on a final proposal to send to the House and Senate. This was the first year that expansion has received serious legislative discussion in Mississippi, which is one of the poorest states in the U.S. and has some of the worst health outcomes. Any plan would have needed to pass with at least a two-thirds vote — a wide enough margin to survive an expected veto from Republican Gov. Tate Reeves, who refers to Medicaid as “welfare” and says he does not want more people to enroll. read more
Medicaid expansion efforts fizzled and died Thursday in Republican-led Mississippi because top lawmakers could not agree on a final proposal to send to the House and Senate. This was the first year that expansion has received serious legislative discussion in Mississippi, which is one of the poorest states in the U.S. and has some of the worst health outcomes. Any plan would have needed to pass with at least a two-thirds vote — a wide enough margin to survive an expected veto from Republican Gov. Tate Reeves, who refers to Medicaid as “welfare” and says he does not want more people to enroll. read more
KFF, May 1
Managed care is the dominant delivery system for Medicaid enrollees. The latest national Medicaid managed care enrollment data (from 2021) show 74% of Medicaid beneficiaries were enrolled in comprehensive managed care organizations (MCOs). The Centers for Medicare and Medicaid Services (CMS) continues to highlight the role MCOs can play in helping people eligible for Medicaid use and keep their coverage during the unwinding of the continuous enrollment requirement. read more
Managed care is the dominant delivery system for Medicaid enrollees. The latest national Medicaid managed care enrollment data (from 2021) show 74% of Medicaid beneficiaries were enrolled in comprehensive managed care organizations (MCOs). The Centers for Medicare and Medicaid Services (CMS) continues to highlight the role MCOs can play in helping people eligible for Medicaid use and keep their coverage during the unwinding of the continuous enrollment requirement. read more