11 Dec MEDICAID NEWS RECAP – NOVEMBER 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, November 27
Improper payments and fraud remain persistent and costly challenges for Medicaid and other government-funded programs. The GAO defines improper payments as payments that should not have been made or that were made in an incorrect amount (including overpayments and underpayments) under statutory, contractual, administrative, or other legally applicable requirements. According to GAO estimates, the federal government loses between $233 billion and $521 billion annually to fraud alone. read more
Improper payments and fraud remain persistent and costly challenges for Medicaid and other government-funded programs. The GAO defines improper payments as payments that should not have been made or that were made in an incorrect amount (including overpayments and underpayments) under statutory, contractual, administrative, or other legally applicable requirements. According to GAO estimates, the federal government loses between $233 billion and $521 billion annually to fraud alone. read more
Louisiana Illuminator, November 24
Trevor Hawkins, an attorney at Legal Aid of Arkansas, remembers how busy his job got when the state for a time imposed work requirements on Medicaid recipients: His office was swamped with frantic phone calls from people who said they couldn’t comply with the new rule because they weren’t healthy enough to work or had to care for sick relatives. “A whole heap of folks, after a month or two, started getting notices saying, read more
Trevor Hawkins, an attorney at Legal Aid of Arkansas, remembers how busy his job got when the state for a time imposed work requirements on Medicaid recipients: His office was swamped with frantic phone calls from people who said they couldn’t comply with the new rule because they weren’t healthy enough to work or had to care for sick relatives. “A whole heap of folks, after a month or two, started getting notices saying, read more
CMS allows 5 states to adopt multiyear continuous Medicaid eligibility for children Healthcare Dive, November 20
Continuous enrollment ensures beneficiaries don’t suddenly lose access to care if their financial circumstances change, while reducing administrative burden for states, according to the CMS. Under the latest waivers, Colorado and Pennsylvania will also provide a year of continuous eligibility for some people ages 19 through 64 who were recently incarcerated. read more
Continuous enrollment ensures beneficiaries don’t suddenly lose access to care if their financial circumstances change, while reducing administrative burden for states, according to the CMS. Under the latest waivers, Colorado and Pennsylvania will also provide a year of continuous eligibility for some people ages 19 through 64 who were recently incarcerated. read more
Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State KFF, November 15
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.
Medicaid Oversight Committee makes no legislative recommendations – again NPR, November 13
A committee tasked with making legislative recommendations on Medicaid once again submitted a final report with no recommendations. This means the committee has not produced any recommendations since it began in 2023. Last year, Sen. Ryan Mishler (R-Mishawaka), the committee chair, said they would use any information from hearings to inform recommendations this year ahead of the new state budget. read more
A committee tasked with making legislative recommendations on Medicaid once again submitted a final report with no recommendations. This means the committee has not produced any recommendations since it began in 2023. Last year, Sen. Ryan Mishler (R-Mishawaka), the committee chair, said they would use any information from hearings to inform recommendations this year ahead of the new state budget. read more
Status of State Medicaid Expansion Decisions KFF, November 12
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
What Administrative Changes Can Trump Make to Medicaid?
KFF, November 8
With Donald Trump returning to the presidency, the future of Medicaid is uncertain. While Medicaid did not receive a lot of attention directly during the campaign, Trump’s first term can shed light on potential changes that could be implemented administratively without Congress. 1. Trump administration could encourage and approve Medicaid waivers to advance priorities, including work requirements. read more
KFF, November 8
With Donald Trump returning to the presidency, the future of Medicaid is uncertain. While Medicaid did not receive a lot of attention directly during the campaign, Trump’s first term can shed light on potential changes that could be implemented administratively without Congress. 1. Trump administration could encourage and approve Medicaid waivers to advance priorities, including work requirements. read more
Lessons Learned From Medicaid Unwinding as States Tackle Eligibility Checks AJMC, November 7
During the COVID-19 pandemic, Congress temporarily suspended eligibility checks for Medicaid and the Children’s Health Insurance Program (CHIP), ensuring uninterrupted access to health care for millions of Americans.1 As a result, Medicaid and CHIP enrollment surged from 71 million in February 2020 to 94 million by April 2023. However, with the pandemic emergency ending in May 2023, states resumed eligibility reviews, initiating a process termed “unwinding.” read more
During the COVID-19 pandemic, Congress temporarily suspended eligibility checks for Medicaid and the Children’s Health Insurance Program (CHIP), ensuring uninterrupted access to health care for millions of Americans.1 As a result, Medicaid and CHIP enrollment surged from 71 million in February 2020 to 94 million by April 2023. However, with the pandemic emergency ending in May 2023, states resumed eligibility reviews, initiating a process termed “unwinding.” read more
South Dakotans approve consideration of Medicaid expansion work requirements South Dakota Searchlight, November 6
A ballot measure authorizing South Dakota state officials to consider work requirements for Medicaid expansion recipients was winning in unofficial results. The tally was 56% in favor of Amendment F and 44% opposed as of 9:45 a.m. Central time Wednesday, with about 90% of statewide votes counted. Medicaid is a federal-state health insurance program for people with low incomes. In the past, Medicaid was not available to able-bodied adults younger than 65, unless they were below the poverty line and had young children. read more
A ballot measure authorizing South Dakota state officials to consider work requirements for Medicaid expansion recipients was winning in unofficial results. The tally was 56% in favor of Amendment F and 44% opposed as of 9:45 a.m. Central time Wednesday, with about 90% of statewide votes counted. Medicaid is a federal-state health insurance program for people with low incomes. In the past, Medicaid was not available to able-bodied adults younger than 65, unless they were below the poverty line and had young children. read more
HHS-OIG’s Oversight of COVID-19 Response and Recovery
U.S. DHHS Office of Inspector General, November 5
The emergence of COVID-19 created unprecedented challenges for the Department of Health and Human Services (HHS) and for the delivery of health care and human services to those enrolled in Federal health care programs. HHS leads the Federal public health and medical response during public health emergencies. As the oversight agency for HHS, the Office of Inspector General (OIG) works to enhance the effectiveness of HHS’s response and recovery efforts related to the pandemic. read more
U.S. DHHS Office of Inspector General, November 5
The emergence of COVID-19 created unprecedented challenges for the Department of Health and Human Services (HHS) and for the delivery of health care and human services to those enrolled in Federal health care programs. HHS leads the Federal public health and medical response during public health emergencies. As the oversight agency for HHS, the Office of Inspector General (OIG) works to enhance the effectiveness of HHS’s response and recovery efforts related to the pandemic. read more
MACPAC calls for greater transparency amid steep rise in Medicaid directed payments Healthcare Dive, November 5
A widespread Medicaid funding mechanism could help increase healthcare access for some of America’s most vulnerable patients, but needs additional transparency, according to key congressional advisors. Spending through the arrangements, called state directed payments, is projected to skyrocket, exacerbating concerns that states could be using creative financing schemes to inflate Medicaid funding from the federal government. read more
A widespread Medicaid funding mechanism could help increase healthcare access for some of America’s most vulnerable patients, but needs additional transparency, according to key congressional advisors. Spending through the arrangements, called state directed payments, is projected to skyrocket, exacerbating concerns that states could be using creative financing schemes to inflate Medicaid funding from the federal government. read more
The Durango Herald, November 4
The number of La Plata County residents enrolled in Colorado’s Medicaid program shrank by 40% during the 14-month period in which Health First Colorado customers had, for the first time in three years, to prove their eligibility for state-subsidized health care. “We hear from a lot of people who are very upset about having lost their Medicaid, who don’t understand why they did,” said the county’s Human Services Director Martha Johnson. read more
The number of La Plata County residents enrolled in Colorado’s Medicaid program shrank by 40% during the 14-month period in which Health First Colorado customers had, for the first time in three years, to prove their eligibility for state-subsidized health care. “We hear from a lot of people who are very upset about having lost their Medicaid, who don’t understand why they did,” said the county’s Human Services Director Martha Johnson. read more
ABC, November 1
The state of Nevada is poised to join more than a dozen other states in providing Medicaid coverage to people leaving prisons, jails and youth correctional facilities. The initiative stems from AB389, which passed during the 82nd Legislative Session of the Nevada Legislature and the Consolidated Appropriations Act of 2023 which requires some health services to be provided in justice facilities by Jan. 1, 2025. read more
The state of Nevada is poised to join more than a dozen other states in providing Medicaid coverage to people leaving prisons, jails and youth correctional facilities. The initiative stems from AB389, which passed during the 82nd Legislative Session of the Nevada Legislature and the Consolidated Appropriations Act of 2023 which requires some health services to be provided in justice facilities by Jan. 1, 2025. read more