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 relate 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.
MEDICAID IMPROPER PAYMENTS & UNKNOWN COMMERCIAL COVERAGE: THE BUDGET CRISIS STATES ARE FACING
Syrtis Solutions, November 30
In 2024, Medicaid improper payments surged to $31.1 billion, placing enormous pressure on state budgets and threatening the program’s stability. A disproportionate share of these losses came from claims Medicaid should never have paid in the first place—claims that were the responsibility of commercial insurers. At any given time, roughly 1 in 10 Medicaid beneficiaries have unreported commercial coverage. read more
Syrtis Solutions, November 30
In 2024, Medicaid improper payments surged to $31.1 billion, placing enormous pressure on state budgets and threatening the program’s stability. A disproportionate share of these losses came from claims Medicaid should never have paid in the first place—claims that were the responsibility of commercial insurers. At any given time, roughly 1 in 10 Medicaid beneficiaries have unreported commercial coverage. read more
HMA, November 20
KFF and Health Management Associates (HMA), on November 13, 2025, released the annual Medicaid Budget Survey, A View of Medicaid Today and a Look Ahead: Balancing Access, Budgets and Upcoming Changes Results from an Annual Medicaid Budget Survey for State Fiscal Years 2025 and 2026. read more
KFF and Health Management Associates (HMA), on November 13, 2025, released the annual Medicaid Budget Survey, A View of Medicaid Today and a Look Ahead: Balancing Access, Budgets and Upcoming Changes Results from an Annual Medicaid Budget Survey for State Fiscal Years 2025 and 2026. read more
Federal Reforms to Medicaid Financing: What Counties Should Know NACO, November 20
Medicaid is a joint federal, state and local program that provides health coverage to low-income individuals, including children, pregnant women, elderly adults and people with disabilities. The program accounts for almost 30 percent of state expenditures and is the largest single source of federal funding in state budgets. read more
Medicaid is a joint federal, state and local program that provides health coverage to low-income individuals, including children, pregnant women, elderly adults and people with disabilities. The program accounts for almost 30 percent of state expenditures and is the largest single source of federal funding in state budgets. read more
CMS Issues New Guidance on H.R. 1’s Restrictions on State Use of Provider Taxes to Finance Medicaid
Georgetown University McCourt School of Public Policy, November 18
On November 14, 2025, the Centers for Medicare & Medicaid Services (CMS) issued new guidance with some new detail about how it will implement provisions in H.R. 1 — the budget reconciliation law also known as the One Big Beautiful Bill Act — that restrict states’ use of provider taxes to finance their share of Medicaid costs. read more
Georgetown University McCourt School of Public Policy, November 18
On November 14, 2025, the Centers for Medicare & Medicaid Services (CMS) issued new guidance with some new detail about how it will implement provisions in H.R. 1 — the budget reconciliation law also known as the One Big Beautiful Bill Act — that restrict states’ use of provider taxes to finance their share of Medicaid costs. read more
Federal Budget Reconciliation Law and Other Recent Medicaid Rule-Making Implementation Timeline
Families USA, November 17
This timeline integrates implementation dates from several recent federal law and regulatory changes that impact Medicaid managed care into one place to help advocates better understand the evolving landscape. Specifically, it examines (1) upcoming requirements and policy changes and how they may relate to one another; (2) the ways shifts in federal policy impact state Medicaid managed care systems;… read more
Families USA, November 17
This timeline integrates implementation dates from several recent federal law and regulatory changes that impact Medicaid managed care into one place to help advocates better understand the evolving landscape. Specifically, it examines (1) upcoming requirements and policy changes and how they may relate to one another; (2) the ways shifts in federal policy impact state Medicaid managed care systems;… read more
Office of Inspector General, November 17
As one of the largest contracting agencies in the Federal Government, the Department of Health and Human Services (HHS) awarded contracts totaling $38.5 billion in Fiscal Year (FY) 2023. The Centers for Medicare & Medicaid Services (CMS) was responsible for $7.4 billion, or 19 percent of HHS contracting action spending, in FY 2023. read more
As one of the largest contracting agencies in the Federal Government, the Department of Health and Human Services (HHS) awarded contracts totaling $38.5 billion in Fiscal Year (FY) 2023. The Centers for Medicare & Medicaid Services (CMS) was responsible for $7.4 billion, or 19 percent of HHS contracting action spending, in FY 2023. read more
CMS Issues Guidance to Strengthen Oversight of Medicaid Financing West CMS, November 14
The Centers for Medicare & Medicaid Services (CMS) is issuing preliminary guidance for states regarding the implementation of new federal requirements on health care-related (provider) taxes in Medicaid. Providing this guidance now allows states time to plan their efforts to meet the requirements laid out in the Working Families Tax Cuts legislation (Public Law 119-21) while CMS develops additional policies, guidance, and implementing regulations. The letter sent today provides details regarding limits on new or increased healthcare-related taxes. It also includes information about transition periods related to the closure of a financing loophole and the next steps for compliance. read more
The Centers for Medicare & Medicaid Services (CMS) is issuing preliminary guidance for states regarding the implementation of new federal requirements on health care-related (provider) taxes in Medicaid. Providing this guidance now allows states time to plan their efforts to meet the requirements laid out in the Working Families Tax Cuts legislation (Public Law 119-21) while CMS develops additional policies, guidance, and implementing regulations. The letter sent today provides details regarding limits on new or increased healthcare-related taxes. It also includes information about transition periods related to the closure of a financing loophole and the next steps for compliance. read more
State Medicaid Officials Project Flat Enrollment Post Unwinding but Increased Spending and Budget Pressures, as States Prepare for Impact of Federal Medicaid Policy Changes
KFF, November 13
As states completed the “unwinding” of pandemic-era continuous coverage, Medicaid enrollment fell 7.6% in FY 2025 and is expected to be largely flat in FY 2026, according to KFF’s 25th annual Medicaid Budget Survey. At the same time, total Medicaid spending grew by 8.6% in FY 2025 and is expected to grow by 7.9% in FY 2026. States report that provider rate increases, greater enrollee health care needs, and increasing costs for long-term care, pharmacy benefits, and behavioral health services are the most significant drivers of increased costs. read more
KFF, November 13
As states completed the “unwinding” of pandemic-era continuous coverage, Medicaid enrollment fell 7.6% in FY 2025 and is expected to be largely flat in FY 2026, according to KFF’s 25th annual Medicaid Budget Survey. At the same time, total Medicaid spending grew by 8.6% in FY 2025 and is expected to grow by 7.9% in FY 2026. States report that provider rate increases, greater enrollee health care needs, and increasing costs for long-term care, pharmacy benefits, and behavioral health services are the most significant drivers of increased costs. read more
A View of Medicaid Today and a Look Ahead: Balancing Access, Budgets and Upcoming Changes
KFF, November 13
This annual Medicaid budget survey report highlights certain policies in place in state Medicaid programs in state fiscal year (FY) 2025 and policy changes implemented or planned for FY 2026. The findings are drawn from the 25th annual budget survey of Medicaid officials conducted by KFF and Health Management Associates (HMA), in collaboration with the National Association of Medicaid Directors (NAMD). read more
KFF, November 13
This annual Medicaid budget survey report highlights certain policies in place in state Medicaid programs in state fiscal year (FY) 2025 and policy changes implemented or planned for FY 2026. The findings are drawn from the 25th annual budget survey of Medicaid officials conducted by KFF and Health Management Associates (HMA), in collaboration with the National Association of Medicaid Directors (NAMD). read more
Medicaid Enrollment & Spending Growth: FY 2025 & 2026 KFF, November 13
States are facing a more tenuous fiscal climate due to slowing revenue growth and increasing spending demands in state fiscal year (FY) 2026. Recent shifts in economic conditions as well as recent federal actions, including cuts to safety net programs and tax code changes in the recently passed reconciliation law (H.R.1), changes to the Affordable Care Act (ACA) enhanced Marketplace subsidies, federal workforce cuts, and tariff changes, contribute to further fiscal uncertainty for states, though fiscal conditions and the impact of federal changes vary across states. read more
States are facing a more tenuous fiscal climate due to slowing revenue growth and increasing spending demands in state fiscal year (FY) 2026. Recent shifts in economic conditions as well as recent federal actions, including cuts to safety net programs and tax code changes in the recently passed reconciliation law (H.R.1), changes to the Affordable Care Act (ACA) enhanced Marketplace subsidies, federal workforce cuts, and tariff changes, contribute to further fiscal uncertainty for states, though fiscal conditions and the impact of federal changes vary across states. read more
Balancing Medicaid Changes and State Budget and Health Priorities NCSL, November 11
With federal health policy evolving, 2025 proved to be a landmark year for legislative action in the states. Lawmakers enacted hundreds of bills addressing Medicaid, private insurance coverage, public health and more. Looking ahead to the coming legislative session, lawmakers will be racing against mounting budget pressures to adapt health systems and coverage to meet their constituents’ needs—and the top policy priorities look much like what they worked on this year:… read more
With federal health policy evolving, 2025 proved to be a landmark year for legislative action in the states. Lawmakers enacted hundreds of bills addressing Medicaid, private insurance coverage, public health and more. Looking ahead to the coming legislative session, lawmakers will be racing against mounting budget pressures to adapt health systems and coverage to meet their constituents’ needs—and the top policy priorities look much like what they worked on this year:… read more
