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, October 28
Under the Payment Integrity Information Act of 2019, the Centers for Medicare & Medicaid Services (CMS) was required to review federal programs at risk of improper payments. The bill tasked CMS to assess what programs are at risk, estimate the number of improper payments, and report on actions taken to reduce improper payments. In November, CMS released its Medicaid Payment Error Rate Measurement (PERM) audit findings. CMS determined that the national Medicaid improper payment rate estimate reached 21.36 percent in FY 2020, representing $86.49 billion in improper payments.  read more


Syrtis Solutions, October 27
The vast majority of Medicaid improper payments occur due to antiquated data systems that result in eligibility errors. As the program has grown, identifying primary commercial coverage, also known as Third Party Liability (TPL), has become increasingly more complex and challenging. By law, Medicaid plans are payers of last resort. This means if a beneficiary has health care coverage through any other third party, that third party must pay its legal liability first. If any liability remains, Medicaid plans will then pay.  read more


The Wyoming Senate voted against introducing a bill to expand Medicaid in Wyoming during the legislature’s special session on Monday, October 27. Sen. Cale Case (Fremont County), asked that the Senate approve Senate File 1011, which is known as the Medical Treatment Opportunity Act. Case said that expanding Medicaid could benefit 25,000 people in Wyoming. He said the would be “mostly females that are working in this state.” “They are people that serve you breakfast, clean your hotel rooms.  read more


The coronavirus pandemic has generated both a public health crisis and an economic crisis, with major implications for Medicaid—a countercyclical program—and its beneficiaries. The pandemic has profoundly affected Medicaid program spending, enrollment, and policy, challenging state Medicaid agencies, providers, and enrollees in a variety of ways.1 As states continue to respond to pandemic challenges, they are also pushing forward non-emergency initiatives as well as preparing for the unwinding of the public health emergency (PHE) and the return to a new normal of operations.  read more


KFF, October 27
In March 2020, the COVID-19 pandemic generated both a public health crisis and an economic crisis, with major implications for Medicaid – a countercyclical program – and its beneficiaries. During economic downturns, more people enroll in Medicaid, increasing program spending at the same time state tax revenues may be falling. While state revenues have substantially rebounded after dropping precipitously at the onset of the pandemic, the public health crisis has continued as a new surge of COVID-19 infections, hospitalizations, and deaths, fueled by the Delta variant, began to take hold in the U.S. in late July and August 2021.  read more


More than 18 months into the COVID-19 pandemic, state Medicaid programs around the country continue to reshape policy in response to the public health emergency and at the same time advance broader initiatives and priorities, including efforts to address the social determinants of health and health equity, finds a new KFF survey. The 21st annual KFF survey of Medicaid directors in states and the District of Columbia highlights policies in place and changes implemented or planned for the current fiscal year (which for most states runs from July to June).  read more


Tennessee’s Medicaid program may owe feds $767 million  Courthouse News Service, October 22
Tennessee may have to repay as much as $767 million to the federal government after an audit found that the state’s Medicaid program overbilled and didn’t keep proper documentation for certain claims between 2009 and 2014. The program, called TennCare, provides health care for about 1.5 million Tennesseans, or 20% of the state’s population, including 50% of births and 50% of children. Its members are primarily low-income pregnant women, children and individuals who are elderly or have a disability.  read more


The Biden-Harris Administration is ensuring that 144 million people enrolled in Medicare, Medicaid and Children’s Health Insurance Program (CHIP) have access to COVID-19 treatments. Today, the Centers for Medicare & Medicaid Services (CMS) issued guidance to states about the statutory requirement for states to cover COVID-19-related treatment without cost-sharing in Medicaid and CHIP for many seniors, low-income adults, pregnant women, children, and people with disabilities who receive health coverage through these programs.  read more


A report from the state auditor’s office has found that after private “managed care organizations” took over the state’s Medicaid system, the number of Iowans improperly denied medical care and services dramatically increased. State Auditor Rob Sand says this is the fourth Medicaid-related audit his office has released. “What we’re trying to do is figure out whether or not Iowa taxpayers are getting what we’re paying for with the MCOs,” Sand says. “The answer, pretty clearly, is that we’re not.”  read more


There has been a “seismic shift” toward government-sponsored health care in the past four years, and health insurers must pay attention to it, said a speaker at Monday’s Society of Insurance Research virtual annual conference. Geoff Cich, director of competitive intelligence with Florida Blue, looked at some trends in the health insurance industry and saw an increasing shift toward government-sponsored business. Since 2017, the percentage of managed care organization members who receive care through Medicare or Medicaid jumped from 31% to 41%.  read more


WTRF, October 14
U.S. Senator Joe Manchin (D-WV), member of the Senate Appropriations Committee, today announced $671,438 from the U.S. Centers for Medicare & Medicaid Services (CMS) to the West Virginia Offices of the Insurance Commissioner to increase and improve health insurance coverage options and access in West Virginia. This funding will allow the West Virginia Insurance Commissioner to implement additional consumer protections and reforms to improve coverage options for consumers across the state.  read more


The Louisiana Department of Health is evaluating proposals from six health care providers that submitted proposals in September to provide Medicaid services to nearly 1.7 million people in Louisiana. It’s the second time in two years the state has gone through the process. In August 2020, LDH announced it would rebid the contracts—worth an estimated $21 billion and, collectively, the largest state contract—after an impasse over protests from two losing bidders who challenged the four contractors awarded the lucrative deal in 2019. The six providers that responded to the recent RFP include the five companies that shared the contract before it was rebid in 2019.  read more


Following Missouri’s approval for Medicaid expansion, more than 275,000 individuals are eligible for healthcare coverage, CMS reported. Missouri will receive around $968 million from the American Rescue Plan over the next two years to fund the expansion. In order to encourage Medicaid expansion, the American Rescue Plan offers states a five percent increase to their original federal matching rate for services for two years. States that enroll in Medicaid expansion also receive 90 percent matching funds for medical services through the Affordable Care Act.  read more


An Ohio-based company called CareSource plans to submit a bid to be among the private companies managing Iowa’s Medicaid program. In 2016, the State of Iowa switched to privately managed care of Medicaid, which currently covers health care costs for 750-thousand poor, elderly and disabled Iowans. Two companies — Amerigroup and Iowa Total Care — have existing contracts to manage care for those Iowans. CareSource, based in Dayton, Ohio, has rented office space in Des Moines and hiring Iowa staff, preparing to submit the paperwork for an Iowa Medicaid managed care contract.  read more


Beginning today, Nebraska Medicaid provides a full range of benefits to everyone enrolled under the voter-approved expansion program. The benefits match those covered under traditional Medicaid and fulfill the intent of the groups that backed the expansion ballot measure. They include physical and mental health care and prescription drugs, which have been covered previously, while adding dental, vision and over-the-counter medications, which had only been covered for some Medicaid expansion groups.  read more