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.

Medicaid directors identified enrollment and the end of flexibilities tied to the public health emergency as major influences on Medicaid spending, according to a report compiled by Health Management Associations and published by Kaiser Family Foundation. Health Management Associations surveyed Medicaid directors across every state plus the District of Columbia from June 2022 to October 2022. Only Georgia and Arkansas did not respond.  read more


Axios. October 26
States could start the new year grappling with a surge in Medicaid spending to accompany supply chain pressures, workforce shortages and the effects of inflation. The big picture: The end of the COVID-19 public health emergency could result in state Medicaid outlays growing at a rate of 16.3% in fiscal 2023, even with efforts underway to control future program costs, according to a report from the Kaiser Family Foundation.  read more


After steep gains since 2020, state Medicaid agencies expect Medicaid enrollment to begin to decline in FY 2023, following the expiration of the COVID-19 public health emergency (PHE), which most states assumed would occur during FY 2023, according to KFF’s new state Medicaid budget survey. Projections of declining enrollment tied to the end of the federal continuous enrollment requirement are also expected to translate into slower total Medicaid spending growth in FY 2023.  read more


About four years ago, Cecelia “Biz” Spotted Tail felt a lump growing in her lower belly. “I know something’s wrong, I know my body,” she says. “I couldn’t lay on my stomach because I kept feeling that ball.” Spotted Tail, 53, lives in South Dakota, where she has raised five kids on the Rosebud Indian Reservation. After working in mental health services for many years, she recently started a small business, a flower farm called Bizzie’s Bees. Spotted Tail says it took months for an Indian Health Service gynecologist to take her concerns seriously.  read more


Since March 2020, the COVID-19 pandemic and its economic impact have had significant implications for Medicaid spending and enrollment. To provide broad fiscal relief to states while preventing coverage losses during the pandemic, Congress passed the Families First Coronavirus Response Act (FFCRA) early in the pandemic to provide a 6.2 percentage point increase in the federal Medicaid match rate (“FMAP”) for states that meet certain “maintenance of eligibility” (MOE) requirements, including a continuous enrollment requirement.  read more


At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a requirement that Medicaid programs keep people continuously enrolled through the end of the month in which the COVID-19 public health emergency (PHE) ends, in exchange for enhanced federal funding. Primarily due to the continuous enrollment requirement, Medicaid enrollment has grown substantially compared to before the pandemic and the uninsured rate has dropped.  read more


U.S. News, October 20 
Gov. Andy Beshear on Thursday extended Medicaid coverage for dental, vision and hearing care to hundreds of thousands of Kentucky adults, saying the sweeping initiative will remove some of the health-related obstacles keeping people from getting jobs. The expansion will cover about 900,000 adults enrolled in the state’s Medicaid program, the Democratic governor said at his weekly news conference. They will be eligible for the extended benefits starting Jan. 1, 2023, with no special enrollment period needed. Beshear linked good health to workforce participation in announcing the initiative.  read more


The Washington Informer, October 19 
After months of wrangling between the District government and managed care organizations, the D.C. Council approved, 10-3, on Oct. 18 Medicaid contracts to service the city’s indigent 250,000 patients until 2028. The approximately $8.8 billion contract was awarded by the council to health care providers AmeriHealth Caritas, AmeriGroup and MedStar Health. CareFirst, the fourth company, lobbied the council intensely for the chance to have a piece of the contracts but fell short in the process.  read more


A silver minivan decorated with a large sticker reading “Love Your Neighbor Tour” recently circumnavigated South Dakota. Catholic nuns, Protestant pastors, a synagogue president, and a Muslim nonprofit professional were among the interfaith leaders who packed into the rented six-seater or caravanned behind. The road trip’s mission: to register voters and urge them to support expansion of the state’s Medicaid program to cover thousands more low-income adults.  read more


In November, Oregon voters will decide whether to amend the state’s constitution to create a new fundamental right for everyone living here: access to affordable health care. The language of the measure is simple. It states: “It is the obligation of the state to ensure that every resident of Oregon has access to cost-effective, clinically appropriate and affordable health care as a fundamental right.” If it passes, Oregon will be the first state in the nation with a right to health care in its constitution.  read more


The White House, October 14
By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows: Section 1. Policy. Too many Americans face challenges paying for prescription drugs. On average, Americans pay two to three times as much as people in other countries for prescription drugs, and one in four Americans who take prescription drugs struggle to afford their medications.  read more


Kelly Garcia said the state has learned from missteps made during previous times of transition under the privately managed care of the state’s $7 billion Medicaid program, and pledged that those hard lessons are being applied as the state once again brings on a new private partner. “Obviously through some of the pain points experienced with the managed care rollout and onboarding MCOs in the state, we have a number of lessons learned that we have taken,” Garcia said Thursday in an interview for The Gazette’s Iowa Ideas 2022 conference.  read more


Washington Examiner, October 13 
Since the Affordable Care Act became law in 2010, states have had the choice to extend Medicaid coverage to most nonelderly adults. Three-quarters of the states plus the District of Columbia have adopted the Medicaid expansion, while 12 have not. That may be changing in North Carolina. Specifically, the debate over expanding Medicaid, the nation’s public health insurance program for people with low income, is evolving. Nationally, the Medicaid program covers 1 in 5 people, including many with complex and costly needs for care.  read more


State of Reform, October 11 
Utah Medicaid said the months leading up to and following the end of the public health emergency (PHE) will be critical to ensuring a smooth transition for members. It has developed a communication toolkit that outlines the department’s response to the expiration of continuous coverage provisions. DHHS will provide advance notice to members 60 days prior to the end of PHE and is making preparations to submit baseline eligibility data and a Medicaid redetermination plan to CMS before the PHE’s continuous coverage expires.  read more


Inspector General Texas Health and Human Services, October 11 
The OIG has focused the evolution of fraud, waste and abuse (FWA) detection on a foundation of data analytics. Capitalizing on the power of data drives the agency to more efficient and comprehensive investigations, reviews, audits and inspections. Each year, the OIG team uses emerging technology used for data analytics to assess the billing trends and patterns of providers, clients, retailers, and contractors participating in HHS programs.  read more


Texas state legislators led a panel discussion on Democratic health policy leadership at the 2022 North Texas State of Reform Health Policy Conference on September 27th. Speaking to an audience of leaders in the health care space in North Texas, Sen. Nathan Johnson (D – Dallas) and Rep. Julie Johnson (D – Carrollton) looked ahead to some of the health care reforms they plan to pursue in next year’s legislative session.  read more


The New Mexico Human Services Department (HSD) announced today they are soliciting competitive proposals from health insurance companies, known as Medicaid Managed Care Organizations (MCOs), to deliver services to the state’s 969,093 Medicaid members. Managed care organizations work in partnership with the state’s Medicaid program and clinicians to provide access to physical and behavioral health, and long-term care services.  read more


U.S. Department of Health and Human Services, October 3 
Unified Program Integrity Contractors (UPICs) are CMS’s only program integrity contractors that safeguard both the Medicare fee-for-service (FFS) and the Medicaid programs from fraud, waste, and abuse. Combined, Medicare and Medicaid provided health care coverage to 139 million people at a cost of $1.5 trillion in 2020. Given the cost and scope of these Federal health care programs, it is essential that UPICs successfully detect and deter fraud, waste, and abuse.  read more