MEDICAID NEWS RECAP – OCTOBER 2024

SYRTIS SOLUTIONS MONTHLY MEDICAID NEWS RECAP NOVEMBER 2024

11 Nov MEDICAID NEWS RECAP – OCTOBER 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.


California medical lobby ask voters to guarantee billions in annual funding  Politico, October 31 
California’s zealous commitment to direct democracy often enlists voters to weigh in on proposals that commit funding to certain priorities. But rarely have they been invited to do what this year’s Proposition 35 asks: decide some of the nitty-gritty line items in the state’s vast Medicaid budget, work that typically takes lawmakers months of tortuous negotiating and debating each year.  read more

Mississippi legislative leaders advocate Medicaid expansion, heading to conflict with the governor  ABC News, October 31
Mississippi’s Republican legislative leaders said Thursday that they plan to push for Medicaid expansion to cover working people who earn too little to afford private insurance — a position that business groups have advocated but that Republican Gov. Tate Reeves opposes. House Speaker Jason White and Lt. Gov. Delbert Hosemann spoke about their 2025 policy priorities to hundreds of business people and community leaders at Hobnob, a social gathering hosted by Mississippi Economic Council, the state chamber of commerce.  read more

Syrtis Solutions, October 28
Syrtis Solutions, a leading provider of real-time Other Health Insurance (OHI) coverage information for payers of last resort, recently achieved a significant milestone by being named a preferred vendor for the Association for Community Affiliated Plans (ACAP). This designation is a reflection of Syrtis Solutions’ commitment to reducing costs and enhancing operational efficiency for government-funded health plans.  read more

Statesman Journal, October 28
Oregon paid $445 million toward duplicate Medicaid enrollments between 2019 and 2022, an audit the state conducted with the Office of the Washington State Auditor and the U.S. Department of Health and Human Services Office of Inspector General found. The Oregon Secretary of State’s auditors said “about 3% of Oregon’s Medicaid recipients were also enrolled in another state.”  read more

Medicaid Enrollment & Spending Growth: FY 2024 & 2025 
KFF, October 23
For a three-year period following the onset of the COVID-19 pandemic, states provided continuous Medicaid enrollment in exchange for an increase in the federal share of Medicaid spending (known as the Federal Medical Assistance Percentage or “FMAP”). This policy resulted in the largest ever number of enrollees in Medicaid, which, along with enhanced subsidies in the Affordable Care Act (ACA) Marketplaces, contributed to the lowest ever uninsured rate.  read more

50-State Medicaid Budget Survey Archives
KFF, October 23
This page provides access to the reports stemming from the 50-state Medicaid budget surveys published annually since 2000 by KFF. It includes the annual surveys as well as shorter mid-year updates that were conducted in select years. The report based on the annual survey is traditionally released each Fall and tracks trends in Medicaid spending and enrollment, as well as Medicaid policy actions around eligibility and enrollment, provider rates, provider taxes/fees, premiums and cost-sharing, benefits and pharmacy, long-term care and delivery system and payment reform.  read more

After Blue Cross, Tufts appeal $15B Medicaid contract, state agrees to reevaluate  Rhode Island Current, October 16
Rhode Island officials have agreed to take a fresh look at the bids received for a five-year, $15.5 billion Medicaid contract based on an appeal by the two companies denied in an initial award. In an Oct. 15 letter to State Purchasing Agent Nancy McIntyre, Chief Purchasing Officer Jonathan Womer, who also heads the Rhode Island Department of Administration, acknowledged some, but not all, of the concerns raised by the losing bidders, along with feedback from the state Medicaid office.  read more

KFF, October 11
Managing the Medicaid prescription drug benefit and pharmacy expenditures is a long-standing policy priority for state Medicaid programs. Prescription drugs account for approximately 6% of total Medicaid spending, and Medicaid gross and net spending on prescription drugs continues to rise, in part due to the emergence of new, high cost drugs, including anti-obesity medications and cell and gene therapies that treat, and sometimes cure, rare diseases.  read more

Fierce Healthcare, October 8
Texas is halting the state’s new Medicaid contracts, a district judge declared Oct. 4. The judge issued a temporary injunction, stopping the Texas Health and Human Services Commission (HHSC) from implementing new contracts for its Medicaid STAR and CHIP managed care programs.  read more

Wisconsin Policy Forum: Wisconsin could save $1.7 billion if eligibility for BadgerCare Plus is expanded  Milwaukee Journal Sentinel, October 2
A new report by the Wisconsin Policy Forum underscores the hundreds of millions in yearly savings Wisconsin stands to gain if it expands Medicaid eligibility, a proposal that for years has been a political nonstarter with Republican lawmakers but could become possible if control of the state Legislature shifts. Wisconsin is one of 10 states that has not expanded Medicaid eligibility under the Affordable Care Act, also known as Obamacare, to provide health coverage to adults with incomes up to 138% of the federal poverty level.  read more

Ambetter from WellCare of Kentucky Offers Affordable, Accessible Healthcare Coverage Statewide in 2025  Centene Corporation Investor Relations, October 2
Ambetter from WellCare of Kentucky, a product offered by a Centene Corporation (NYSE: CNC) company, which provides insurance to under-insured and uninsured populations through the State Based Exchange will offer residents a variety of affordable health insurance plans in Kentucky in plan year 2025. Open enrollment for the Health Insurance Marketplace for Kentucky runs from Nov. 1, 2024, through Jan. 15, 2025, for coverage starting Jan. 1, 2025.