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 noteworthy Medicaid news.

The Nevada Independent, September 30
With implementation of Nevada’s second-in-the-nation public health insurance option still years away, Senate Majority Leader Nicole Cannizzaro (D-Las Vegas) is considering a list of shorter-term solutions to reduce the number of uninsured people in the state. A new memo, drafted by the national nonprofit group United States of Care at Cannizzaro’s request, outlines more than a dozen policies Nevada could implement administratively or legislatively while the public option process plays out over the next few years.  read more


Hours after the Supreme Court in 2012 narrowly upheld the Affordable Care Act but rejected making Medicaid expansion mandatory for states, Obama administration officials laughed when asked whether that would pose a problem. In a White House briefing, top advisers to President Barack Obama told reporters states would be foolish to turn away billions in federal funding to help residents lacking the security of health insurance. Flash-forward nearly a decade, and it’s clear to see the consequences of that ruling.  read more


Dependence on the Medicaid program has increased exponentially over time. Currently, it is the single largest insurer in the United States, and in FY 2019, it accounted for more than half of all federal funds distributed to states. Unfortunately, as the safety net program has grown, waste has also become more prevalent. Improper payments are costing the program billions of dollars every year. Despite being on the GAO’s High Risk List since 2003, Medicaid’s improper payment rate continues to surge and put more strain on budgets.  read more


The Urban Institute recently released a study showing the increase in Medicaid enrollment growth rates in states across the country, due to “unprecedented” job loss and the Families First Coronavirus Response Act’s prohibition on disenrolling beneficiaries. The study found that Utah had the highest enrollment growth rate in the country in the last six months data was reported. Higher growth rates might lead redetermination backlog as the public health emergency (PHE) disenrollment prohibition ends, which is expected at the end of 2021.  read more


Fierce Healthcare, September 24
The Biden administration plans to lean heavily on the Affordable Care Act’s insurance exchanges to sign up people who may quickly drop off Medicaid’s rolls once the public health emergency ends, according to the head of Medicare and Medicaid. Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure said that the agency realizes states have a pending dilemma with how to redetermine Medicaid eligibility after the end of the COVID-19 public health emergency ends, which could be some time next year.


Fierce Healthcare, September 23
With moderate Democrats seeking to pare down a major $3.5 trillion infrastructure package, lawmakers and advocates are looking to ensure priorities on maternal and home health and closing the Medicaid coverage gap don’t get cut. Democratic lawmakers made their case Thursday to preserve $1 billion in maternal health care funding and to close the Medicaid coverage gap in states that have not expanded under the Affordable Care Act (ACA).  read more


On Thursday Nebraska’s Department of Health and Human Services (DHHS) announced good news for all state residents covered by Medicaid. Beginning Oct. 1, all Nebraskans covered will now automatically receive full Medicaid benefits. This includes dental, vision, and over-the-counter medications as part of the state’s expansion efforts. The change to the Medicaid Expansion program coincides with Nebraska’s DHHS announcement earlier this year that it would no longer implement the Heritage Health Adult (HHA) demonstration program.   read more


Senator Jon Ossoff and Senator Raphael Warnock say they are urging congress to expand Medicaid. Today in a press conference the two senators say Medicaid is the solution to get the health care coverage the state needs. They also say when the two were elected for the Senate, Georgia voted for expansion. Senator Ossoff spoke about a Georgia hospital in Cuthbert, that closed last year in the middle of the pandemic — one of nine to close in the last 11 years in Georgia.  read more


Healthcare Finance, September 22
Delivering opening remarks during the AHIP 2021 National Conference this week, AHIP President and CEO Matt Eyles called for strengthening and protecting Medicare Advantage as well as Medicaid Managed Care, calling the programs “efficient, effective and popular.” Eyles touted the benefits of protecting such programs, particularly in the midst of the COVID-19 pandemic. Speaking specifically about Medicare Advantage – which offers Medicare beneficiaries access to private healthcare plans with their own programs and benefits – Eyles said MA was a “prime example” of the public and private sectors working together to provide coverage for beneficiaries.  read more


Democrats in the U.S. Congress are considering a way to offer health care insurance for low income Mississippians who have been denied coverage because of the refusal of the state’s political leadership to expand Medicaid. The proposal would provide health care coverage to people who are below the federal poverty level (an individual making $12,880 per year or less) in the 12 primarily Southern states — including Mississippi — that have not expanded Medicaid under the Affordable Care Act.  read more


An estimated 15 million people could lose Medicaid insurance coverage after the COVID-19 public health emergency ends, according to a new study that sounds the alarm for states and the federal government to ensure enrollees have continuous coverage. The Urban Institute’s study, released Wednesday and conducted on behalf of the Robert Wood Johnson Foundation, explores what would happen if key requirements to keep Medicaid recipients enrolled go away after the PHE, which is expected to run through the rest of this year. States will need to take action to ensure that affected residents know of other options for coverage.  read more


Just before Frank Berry left his job as head of Georgia’s Medicaid agency this summer, he said the state “will be looking for the best bang for the buck” in its upcoming contract with private insurers to cover the state’s most vulnerable. But whether the state — and Medicaid patients — are getting an optimal deal on Medicaid is up for debate. Georgia pays three insurance companies — CareSource, Peach State Health Plan and Amerigroup — over $4 billion in total each year to run the federal-state health insurance program for low-income residents and people with disabilities.  read more


Molina Healthcare Awarded Nevada Medicaid Contract  Los Angeles Business Journal, September 13
Chalk up another contract win for Long Beach-based health insurance giant Molina Healthcare Inc. Molina announced Aug. 17 that its Nevada health plan subsidiary was awarded a Medicaid managed care contract from the Nevada Department of Health and Human Services. The new four-year Medicaid contract, with a potential two-year extension, will start Jan. 1. Under the new contract, Molina’s Nevada health plan will be one of four managed care organizations offering health care coverage to approximately 630,000 Medicaid beneficiaries in Clark County, which includes Las Vegas, and Washoe County, which includes Reno.  read more


Florida Politics, September 12
Information posted to the Agency for Healthcare Administration website shows there were 4,917,093 people enrolled in the Medicaid program at the end of August. That’s about a 1% increase from the previous month. State economists met in July and August to discuss Florida Medicaid enrollment and costs for the current fiscal year, which ends June 30, 2022. Economists from the Governor’s office and the House and Senate agreed Medicaid enrollment would grow to 5,042,246 by next summer.  read more


Ohio will appeal a move by President Joe Biden’s administration to rescind federal approval of a work requirement that the state wants to use to determine Medicaid eligibility, Gov. Mike DeWine announced Thursday. Attorney General Dave Yost filed a notice of appeal with the Centers for Medicare & Medicaid Services just weeks after the agency withdrew its approval for the “community engagement” requirement. The measure would require all new adult group beneficiaries under 50 years old to complete 80 hours per month of employment, education or job skills training.  read more, September 8
For three years, Delaware’s Department of Health and Social Services (DHSS) has been unable to demonstrate that it effectively screens Medicaid applicants for eligibility before approving or denying benefits, State Auditor Kathy McGuiness said today. In releasing the 16 overall findings from Delaware’s annual Single Audit, McGuiness pointed out that five of them were repeat findings – and that all of the repeat findings involved federal programs administered by DHSS. “It is unconscionable that these failures continue to happen, especially within the Medicaid program, which serves such a vulnerable population,” McGuiness said.   read more


kbia, September 1
Saralyn Erwin has been a certified application counselor for close to a decade. She helps patients at the Northeast Missouri Health Council in Kirksville navigate the often complicated process of accessing social services, like Medicaid. And the legislative and legal fights over Medicaid expansion have only added to the confusion. “It’s been kind of like a rollercoaster,” Erwin explained. “Yes it’s going to happen, no it’s not, it’s going to court and then yes it’s going to happen.”  read more