14 Oct MEDICAID NEWS RECAP – SEPTEMBER 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.
Biden-Harris Administration Releases Historic Guidance on Health Coverage Requirements for Children and Youth Enrolled in Medicaid and the Children’s Health Insurance Program U.S. DHHS, September 26
In another demonstration of the Biden-Harris Administration’s unwavering commitment to children’s health, today the Centers for Medicare & Medicaid Services (CMS) released comprehensive guidance to support states in ensuring the 38 million children with Medicaid and the Children’s Health Insurance Program (CHIP) coverage – nearly half of the children in this country – receive the full range of health care services they need. read more
In another demonstration of the Biden-Harris Administration’s unwavering commitment to children’s health, today the Centers for Medicare & Medicaid Services (CMS) released comprehensive guidance to support states in ensuring the 38 million children with Medicaid and the Children’s Health Insurance Program (CHIP) coverage – nearly half of the children in this country – receive the full range of health care services they need. read more
The Baltimore Banner, September 25
The Maryland Department of Health and Kaiser Permanente struck a deal Wednesday that will keep more than 100,000 Marylanders on Medicaid from having to change providers next year, WYPR has learned. Last week, the MDH said it may have to drop Kaiser as a Medicaid managed care organization due to a breakdown in contract negotiations. Now, Kaiser will join eight other MCOs to provide coverage to Marylanders on Medicaid. read more
The Maryland Department of Health and Kaiser Permanente struck a deal Wednesday that will keep more than 100,000 Marylanders on Medicaid from having to change providers next year, WYPR has learned. Last week, the MDH said it may have to drop Kaiser as a Medicaid managed care organization due to a breakdown in contract negotiations. Now, Kaiser will join eight other MCOs to provide coverage to Marylanders on Medicaid. read more
Centene’s Health Net Wins Medi-Cal Contract in California
Yahoo Finance, September 24
Centene Corporation CNC recently unveiled that its subsidiary, Health Net Community Solutions, has been chosen by the California Department of Health Care Services to cater to the dental health needs of members enrolled in the State’s Medicaid program, Medi-Cal, and residing in Los Angeles and Sacramento counties. Likely to commence from July 1, 2025, the new contract will run for a period of 54 months. read more
Yahoo Finance, September 24
Centene Corporation CNC recently unveiled that its subsidiary, Health Net Community Solutions, has been chosen by the California Department of Health Care Services to cater to the dental health needs of members enrolled in the State’s Medicaid program, Medi-Cal, and residing in Los Angeles and Sacramento counties. Likely to commence from July 1, 2025, the new contract will run for a period of 54 months. read more
CMS: States have 2 years to fix Medicaid renewal problems
Becker’s Payer Issue, September 23
States must be in full compliance with all of CMS’ Medicaid renewal requirements by the end of 2026. In an informational bulletin published Sept. 20, Daniel Tsai, deputy administrator and director of the Center for Medicaid and CHIP services, said states must submit action plans for their plan to comply with renewal requirements by the end of 2024. During the Medicaid redetermination process, CMS warned states several times about their lack of compliance with federal renewal requirements. read more
Becker’s Payer Issue, September 23
States must be in full compliance with all of CMS’ Medicaid renewal requirements by the end of 2026. In an informational bulletin published Sept. 20, Daniel Tsai, deputy administrator and director of the Center for Medicaid and CHIP services, said states must submit action plans for their plan to comply with renewal requirements by the end of 2024. During the Medicaid redetermination process, CMS warned states several times about their lack of compliance with federal renewal requirements. read more
Montana lawmakers hear conflicting arguments on renewing expanded Medicaid program Daily Montanan, September 20
Lawmakers on the health and human services budget committee on Wednesday heard opposing presentations about Medicaid expansion in Montana and its purported benefits and drawbacks as the legislature sets up what will likely be one of its biggest decisions next year – whether it should continue the expanded Medicaid program or let it expire next June. Under Medicaid expansion, which was created under the Affordable Care Act, able-bodied adults earning up to 138% of the Federal Poverty Level – around $20,782 annually this year for a single person – can get health insurance coverage paid for primarily by the federal government, but partially the state. read more
Lawmakers on the health and human services budget committee on Wednesday heard opposing presentations about Medicaid expansion in Montana and its purported benefits and drawbacks as the legislature sets up what will likely be one of its biggest decisions next year – whether it should continue the expanded Medicaid program or let it expire next June. Under Medicaid expansion, which was created under the Affordable Care Act, able-bodied adults earning up to 138% of the Federal Poverty Level – around $20,782 annually this year for a single person – can get health insurance coverage paid for primarily by the federal government, but partially the state. read more
California Medicaid ballot measure is popular, well funded — and perilous, opponents warn News Medical Life Sciences, September 19
The proponents of Proposition 35, a November ballot initiative that would create a dedicated stream of funding to provide health care for California’s low-income residents, have assembled an impressive coalition: doctors, hospitals, community clinics, dentists, ambulance companies, several county governments, numerous advocacy groups, big business, and both major political parties. read more
The proponents of Proposition 35, a November ballot initiative that would create a dedicated stream of funding to provide health care for California’s low-income residents, have assembled an impressive coalition: doctors, hospitals, community clinics, dentists, ambulance companies, several county governments, numerous advocacy groups, big business, and both major political parties. read more
Unpacking the Unwinding: Medicaid to Marketplace Coverage Transitions Georgetown University CCF, September 18
As Medicaid unwinding draws to a close, millions of people have had to find new health coverage options, many of them through the Affordable Care Act (ACA) Marketplaces. What do we know about how they have fared, and whether state efforts to smooth coverage transitions have been successful? Following the April 2023 end of pandemic-era continuous coverage requirements, and with state Medicaid agencies resuming eligibility renewals and terminations, more than 25 million people across the country have been disenrolled from Medicaid coverage. read more
As Medicaid unwinding draws to a close, millions of people have had to find new health coverage options, many of them through the Affordable Care Act (ACA) Marketplaces. What do we know about how they have fared, and whether state efforts to smooth coverage transitions have been successful? Following the April 2023 end of pandemic-era continuous coverage requirements, and with state Medicaid agencies resuming eligibility renewals and terminations, more than 25 million people across the country have been disenrolled from Medicaid coverage. read more
States’ Share of Medicaid Costs Remains Low but Is Set to Increase
Pew, September 12
In fiscal year 2022, states spent 12.9 cents of every state-generated dollar on Medicaid for low-income Americans—2.7 cents less than the 15-year average. As was the case in fiscal 2021, surging tax revenue and a temporary increase in federal funding contributed to the decreased share. But the share of state revenue dedicated to Medicaid is likely to show a rise for fiscal 2023 and beyond as federal pandemic aid expires and spending pressures grow.
Pew, September 12
In fiscal year 2022, states spent 12.9 cents of every state-generated dollar on Medicaid for low-income Americans—2.7 cents less than the 15-year average. As was the case in fiscal 2021, surging tax revenue and a temporary increase in federal funding contributed to the decreased share. But the share of state revenue dedicated to Medicaid is likely to show a rise for fiscal 2023 and beyond as federal pandemic aid expires and spending pressures grow.
OCPA, September 11
In 2020, Oklahoma voters narrowly approved a ballot measure that allowed able-bodied adults to receive taxpayer-funded Medicaid benefits. The expansion went into effect in 2021. Now a new report by the Legislative Office of Fiscal Accountability, a state fiscal watchdog, shows that Medicaid expansion will cost taxpayers an additional $2.5 billion next year and ultimately force lawmakers to divert hundreds of millions of state taxpayer dollars from other uses.
In 2020, Oklahoma voters narrowly approved a ballot measure that allowed able-bodied adults to receive taxpayer-funded Medicaid benefits. The expansion went into effect in 2021. Now a new report by the Legislative Office of Fiscal Accountability, a state fiscal watchdog, shows that Medicaid expansion will cost taxpayers an additional $2.5 billion next year and ultimately force lawmakers to divert hundreds of millions of state taxpayer dollars from other uses.
Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State KFF, September 10
This page tracks approved and pending Section 1115 Medicaid demonstration waivers, which offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute. Key themes in current approved and pending waivers include targeted eligibility expansions, benefit expansions (particularly in the area of behavioral health, such as coverage of services provided in IMDs), and provisions related to social determinants of health.
This page tracks approved and pending Section 1115 Medicaid demonstration waivers, which offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute. Key themes in current approved and pending waivers include targeted eligibility expansions, benefit expansions (particularly in the area of behavioral health, such as coverage of services provided in IMDs), and provisions related to social determinants of health.
Somerset mayor points to growing blind spot for waste and fraud in Kentucky’s Medicaid system WKU, September 9
Somerset Mayor Alan Keck is pressing the state to restore prior authorization for recovery services in an effort to prevent Medicaid fraud and abuse. The practice was suspended during the pandemic and has never returned. In a letter to the Kentucky Cabinet for Health and Family Services, Keck asked for the checks-and-balances measure to be reinstated. “You can talk to any mayor in Kentucky and they’ll tell you there are countless individuals that aren’t from their city or county who are there now trying to get treatment,” Keck told WKU Public Radio. read more
Somerset Mayor Alan Keck is pressing the state to restore prior authorization for recovery services in an effort to prevent Medicaid fraud and abuse. The practice was suspended during the pandemic and has never returned. In a letter to the Kentucky Cabinet for Health and Family Services, Keck asked for the checks-and-balances measure to be reinstated. “You can talk to any mayor in Kentucky and they’ll tell you there are countless individuals that aren’t from their city or county who are there now trying to get treatment,” Keck told WKU Public Radio. read more
MHA Updates Medicaid and Medicare Enrollment Analysis
MHA, September 6
The MHA updated its analysis of Medicaid and Medicare enrollment to reflect July 2024 data. The analysis now includes program enrollment as a percentage of each county’s total population and the split between fee-for-service and managed care organizations. Just over 26% of Michigan’s total population is enrolled in Medicaid and 22% is enrolled in Medicare. read more
MHA, September 6
The MHA updated its analysis of Medicaid and Medicare enrollment to reflect July 2024 data. The analysis now includes program enrollment as a percentage of each county’s total population and the split between fee-for-service and managed care organizations. Just over 26% of Michigan’s total population is enrolled in Medicaid and 22% is enrolled in Medicare. read more