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.

Syrtis Solutions Blog, October 30
Data from the federal government indicates that more than 4 million people enrolled in the Medicaid program this spring due to the pandemic driven economic downturn. The 5.7% spike came after the surge in unemployment and the loss of corresponding employer-sponsored healthcare coverage. In response to the Coronavirus and the recession, the CARES Act was passed in March. The bill prohibited states from disenrolling members and scaling back program eligibility during the public health crisis.  


As the Trump administration reaches the end of its first term, this issue brief considers the landscape of approved and pending Section 1115 Medicaid demonstration waivers under this administration and how the November 2020 presidential election may impact this landscape. Section 1115 waivers offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute and can provide states considerable flexibility in how they operate their programs.  read more


Missourian, October 27
Candidates were asked how they would implement and cover the costs of Medicaid expansion in light of its passage by voters in the August primaries. A proponent of Medicaid expansion, Democratic challenger Nicole Galloway said her health care plan will save money for Missouri residents. “I know it can be implemented in a fiscally responsible way without raising taxes or cutting other accounts,” Galloway, the state auditor, said.  read more


Indiana has received federal approval to continue its Healthy Indiana Plan for another decade, making Indiana the first state to receive a 10-year extension for its Medicaid expansion alternative. The extension comes as more Hoosiers than ever are enrolled in the health coverage plan. More than 572,000 Indiana low-income residents receive their health insurance through the plan, about 100,000 more than at this time last year, officials for the Indiana Family and Social Services Administration said.  read more


Policy discussions around the potential elimination of the Affordable Care Act (ACA) under the court challenge California v. Texas have largely focused on coverage provisions related to the exchanges, Medicaid and preexisting condition protections. The repeal of the ACA could mean loss of Medicaid coverage for up to 15 million that were enrolled in the ACA Medicaid expansion group prior to the COVID-19 pandemic; however, repeal could also mean significant changes to Medicaid prescription drug policy with implications for state and federal spending for prescription drugs for non-expansion Medicaid enrollees.  read more


A Frankfort judge ordered the state Friday to keep Anthem Inc. as one of its managers of Medicaid, an $8 billion program that pays for health care for one of every three Kentuckians. Franklin Circuit Judge Phillip Shepherd’s order “comes just days before the state is set to begin enrolling people in Medicaid health plans for 2021 on Nov. 2, and as the state is facing record enrollment of 1.6 million Kentuckians in Medicaid, largely because of the covid-19 pandemic,” notes Deborah Yetter of the Courier Journal.  read more


States are expecting a pretty significant jump in Medicaid enrollment and spending for 2021, according to a new analysis. Researchers at Kaiser Family Foundation surveyed Medicaid directors in 43 states, and found that they’re expecting enrollment to grow by 8.2% in fiscal year 2021, on the back of a pandemic-fueled economic downturn and a new maintenance of eligibility requirement linked to increased federal aid. Enrollment growth for fiscal year 2020 was flat, increasing by 0.04%, according to the report.  read more


Red states in recent years have been approving the expansion of Medicaid eligibility under the ACA through voter referendums, as was the case in Utah, Oklahoma, Missouri and Nebraska. Georgia has taken a different path – a waiver from the Trump administration. And, as a result, it will almost certainly have far fewer of its residents joining the Medicaid rolls. The 1115 waiver approved by CMS on Thursday is known as “Georgia Pathways.” It will allow Georgians with incomes of up to 100% of the federal poverty level to enroll in Medicaid, a far less generous threshold than the 138% cutoff under the ACA.  read more


The coronavirus pandemic has generated both a public health crisis and an economic crisis, with major implications for Medicaid, a countercyclical program. During economic downturns, more people enroll in Medicaid, increasing program spending at the same time state tax revenues may be falling. As demand increases and state revenues decline, states face difficult budget decisions to meet balanced budget requirements.  read more


KFF, October 14
The coronavirus pandemic has generated both a public health crisis and an economic crisis, with major implications for Medicaid, a countercyclical program. During economic downturns, more people enroll in Medicaid, increasing program spending at the same time state tax revenues may be falling. To help both support Medicaid and provide broad fiscal relief as revenues have declined precipitously, the Families First Coronavirus Response Act (FFCRA) authorized a 6.2 percentage point increase in the federal match rate (“FMAP”) (retroactive to January 1, 2020) available if states meet certain “maintenance of eligibility” (MOE) requirements.  read more


The Baltimore Sun, October 13
The University of Maryland Medical System has sold its health plans that provide insurance coverage to tens of thousand of Medicaid beneficiaries in the state. UMMS and the buyer, CareFirst BlueCross Blue Shield, declined to disclose terms of the deal. But the move, approved by regulators and closed this week, expands CareFirst’s reach into management of Medicaid plans. Medicaid is a government-funded health program for low-income people that is managed by private carriers in Maryland.  read more


Gov. Kevin Stitt seeks to outsource care for many of Oklahoma’s Medicaid recipients. Still in the early stages of the process, Stitt’s push to privatize Medicaid by hiring a for-profit company to manage the program’s spending is already facing pushback from some members of his own party. The Oklahoma Health Care Authority is preparing to solicit proposals for a company or companies to take over care for hundreds of thousands of Medicaid recipients, including pregnant women, low-income parents and children. The chosen companies would oversee spending for low-income adults who will be eligible for benefits under Medicaid expansion.  read more


Fierce Healthcare, October 7
The head of Centers for Medicare & Medicaid Services reiterated support for Medicaid work requirements as enrollment in the program swells this year. CMS Administrator Seema Verma spoke about work requirements during an interview Wednesday with the Aspen Institute. Her remarks come less than a month after a study in Health Affairs found that work requirements in Arkansas did not lead to more employment. “I am supportive of states making decisions about their programs and deciding what has worked best,” Verma said. She added that 20 states have been interested in the work requirements program.  


Richmond Times-Dispatch, October 5
Virginia will get additional federal emergency relief for Medicaid through the end of March on top of more than half a billion dollars that the state saved in reduced spending in the last fiscal year, primarily because of an abrupt decline in use of medical services during the COVID-19 pandemic. U.S. Secretary of Health and Human Services Alex Azar announced late Friday that the federal government would extend the public health emergency through late January, ensuring that the federal government will pay an additional 6.2% share of Virginia’s Medicaid costs through March 31, state Medicaid officials told legislators on Monday.  read more


The debate over filling the Supreme Court seat previously held by Ruth Bader Ginsburg has brought renewed attention to the possibility of the Affordable Care Act (ACA) being overturned under the court challenge in California v. Texas, currently scheduled to be heard shortly after the election this November. The expansion of Medicaid was a central component of the ACA, and 39 states have now adopted the ACA expansion into their Medicaid programs. Because Medicaid is administered by states, under federal guidelines, there may be some confusion about how overturning the federal law would affect state Medicaid programs.  read more


Shifting insurance enrollment creates significant ripple effects for the rest of the healthcare industry. As the COVID-19 pandemic continues to weigh on the economy and as unemployment remains stubbornly high, many provider executives are bracing for a shift in payer mix — moving from commercially insured to those with Medicaid. It poses some real challenges for providers who prize commercially insured patients. That type of employer-sponsored coverage, which most Americans have, typically reimburses more than government-sponsored programs such as Medicaid or Medicare — and the gap is growing.  read more


Nebraska will officially offer expanded Medicaid coverage to low-income people after years of political battles in the Legislature, a statewide ballot campaign that led voters to approve it and a nearly two-year rollout that left some residents in health care limbo. The state will provide coverage to 10,288 residents who have signed up so far, a number roughly in line with state projections. State officials expect the number enrolled will to rise to about 90,000 within a few years. Nebraska was among several conservative states where state lawmakers and governors declined to expand Medicaid, only to see the issue go to voters.  read more