Medicaid expansion was an important issue in the 2018 midterm elections. Three states – Idaho, Nebraska, and Utah - successfully passed ballot initiatives to expand their Medicaid programs, while Kansas and Maine elected pro-expansion governors. As a result, almost 500,000 additional low-income citizens will be...
Of the $4 trillion spent by the government in 2017, nearly $141 billion were improper payments. These are payments made in error either to the wrong recipient, in the incorrect amount, or for a service that is not legitimate. Fraud, antiquated data systems, and methodologies...
Over the last year, there has been a wave of PBM and healthcare provider mega-mergers. These acquisitions have undergone intense review and the approvals suggest that government regulators are more comfortable with vertical integration as opposed to horizontal. Here is an overview of these mergers. CVS...
In August, the GAO submitted a report to Congress that focused on what CMS would need in order to better target risks and improve Medicaid oversight. The review determined that one of the critical problems the agency is facing is the failure to implement new...
In 2017, improper payments within the Medicaid program reached a total of $37 billion, according to CMS. That equals 10 percent of the federal dollars spent on the program. Moreover, 99.2 percent of the payments made were overpayments. To make matters worse, under the current...
Support for Medicaid expansion is on the rise as states approach general elections this fall. Advocates for expansion have been busy in recent months as they look to expand their programs by way of ballot initiatives. In May we reviewed a number of states considering...
The Center for Medicare and Medicaid Services recently released a Medicaid Scorecard to promote transparency and accountability. The scorecard consists of care quality data from 2015 statistics provided by participating states, along with federally reported information. By consolidating this data, CMS and the states look to...
After months of debate amongst Republican representatives in both the House and Senate, legislators in Virginia voted in favor of Medicaid expansion under the ACA on May 30th, 2018. The provision to expand the state's Medicaid program to over 400,000 Virginia residents was included in the...
It has been six weeks since Virginia's General Assembly met for a special session to produce the state's budget for FY 2019 and decide the fate of Medicaid expansion. On Tuesday, the Finance Committee met but Virginia Senate Republicans delayed a decision on a proposed...
Last month, President Trump delayed presenting his plan to address the soaring costs of prescription drugs. Despite the delay, New York’s Medicaid Drug Utilization Review Board (DURB) took it upon themselves to negotiate with drug manufacturers. DURB voted in favor of lowering the price its...
