CMS warned states about their compliance with Medicaid redetermination guidelines, and Medicaid expansion in North Carolina is hitting roadblocks.
Here are 10 updates about Medicaid Becker's has reported since Aug. 4.
- Georgia approved 265 people to take part in the nation's only Medicaid program that requires proof of work to receive benefits. The program launched July 1 and partially expands Medicaid coverage, but enrollees earning less than $14,580 annually — with some exceptions — must complete 80 hours of work, job training, education or community service per month to receive coverage.
- A growing number of older adults and low-income individuals are losing health insurance coverage because of a reimbursement rate dispute between Anthem Blue Cross Blue Shield plans and Cincinnati-based Bon Secours Mercy Health.
- Florida's Medicaid program could be facing a financial shortfall, as more residents than the state predicted have remained on the program through the redetermination process.
- CMS warned Medicaid directors in 27 states and Washington, D.C., their rates of procedural terminations — Medicaid beneficiaries removed from the program because of missing paperwork or other red tape, rather than being determined ineligible for the program — were too high.
- New Mexico will award Medicaid managed care contracts to Blue Cross Blue Shield of New Mexico, Presbyterian Health Plan, United Health Plan and Molina Health Plan. The state's human services department said it would not negotiate a new contract with Centene subsidiary Western Sky Community Care.
- A physician, health equity executive and Baltimore native is now overseeing healthcare coverage for more than 330,000 of the most vulnerable individuals in Maryland. In August, Elevance Health tapped its inaugural chief health equity officer, Darrell Gray II, MD, to lead Wellpoint, its Medicaid plan in the state — a move Dr. Gray told Becker's came only after "much prayer" and careful consideration of his own mission and values.
- U.S. representatives introduced a bill that aims to alleviate staffing shortage at state Medicaid agencies so beneficiaries do not lose coverage due to procedural issues during the redetermination process.
- HHS sent letters to Medicaid directors in all 50 states, evaluating states' performance on Medicaid call center wait times and call abandonment rates, rates of procedural terminations, and the average wait time for applications to be approved. The agency warned 36 states they were falling short of regulatory requirements in at least one area and warned five states they were falling short in all three categories.
- North Carolina's budget negotiations could continue into September, which would delay the start date of the state's Medicaid expansion. Gov. Roy Cooper's administration set an Oct. 1 start date for the expansion, but the program's funding is linked to the passage of the state's 2023-2024 budget. The budget needs to be passed by Sept. 1 for the state to meet the October start date. If that deadline is not met, expansion would be delayed until Dec. 1.
- Centene had the highest Medicaid membership of the largest payers in the second quarter of 2023. The company also lost the most members during the redeterminations process. Here's how payers' Medicaid membership stacked up, according to second-quarter earnings reports.