Medicaid

CMS says its “Medicaid Fraud War Room” has identified 50 high-risk providers tied to more than $203 million in Medicaid payments in its first 88 days. In a July 28 news release, CMS characterized the payments as “potentially improper,” and…

Indiana Health Coverage Programs got CMS approval to progress with an enrollment and certification moratorium for some Medicaid providers beginning Aug. 1. According to a July 23 bulletin, the freeze will continue for six months. IHCP can extend the pause in six-month…

CMS on July 21 proposed sweeping changes to Medicaid provider tax policy that would replace the longstanding 6% federal threshold with state- and provider-specific limits, phase down allowable taxes in Medicaid expansion states, create a new provider tax class for…

HHS and CMS are deferring more than $1 billion in federal Medicaid funds to Minnesota and California, agency officials confirmed July 21.  The agencies said they are deferring approximately $867.5 million in payments to California and $199 million to Minnesota…

Basing Medicaid drug prices on what other wealthy countries pay could save 47 states and the District of Columbia a combined $8.6 billion — about 35% of net spending on the drugs studied — according to research published July 15…

The Maryland Department of Health did not audit pharmacy claims for three of its four fee-for-service pharmacy programs, leaving approximately $674.5 million in fiscal 2025 claims without routine reviews for fraud, waste, abuse and billing violations, according to a July…

Approximately 12 million Americans enrolled in both Medicare and Medicaid account for a disproportionate share of both programs’ spending while facing substantially greater health, functional and financial challenges than other Medicare beneficiaries, according to two KFF reports published July 15.…

Elevance Health plans to exit additional Medicaid markets over the next 12 to 18 months where it doesn’t see a viable path forward, executives said July 15 during the company’s second-quarter earnings call. The move follows Elevance’s recent mutual agreement…

Wellpoint D.C., Elevance Health’s Medicaid subsidiary in the District of Columbia, will exit the district’s Medicaid managed care program effective Aug. 1. Enrollees currently with Wellpoint, formerly Amerigroup D.C., will be automatically reassigned to AmeriHealth Caritas starting Aug. 1, according…

CMS has rescinded a decade-old “fast-track” review process for certain Medicaid Section 1115 demonstration waiver extensions as the agency prepares to implement new federal budget neutrality requirements that take effect in 2027. The July 7 informational bulletin formally withdraws 2015…