Medicaid

Thirty of the 44 states required to implement Medicaid work requirements next year are holding a gubernatorial election Nov. 3. Most winners will take office in January, just as the new rules take effect. HR 1 requires states to begin…

Georgetown University McCourt’s Center for Children and Families will kick off a one-year research study exploring the fallout of Medicaid work requirements and six-month redeterminations, according to an Oct. 23 news release. Georgetown and research firm PerryUndem will connect with…

Following a trough year for Medicaid margins, leaders at Elevance Health and Molina Healthcare are more optimistic about their Medicaid businesses in 2027. In August, Elevance’s Medicaid subsidiary Wellpoint DC left the District of Columbia’s managed care program, with 85…

The Medicaid landscape is radically shifting, and some managed care organizations have questioned whether it is sustainable to continue in certain markets. When redeterminations restarted in April 2023 after the pandemic, average acuity increased, according to a February white paper…

Centene’s ‘Ohana Health Plan is leaving Hawaii’s Medicaid managed care program, QUEST, on Dec. 31, according to a Sept. 1 letter to plan members. Centene also did not bid on the contract for Community Care Services, a behavioral health managed…

The Minnesota Department of Human Services told Becker’s Oct. 15 that it may need to claw back funds from Medicaid providers if it faces a disallowance from CMS in the coming weeks. CMS has deferred $550 million in Medicaid funds…

A top CMS official wants provider suspensions to quadruple in the next six months as the agency puts new exclusion authority to work and tests AI tools to catch fraud, Nextgov/FCW reported Oct. 15. CMS Deputy Administrator Kimberly Brandt discussed…

HR 1 set several key Medicaid provisions into motion. While these changes weigh most heavily on expansion states, there is a patchwork of which provisions apply to which states. HR 1’s eligibility provisions — including work requirements, more frequent redeterminations…

CMS estimates that 77% of fiscal year 2025 Medicaid improper payments resulted from insufficient documentation rather than fraud or abuse, according to an Oct. 7 report from the Congressional Research Service. The report outlines how federal and state agencies oversee…

Medicaid members in the Bronx will be exempt from new federal work requirements when they take effect Jan. 1 because the county meets the law’s unemployment threshold, the New York State Department of Health said in statements to Becker’s. Under…