Medicaid

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CMS has rescinded a decade-old “fast-track” review process for certain Medicaid Section 1115 demonstration waiver extensions as the agency prepares to implement new federal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…

Centene’s Ambetter is exiting Arkansas’ Medicaid expansion program, Arkansas Health and Opportunity for Me, in 2027. In a July 6 statement to Becker’s, the company attributed the decision to “current funding challenges.” Arkansas Health & Wellness — Centene’s managed care…

Some Wisconsin Medicaid members getting a monthly cash benefit through the state’s Supplemental Security Income program had mail containing private information sent to outdated addresses. The letters concerned an increase in benefits. The Wisconsin Department of Health Services confirmed the…

The HHS Office of Inspector General sent a letter June 30 informing New York officials that federal grant funds to the state’s Medicaid fraud control unit are suspended effective July 1. New York gets roughly $60 million in taxpayer dollars…

Democratic governors and attorneys general from 25 states and Washington, D.C., sued the Trump administration June 29 over CMS’ interim final rule implementing Medicaid work requirements. Eight things to know: 1. The 74-page lawsuit, filed in U.S. District Court for…

Montana is preparing to roll out its community engagement rules for Medicaid July 1, and Arkansas is soft-launching its requirements that same day. HR 1 outlined how low-income, nonpregnant adults ages 19 to 64 must work, perform community service or…

Federal prosecutors and auditors are targeting Medicaid behavioral health fraud on multiple fronts, with billions in alleged false claims under scrutiny nationally and two states alone facing audit findings of more than $123 million combined in potentially improper payments for…

The Justice Department has charged 455 defendants, including 90 physicians, nurses and other licensed medical professionals, for allegedly participating in healthcare fraud and opioid abuse schemes. The charges are part of the department’s 2026 National Healthcare Fraud Takedown, which is…

Community Behavioral Health, a Medicaid behavioral health managed care plan in Philadelphia, didn’t meet federal and state requirements around prior authorization denials, according to a June audit report from HHS’ Office of Inspector General. CBH received about $1.28 billion in…