Medicaid

The reality of Medicaid work rules has been setting in, from CMS releasing its implementation framework to health system CEOs modeling the fallout. HR 1 established community engagement requirements for low-income, nonpregnant people between ages 19 and 64, which are…

As of fiscal 2023, nearly three-quarters of Medicaid beneficiaries were enrolled in a full-risk managed care organization, up from less than half in fiscal 2010. On June 15, the Medicaid and CHIP Payment and Access Commission, an agency that advises…

States have begun receiving payments from CVS Pharmacy’s $36.5 million settlement over allegations that the company overbilled Medicaid programs for insulin prescriptions between 2010 and 2020.  According to federal and state investigators, CVS dispensed more insulin pen cartons than prescriptions…

CMS issued guidance June 11 outlining plans to update its assessment of Medicaid section 1115 demonstration projects. Section 1115 demonstration projects allow states to test approaches for delivering and paying for Medicaid care. The June guidance stems from an HR…

Iowa’s state auditor, Rob Sand, released a report raising concerns about how pharmacy benefit managers handled prescription drug payments within Iowa Medicaid and whether the state had sufficient access to information to oversee those arrangements. The June 10 report found…

Less than half of rural hospitals in the U.S. still offer labor and delivery services, and researchers warn the situation will worsen unless commercial payers, Medicaid programs and employers change how they pay for maternity care. A June 8 report…

Six insurers received HealthChoice Illinois contracts, totaling $431 billion across the initial and renewal terms. HealthChoice Illinois is the state’s managed Medicaid program. A June 8 document from the Illinois Chief Procurement Office for General Services shows five plans available…

Philadelphia-based Jefferson Health Plans is rebranding its Medicaid and Children’s Health Insurance Program products. Originally called Health Partners Plans, the Medicaid plans are now Jefferson Health Plans EverWell, and the CHIP plans are Jefferson Health Plans CHIP, according to a…

HHS Inspector General T. March Bell said Hawaii’s Medicaid fraud control unit is no longer certified — and has lost reimbursements from the federal government, as a result. In a June 4 letter to Hawaii officials, Mr. Bell called out…

CMS on June 1 published the interim final rule outlining how states will carry out Medicaid work requirements. The rule sets the operational framework for a policy hospitals warn will push eligible patients off coverage and drive up uncompensated care.…