Medicaid

In Minnesota’s review of 5,583 “high-risk” Medicaid providers, 2,061 were revalidated, but 3,411 were notified of their disenrollment. A state report confirmed Minnesota completed its revalidation by May 31. The review removed 111 providers who were no longer offering high-risk…

CMS published its interim final rule for state implementation of Medicaid work requirements June 1.  HR 1 outlined how low-income, nonpregnant people between ages 19 and 64 must work, engage in community service or attend school — or some mix of these —…

Dayton, Ohio-based CareSource suspended repayment demands it previously issued to some Ohio behavioral health providers after therapists and social workers organized public opposition to the policy change, Cleveland.com reported May 25.  The organization, Ohio’s largest Medicaid managed care plan covering…

CMS on May 20 proposed a rule that would cap certain state Medicaid payments and align them more closely with Medicare rates.  The proposed rule would create new limits for Medicaid state-directed payments and certain fee-for-service payments to reduce Medicaid…

Anthem Blue Cross and Blue Shield has been awarded a contract to participate in Wisconsin’s Family Care program, a managed Medicaid long-term services and supports program. Anthem is the first organization added to Family Care in several years, the company…

The Medicaid and CHIP Payment and Access Commission approved recommendations to boost transparency with Medicaid prior authorization automation and AI use. MACPAC advises Congress on Medicaid and CHIP, or the Children’s Health Insurance Program, policy. Recommendations were shared during a…

Hospitals are confronting a new and unexpected pressure point in 2026: Fewer patients losing coverage are transitioning to Medicaid. The slowdown, emerging alongside ACA exchange attrition, is adding to uninsured volumes and complicating payer mix assumptions for some of the…

CMS is imposing a $48,833 fine against a Providence PACE organization in Napa, Calif., according to an April 29 notice from the agency. The penalty was issued to Collabria Care, the name under which Providence Community Health Napa Valley holds…

On May 1, Nebraska becomes the first state to launch Medicaid work requirements under HR 1, setting the stage as other states prepare to follow suit by 2027. The community engagement requirements will apply to adults — with some exceptions…

Baylor Scott & White Health Plan is exiting the Texas Medicaid managed care market by the end of August and will no longer offer individual marketplace plans past 2026. The insurer, part of the Dallas-based health system, administers Medicaid benefits…