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…
Medicaid
Twenty-four percent of maternal health providers on Medicaid managed care network lists sent to states are not actually in network, according to the HHS Office of Inspector General. These listings are commonly referred to as “ghost providers,” meaning they appear…
More than 2 million fewer children have been enrolled in Medicaid or the Children’s Health Insurance Program since January 2025, according to a June 10 analysis from the Georgetown University McCourt School of Public Policy Center for Children and Families…
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…
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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…