Medicaid

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.…

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…