Medicaid - Health Care Quality Digest

Biden proposes Medicare, Medicaid cover anti-obesity drugs

Fierce Healthcare

NOVEMBER 26, 2024

The Centers for Medicare & Medicaid Services (CMS) is attempting to cover anti-obesity medications under Medicare Part D and Medicaid, the agency announced Nov.

Medicaid

Medicaid Medicare

CMS sets Medicaid renewal compliance deadlines

Fierce Healthcare

SEPTEMBER 24, 2024

The feds have set new deadlines for compliance with Medicaid renewal requirements given widespread enrollment concerns during the unwinding. | The feds have set new deadlines for compliance with Medicaid renewal requirements given widespread enrollment concerns during the unwinding.

Medicaid

Centene beats investor expectations despite Medicaid headwinds

Health Care Dive

OCTOBER 26, 2024

Like other payers, Centene flagged a mismatch between patient acuity and payment rates in Medicaid. But the insurer said a diversified portfolio helped it navigate challenges in the third quarter.

Medicaid

State Medicaid directors concerned about program’s stability: KFF

Health Care Dive

OCTOBER 24, 2024

The presidential election, loss of higher federal funding, inflationary pressures and other challenges are leaving state regulators uncertain about Medicaid’s “new normal.”

Medicaid

Medicaid Regulations

UnitedHealth projects shaky Medicaid redetermination aftermath

Fierce Healthcare

MAY 30, 2024

UnitedHealth is predicting an upcoming “disturbance” among its Medicaid programs as members continue to disenroll after the COVID-19 public health emergency. UnitedHealth gave an overview of areas in which the insurer can improve upon, how Medicaid redeterminations will affect the company and thoughts on OptumRx.

Medicaid

Indiana insurers, hospitals accused of Medicaid fraud in giant whistleblower lawsuit

Fierce Healthcare

SEPTEMBER 19, 2024

Major Indiana managed care organizations and health systems are blamed for defrauding the state Medicaid system by tens, if not hundreds, of millions of dollars, says a newly unsealed whistleblower | A newly unsealed lawsuit alleges major health insurers and health systems defrauded Indiana Medicaid by hundreds of millions of dollars, with the government (..)

Medicaid

Medicaid Hospitals

Medicaid redeterminations still affecting Centene as stock plunges

Fierce Healthcare

SEPTEMBER 4, 2024

Centene’s business is still impacted by Medicaid redeterminations, a process that began in early 2023, the company said during the Wells Fargo Healthcare Conference. Centene's stock sunk Wednesday after the company highlighted issues it faces surrounding Medicaid redeterminations.

Medicaid

Medicaid Healthcare

MACPAC calls for greater transparency amid steep rise in Medicaid directed payments

Health Care Dive

NOVEMBER 5, 2024

Dramatic growth in an opaque Medicaid funding mechanism is exacerbating concerns about the program’s fiscal integrity — while spurring financial gains for the hospital industry.

Medicaid

Medicaid Integration Hospitals

Elevance lowers guidance on ‘unprecedented’ Medicaid challenges

Health Care Dive

OCTOBER 17, 2024

Executives said the increased costs pressuring its Medicaid business would improve after states updated payment rates to better match member acuity.

Medicaid

TennCare violated healthcare rights of Tennessee Medicaid beneficiaries, judge rules

Fierce Healthcare

AUGUST 27, 2024

TennCare, the state of Tennessee’s Medicaid program, intentionally prevented families from receiving healthcare coverage and benefits, a federal district judge determined Aug.

Medicaid

Medicaid Healthcare Prevention

Centene looks beyond Medicaid redeterminations

Health Care Dive

APRIL 26, 2024

The nation's largest Medicaid insurer expects to return to normal operations this year, though redeterminations continue to dog Centene through a mismatch between rates and acuity.

Medicaid

HHS OIG finds gaps in opioid treatment for Medicare, Medicaid enrollees

Fierce Healthcare

SEPTEMBER 27, 2024

Many counties do not have medication for opioid use disorder (MOUD) services available through providers and treatment programs, and even in counties that do, Medicare and Medicaid beneficiaries of | A new report from HHS OIG looked at access to medication for opioid use disorder services and found many high need counties do not have specialized providers. (..)

Medicaid

Medicaid Medicare

States using unwinding lessons to improve Medicaid: KFF

Health Care Dive

JUNE 21, 2024

Medicaid unwinding has been less than perfect. However, the process has helped states expand Medicaid eligibility to more people and streamline enrollment and outreach, according to a new survey.

Medicaid

CMS sets Medicaid payments to home care workers at 80%

Fierce Healthcare

APRIL 22, 2024

The Centers for Medicare & Medicaid Services is hoping to improve Medicaid enrollees’ access to care through a final rule that better compensates caregiving roles. | CMS released a series of final rules Monday, including Medicaid access regulations that some groups worry will cause providers to close.

Medicaid

Medicaid Home Care Regulations Medicare

Mississippi Medicaid awarding contracts to Centene, Molina, TrueCare after 2-year delay

Fierce Healthcare

SEPTEMBER 6, 2024

Two years after Mississippi awarded Medicaid contracts to three insurers, the state is finally moving forward with its decision following challenges from UnitedHealthcare and Elevance Health.

Medicaid

Medicaid overtakes Medicare Advantage as health insurers’ bogeyman in Q2

Health Care Dive

AUGUST 15, 2024

Despite challenges in Medicaid and MA, major insurers still posted large earnings in the second quarter — many helped by growing health services divisions.

Medicaid

Medicaid Medicare

Exclusive: Medicaid insurers can do more to improve maternal health access, HHS report says

Fierce Healthcare

OCTOBER 1, 2024

States are missing opportunities to require Medicaid managed care organizations (MCOs) to improve maternal health access, a new report from the Department of Health and Human Services Office of Ins | With the country facing a maternal health crisis, HHS OIG's latest report argues states could be doing more to ensure Medicaid managed care organizations (..)

Medicaid

MACPAC suggests changes to Medicaid appeals process

Fierce Healthcare

JANUARY 29, 2024

The Medicaid and Chip Payment and Access Commission (MACPAC) voted in favor of seven recommendations during a meeting Jan. Medicaid advisers want to overhaul the denials and appeals process, partly by implementing a clinician-led independent review. 26 that would reshape how beneficiaries are able to appeal for care.

Medicaid

CMS simplifying Medicaid, CHIP enrollment and renewal processes

Fierce Healthcare

MARCH 27, 2024

The Centers for Medicare & Medicaid Services (CMS) released a final rule Wednesday to help individuals obtain and retain Children's Health Insurance Program (CHIP) coverage. | In a final rule set to take effect in two months, CMS is streamlining its Medicaid and CHIP eligibility, enrollment and renewal processes.

Medicaid

Medicaid Medicare

Kansas Medicaid selects UnitedHealth, Blue Cross and Centene

Fierce Healthcare

MAY 16, 2024

Three managed care organizations were recently selected to serve Kansas Medicaid members, the state’s department of health and environment announced. KanCare, the state Medicaid program, opted against awarding a bid to Aetna Better Health of Kansas.

Medicaid

Medicaid enrollment to decrease by 8.6% in 2024: KFF

Fierce Healthcare

NOVEMBER 14, 2023

Medicaid enrollment is projected to slide further next year, according to an annual budget survey of Medicaid officials conducted by KFF and Health Management Associates in collaboration with the N | State Medicaid directors once again see redeterminations as one of the biggest challenges they face heading into next year.

Medicaid

Colorado dropped Medicaid enrollees as red states have, alarming advocates for the poor

Fierce Healthcare

JULY 12, 2024

Colorado stands out among the 10 states that have disenrolled the highest share of Medicaid beneficiaries since the U.S. Colorado stands out among the 10 states that have disenrolled the highest share of Medicaid beneficiaries since the U.S.

Medicaid

1 in 8 enrollees exited Medicaid during redeterminations in 4 Southern states: study

Health Care Dive

JULY 3, 2024

The survey, which included low-income people in Arkansas, Kentucky, Louisiana and Texas, found about half of those who were no longer enrolled in Medicaid became uninsured.

Medicaid

Medicaid, MA headwinds pressure payers in Q2. Here's a look at how major companies fared

Fierce Healthcare

AUGUST 9, 2024

Medicare Advantage and Medicaid woes continued to plague some major payers in the second quarter, with UnitedHealth Group regaining its crown as the most profitable company in the industry for Q2.<

Medicaid

Medicaid Medicare

UnitedHealthcare, Neighborhood Health Plan win Rhode Island Medicaid contracts

Health Care Dive

JULY 18, 2024

The state’s managed care organizations handle health benefits for 90% of its Medicaid beneficiaries each year.

Medicaid

CMS opens door for New York Medicaid investments

Fierce Healthcare

JANUARY 9, 2024

Centers for Medicare & Medicaid Services approved New York's amended Medicaid section 1115 demonstration on Tuesday, spurring the agency to invest in behavioral health and health equity initiat | CMS is helping revamp Medicaid in New York, including more than $3 billion in investments for high-risk social needs services.

Medicaid

Medicaid Medicare

MACPAC wants Congress to force states to disclose Medicaid financing streams

Health Care Dive

JUNE 12, 2024

The influential advisory group has been lobbying the federal government to collect more detailed information on how states loop providers into funding Medicaid for almost a decade.

Medicaid

Despite redeterminations, Medicaid enrollment is higher than pre-pandemic levels

Fierce Healthcare

SEPTEMBER 20, 2024

The Medicaid unwinding is coming to a close, and a new analysis from KFF finds that while many people have lost coverage during this period, enrollment remains above pre-pandemic levels. |

Medicaid

Texas pauses $116B Medicaid contract awards; state health plans relieved

Fierce Healthcare

OCTOBER 8, 2024

Texas is halting the state’s new Medicaid contracts, a district judge declared Oct. The state's Medicaid procurement process was deemed unfair. A Texas judge sided with four health over plans over the state government.

Medicaid

Flashback: 2005 Tennessee Medicaid disenrollment led to increased crime, study finds

Fierce Healthcare

MARCH 20, 2024

Large-scale Medicaid disenrollment in Tennessee nearly 20 years ago led to increased total crime rates, a new study by the National Bureau of Economic Research found. |

Medicaid

Here are the 8 states where Medicaid disenrollments far exceeded projections

Fierce Healthcare

MAY 2, 2024

Two new studies released Thursday shed new light on how states are handling the Medicaid unwinding process for adults and children. Analyses out of Georgetown University and the Urban Institute show just how dire the Medicaid redetermination crisis is in some states.

Medicaid

DOJ, HHS press state Medicaid admins to cover Hepatitis C meds

Fierce Healthcare

JANUARY 26, 2024

State Medicaid agencies are required to cover Hepatitis C medications for people who have the disease or a substance use disorder, states were "encouraged" earlier this week.

Medicaid

Civil rights groups deal failing grades to states on Medicaid disenrollments

Fierce Healthcare

NOVEMBER 17, 2023

A coalition including the NAACP and other civil rights organizations released a scorecard Thursday grading each state on its policies handling the Medicaid unwinding period. Just one state received a passing score on Medicaid redeterminations from a coalition of nationally recognized civil rights groups.

Medicaid

CMS suspects auto-renewal process at fault for wrongful Medicaid disenrollments

Fierce Healthcare

AUGUST 30, 2023

In a letter sent to all states (PDF), the Centers for Medicare & Medicaid Services ( | As more Medicaid beneficiaries are wrongly kicked off the program, CMS is requiring states to reevaluate its eligibility systems and auto-renewal process.

Medicaid

Medicaid Medicare

UnitedHealth, CVS, Molina the big losers in Florida Medicaid contract awards

Fierce Healthcare

APRIL 15, 2024

Insurers Humana, Centene and Elevance Health were selected as the three statewide Medicaid contract awardees in Florida on April 12. Just three insurers earned statewide contracts for Florida's state-run managed care program, but UnitedHealth, Aetna and Molina were not selected.

Medicaid

Many disproportionate share hospitals face lower Medicaid payments under new final rule

Fierce Healthcare

FEBRUARY 21, 2024

Medicaid disproportionate share hospital (DSH) payments are being cut by $8 billion annually during the current and next four federal fiscal years under a new Centers for Medicare and Medicaid Serv | Published Tuesday and set to go into effect in two months, the final rule limits the calculation of a hospitals Medicaid shortfall to beneficiaries with (..)

Medicaid

Medicaid Hospitals Medicare

Mississippi awards Medicaid contracts to Centene, Molina, TrueCare

Health Care Dive

SEPTEMBER 5, 2024

The Magnolia State has finally issued new contracts for its Medicaid managed care program, two years later than intended after UnitedHealth and Elevance challenged the awards following unsuccessful bids.

Medicaid

One year after unwinding, community health centers struggle with Medicaid reenrollment

Fierce Healthcare

APRIL 10, 2024

Almost all community health centers (95%) are reporting Medicaid disenrollment, influencing the level of care provided to individuals that rely on these locations. States have handled the Medicaid redetermination process with varying degrees of success. A new study looks at how community health centers have been impacted.

Medicaid

Ophelia's virtual OUD care now in-network for Medicaid, dual-eligible Highmark Wholecare members

Fierce Healthcare

MARCH 20, 2024

It is now in-network for Wholecare Medicaid and dual-eligible members. Ophelia works with 13 Medicaid plans overall. . | Ophelia has been part of Highmark Health’s network in Pennsylvania since 2021, serving 2.9 million commercial members.

Medicaid

Payer Roundup—Iowa extends postpartum Medicaid coverage; Aetna settles fertility lawsuit

Fierce Healthcare

MAY 10, 2024

This month, Iowa signed into a law a postpartum Medicaid expansion, L.A. Below is a roundup of payer-centric news headlines you may have missed during the month of May 2024. Care Health commited $3 million to providers, Aetna settled a lawsuit alleging fertility discrimination, a former NBA champion was sentenced to prison and more.

Medicaid

UHS and HCA could see financial boost from growth in state-directed payments for Medicaid services

Health Care Dive

OCTOBER 16, 2024

Higher state-directed Medicaid payments in four states could boost HCA and UHS’ profitability in the near term, according to analysts.

Medicaid

Brightside Health to start serving Medicare, Medicaid beneficiaries

Fierce Healthcare

OCTOBER 4, 2023

Mental health provider Brightside Health is partnering with Centene, Optum, Lucet, Blue Cross and Blue Shield of Texas and other payers to serve 50 million people in Medicare and Medicaid. Brightside Health announced expanded partnerships with major health payers including Centene, Optum and Lucet on Thursday.

Medicaid

Medicaid Medicare

Medicaid expansion could cover more than 2M additional people

Fierce Healthcare

OCTOBER 23, 2023

A new report projects that if states holding out from expanding Medicaid reversed course, 2.3 million people would get access to healthcare.

Medicaid

Medicaid Healthcare

One year, 19M disenrollments: A look at Medicaid redeterminations so far

Health Care Dive

APRIL 2, 2024

Threats of fines, procedural errors and 19 million Americans disenrolled: Here are the major headlines from the past year of states unwinding Medicaid.

Medicaid

Biden proposes Medicare, Medicaid cover anti-obesity drugs

CMS sets Medicaid renewal compliance deadlines

Trending Sources

Centene beats investor expectations despite Medicaid headwinds

State Medicaid directors concerned about program’s stability: KFF

UnitedHealth projects shaky Medicaid redetermination aftermath

Indiana insurers, hospitals accused of Medicaid fraud in giant whistleblower lawsuit

Medicaid redeterminations still affecting Centene as stock plunges

MACPAC calls for greater transparency amid steep rise in Medicaid directed payments

Elevance lowers guidance on ‘unprecedented’ Medicaid challenges

TennCare violated healthcare rights of Tennessee Medicaid beneficiaries, judge rules

Centene looks beyond Medicaid redeterminations

HHS OIG finds gaps in opioid treatment for Medicare, Medicaid enrollees

States using unwinding lessons to improve Medicaid: KFF

CMS sets Medicaid payments to home care workers at 80%

Mississippi Medicaid awarding contracts to Centene, Molina, TrueCare after 2-year delay

Medicaid overtakes Medicare Advantage as health insurers’ bogeyman in Q2

Exclusive: Medicaid insurers can do more to improve maternal health access, HHS report says

MACPAC suggests changes to Medicaid appeals process

CMS simplifying Medicaid, CHIP enrollment and renewal processes

Kansas Medicaid selects UnitedHealth, Blue Cross and Centene

Medicaid enrollment to decrease by 8.6% in 2024: KFF

Colorado dropped Medicaid enrollees as red states have, alarming advocates for the poor

1 in 8 enrollees exited Medicaid during redeterminations in 4 Southern states: study

Medicaid, MA headwinds pressure payers in Q2. Here's a look at how major companies fared

UnitedHealthcare, Neighborhood Health Plan win Rhode Island Medicaid contracts

CMS opens door for New York Medicaid investments

MACPAC wants Congress to force states to disclose Medicaid financing streams

Despite redeterminations, Medicaid enrollment is higher than pre-pandemic levels

Texas pauses $116B Medicaid contract awards; state health plans relieved

Flashback: 2005 Tennessee Medicaid disenrollment led to increased crime, study finds

Here are the 8 states where Medicaid disenrollments far exceeded projections

DOJ, HHS press state Medicaid admins to cover Hepatitis C meds

Civil rights groups deal failing grades to states on Medicaid disenrollments

CMS suspects auto-renewal process at fault for wrongful Medicaid disenrollments

UnitedHealth, CVS, Molina the big losers in Florida Medicaid contract awards

Many disproportionate share hospitals face lower Medicaid payments under new final rule

Mississippi awards Medicaid contracts to Centene, Molina, TrueCare

One year after unwinding, community health centers struggle with Medicaid reenrollment

Ophelia's virtual OUD care now in-network for Medicaid, dual-eligible Highmark Wholecare members

Payer Roundup—Iowa extends postpartum Medicaid coverage; Aetna settles fertility lawsuit

UHS and HCA could see financial boost from growth in state-directed payments for Medicaid services

Brightside Health to start serving Medicare, Medicaid beneficiaries

Medicaid expansion could cover more than 2M additional people

One year, 19M disenrollments: A look at Medicaid redeterminations so far

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