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A new report found that millions could lose access to care, even though most Medicaid beneficiaries are working or should be eligible for exemptions from work requirements.
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.
Reducing spending on Medicaid and the food assistance program could batter state economies and lead to job cuts — including 477,000 roles in in the healthcare sector alone, according to the Commonwealth Fund.
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.
The Centers for Medicare & Medicaid Services (CMS) is attempting to cover anti-obesity medications under Medicare Part D and Medicaid, the agency announced Nov.
incorrectly said that Medicaid was fully funded by the federal government and that Medicare is a fee-for-service program during a hearing in front of the Senate Finance Committee on Wednesday. Kennedy Jr.
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 (..)
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.
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.
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.
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.
TennCare, the state of Tennessee’s Medicaid program, intentionally prevented families from receiving healthcare coverage and benefits, a federal district judge determined Aug.
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.
Image by freepik What You Should Know: – A new analysis by the Urban Institute, supported by the Robert Wood Johnson Foundation , reveals that healthcare providers in 41 states that expanded Medicaid eligibility would face significant financial losses if federal funding for Medicaid expansion programs is cut.
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. (..)
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.
The 41 states that expanded Medicaid could be asked to spend 25% more to cover care costs if planned cuts are approved by Congress. Some states may cut the expansion program instead.
States have increased provider payment rates to address workforce shortages, but they may have to cut back if spending cuts hit Medicaid, according to the health policy researcher.
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 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.
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.
The presidential election, loss of higher federal funding, inflationary pressures and other challenges are leaving state regulators uncertain about Medicaid’s “new normal.”
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.
Despite challenges in Medicaid and MA, major insurers still posted large earnings in the second quarter — many helped by growing health services divisions.
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.
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.
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.
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.<
A Pennsylvania pension fund had argued Centene board members failed in their oversight responsibilities and ignored red flags about a Medicaid overbilling scheme.
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.
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.
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.
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.
Elevance Health is launching a new initiative that aims to put smartphones in the hands of Medicaid members who otherwise cannot connect to virtual services. In the wake of the COVID-19 pandemic, virtual care and digital health tools are more popular than ever.
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.
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. |
Days before the 2024 presidential election, the Centers for Medicare & Medicaid Services (CMS) released an unpublished version of the final calendar year 2025 physician fee schedule final rule | Digital therapeutics, telehealth, rural heath clinics and opioid treatment programs all got updates in the final 2025 Medicare physician fee schedule rule, (..)
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.
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.
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 (..)
Under a final rule issued by the Centers for Medicare and Medicaid Services, outpatient hospital facilities and ambulatory surgical centers will get a 2.9% Medicare pay increase next year, up from | Under a final rule issued by CMS, outpatient hospital facilities and ambulatory surgical centers will get a 2.9%
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