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Medicaid

DoJ Charges 412 in Medicare Fraud Schemes Totaling $1.3B

July 21, 2017 - The Department of Justice (DoJ) announced the largest ever healthcare enforcement action in the history of the federal agency took place when the Medicare Fraud Strike Force (MFSF) charged 412 defendants for Medicare fraud losses totaling $1.3 billion. MFSF collaborated with the United States Attorney’s Office, FBI, HHS, and OIG on the investigation and enforcement. Consisting of healthcare...


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Medicaid Beneficiaries Satisfied with Coverage and Access

by Jesse Migneault

A recent Harvard Chan School of Public Health analysis found that Medicaid beneficiaries are overwhelmingly satisfied with their coverage and access to providers.  The nationwide survey of more than 60,000 beneficiaries also evaluated enrollees...

Spike in Late Stage Cancer Diagnosis Related to Medicaid Cut

by Jesse Migneault

A significant rollback of Medicaid coverage in Tennessee has led to a spike in late stage diagnosis for breast cancer, according to a new data analysis published in the American Cancer Society journal Cancer. The research team led by Virginia...

Texas Requests Medicaid Waiver Extension for $6.2 Billion

by Jesse Migneault

Although Texas refused federal funds in the 2014 ACA Medicaid expansion, it has recently submitted documents requesting its second Medicaid waiver extension for $6.2 billion.   Originally approved in 2011, the 1115 Medicaid Waiver was...

Flexibility and Innovation Needed To Control Medicaid Costs

by Jesse Migneault

As state and federal regulators debate the future of Medicaid spending, health researchers have identified the need for flexibility and innovation in Medicaid policies involving payment models, delivery of care and drug costs. The recommendations...

ACA Medicaid Expansion Boosted Care Access, Patient Outcomes

by Jesse Migneault

Low-income adults taking advantage of the Affordable Care Act’s Medicaid expansion experience more financial stability and better outcomes, according to a new study from the Harvard T. H. Chan School of Public Health. “Our four years...

Nevada Legislature: All Residents Should Have Medicaid Access

by Jesse Migneault

The Nevada State Assembly has passed a bill which would open Medicaid enrollment to all of the state’s residents, regardless of income or health status.   The Nevada Care Plan would allow every state resident without health insurance...

WI Medicaid Waiver Adds Drug Testing, Behavior Incentives

by Jesse Migneault

The Wisconsin Department of Health Services (DHS) will submit a section 1115 Medicaid waiver for the 2018 enrollment period that aims to add drug testing, healthy behavior incentives, and premium payments for certain beneficiaries. The waivers...

Maine Medicaid Waiver Would Increase Patient Responsibility

by Jesse Migneault

Maine will apply for a Section 1115 Medicaid waiver from the Centers for Medicare and Medicaid Services (CMS) to be granted flexibility to circumvent federal regulations and impose reforms on its Medicaid program. The state’s proposed changes...

AHIP Sees 28% Increase in Medigap Enrollment Among Seniors

by Jesse Migneault

AHIP has released data showing that enrollment in the Medicare Supplement, Medigap, has seen a steady increase from 2014 to December 2015.   The data represents statistics from 11.8 million enrollees with policies from 305 separate...

Tufts Health Plan Sees Opportunities as New RI Medicaid Option

by Jesse Migneault

Rhode Island will add Tufts Health Plan (THP) as its first new Medicaid option in seven years, according to the Rhode Island Executive Office of Health & Human Services (EOHHS).  The new program, RITogether, will allow Medicaid...

Medicaid Service Equals or Surpasses Private Health Payers

by Jesse Migneault

A new report by the Commonwealth Fund found that Medicaid provides equal or better quality health coverage to private health insurance plans.  The Commonwealth Fund’s 2016 Biennial Health Insurance Survey measured statistics related...

Proposed MA State Budget Targets Medicaid Program Funding

by Thomas Beaton

The Massachusetts House of Ways and Means Committee approved a state budget for fiscal year (FY) 2018 that funds MassHealth, the state’s Medicaid program, through new tax revenues. The committee budget follows the one proposed by Governor...

MA Medicaid Wrongly Paid $193M in Fee-for-Service Claims

by Thomas Beaton

An audit of MassHealth, the Massachusetts state Medicaid program, found the agency improperly paid approximately $193 million in fee-for-service claims for behavioral healthcare between 2010 and 2015.   Questionable payments to the Massachusetts...

BCBS of Minn. Cites Risk Pools for $322.4M in 2016 Losses

by Thomas Beaton

Blue Cross Blue Shield (BCBS) of Minnesota reported a net operating loss of $322.4 million in their 2016 financial audit, citing unbalanced risk pools and rising premium pricing as a current and future detriment to profitability. At the end of...

Price, Verma Push for Better State Control of Medicaid Programs

by Jacqueline Belliveau

As one of her first actions as CMS Administrator, Seema Verma collaborated with the Department of Health and Human Services (HHS) Secretary Tom Price to detail how the federal government plans to improve its state partnerships to enhance state...

CMS Ruling Changes Medicare Advantage and Part D Programs

by Vera Gruessner

Yesterday, the Centers for Medicare & Medicaid Services (CMS) announced in a press release new changes taking place for the Medicare Advantage and Part D Prescription Drug Program starting in 2017. Essentially, these deviations are meant...

Is the Affordable Care Act Sufficient for Mental Healthcare?

by Vera Gruessner

There are specific provisions that the Patient Protection and Affordable Care Act has brought to the American people. This includes eliminating healthcare coverage restrictions such as the clause surrounding pre-existing conditions. Additionally,...

How Medicaid Expansion Improves Behavioral Healthcare Access

by Vera Gruessner

When the Patient Protection and Affordable Care Act was passed into law, it established that Medicaid expansion across all 50 states would take place. However, a Supreme Court ruling created a clause that allowed Medicaid expansion to be optional...

Medicaid Challenges with Value-Based Care Payment Models

by Vera Gruessner

With the federal government and the healthcare industry as a whole focusing their efforts on adopting value-based care payment models that revolutionize medical care, it should come as no surprise that the National Association of Medicaid Directors...

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