Medicaid Reimbursement

Medicaid Supplemental Payments Are Inefficient, Demand Change

April 26, 2023 - Medicaid supplemental payments are not need-based and often leave certain states with excess funds, demonstrating that the processes involved in these payments need to change, according to an issue brief published by the Robert Wood Johnson Foundation (RWJF) and the Urban Institute. The researchers chose not to include certain supplemental...

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How State Medicaid Programs Address the Behavioral Health Workforce Shortage

by Victoria Bailey

State Medicaid programs have implemented or plan to implement strategies to address the behavioral health workforce shortage, including increasing reimbursement rates and reducing administrative...

How Private Payers, Medicaid Cover At-Home COVID-19 Testing

by Kelsey Waddill

A handful of the largest private payers are evenly split regarding whether they provide direct coverage for at-home COVID-19 testing, according to the Kaiser Family Foundation (KFF) which assessed both...

MO Medicaid Home Healthcare Program Received Improper Payments

by Victoria Bailey

Missouri claimed $3.4 million in improper payments for its Medicaid home healthcare program providers and did not comply with federal and state Medicaid requirements, according to a report from the...

OBGYNs Face Challenges When Providing Care To Medicaid Members

by Hannah Nelson

Obstetrician-gynecologists (OBGYNs) experience reimbursement and referral challenges for care provided to Medicaid beneficiaries, according to a new nationally representative survey of OBGYNs conducted...

NC Medicaid Program Audit Reveals Improper Medicaid Payments

by Kelsey Waddill

An audit of North Carolina’s Department of Health and Human Services (DHHS) revealed that the department failed to properly conduct Medicaid provider credentials verifications and other key...

Differences in Medicaid Expansion, Nonexpansion Program Policies

by Kelsey Waddill

Differences between Medicaid expansion and nonexpansion states go beyond whether states opted into the Affordable Care Act allowance, a Health Affairs study found. Researchers have discovered Medicaid...

Block Grant Complexity, Vagueness May Limit Medicaid Uptake

by Kelsey Waddill

Healthy Adult Opportunity (HAO), a section 1115 Medicaid demonstration that creates a non-mandatory block grant for certain Medicaid populations, could require an expansion state to generate Medicaid...

Experts Lambast CMS MFAR as Detrimental to Employers, Patients

by Kelsey Waddill

The US Chamber of Commerce is the most recent opponent to the CMS Medicaid Fiscal Accountability Regulation (MFAR), joining governors, providers, and payers in its disavowal of the rule’s...

What are Impacts of the Medicaid Fiscal Accountability Regulation?

by Kelsey Waddill

It is no secret that Medicaid reimbursement is low. Extra payments that well-intentioned states give providers to compensate for the low Medicaid reimbursement rates add a layer of complexity to an...

AHA: Proposed CMS Rule Hinders Medicaid Reimbursements

by Kelsey Waddill

American Hospital Association (AHA) is concerned that the recent CMS proposal to relax the 2015 mandatory Medicaid access monitoring review plans will limit providers’ ability to confront...

Iowa Raises Privatized Medicaid Capitation Rate By 8.6%

by Kelsey Waddill

Iowa’s Department of Human Services will be raising privatized Medicaid capitation rates by 8.6 percent and has signed contracts from Amerigroup Iowa and Iowa Total Care for fiscal year (FY)...

CMS Considers Loosening Medicaid Access Monitoring Review Rules

by Kelsey Waddill

CMS is proposing to relax rules requiring states to submit and update Medicaid access monitoring review plans, which would largely leave states in charge of ensuring adequate Medicaid beneficiary...

Health Plan Variety Does Not Boost Managed Medicaid Performance

by Thomas Beaton

Managed Medicaid performance does not increase as state Medicaid programs introduce more health plan variety, but a single health plan with value-based characteristics may be more effective in...

Arkansas Slips Up on Supplemental Medicaid Payments

by Thomas Beaton

A lack of administrative oversight led Arkansas to miss supplemental Medicaid payments, make several payments to Medicaid-ineligible providers, and receive excess Medicaid dollars, found a report from...

Medicaid Reform Requires Outcomes-Based Innovation, Better Data

by Thomas Beaton

Medicaid has steadily provided low-income patients with quality healthcare coverage and could further improve by addressing problematic areas through outcomes-based innovation and data analytics...

Low Medicaid Payment Rates Decrease Residential Care Quality

by Thomas Beaton

Low Medicaid payment rates discourage providers to serve Medicaid beneficiaries in residential care services (RCS) that in turn can cause beneficiaries to purchase more expensive long-term support...

Texas Wrongly Claimed $3.8M in Medicaid Reimbursements

by Thomas Beaton

Texas’s Department of Health and Human Services failed to adhere to federal guidelines and inappropriately claimed $3.8 million in Medicaid managed care reimbursement.    The Office of...

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....

AHA Condemns CMS Rule for Medicaid Third-Party DSH Payments

by Thomas Beaton

The American Hospital Association expressed “deep disappointment” about a CMS final rule that will only include uncompensated care costs for covered Medicaid services in the calculation of...

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