Syrtis Solutions distributes a monthly Medicaid news summary to help you stay up-to-date. The monthly roundup focuses on developments, research, and legislation that relate to Medicaid program integrity, cost avoidance, coordination of benefits, improper payments, fraud, waste, and abuse. Below is a summary of last month’s Medicaid news.
Auditor warns Kentucky risks losing federal funds after finding $836M in ‘Medicaid waste’ WHAS11, March 30
Kentucky may lose some federal funds due to issues uncovered in the state’s annual audit, according to Auditor Allison Ball. On Monday, Ball released the second half of the audit report, which focused primarily on the Kentucky Medicaid program. Ball accused the Cabinet for Health and Family Services (CHFS) of failing to properly oversee the state Medicaid program after a recent special examination uncovered $836 million in alleged waste. read more
Kentucky may lose some federal funds due to issues uncovered in the state’s annual audit, according to Auditor Allison Ball. On Monday, Ball released the second half of the audit report, which focused primarily on the Kentucky Medicaid program. Ball accused the Cabinet for Health and Family Services (CHFS) of failing to properly oversee the state Medicaid program after a recent special examination uncovered $836 million in alleged waste. read more
The White House Task Force to Eliminate Fraud: What’s at Stake for Medicaid Georgetown University McCourt School of Public Policy, March 27
On March 19, President Trump issued an Executive Order Establishing the Task Force to Eliminate Fraud. The stated purpose of the Task Force, which is chaired by Vice President J.D. Vance, is to “coordinate and accelerate a comprehensive national strategy to stop fraud, waste, and abuse within Federal benefit programs, including programs administered jointely with State, local, tribal, and territorial partners.” Members of the task force include representatives of nine cabinet agencies, including the Department of Justice, which recently created a National Fraud Enforcement Division, as well as HHS. read more
On March 19, President Trump issued an Executive Order Establishing the Task Force to Eliminate Fraud. The stated purpose of the Task Force, which is chaired by Vice President J.D. Vance, is to “coordinate and accelerate a comprehensive national strategy to stop fraud, waste, and abuse within Federal benefit programs, including programs administered jointely with State, local, tribal, and territorial partners.” Members of the task force include representatives of nine cabinet agencies, including the Department of Justice, which recently created a National Fraud Enforcement Division, as well as HHS. read more
Medicaid Enrollment and Unwinding Tracker
KFF, March 27
The Medicaid Enrollment and Unwinding Tracker presents the most recent data on monthly Medicaid/CHIP enrollment reported by the Centers for Medicare & Medicaid Services (CMS) as part of the Performance Indicator Project as well as archived data on renewal outcomes reported by states during the unwinding of the Medicaid continuous enrollment provision. The unwinding data were pulled from state websites, where available, and from CMS. read more
KFF, March 27
The Medicaid Enrollment and Unwinding Tracker presents the most recent data on monthly Medicaid/CHIP enrollment reported by the Centers for Medicare & Medicaid Services (CMS) as part of the Performance Indicator Project as well as archived data on renewal outcomes reported by states during the unwinding of the Medicaid continuous enrollment provision. The unwinding data were pulled from state websites, where available, and from CMS. read more
FRAUD, WASTE, AND ABUSE IN MEDICAID THREATEN CRITICAL RESOURCES FOR BENEFICIARIES
Syrtis Solutions, March 25
Medicaid has become one of the most essential pillars of the American healthcare system, providing coverage to tens of millions of low-income individuals, seniors, and people with disabilities. As the program has grown in size and scope, so too has the importance of ensuring that its resources are used effectively. Yet fraud, waste, and administrative inefficiencies continue to divert billions of dollars each year—funds that would otherwise support care for some of the nation’s most vulnerable populations. read more
Syrtis Solutions, March 25
Medicaid has become one of the most essential pillars of the American healthcare system, providing coverage to tens of millions of low-income individuals, seniors, and people with disabilities. As the program has grown in size and scope, so too has the importance of ensuring that its resources are used effectively. Yet fraud, waste, and administrative inefficiencies continue to divert billions of dollars each year—funds that would otherwise support care for some of the nation’s most vulnerable populations. read more
Projected Reductions in Medicaid Expansion Enrollment Under OBBBA’s Work Requirements and Six-Month Redeterminations
Urban Institute, March 25
The One Big Beautiful Bill Act (OBBBA) established new work requirements and increased the frequency of eligibility redeterminations for adults covered by the Affordable Care Act Medicaid expansion starting in January 2027. Using the Health Insurance Policy Simulation Model, we project the impacts of these two policies on expansion enrollment among adults ages 19 to 64 in 2028, a year after these policies are scheduled to be implemented. read more
Urban Institute, March 25
The One Big Beautiful Bill Act (OBBBA) established new work requirements and increased the frequency of eligibility redeterminations for adults covered by the Affordable Care Act Medicaid expansion starting in January 2027. Using the Health Insurance Policy Simulation Model, we project the impacts of these two policies on expansion enrollment among adults ages 19 to 64 in 2028, a year after these policies are scheduled to be implemented. read more
Legislators back bill to make large employers help fund Medicaid benefits The Sum and Substance, March 24
Staring down a $740 million budget shortfall, Colorado legislators are starting to think creatively about new ways to pay for high-cost programs like Medicaid. On Tuesday, a House committee advanced a proposal to use some large employers as a funding source. Specifically, House Bill 1327 would require companies that have more than 500 part-time workers receiving Medicaid benefits to pay $2,300 to the state for each of those employees on the public health-insurance program for low-income individuals. read more
Staring down a $740 million budget shortfall, Colorado legislators are starting to think creatively about new ways to pay for high-cost programs like Medicaid. On Tuesday, a House committee advanced a proposal to use some large employers as a funding source. Specifically, House Bill 1327 would require companies that have more than 500 part-time workers receiving Medicaid benefits to pay $2,300 to the state for each of those employees on the public health-insurance program for low-income individuals. read more
CMS’ New Approach to Federal Medicaid Spending in Cases of Potential Fraud KFF, March 19
The current administration is placing a new emphasis on potential fraud in Medicaid with its Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) initiative. The Centers for Medicare and Medicaid Services (CMS’) started the new initiative in Medicaid focusing on Minnesota and three other states with Democratic governors (California, Maine, and New York) while the House Committee on Energy and Commerce sent requests for information to 11 states. read more
The current administration is placing a new emphasis on potential fraud in Medicaid with its Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) initiative. The Centers for Medicare and Medicaid Services (CMS’) started the new initiative in Medicaid focusing on Minnesota and three other states with Democratic governors (California, Maine, and New York) while the House Committee on Energy and Commerce sent requests for information to 11 states. read more
Nearly 3 Million Uninsured Adults Would Gain a Path to Medicaid Coverage if Their States Adopted ACA Medicaid Expansion
CBPP, March 19
As part of the Affordable Care Act’s (ACA’s) Medicaid expansion, 40 states and Washington, D.C. have extended Medicaid eligibility to adults with incomes up to 138 percent of the federal poverty level (FPL), or about $22,000 for an individual. In these states, Medicaid expansion has substantially expanded access to affordable health coverage for millions of people, helping to drive the uninsured rate to record lows. Nevertheless, congressional Republicans and President Trump enacted unprecedented and harmful changes to the Medicaid expansion in last year’s reconciliation law, including a work requirement and more frequent eligibility redeterminations. read more
CBPP, March 19
As part of the Affordable Care Act’s (ACA’s) Medicaid expansion, 40 states and Washington, D.C. have extended Medicaid eligibility to adults with incomes up to 138 percent of the federal poverty level (FPL), or about $22,000 for an individual. In these states, Medicaid expansion has substantially expanded access to affordable health coverage for millions of people, helping to drive the uninsured rate to record lows. Nevertheless, congressional Republicans and President Trump enacted unprecedented and harmful changes to the Medicaid expansion in last year’s reconciliation law, including a work requirement and more frequent eligibility redeterminations. read more
Rep. Brownlee Introduces Medicaid Savings Act to Increase Efficiency, Reduce Costs, and Increase Access to Care
The Ohio House of Representatives, March 19
State Rep. Karen Brownlee (D-Symmes Twp) today introduced legislation to move the Department of Medicaid away from the current Managed Care Organization (MCO) model to an Administrative Services Organization (ASO) model. This ASO model will integrate Medicaid care management for medical, behavioral health, and nursing care-creating a single line of Medicaid administration which will allow for simplified management, significantly reduced administrative costs, and better access to health care for Ohioans. read more
The Ohio House of Representatives, March 19
State Rep. Karen Brownlee (D-Symmes Twp) today introduced legislation to move the Department of Medicaid away from the current Managed Care Organization (MCO) model to an Administrative Services Organization (ASO) model. This ASO model will integrate Medicaid care management for medical, behavioral health, and nursing care-creating a single line of Medicaid administration which will allow for simplified management, significantly reduced administrative costs, and better access to health care for Ohioans. read more
5 Key Facts About Medicaid Prescription Drugs
KFF, March 13
Medicaid is the primary program providing comprehensive health and long-term care to low-income people, including access to prescription drugs to treat acute problems and manage ongoing chronic conditions, covering about one in five people in the United States. In recent years, Medicaid spending on prescription drugs has grown substantially, in part due to the emergence of new, high-cost drugs, including GLP-1s and cell and gene therapies that treat, and sometimes cure, rare diseases. read more
KFF, March 13
Medicaid is the primary program providing comprehensive health and long-term care to low-income people, including access to prescription drugs to treat acute problems and manage ongoing chronic conditions, covering about one in five people in the United States. In recent years, Medicaid spending on prescription drugs has grown substantially, in part due to the emergence of new, high-cost drugs, including GLP-1s and cell and gene therapies that treat, and sometimes cure, rare diseases. read more
Recent Trends in Medicaid Outpatient Prescription Drugs and Spending KFF, March 12
In recent years, Medicaid spending on prescription drugs has grown, in part due to the emergence of new, high-cost drugs, including GLP-1s and cell and gene therapies that treat, and sometimes cure, rare diseases. There have been several recent Trump administration prescription drug initiatives (Box 1), including new payment models, that could help combat rising costs for state Medicaid programs, though questions remain about the implementation and impact of the deals. read more
In recent years, Medicaid spending on prescription drugs has grown, in part due to the emergence of new, high-cost drugs, including GLP-1s and cell and gene therapies that treat, and sometimes cure, rare diseases. There have been several recent Trump administration prescription drug initiatives (Box 1), including new payment models, that could help combat rising costs for state Medicaid programs, though questions remain about the implementation and impact of the deals. read more
Total Medicaid expenditure from 1975 to 2024
Statista, March 11
In 2024, the expenditures on Medicaid in the U.S. were 949 billion U.S. dollars. Medicaid public health insurance program that aims to provide affordable health care options to low-income residents and people with disabilities. Medicaid was signed into law in 1965. By 1975, around 13 billion U.S. dollars had been spent on the program. There are several components of the Medicaid health insurance program. The Children’s Health Insurance Program (CHIP) was started in 1997 to provide health coverage to families and children who could not afford care. read more
Statista, March 11
In 2024, the expenditures on Medicaid in the U.S. were 949 billion U.S. dollars. Medicaid public health insurance program that aims to provide affordable health care options to low-income residents and people with disabilities. Medicaid was signed into law in 1965. By 1975, around 13 billion U.S. dollars had been spent on the program. There are several components of the Medicaid health insurance program. The Children’s Health Insurance Program (CHIP) was started in 1997 to provide health coverage to families and children who could not afford care. read more
Medicaid and CHIP reliance by state: 2026 study
Herald Review, March 11
With some Medicaid funds to Minnesota currently halted due to fraud investigations led by Vice President JD Vance and the White House, many individuals may be wondering if their benefits could be at stake next. Statistics show that up to 33% of the population in each state, including children, may be receiving Medicaid or CHIP (Children’s Health Insurance Program) benefits as of October 2025. Even the most independent states from the Medicaid program are shown to have about 10% of their population enrolled in these benefits. read more
Herald Review, March 11
With some Medicaid funds to Minnesota currently halted due to fraud investigations led by Vice President JD Vance and the White House, many individuals may be wondering if their benefits could be at stake next. Statistics show that up to 33% of the population in each state, including children, may be receiving Medicaid or CHIP (Children’s Health Insurance Program) benefits as of October 2025. Even the most independent states from the Medicaid program are shown to have about 10% of their population enrolled in these benefits. read more
Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State KFF, March 9
Section 1115 Medicaid demonstration waivers offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute, if [in the HHS Secretary’s view] the approach is likely to “promote the objectives of the Medicaid program.” They can provide states additional flexibility in how they operate their programs, beyond the considerable flexibility that is available under current law. Waivers generally reflect priorities identified by states as well as changing priorities from one presidential administration to another. read more
Section 1115 Medicaid demonstration waivers offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute, if [in the HHS Secretary’s view] the approach is likely to “promote the objectives of the Medicaid program.” They can provide states additional flexibility in how they operate their programs, beyond the considerable flexibility that is available under current law. Waivers generally reflect priorities identified by states as well as changing priorities from one presidential administration to another. read more
CMS notifies states of options for transitioning to 6-month Medicaid renewals American Hospital Association, March 9
The Centers for Medicare & Medicaid Services March 6 issued guidance to states on transitioning to six-month Medicaid redeterminations in 2027, a change established by the budget reconciliation bill passed last year. For individuals enrolled in the adult expansion group on Jan. 1, 2027, the guidance provides states with two permissible implementation options. The first allows states to reschedule renewal initiation dates no earlier than Jan. 1, 2027, to transition beneficiaries much earlier into the six month renewal cycle, while the second allows states to apply the six month renewal requirement at the beneficiary’s next scheduled renewal in 2027. read more
The Centers for Medicare & Medicaid Services March 6 issued guidance to states on transitioning to six-month Medicaid redeterminations in 2027, a change established by the budget reconciliation bill passed last year. For individuals enrolled in the adult expansion group on Jan. 1, 2027, the guidance provides states with two permissible implementation options. The first allows states to reschedule renewal initiation dates no earlier than Jan. 1, 2027, to transition beneficiaries much earlier into the six month renewal cycle, while the second allows states to apply the six month renewal requirement at the beneficiary’s next scheduled renewal in 2027. read more
Federal cuts revive a California lawmaker’s push for single-payer health care Daylght San Diego, March 9
The latest set of health care proposals from the Trump administration has done nothing but embolden a California lawmaker to continue swinging for the fences: the creation of a single-payer, state-run system of care that virtually removes health insurance companies from the mix. That idea is hardly a new one. In fact, the legislator, Assemblymember Ash Kalra (D-San Jose), has himself introduced or reintroduced a form of it four times over the past five years. Those proposals have made little headway in Sacramento. read more
The latest set of health care proposals from the Trump administration has done nothing but embolden a California lawmaker to continue swinging for the fences: the creation of a single-payer, state-run system of care that virtually removes health insurance companies from the mix. That idea is hardly a new one. In fact, the legislator, Assemblymember Ash Kalra (D-San Jose), has himself introduced or reintroduced a form of it four times over the past five years. Those proposals have made little headway in Sacramento. read more
Statewide single-payer health care is back on the table, with a promise of no tax increase for 91% of Ohioans
Cleveland.com, March 9
A sweeping proposal to replace much of Ohio’s private health insurance system with a government-run universal plan resurfaced at the Statehouse this week. Senate Bill 78 had its first hearing before the Senate Financial Institutions, Insurance and Technology Committee during a meeting on March 3, where Democratic sponsors pitched the idea as a cost-saving transformation of the state’s health system. This prompted a discussion about feasibility, funding and whether a state government could realistically run such a program. read more
Cleveland.com, March 9
A sweeping proposal to replace much of Ohio’s private health insurance system with a government-run universal plan resurfaced at the Statehouse this week. Senate Bill 78 had its first hearing before the Senate Financial Institutions, Insurance and Technology Committee during a meeting on March 3, where Democratic sponsors pitched the idea as a cost-saving transformation of the state’s health system. This prompted a discussion about feasibility, funding and whether a state government could realistically run such a program. read more
