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.
MEDICAID AT THE CROSSROADS: PROTECTING MEMBER BENEFITS THROUGH REAL-TIME COB AND THIRD-PARTY LIABILITY
Syrtis Solutions, October 31
Medicaid COB has never been more critical as states confront mounting fiscal pressure and federal funding cuts. Many states have already begun reducing their Medicaid budgets — even before the most significant federal reductions take effect. According to the Medicare Rights Center, states like North Carolina are slashing provider payments, while others such as Nevada are struggling to manage Medicaid programs that consume nearly a quarter of total state spending. read more
In Focus: A look at Kentucky’s Medicaid Oversight and Advisory Board
Spectrum News 1, October 20
On this week’s “In Focus Kentucky” program, we’re discussing efforts to address and improve transparency and fiscal stewardship within Kentucky’s most extensive government program, the Medicaid program. Kentucky Medicaid is a state and federal program authorized by Title XIX of the Social Security Act to provide health care for eligible, low-income populations. These populations include children, low-income families, pregnant women, the aged and the disabled. Eligibility for these groups is determined by several factors, including family size, income and the Federal Poverty Level. read more
800 inactive Medicaid providers dropped as Minnesota aims to ‘tightens oversight’
Fox 9, October 16
The Minnesota Department of Human Services has dropped inactive Medicaid providers. This comes as the state aims to tighten oversight after investigators uncovered widespread fraudulent practices. About 800 providers were dropped, excluding 621 inactive housing stabilization services set to be cut off when the program ends on Oct. 31. This move comes after widespread fraud was uncovered in the state’s Medicaid program. read more
NC Medicaid cuts under scrutiny amid funding stalemate
WRAL News, October 14
North Carolina health officials said Tuesday that they continue to explore ways to save money for the state’s Medicaid program amid state budget constraints and looming cuts from the federal government. The state Department of Health and Human Services said earlier this year that North Carolina’s Medicaid program needed additional state funding by Oct. 1 to avoid cutting their reimbursement rates to hospitals, nursing homes and other medical providers who treat Medicaid patients. read more
California governor signs bill that cracks down on PBMs
Fierce Healthcare, October 13
California Gov. Gavin Newsom signed into law legislation aimed at “reining in” pharmacy benefit managers, becoming the latest state to implement regulations on the industry. The bill, signed Friday, would require all PBMs in the state to be licensed by its Department of Insurance and prohibits multiple business practices that have drawn the ire of PBM critics, namely spread pricing arrangements and efforts to steer patients toward affiliated pharmacies. read more
Senators Press Deloitte, Other Contractors on Errors in Medicaid Eligibility Systems
KFF, October 10
Senators have launched an inquiry into companies paid billions in taxpayer dollars to build eligibility systems for Medicaid, expressing concern that error-riddled technology and looming work requirements “will cause Americans to lose Medicaid coverage to this bureaucratic maze.” The letters, dated Oct. 10, were sent to four companies and follow a KFF Health News investigation that exposed widespread issues in states using Deloitte-run systems to assess Medicaid eligibility for millions of people. read more
WV potentially paid $32M to provide Medicaid to ineligible people, including some who were deceased
KFF, September 30
The state is working to recover up to $32.4 million after it came to light that it may have mistakenly paid Medicaid participant fees for thousands of ineligible individuals who were incarcerated or dead, a new audit revealed. West Virginia uses managed care organizations to manage Medicaid services for most of the state’s Medicaid users and pays per enrollee. read more
Hoping to improve health care access, Louisiana increases Medicaid payments to doctors
Louisiana Illuminator, October 8
Louisiana has increased the amount of money the state will pay to physicians and other health care providers treating Medicaid patients in an effort to expand health care access for low-income people. Medicaid enrollees often struggle to find doctors willing to treat them because the government health care program pays low reimbursement rates for services. The Louisiana Department of Health announced Tuesday it has raised rates in order to incentivize more medical professionals to see people with Medicaid coverage. read more
Why are CT Medicaid costs rising? GOP wants auditors to find out
CT Minor, October 8
Minority Republicans in the state Senate are calling for a new audit and other reviews of Connecticut’s Medicaid program to stem cost overruns that have plagued the program in recent years. The GOP caucus, which controls 11 out of 36 Senate seats, sent a letter to the state auditors of public accounts, John Geragosian and Craig Miner, asking for a review “to reveal potential efficiency measures which could produce significant savings for taxpayers.” read more
More than $132 Million in New Jersey Medicaid Funds Recovered, Office of the State Comptroller Announces
New Jersey OSC, October 7
More than $132 million in New Jersey Medicaid funds were recovered in fiscal year 2025, a jump of 11 percent from the previous year, the Office of the State Comptroller (OSC) announced today. Due to efforts by OSC’s Medicaid Fund Division, $132,475,474 in Medicaid funds were returned to state and federal budgets in fiscal year 2025, as compared to $119,210,896 in the prior year. The 2025 recovery marks the second-highest amount recouped in the last ten years, with $144,814,560 recovered in fiscal year 2022. read more
New Medicaid work requirements will cause enrollment to decline, WV lawmakers told
West Virginia Watch, October 6
Some West Virginia Medicaid recipients will lose their health care when new federal work requirements go into effect in 2027, lawmakers were told Monday. “I do anticipate that we will see some of our enrollment go down for the community engagement,” Cindy Beane, commissioner for the West Virginia Bureau for Medical Services, told the Legislature’s Joint Standing Committee on Finance. She used a term she said referred to new federal work requirements. read more
