Medicaid

Future Moms Face Challenge Finding Docs Who Accept Medicaid

The provider directories of Medicaid managed care plans often list maternal providers who do not accept Medicaid patients. At the same time, many of those provider directories list incorrect contact information for their participating maternal health providers. These are among the findings of the U.S. Department of Health and Human Services’ Office of the Inspector General. In two new audit reports, the OIG found that a review of several of the largest Medicaid managed care plans in the country found that anywhere from four to 22 percent of the maternal care providers listed in their provider networks were not actually [...]

joe2026-06-18T16:34:32-04:00June 22, 2026|Medicaid, Medicaid managed care|

Making Sense of New Medicaid Medical Frailty Exemption

The recent release of new Medicaid work and community engagement requirements has raised nearly as many questions as it answers about who will and who will not be eligible for Medicaid when the new criteria take effect next year. While the work and community engagement requirements themselves are relatively straightforward, questions remain about the medical frailty exception and who, based on their medical condition, will be exempt from the work or community engagement requirement. A number of sources have reported on the medical frailty exception. NY Times – “Trump Administration Announces Stricter Rules for Medicaid Work Requirement” Health Affairs – [...]

joe2026-06-17T12:21:01-04:00June 18, 2026|Medicaid|

HHS Advisory Committee Holds First Meeting

An advisory panel created by the Department of Health and Human Services to advise the agency on how to improve the financing and delivery of health care by Medicare, Medicaid, and the Children’s Health Insurance Program and through the health insurance marketplace held its first public meeting earlier this week. HHS’s Healthcare Advisory Committee, which consists of 15 members, discussed its bylaws and heard presentations from the leaders of its six workgroups. Those workgroups are: Reducing Administrative Burden MAHA by Improving Wellness and Preventing Chronic Disease Deploying Real-Time Data Improving Care for Vulnerable Populations Strengthening Medicare Advantage Crushing Fraud, Waste, [...]

joe2026-05-20T09:26:01-04:00May 22, 2026|Medicaid, Medicare|

CMS Introduces Next Step in Fighting Medicaid Fraud, Waste, and Abuse

In his agency’s latest attempt to identify and address Medicaid fraud, Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz has announced that states will have 30 days to submit to CMS a plan for revalidating all providers enrolled in their Medicaid programs. In explaining his rationale for this approach, Oz told participants at a recent event that "The basic thing you'd want to do, if you actually cared about the program, is to make sure that legitimate providers are providing services that you're paying for and doing it the right way… So we're asking the states to own [...]

joe2026-04-21T15:42:28-04:00April 22, 2026|Centers for Medicare & Medicaid Services, Medicaid|

MACPAC Submits March Report to Congress

The Medicaid and CHIP Payment and Access Commission has submitted its mandated March report to Congress. The report consists of four chapters: Chapter 1 offers a recommendation to support the home- and community-based services (HCBS) workforce by requiring states to report hourly wages paid to HCBS workers to help states set effective HCBS payment rates. Chapter 2 focuses on behavioral health in Medicaid and CHIP. Chapter 3 looks at the role of Medicaid in supporting justice-involved youth. Chapter 4 provides an overview of how Medicaid meets the needs of children in child welfare. Learn more from this MACPAC news release, which summarizes the [...]

joe2026-03-17T13:15:26-04:00March 18, 2026|MACPAC, Medicaid, Medicaid long-term services and supports|

Docs Not Always Caring for Medicaid Patients

More than a quarter of all doctors enrolled to serve Medicaid patients in 2021 did not serve any Medicaid patients at all while another ten percent treated fewer than 10 Medicaid patients, according to a new Health Affairs study. Among different types of doctors, primary care physicians and cardiologists were most likely to care for higher numbers of Medicaid patients while Medicaid patients seeking the services of psychiatrists were mostly out of luck. Many of the doctors who care for Medicaid patients, and especially those who do not, cite reimbursement that is lower than – and often much lower than [...]

joe2026-02-05T16:51:38-05:00February 10, 2026|Medicaid|

Federal Health Policy Update for January 15

The following is the latest health policy news from the federal government for January 9-15. Some of the language used below is taken directly from government documents. The White House The White House has unveiled “The Great Healthcare Plan,” which it describes as “… a broad healthcare initiative that will slash prescription drug prices, reduce insurance premiums, hold big insurance companies accountable, and maximize price transparency in the American healthcare system.” The major components of the plan, and the key steps for each, are: lower drug prices slash prescription drug prices allow more over-the-counter medicines lower insurance premiums send the [...]

joe2026-01-15T16:13:09-05:00January 15, 2026|340b, Affordable Care Act, Centers for Medicare & Medicaid Services, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare|

Federal Health Policy Update for December 18

The following is the latest health policy news from the federal government for December 12-18. Some of the language used below is taken directly from government documents. Congress In a 216-211 vote yesterday, the House passed the Lower Health Care Premiums for All Americans Act, a Republican package aimed at addressing multiple health care policies. The legislation includes provisions for employee tax-advantaged benefits like HSAs and FSAs, cost-sharing reductions (CSR) subsidies, and increased transparency requirements for pharmacy benefit managers (PBMs). It notably did not include an extension of the enhanced Affordable Care Act premium tax credits that many of the [...]

joe2025-12-18T16:29:43-05:00December 18, 2025|Accountable Care Organization, ACO, Affordable Care Act, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for October 30

The following is the latest health policy news from the federal government for October 24-30. Some of the language used below is taken directly from government documents. Please note that most HHS and other health care-related agencies have indicated that they will not be announcing new policies, publishing proposed regulations, or updating their web sites during the current federal government shutdown. Congress and the Shutdown The federal government remains shut down and the Senate expects to leave Washington today without another vote on the House-passed continuing resolution (CR), ensuring that the shutdown will continue into next week. Republican leaders believe [...]

joe2025-10-31T12:15:23-04:00October 30, 2025|340b, Affordable Care Act, Centers for Medicare & Medicaid Services, Congress, Medicaid, Medicare|

States Looking to Medicaid For Spending Cuts?

Amid growing budget pressures, a number of states have reduced Medicaid payments to providers – and others are looking to Medicaid as a possible source of savings. So far, Idaho and North Carolina have reduced Medicaid payments to providers while Illinois is looking at Medicaid, among other sources, in the face of its governor’s desire to reduce spending by four percent in the coming year. In addition, Indiana is pursuing a complex process of increasing state Medicaid payments to some providers through state directed payments but the net effect, according to hospital groups, could be an actual reduction of nearly [...]

joe2025-10-08T11:42:46-04:00October 9, 2025|Medicaid|