Medicaid - Health Care Compliance Brief

Centene looks beyond Medicaid redeterminations

Healthcare Dive

APRIL 26, 2024

The nation's largest Medicaid insurer expects to return to normal operations this year, though redeterminations continue to dog Centene through a mismatch between rates and acuity.

Medicaid

Medicaid Medicaid

Centene beats investor expectations despite Medicaid headwinds

Healthcare Dive

OCTOBER 26, 2024

Like other payers, Centene flagged a mismatch between patient acuity and payment rates in Medicaid. But the insurer said a diversified portfolio helped it navigate challenges in the third quarter.

Medicaid

Medicaid Medicaid

Physician venture investor talks telehealth, digital therapeutics, Medicaid tech

Healthcare It News

MARCH 18, 2022

Norden is particularly passionate about funding companies focused on the Medicaid population – a traditionally tricky and often ignored area. You are passionate about funding companies focused on the Medicaid population – a traditionally tricky and often ignored area. What's happening in this area of digital health?

Medicaid

Medicaid Medicaid COVID-19 Telemedicine

UnitedHealthcare, Neighborhood Health Plan win Rhode Island Medicaid contracts

Healthcare Dive

JULY 18, 2024

The state’s managed care organizations handle health benefits for 90% of its Medicaid beneficiaries each year.

Medicaid

Medicaid Medicaid

States using unwinding lessons to improve Medicaid: KFF

Healthcare Dive

JUNE 21, 2024

Medicaid unwinding has been less than perfect. However, the process has helped states expand Medicaid eligibility to more people and streamline enrollment and outreach, according to a new survey.

Medicaid

Medicaid Medicaid

End of Medicaid continuous coverage may leave millions of children uninsured, analysis finds

Healthcare Dive

APRIL 19, 2022

Children are at highest risk in Texas, Florida and Georgia when states resume checking Medicaid eligibility after the public health emergency expires, Georgetown University researchers found.

Medicaid

Medicaid Medicaid Public Health

State Medicaid directors concerned about program’s stability: KFF

Healthcare Dive

OCTOBER 24, 2024

The presidential election, loss of higher federal funding, inflationary pressures and other challenges are leaving state regulators uncertain about Medicaid’s “new normal.”

Medicaid

Medicaid Medicaid

1 in 8 enrollees exited Medicaid during redeterminations in 4 Southern states: study

Healthcare Dive

JULY 3, 2024

The survey, which included low-income people in Arkansas, Kentucky, Louisiana and Texas, found about half of those who were no longer enrolled in Medicaid became uninsured.

Medicaid

Medicaid Medicaid

Upcoming Medicaid redeterminations could hamper hospitals, payers

Healthcare Dive

JANUARY 26, 2023

Medicaid eligibility checks beginning in April will likely curb hospital revenue and enrollment growth for payers, Moody's Investors Service said in a report.

Medicaid

Medicaid Medicaid Hospitals

Medicaid overtakes Medicare Advantage as health insurers’ bogeyman in Q2

Healthcare Dive

AUGUST 15, 2024

Despite challenges in Medicaid and MA, major insurers still posted large earnings in the second quarter — many helped by growing health services divisions.

Medicaid

Medicaid Medicaid Health Insurance Medicare

MACPAC calls for greater transparency amid steep rise in Medicaid directed payments

Healthcare Dive

NOVEMBER 5, 2024

Dramatic growth in an opaque Medicaid funding mechanism is exacerbating concerns about the program’s fiscal integrity — while spurring financial gains for the hospital industry.

Medicaid

Medicaid Medicaid Hospitals

Medicaid enrollees largely unaware of upcoming redeterminations, survey finds

Healthcare Dive

FEBRUARY 21, 2023

About 64% of adults in a Medicaid-enrolled family said they did not know they may lose coverage once pandemic-era policy ends and eligibility checks resume on April 1, a survey from the Robert Wood Johnson Foundation found.

Medicaid

Medicaid Medicaid

Prison Health Care is Broken Under the Medicaid Inmate Exclusion Policy

Bill of Health

JANUARY 26, 2022

As a first step to protecting incarcerated individuals’ right to health, Congress should repeal the Medicaid Inmate Exclusion Policy (MIEP). The MIEP, established in 1965, prohibits Medicaid from covering incarcerated individuals, despite any prior eligibility. Specifically, states that have expanded Medicaid could save $4.7

Medicaid

Medicaid Medicaid COVID-19 Public Health

One Medical’s innovation chief on Amazon, Medicaid and more

Healthcare Dive

NOVEMBER 18, 2022

Rushika Fernandopulle discussed how remote work trends are affecting the business, One Medical’s ongoing shift toward risk and its interest in Medicaid.

Medicaid

Medicaid Medicaid

State Medicaid spending fell below pre-pandemic levels during continuous enrollment

Healthcare Dive

JUNE 21, 2023

An analysis by KFF found state spending on Medicaid fell during the COVID-19 pandemic even as enrollment soared. But spending will likely increase as the federal government begins to pare back its increased contribution.

Medicaid

Medicaid Medicaid COVID-19 Governance

Elevance lowers guidance on ‘unprecedented’ Medicaid challenges

Healthcare Dive

OCTOBER 17, 2024

Executives said the increased costs pressuring its Medicaid business would improve after states updated payment rates to better match member acuity.

Medicaid

Medicaid Medicaid

Could Medicaid redeterminations cause short-term health plan signups to spike?

Healthcare Dive

FEBRUARY 21, 2023

Short-term plan operators will likely ramp up their marketing in April to nab new consumers from the Medicaid churn, but health policy experts largely aren't concerned.

Medicaid

Medicaid Medicaid

Medicaid redeterminations will restart Saturday. Here’s what we know

Healthcare Dive

MARCH 31, 2023

States can begin disenrolling ineligible beneficiaries from Medicaid on April 1, in an event the CMS has called the biggest health coverage transition since the first ACA open enrollment.

Medicaid

Medicaid Medicaid ACA

MACPAC wants Congress to force states to disclose Medicaid financing streams

Healthcare Dive

JUNE 12, 2024

The influential advisory group has been lobbying the federal government to collect more detailed information on how states loop providers into funding Medicaid for almost a decade.

Medicaid

Medicaid Medicaid Governance

Maven raises $90M, fueling push into Medicaid, CMO says

Healthcare Dive

NOVEMBER 15, 2022

Roadblocks for the startup inclulde shifting requirements state-by-state and historically low margins in Medicaid.

Medicaid

Medicaid Medicaid

CMS requires 30 states to pause Medicaid disenrollments after systems error

Healthcare Dive

SEPTEMBER 22, 2023

Nearly 500,000 people will regain Medicaid or Children’s Health Insurance Program coverage after being improperly removed from the rolls during redeterminations, according to the HHS.

Medicaid

Medicaid Medicaid Health Insurance

CMS targets Medicaid payment transparency, wait times in new proposed rules

Healthcare Dive

APRIL 28, 2023

The agency wants to create maximum waiting times for certain appointments in addition to requiring stronger quality monitoring and reporting standards for Medicaid and CHIP managed care plans.

Medicaid

Medicaid Medicaid

Medicaid stakeholders warn of hurdles for redeterminations process

Healthcare Dive

JANUARY 24, 2022

Resuming the process of determining whether people are still eligible for Medicaid may sound easy, but stakeholders caution it's much more nuanced than flipping a switch, and poor planning risks massive enrollment losses.

Medicaid

Medicaid Medicaid

Molina expects contract wins to offset Medicaid losses

Healthcare Dive

FEBRUARY 9, 2023

million Medicaid members when pandemic protections end and states to resume eligibility checks. The forecast comes as its competitor, Centene, expects to lose as many as 2.2

Medicaid

Medicaid Medicaid

Majority of states plan to take their time with Medicaid redeterminations

Healthcare Dive

MARCH 16, 2023

Some states are proposing to unwind Medicaid coverage more slowly, while others are moving more quickly to focus on reducing budgetary costs, according to a survey from the Kaiser Family Foundation.

Medicaid

Medicaid Medicaid

Molina, Elevance nab Iowa Medicaid contracts on heels of California win

Healthcare Dive

SEPTEMBER 1, 2022

Iowa will soon have three health insurers to manage its $7 billion Medicaid program.

Medicaid

Medicaid Medicaid Health Insurance

Who doesn’t text in 2022? Most state Medicaid programs

Healthcare It News

APRIL 15, 2022

Postal Service and an online account this summer to connect with Medicaid enrollees about the expected end of the covid public health emergency, which will put many recipients at risk of losing their coverage. State Medicaid agencies for months have been preparing for the end of the public health emergency.

Medicaid

Medicaid Medicaid US Department of Health and Human Services COVID-19

Over half a million disenrolled amid Medicaid redeterminations so far

Healthcare Dive

JUNE 1, 2023

A KFF analysis of 11 states found many of the people who have already been removed from the Medicaid program were disenrolled for procedural reasons.

Medicaid

Medicaid Medicaid

Rollback of pandemic protections to test Medicaid managed care organizations

Healthcare Dive

MAY 26, 2022

At question is whether insurers will be able to shift Medicaid members who lose coverage to subsidized marketplace plans.

Medicaid

Medicaid Medicaid

CMS finalizes rule to cut Medicaid DSH payments for some hospitals

Healthcare Dive

FEBRUARY 21, 2024

Under the new definition, hospitals can only receive disproportionate share hospital Medicaid reimbursements for beneficiaries who are primarily insured by the safety-net program.

Medicaid

Medicaid Medicaid Hospitals

Move over, Medicare Advantage — UnitedHealth, Centene flag higher Medicaid utilization concerns

Healthcare Dive

MAY 30, 2024

Worries about higher-than-expected medical spending have reached Medicaid, as redeterminations spark turbulence in the program.

Medicaid

Medicaid Medicaid Medicare Medicare

18M projected to lose Medicaid coverage at end of COVID-19 emergency

Healthcare Dive

DECEMBER 6, 2022

Many people who are currently enrolled in Medicaid will transition to other coverage, but 3.8 million people will completely lose insurance, according to the Robert Wood Johnson Foundation.

Medicaid

Medicaid Medicaid COVID-19

Molina, Elevance, Centene win big with Medicaid contracts in California

Healthcare Dive

AUGUST 26, 2022

The managed care organizations already held Medicaid contracts with the state, but the overhaul in counties served is causing one payer to consider appealing the proposed contracts.

Medicaid

Medicaid Medicaid

North Carolina becomes 40th state to expand Medicaid

Healthcare Dive

MARCH 27, 2023

The expansion puts an end to a decade-plus political battle in North Carolina over Medicaid and illustrates mounting support for the program.

Medicaid

Medicaid Medicaid

California revises Medicaid contract awards, adding 2 insurers

Healthcare Dive

JANUARY 4, 2023

Five insurers will now receive lucrative contracts to provide managed care services, starting in 2024, in the country's largest Medicaid market.

Medicaid

Medicaid Medicaid

Majority of Medicaid enrollees satisfied with plans, despite flaws, survey finds

Healthcare Dive

NOVEMBER 29, 2023

Medicaid enrollees are more likely to understand and be satisfied with their plans, despite reporting poorer health outcomes, according to a new report from KFF.

Medicaid

Medicaid Medicaid Health Outcomes

Insurers may be padding Medicaid physician networks, study finds

Healthcare Dive

MAY 3, 2022

Some doctors listed in managed care provider network directories didn't file any Medicaid claims over the course of a year, according to new research published in Health Affairs.

Medicaid

Medicaid Medicaid Doctors

UHS and HCA could see financial boost from growth in state-directed payments for Medicaid services

Healthcare Dive

OCTOBER 16, 2024

Higher state-directed Medicaid payments in four states could boost HCA and UHS’ profitability in the near term, according to analysts.

Medicaid

Medicaid Medicaid

Molina loses Medicaid contract in Virginia

Healthcare Dive

MARCH 1, 2024

It’s the second recent Medicaid state loss for Molina, despite executives expressing confidence about the insurer’s ability to retain contracts.

Medicaid

Medicaid Medicaid

Government watchdog warns of Medicaid oversight gaps

Healthcare Dive

MARCH 18, 2024

The CMS doesn’t require states to report data on outcomes or care denials, and has made “delayed” progress on plans to analyze the information and make it public, according to the Government Accountability Office.

Governance

Governance Medicaid Medicaid

States’ varying approaches complicate effort to determine impact of Medicaid redeterminations

Healthcare Dive

JULY 13, 2023

Nearly two million people have been disenrolled from Medicaid to date, but it’s too early to get a full picture of redeterminations’ effect on vulnerable Americans, experts say.

Medicaid

Medicaid Medicaid

Prior authorization denials could limit access in Medicaid managed care, OIG reports

Healthcare Dive

JULY 20, 2023

Medicaid managed care organizations studied by the HHS’ Office of the Inspector General denied one out of every eight requests for prior authorization in 2019, and most states don’t regularly monitor whether denials are appropriate.

Medicaid

Medicaid Medicaid

More than 20M disenrolled amid Medicaid redeterminations

Healthcare Dive

APRIL 12, 2024

Overall, 31% of people with a completed renewal were removed from the safety-net insurance program, while 69% had their coverage renewed, according to KFF.

Medicaid

Medicaid Medicaid

CMS releases Medicaid payment flexibilities during Change cyberattack

Healthcare Dive

MARCH 18, 2024

The relief comes as 94% of hospitals reported financial impact from the outage, according to a survey from the American Hospital Association.

Medicaid

Medicaid Medicaid Hospitals

Centene looks beyond Medicaid redeterminations

Centene beats investor expectations despite Medicaid headwinds

Trending Sources

Physician venture investor talks telehealth, digital therapeutics, Medicaid tech

UnitedHealthcare, Neighborhood Health Plan win Rhode Island Medicaid contracts

States using unwinding lessons to improve Medicaid: KFF

End of Medicaid continuous coverage may leave millions of children uninsured, analysis finds

State Medicaid directors concerned about program’s stability: KFF

1 in 8 enrollees exited Medicaid during redeterminations in 4 Southern states: study

Upcoming Medicaid redeterminations could hamper hospitals, payers

Medicaid overtakes Medicare Advantage as health insurers’ bogeyman in Q2

MACPAC calls for greater transparency amid steep rise in Medicaid directed payments

Medicaid enrollees largely unaware of upcoming redeterminations, survey finds

Prison Health Care is Broken Under the Medicaid Inmate Exclusion Policy

One Medical’s innovation chief on Amazon, Medicaid and more

State Medicaid spending fell below pre-pandemic levels during continuous enrollment

Elevance lowers guidance on ‘unprecedented’ Medicaid challenges

Could Medicaid redeterminations cause short-term health plan signups to spike?

Medicaid redeterminations will restart Saturday. Here’s what we know

MACPAC wants Congress to force states to disclose Medicaid financing streams

Maven raises $90M, fueling push into Medicaid, CMO says

CMS requires 30 states to pause Medicaid disenrollments after systems error

CMS targets Medicaid payment transparency, wait times in new proposed rules

Medicaid stakeholders warn of hurdles for redeterminations process

Molina expects contract wins to offset Medicaid losses

Majority of states plan to take their time with Medicaid redeterminations

Molina, Elevance nab Iowa Medicaid contracts on heels of California win

Who doesn’t text in 2022? Most state Medicaid programs

Over half a million disenrolled amid Medicaid redeterminations so far

Rollback of pandemic protections to test Medicaid managed care organizations

CMS finalizes rule to cut Medicaid DSH payments for some hospitals

Move over, Medicare Advantage — UnitedHealth, Centene flag higher Medicaid utilization concerns

18M projected to lose Medicaid coverage at end of COVID-19 emergency

Molina, Elevance, Centene win big with Medicaid contracts in California

North Carolina becomes 40th state to expand Medicaid

California revises Medicaid contract awards, adding 2 insurers

Majority of Medicaid enrollees satisfied with plans, despite flaws, survey finds

Insurers may be padding Medicaid physician networks, study finds

UHS and HCA could see financial boost from growth in state-directed payments for Medicaid services

Molina loses Medicaid contract in Virginia

Government watchdog warns of Medicaid oversight gaps

States’ varying approaches complicate effort to determine impact of Medicaid redeterminations

Prior authorization denials could limit access in Medicaid managed care, OIG reports

More than 20M disenrolled amid Medicaid redeterminations

CMS releases Medicaid payment flexibilities during Change cyberattack

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