Managed Care & Medicaid
Expert articles and analysis related to managed care & medicaid.
AI Summary — Last 7 Days
Medicaid managed care and VBC stakeholders are facing a sharper federal-state implementation clash as 24–26 states sued the Trump administration over CMS’ Medicaid work requirements rule, with medical frailty standards—especially for people with HIV and other complex conditions—emerging as a key operational and legal fault line for eligibility, care management, and risk-bearing plans (Healthcare Dive). At the same time, CMS is tightening Medicaid fiscal oversight through revised 1115 budget neutrality expectations focused on prospective spending, while CBO’s updated post-reconciliation projections point to lower Medicaid enrollment and federal spending over the decade—raising pressure on states, MCOs, and providers to manage churn, documentation, and high-need populations under constrained funding (KFF).
Related Articles
Medical Frailty and Medicaid Work Requirements: Challenges for People with HIV
This analysis examines Medicaid work requirements and the implementation of medical frailty exclusions for people with HIV in light of CMS's implementing regulation.
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CBO’s latest projections of Medicaid spending and enrollment from February 2026 show how enrollment and spending are expected to change over the next decade, accounting for the historic policy changes...
States sue Trump administration over Medicaid work requirements rule
Twenty-six states are seeking to overturn some of the regulation released by the CMS this month that outlined Medicaid work requirements — and asking the court to pause implementation for the time bei...
Preparing for Medicaid Compliance & Fraud Enforcement
CMS Revises Budget Neutrality Expectations For Medicaid 1115 Demonstrations To Focus On Prospective Spending - open minds
CMS Revises Budget Neutrality Expectations For Medicaid 1115 Demonstrations To Focus On Prospective Spending open minds
HHS freezes New York’s Medicaid fraud unit funds
HHS freezes New York’s Medicaid fraud unit funds Modern Healthcare News
Fact Sheet: Extending Medicaid Section 1115 Policies to Improve Health for Medicare and Medicaid Beneficiaries
Fact Sheet: Extending Medicaid Section 1115 Policies to Improve Health for Medicare and Medicaid Beneficiaries Milbank Memorial Fund
Attorney General Liz Murrill Announces Medicaid Fraud Bust, New Division, and $73 million in Ordered Restitution - Office of Inspector General (.gov)
Attorney General Liz Murrill Announces Medicaid Fraud Bust, New Division, and $73 million in Ordered Restitution Office of Inspector General (.gov)
Trump administration withholds funds from New York's Medicaid fraud unit
Trump administration withholds funds from New York's Medicaid fraud unit Fierce Healthcare
Medicaid work requirement lawsuit targets CMS exemption rules
A coalition of more than 20 states filed suit to vacate key parts of recent regulations implementing the Medicaid work requirement, arguing that CMS overstepped its bounds. Litigation filed in the U.S...