Medicaid Programs
Expert articles and analysis related to medicaid programs.
AI Summary — Last 30 Days
Medicaid strategy is shifting toward tighter eligibility accountability and operational modernization: the H.R. 1 work requirement debate signals major coverage-continuity risk for Medi-Cal and other Medicaid programs, with downstream implications for VBC attribution, risk adjustment, uncompensated care, and population-health investment (CHCF on H.R. 1 work requirements). At the same time, CMS under the Trump administration is pushing interoperability and electronic prior authorization across federal programs, creating a near-term compliance burden but a longer-term opportunity for Medicaid MCOs, ACOs, and health systems to reduce administrative friction and better manage high-cost utilization (AHA comments on CMS prior authorization rule
Related Articles
Medicaid work requirement rule adds significant wrinkles to program eligibility criteria
For state agencies and potentially healthcare providers, CMS’s regulatory guidance on implementing the Medicaid work requirement imposes responsibilities that go beyond language seen in the underlying...
CMS releases interim final rule on work requirements in Medicaid
The Centers for Medicare & Medicaid Services has released an Interim Final Rule with Comment that gives work requirements for adults to obtain Medicaid coverage.Unless an applicant fits the criteria f...
UnitedHealthcare sued for alleged $100M Medicaid fraud scheme
Massachusetts has sued UnitedHealthcare Insurance Company, alleging the insurer defrauded the state's Medicaid program of at least $100 million by making older members appear sicker or more impaired t...
CMS Announces 80-Hour Medicaid Work Requirement Amid Home Care Concerns
CMS releases Medicaid work requirements guidance for states
The highly anticipated interim final rule weighs in on key issues for states hustling to operationalize work requirements before the 2027 deadline. But there’s still some gray area — and lots of criti...
Medicaid Managed Care State Directed Payments and FFS Targeted Medicaid Practitioner Payments Proposed Rule Summary
HFMA provides a detailed summary of the rule that includes proposals to implement the provisions of the “Working Families Tax Cut” legislation, which modify the limit on the total payment rate and oth...
A Closer Look at North Carolina’s Implementation of the 2025 Reconciliation Law Medicaid Provisions and Other Changes Amid Medicaid Budget Shortfalls
This policy watch provides initial insight into how North Carolina is preparing to implement certain Medicaid provisions of the 2025 reconciliation law and how other policy changes may affect coverage...
New CMS Proposed Rule Would Impose a Payment Limit on Additional State Directed Payments and Establish a Payment Limit for “Targeted” Medicaid Fee-for-Service Payments
Federal Medicaid Work Requirements: What States Should Know | Aurrera Health Group
The Medical Frailty Exemption from Medicaid Work Requirements: Key Issues to Watch for in Upcoming CMS Guidance
This brief describes early state plans to operationalize the medical frailty exemption for Medicaid work requirements and identifies key issues and questions states are facing, some of which may be an...