Author Archives: Maddie McCarthy
MD Medicaid Managed Care Enrollment Is Down 9.9%, 2024 Data
Medicaid managed care enrollment in Maryland was down 9.9% to 1.3 million in at year-end 2024, compared to year-end 2023, after decreasing 2.2% in 2023, and increasing 5.8% in 2022, 8.8% in 2021, and 11.4% in 2020. Enrollment data can be found here.
WA Medicaid Managed Care Enrollment is Down 4.5%, 2024 Data
Medicaid managed care enrollment in Washington is down 4.5% to 1.7 million at year-end 2024, compared to year-end 2023, after decreasing 11.3% in 2023 and rising 7.2% in 2022. Enrollment totals were adjusted to no longer include various tribal and county organizations with Primary Care Case Management (PCCM) lives. Enrollment data can be found here.
NM Governor’s Budget Recommendation, FY 2026
NM Governor’s Executive Budget Recommendation, FY 2026
Additional budget documents can be found here.
Federal Judge Rules Trump Administration Failed to Comply with Mandate to Lift Funding Freeze
The New York Times reported on February 11, 2025, that Federal Judge John J. McConnell, Jr. of the U.S. District Court for the District of Rhode Island ruled that the Trump administration failed to comply with his January 29 order to lift the freeze the president put on federal funding. After the most recent ruling, the president’s lawyers filed an appeal with the U.S. Court of Appeals for the First Circuit seeking to pause the judge’s initial order to keep federal funds flowing while the case is being considered.
CO NEMT Provider Allowed to Resume Services Amid Fraud Investigation
Denver 7 ABC reported on February 10, 2025, that a judge has ruled that MedRide, one of Colorado’s non-emergency medical transport (NEMT) providers, is allowed to continue providing services while the state Department of Health Care Policy and Financing (HCPF) investigates the contractor over concerns it is part of a Medicaid fraud scheme. HCPF previously issued a corrective action plan to MedRide in November 2024, but claims the NEMT provider did not come into compliance with regulations, leading the agency to suspend MedRide’s contract beginning February 7, 2025. MedRide gained a temporary restraining order against the agency and is working with HCPF to re-credential and reinstate themselves in the Medicaid program.
HI Governor’s Proposed Biennium Budget, 2025-27
1. Hawaii Proposed Executive Biennium Budget, Budget in Brief, 2025-27
Additional executive budget documents can be accessed here.
Improper HHS, CMS Payments Total $88.5 Billion in 2024
Modern Healthcare reported on February 7, 2025, that improper payments in the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) reached $88.5 billion in 2024. These payments accounted for 5.6 percent of all outlays, down from 7 percent in 2023. Improper payments most often involve missing or insufficient documentation for claims, and can also include errors and fraud. Improper payments as a percentage of program spending decreased in Medicaid and Medicare Advantage, increased in Medicare fee-for-service, and and stayed flat in Medicare part D between 2023 and 2024.
OH Medicaid Managed Care Enrollment is Down 6.7%, Nov-24 Data
Medicaid managed care enrollment in Ohio is down 6.7% in November 2024, compared to year-end 2023, after decreasing 4.3% in 2023, increasing 0.9% in 2022 and 7.5% in 2021. In February 2023, new contracts were enacted that included a large shift from fee-for-service to managed care and the entrance of AmeriHealth Caritas and Humana into the market.
Starting in 2020, Ohio changed Medicaid managed care enrollment data sources. Year-end 2019 enrollment and subsequent months in 2020 use the updated data source. Historical data is published on the HMAIS website. The new enrollment data source can be found here.
Health Insurers Seek Changes to CY 2026 Medicare Advantage, Part D Proposed Rule
Modern Healthcare reported on February 10, 2025, that health insurers and trade associations are calling on the Trump administration to change provisions of the Contract Year (CY) 2026 Medicare Advantage (MA) and Part D proposed rule, which was released under the Biden administration. In the public comments on the proposed rule, many organizations expressed concerns over the potential regulation and want the Centers for Medicare & Medicaid Services (CMS) to drop the proposal to cover anti-obesity medication for Medicare and Medicaid beneficiaries, delay or abandon a proposal that would require timely updates to provider directories, and bring back the Value-based Insurance Design model, which is set to sunset at the end of 2025. Insurers are also seeking to scale back or eliminate the use of the Health Equity Index in the MA Star Ratings Program.
ID Medicaid Expansion Funding Created $1.5 Billion in Economic Output in Fiscal 2025, Analysis Finds
The Idaho Capital Sun reported on February 10, 2025, that the federal funding the state received due to Medicaid expansion generated $1.5 billion in “net additional gross activity” in fiscal 2025, according to an analysis by an economist with the University of Idaho. The economic output includes about $897.6 million in gross state product, $700 million in job compensation, and increased the state’s tax revenues by almost $47 million. The report also claims that repealing expansion and losing the additional federal funding would cost Idaho taxpayers more money through increased healthcare costs and private insurance premiums. Medicaid expansion covers approximately 89,300 Idahoans, and the Idaho Department of Health and Welfare estimates the program will cost $1.36 billion in fiscal 2026. State lawmakers have introduced legislation to either “reform or repeal”, or outright repeal the expansion.