Latest
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Medicaid Managed Care: The Big Five in Q2 2026
The “Big Five” have announced their results for the calendar quarter ending June 30. They are, of course, the five publicly-traded companies with the largest presence in the Medicaid managed care market, together accounting for about half of all Medicaid enrollees: Centene Corporation, CVS Health/Aetna, Elevance Health, Molina Healthcare, and UnitedHealth Group. The Medicaid market…
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Weaponizing Fraud Against Medicaid in California and Minnesota: Another Quarter, Another Round of Deferrals
At a July 21 press conference, CMS Administrator Mehmet Oz announced that his agency was deferring payment of $1.1 billion in federal Medicaid matching funds to California and Minnesota “pending review of high-risk claims in crackdown on fraud.” The amount of the California deferral was $867.5 million; the Minnesota deferral, $199.0 million. CMS has previously taken…
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Revalidation of ‘High-Risk’ Medicaid Providers: Early Lessons from Minnesota
On April 23, the CMS Administrator, Dr. Mehmet Oz, issued a letter to State Medicaid Directors “formally asking that your state develop and submit a comprehensive two-year provider revalidation (PR) strategy….” This SMD is not posted on Medicaid.gov with all the other SMDs, but you can view it on the Fox News website. The state…
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Medicaid Work Reporting Requirements: States Ask a Federal Court to Protect Medically Frail Individuals from CMS Overreach
On June 3, CMS issued an Interim Final Rule (IFR) misinterpreting the work reporting requirements enacted last July in H.R. 1. The H.R. 1 provisions were bad enough, but as my colleague Leo Cuello has explained, the IFR imposes policies on states and individuals that the Congress did not enact. Most notably, the IFR makes…
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The Administration Weaponizes Fraud Against Medicaid: HHS OIG Hammers Hawaii
On May 13, Vice President Vance, the chair of the White House Task Force to Eliminate Fraud, held a press conference. He announced the deferral of $1.3 billion in federal Medicaid matching payments owed to California, which received considerable attention. He also announced that the HHS Inspector General had by letter that day warned state…
