Medicaid

The Medicaid program is a state and federally funded public health insurance program for low-income individuals, including older adults, individuals with disabilities, children, pregnant women, and those in need of home health or long-term care services. For health and human service provider organizations operating in the Medicaid space, there are new opportunities for serving this complex consumer population, while also navigating challenges related to changes to state-specific Medicaid programs, health plans and enrolment, and new rules.

Latest Resources

• Minnesota Medicaid Disenrolls 61% Of Provider Organizations Delivering Services At High Risk Of Fraud, Most For Incomplete Paperwork
• CMS Proposes Narrow Medical Frailty Definition For Medicaid Work Requirement Exemptions
• North Carolina Healthy Opportunities Pilots Reduced Medicaid Costs By $164 PMPM & Improved Social Outcomes
• North Carolina Healthy Opportunities Pilot Evaluation One-Pager
• Interim Final Rule: Medicaid Program; Community Engagement Requirement For Certain Individuals
• Medicaid Expansion Associated With Reductions In Mortality Among Young Adults With Kidney Failure
• SAMHSA Selects 10 More States To Join The CCBHC Medicaid Demonstration
• North Carolina Medicaid Puts New Restrictions On Autism Treatment
• North Carolina DHHS Draft Changes To Clinical Coverage Policy (CCP) 8F for Research-Based Behavioral Health Treatment (RB-BHT) For Autism Spectrum Disorder
• North Carolina House Bill 696: An Act Making Various Changes To The Medicaid Program & Other Changes Related To Health & Human Services
• Higher Medicaid Reimbursement Linked To Better Nursing Home Quality Ratings
• PacificSource To Exit ACA Market & Pull Out Of Montana Entirely
• Ohio Medicaid Announces New Prior Authorization Standards To Strengthen Oversight Of Behavioral Health Services
• Less Than 15% Of Medicaid Emergency Department Visits For Behavioral Health Followed By A Primary Care Visit To Address The Concern
• CMS Proposes New Limits On Medicaid State-Directed Payments, Projects $775 Billion In Savings Over 10 Years

Nevada Medicaid Issues Notices Of Intent To Award CO D-SNP Contracts To Five Health Plans

Nevada Medicaid has issued notices of intent to award contracts to five health plans for its Coordination Only (CO) Dual Eligible Special Needs Plans (D-SNP) program. The selected organizations are United/Sierra Health, Centene/WellCare, Elevance/HMO Colorado-HMO Nevada, CVS/Aetna, and Prominence Health Plan. Contract negotiations are currently underway, with implementation expected to begin January 1, 2027. A CO D-SNP is a type of Medicare Advantage (MA) Plan, designed for dual eligibles, that coordinates care between Medicare and… Read

• 10 New States Selected To Join CCBHC Medicaid Demonstration Program
• Medicaid Program; Medicaid Managed Care State Directed Payments & Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments
• Arkansas Medicaid Waiver Renewal Request Would Reinstate Work Requirements For 212,000 ARHOME Beneficiaries
• Georgia Governor Limits I/DD Waiver Expansion To 100 Slots Despite Legislative Funding For 900
• Mind The Gap

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