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

• Indiana To Exclude Long-Stay Nursing Home Residents From Medicaid Managed Care Starting July 1, 2027
• Medicaid Foster Care Enrollment Updates, 2022-2024: An OPEN MINDS Market Intelligence Report
• Pennsylvania Replaces $10,000 Lifetime Assistive Technology Cap With $3,000 Annual Limit In I/DD Waivers
• California Reports Progress On 167 Developmental Service Reforms Focused On Access, Equity, Workforce & Accountability
• Memorandum Of Opinion In UnitedHealthcare Of Pennsylvania, Inc. v. Department Of Human Services
• CMS Center For Program Integrity Crushing Fraud: Annual Report 2025 January 1 – December 31, 2025
• CMS Request For Information (RFI) Related To Comprehensive Regulations To Uncover Suspicious Healthcare (CRUSH)
• TenderHeart Advances Value‑Based Durable Medical Equipment Models Aligned With CMS Priorities To Reduce Fraud, Waste & Abuse
• The Next Generation Of Managed Care: Integrating Health & Social Care For Vulnerable Populations – A Discussion With Nestor Plana
• Arkansas DHS I/DD Supported Living Rates 19% Below Modeled Payment Rates, Milliman Analysis Finds
• Ohio Advances Statewide MyCare Expansion With Phase 2 FIDE-SNP Rollout
• U.S. I/DD Spending Reached $105 Billion In 2023, Driven By Medicaid Growth
• State Medicaid Fraud Control Units Recovered $4.64 For Every $1 Spent On Investigations In Fiscal Year 2025
• Florida Health Plan Sunshine Health Awards $100,000 In Child Care & Transportation Grants To Support Workforce Access
• Wellpoint Invests More Than $2 Million To Strengthen Community-Based Care Across Arizona

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

• Nevada Medicaid Issues Notices Of Intent To Award CO D-SNP Contracts To Five Health Plans
• CMS Unveils ASPIRE Pediatric Whole-Person Care Model For High-Risk Youth, Limited To Five States
• Louisiana Department Of Health Ends Medicaid Contract With UnitedHealthcare
• OIG Finds Nursing Homes Inappropriately Diagnosed Residents With Schizophrenia To Mask Misuse Of Antipsychotic Drugs
• Nebraska Audit Identifies Billing Irregularities And Potential Fraud In Medicaid Personal Care Program

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