Medicaid is a lifeline for millions of Americans—and one of the most operationally complex programs in government. State agencies and managed care organizations oversee eligibility determinations, claims adjudication, provider enrollment, and benefit coordination on an enormous scale. As budget pressures mount and oversight intensifies, ensuring...
As states begin outlining fiscal year (FY) 2027 Medicaid budgets, many programs are confronting a tighter and less predictable financial environment. State revenue growth has cooled, healthcare costs remain elevated, and federal policy changes enacted through the 2025 budget reconciliation law have reshaped how funding...
Medicaid, the largest public health insurance program in the United States, is under scrutiny, not for its mission, but for its costs. What started as a vital safety net has grown into a massive budget line item for nearly every state. With Medicaid now accounting...
With federal budget cuts threatening Medicaid funding, states are grappling with how to ensure millions of low-income residents continue to receive essential healthcare. Rising medical costs, increasing enrollment, and shifting policies have made it imperative for states to adopt new strategies to sustain their Medicaid...
Over the last three decades, Medi-Cal, California's Medicaid program, has undergone considerable changes and expansion. By 2016, the program provided coverage to more than one in three Californians, and as of January 2024, eligibility has been expanded to include all residents with incomes below certain...
Since its passage in 1965, the Medicaid program has expanded to become the single largest payer for health care in the United States, costing $671.2 billion in 2020. Because of spikes in enrollment from the pandemic and the present administration's priorities, spending is only projected...
Syrtis Solutions publishes a monthly Medicaid news roundup to help you stay up-to-date. The monthly summary highlights developments, analysis, and legislation that relates to Medicaid program integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Below is a list...
Syrtis Solutions sends out a monthly Medicaid news roundup to help you stay up-to-date. The monthly recap highlights developments, analysis, and legislation that relates to Medicaid integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Below is a list...
In January 2020, the Department of Health and Human Services declared COVID-19 a public health emergency. Since then, the PHE has been renewed nine times, but it is scheduled to expire in August unless it is extended again. Its end will have a major effect...