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The Centers for Medicare & Medicaid Services is hunting for Medicaid waste, fraud, and abuse in at least six Democratic-led states that expanded coverage to low-income and disabled immigrants without legal status, according to records obtained by KFF Health News and The Associated Press.
As states prepare to implement changes to Medicaid required by President Donald Trump’s recent tax-and-spending law, tribal leaders say they are concerned Native American enrollees could lose their coverage, despite exemptions made by Congress.
The Health and Human Services secretary is winding down nearly $500 million in mRNA research funding, citing false claims that the technology is ineffective against respiratory illnesses — and notching a victory for critics of the covid vaccines. And President Donald Trump is demanding drugmakers drop their prices, quickly, but it’s unclear how he could make them comply. Lauren Weber of The Washington Post, Sandhya Raman of CQ Roll Call, and Sarah Karlin-Smith of the Pink Sheet join KFF Health News’ Emmarie Huetteman to discuss these stories and more.
CNN pundit Scott Jennings said almost 5 million nondisabled Medicaid recipients "simply choose not to work" and "spend six hours a day socializing and watching television." But a recent analysis found only about 300,000 cited a lack of interest in working as the reason they were unemployed.
Lawmakers added a $50 billion program for rural health to President Donald Trump’s massive tax and spending package with promises it would help plug the hole left by Medicaid cuts. Rural hospital and clinic leaders worry the infusion won’t reach the right places.
President Donald Trump signed legislation that requires many Medicaid recipients to prove they’re working to qualify for health care coverage, allocating $200 million for states that expanded Medicaid to prepare systems to verify people’s eligibility. Georgia’s program, which has been expensive and difficult to administer, has had limited enrollment.
The No Surprises Act, which was signed in 2020 and took effect in 2022, was heralded as a landmark piece of legislation that would protect people who had health insurance from receiving surprise medical bills. And yet bills that take patients by surprise keep coming.
For-profit hospitals provide most inpatient physical therapy but tend to have worse readmission rates to general hospitals. Medicare doesn’t tell consumers about troubling inspections.
A proposed work requirement would make Medicaid expansion enrollees prove they’re working or meet other criteria. Most already work, but millions are expected to lose coverage if the provision passes, many from red tape. A Missouri mother who cares for her disabled son would probably be subject to the rule.
Dozens of health insurance companies pledged on Monday to improve prior authorization, a process often used to deny care. The announcement comes months after the killing of UnitedHealthcare executive Brian Thompson, whose death in December sparked widespread criticism about insurance denials.
Republican proposals to tighten the use of special taxes to fund Medicaid programs could deprive states of billions of dollars for safety net health care. In California, any such limit would come on top of Medicaid cuts proposed by California Democrats in response to a $12 billion state deficit.
The vast majority of improper payments stem from documentation mistakes and do not fit the definition of waste, fraud, or abuse. They also typically stem from health care providers’ actions, not beneficiaries’ abuse.
This fall, the U.S. Government Accountability Office expects to release a report on how much it costs to run Georgia Pathways to Coverage — the country’s only active Medicaid work requirement program — as other states and Congress consider similar programs.
Breakups between health providers and Advantage plans are increasingly common. The Centers for Medicare & Medicaid Services has allowed whole groups of patients to leave their plans.
When Congress returns next week, it will be writing a budget reconciliation bill that’s expected to cut taxes but also make deep cuts to Medicaid. But at least some Republicans are concerned about cutting a program that aids so many of their constituents. Sarah Karlin-Smith of the Pink Sheet, Tami Luhby of CNN, and Alice Miranda Ollstein of Politico join KFF Health News’ Julie Rovner to discuss this story and more. Also, Rovner interviews KFF Health News’ Rae Ellen Bichell about her story on how care for transgender minors is changing in Colorado.
These fixers, officially known as caseworkers, unraveled complex and arcane health insurance rules to solve people’s coverage issues. They worked in a little-known federal department with which most consumers never interact — until they need help.
Health care price transparency is one of the few bipartisan issues in Washington, D.C. But much of the information that hospitals and health plans have made available to the public is not helpful to patients, and there’s no conclusive evidence yet that it’s lowering costs or increasing competition.
It’s the Trump administration vs. the federal courts, as the Department of Government Efficiency continues to try to cancel federal contracts and programs and fire workers. But in the haste to cut things, jobs and programs are being eliminated even if they align with the new administration’s goal to “Make America Healthy Again.” Jessie Hellmann of CQ Roll Call, Sarah Karlin-Smith of the Pink Sheet, and Rachel Roubein of The Washington Post join KFF Health News’ Julie Rovner to discuss these stories and more.
Rep. Ro Khanna of California warned of Trump administration “cuts” to Medicare telehealth access hitting March 31. But if Medicare recipients lose telemedicine benefits that day, it will be because Congress failed to act.
The Senate Finance Committee questioned Mehmet Oz, President Donald Trump’s nominee to lead the Centers for Medicare & Medicaid Services. KFF Health News reporters discussed the biggest takeaways from the hearing.
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