All articles tagged with #medicaid
Massachusetts and several other states have halted or reduced Medicaid coverage for GLP-1 weight-loss medications, leaving low-income patients who started treatment unable to continue. Coverage had been about a third of states in mid-2025, but by 2026 the share fell to roughly one in five, underscoring widening disparities in access to obesity therapies due to high costs.
CMS is deferring more than $1 billion in federal Medicaid payments to California and Minnesota while it reviews high‑risk claims for possible fraud. Newsom labels the move political and asks for proof, pointing to alleged data requests already answered and tying the action to attacks on Xavier Becerra. The deferrals amount to about $867 million for California and $200 million for Minnesota, with California’s in‑home services spending rising 24% over two federal years (versus an 12% national average).
CMS announced deferrals totaling more than $1 billion in Medicaid funding to California ($867 million) and Minnesota ($199 million) due to suspected fraud, the latest move in a broader crackdown that has deferred over $2.5 billion this year. The withheld funds could be released if the states prove the claims were legitimate, with emphasis on high-risk in-home care services. Minnesota cites provider disenrollments after audits, while California argues the action saves taxpayers; critics call it politically driven and lacking transparency into how deferral amounts are calculated. This is Minnesota’s third deferral and accompanies a broader fraud-fighting push ahead of the 2026 midterms.
The Trump administration’s Health and Human Services agency announced withholding about $867.5 million in California’s Medicaid payments and $199 million for Minnesota over suspected fraud, focused on in‑home health services and eligibility tied to immigration status. CMS cited California’s rapid growth in in‑home care spending and ongoing fraud concerns, while California officials denounced the move as political theater but pledged cooperation to verify services. The action follows earlier deferrals of Medicaid funds to California and fits a broader federal crackdown on suspected Medicaid fraud.
President Trump defends 50% tariffs on most Canadian goods, arguing Canada has long treated the U.S. unfairly and that Canada would struggle without American support; the levies, set to take effect in 30 days, cover a broad range (including wine, hockey sticks, cement) and even some USMCA-protected items, with negotiations expected to intensify. The live updates also note the administration pausing over $1 billion in Medicaid funding to California and Minnesota amid fraud concerns, ongoing Iran-war funding debates, and other political developments such as a Jay Clayton nomination and defense spending talks.
The administration paused more than $1 billion in Medicaid funding to California and Minnesota over suspected fraud and noncompliance, using AI and advanced analytics to flag suspicious payments; California faces roughly $867 million and Minnesota about $200 million in the freeze, following an earlier $243 million pause in Minnesota. The move comes as the HHS expands authority to exclude bad actors from federal programs and states face pressure to document claims, with Minnesota having previously sued over withholding funds.
Nebraska, the first state to implement the Trump administration’s Medicaid work requirements, is seeing extreme mass confusion as thousands of participants await word on whether their coverage will continue, with residents reporting difficulty obtaining clear guidance and deadlines amid chaotic information flows.
Michael Hiltzik argues that Republican policy moves, led by RFK Jr., undermine child health by first rolling back vaccine recommendations and enabling misinformation, then cutting nutrition programs like WIC and SNAP, and tightening Medicaid/ACA access. The result is higher disease risk (measles outbreaks), increased iron-deficiency anemia, and fewer children with insurance, all framed as fiscal discipline rather than anti-child policy. The piece also notes reduced state reporting on vaccination rates, which could mask the full impact, and contrasts these policy choices with rhetoric about family values.
MassHealth will stop covering GLP-1 weight‑loss medications starting Friday, affecting about 22,000 Medicaid beneficiaries (including roughly 2,500 children). Coverage remains for diabetes or obesity with certain medical conditions. The move is projected to save about $15 million but risks weight regain and worsened health for those losing access, leaving some to go without treatment, pay out of pocket, or seek cheaper alternatives; under‑21 coverage remains only with medical necessity.
North Carolina lawmakers advanced a record $34 billion state budget in the first round of votes, including raises for state workers and teachers, one-time pension boosts, and phased personal income tax cuts that could drop to as low as 2.49% by 2034. The plan also raises taxes on data centers and sports betting companies, funds Hurricane Helene relief and reserves, expands Medicaid oversight while trimming some health-department positions, and boosts transportation spending, with final passage and Gov. Stein’s signature expected later this week.
Nearly half of U.S. states filed a multi-state lawsuit against the federal government over Medicaid work requirements, arguing the rules exceed federal authority and could reduce coverage; the suit challenges CMS’s authority to condition Medicaid eligibility on work or community engagement, highlighting a broader political fight over tying welfare programs to work requirements.
Four Louisville-area defendants, including a physician and a nurse, are among those charged in a nationwide, multi-case federal health care fraud crackdown—the 2026 National Health Care Fraud Takedown that charged 455 people with over $6.5 billion in false claims. In Louisville, Angela Renfro and Briana Gosnell (KLF Company LLC and Freedom Center LLC) allegedly submitted more than $11 million in Medicaid claims for peer-support and psychoeducation services using providers’ NPI numbers without authorization. Dr. Christian Berkhahn is charged with conspiracy to obtain controlled substances and health care fraud for prescriptions written under others' names; nurse Meredith Douglass is accused of stealing medications and falsifying records to obtain fentanyl and other Schedule II drugs. A fourth defendant, Einar Serrano Reyes, allegedly used a Louisville location to bill Medicare for over $450,000 for services never provided. Prosecutors say the schemes diverted funds from programs for vulnerable patients; defendants are presumed innocent unless proven guilty.
As part of the DOJ's 2026 National Health Care Fraud Takedown, four Kentucky cases accuse Louisville residents and local companies of defrauding Medicaid, misusing provider identifiers, and submitting fraudulent claims totaling more than $11 million for peer-support services; a Louisville physician allegedly fraudulently procured controlled substances using others’ names; a nurse is charged with stealing medications and falsifying records; and a Florida man is accused of billing Medicare for services never provided. The nationwide crackdown charged 455 defendants with more than $6.5 billion in false claims.
The Department of Justice announced a nationwide healthcare fraud takedown involving $6.5 billion in false claims, charging 455 defendants across 56 U.S. attorneys' offices in 45 states and territories. A New Mexico non-emergency medical transportation provider, SafeWay Medical Transportation, allegedly billed Medicaid for trips that did not occur, with inflated mileage and duplicate trips. The DOJ seeks more than $2 million in restitution and proceeds tied to money laundering, with officials pledging to safeguard taxpayer-funded health programs.
The Justice Department announced the 2026 National Health Care Fraud Takedown, charging 455 defendants—including about 90 doctors and other licensed professionals—for alleged health care fraud and opioid schemes totaling over $6.5 billion in false claims with patient harm; the action spanned 56 federal districts and 45 states/territories, with unprecedented international cooperation. The effort leveraged advanced data analytics, led to thousands of provider suspensions and civil actions, and resulted in asset seizures of over $182 million, illustrating a whole-of-government approach to stop fraud before payments are made and to hold bad actors accountable across medical offices and corporate boards alike.