Blogging Live from AHLA: Medicaid Litigation Update – Challenges to Waivers

Reporting live from the American Health Lawyer’s Association 2018 Institute on Medicare and Medicaid Payment Issues in Baltimore, MD, we are back again. This time, we are reporting on a deeply comprehensive program on recent trends in Medicaid litigation led by Alan Dorn, Chief Counsel of HHS Region V in Chicago, and Felicia Y Sze, a partner of Rotenberg & Sze LLP in San Francisco.

The pair delivered a great program highlighting multiple growing areas of Medicaid litigation over the past year.… More

Blogging Live from AHLA: Enforcing the Medicaid Entitlement

My colleague Tom Barker and (my former boss) Professor Sara Rosenbaum just finished a series of back-to-back sessions on enforcing the Medicaid entitlement – the sessions were entertaining and engaging for all involved. We have written about this topic previously – notably here and here. Tom and Sara’s excellent slide deck can be viewed here:


Blogging Live from AHLA: Calder Lynch on the Medicaid Program

During the opening session of AHLA yesterday, we had the opportunity to hear remarks for Calder Lynch, current Counselor to CMS Administrator Seema Verma and potential replacement pick for outgoing CMCS Director. Lynch reiterated the three pronged approach the current administration is taking to Medicaid (as previously outlined by administrator Verma):

  1. Accountability
  2. Flexibility
  3. Program Integrity

According to Lynch, these “three pillars guide our efforts as we look to the future of the program.”… More

Blogging Live from AHLA: A Review of Recent Trends in Medicaid Waivers

Good morning from snowy Baltimore! Myself, along with my colleagues Tom Barker, Sean Ahern, and Erik Schulwolf are excited to be here here at AHLA’s Institute on Medicare and Medicaid Payment Issuers. Over the next few days we plan on blogging about our insight, key sessions, and other fun tidbits and developments as we take in all of the great information at this annual gathering of the health bar.… More

CMS Approves More Medicaid Work Requirements and Even More States Submit Request for the Same

We’re certain that no one has forgotten about the January CMS policy announced by the current administration that supports states seeking to adopt work and community engagement requirements as part of their Medicaid programs through section 1115 waivers. We certainly have not. We previously covered this topic in-depth following CMS’ policy announcement and the approval of Kentucky’s 1115 waiver containing a work requirement.… More

Trump Administration Outlines Priorities For FY 2019

The past couple of weeks have involved a flurry of healthcare-related developments, including on the Medicaid drug pricing front.  On February 9, 2018, President Trump signed into law the Bipartisan Budget Act of 2018, which revises the rebate formula for line extensions applicable to certain drugs in the Medicaid program.  Then later that same day, the Council of Economic Advisors issued a report titled “Reforming Biopharmaceutical Pricing at Home and Abroad,” which among other things,… More

Come see us at AHLA!

On March 21 and 22, two of this blog’s authors will be presenting on two Medicaid topics at the American Health Lawyer’s Association (AHLA) annual Medicare and Medicaid conference in Baltimore, Maryland.

One of the hottest topics in Medicaid right now is the Trump Administration’s policy on granting Medicaid waivers to states, a topic we have posted about here, here and here. … More

MassHealth Leads The Way Towards Addressing Cell and Gene Therapy Reimbursement

Since August, 2017, a new class of transformative therapies referred to as cell therapies or gene therapies have been approved by the US Food and Drug Administration (FDA).  These new cell and gene therapies are typically administered once, as opposed to repeatedly over the course of the patient’s lifetime.

Payers, providers, and manufacturers have been considering how existing payment systems – particularly Medicare and Medicaid – can recognize the value of these new treatments. … More

CMS to Phase Out Designated State Health Program (DSHP) Funding

On December 15, 2017, CMS Director Brian Neale informed State Medicaid Directors of CMS’ intent to phase out funding for Designated State Health Programs (DSHP) in Section 1115 waivers.  CMS will no longer approve waiver requests under Section 1115 for DSHP funding, and will not renew portions of existing waivers that provide DSHP funding.

DSHP funding in Section 1115 waivers developed alongside of CMS’ funding of Delivery System Reform Incentive Payments (“DSRIP”) following the passage of the Affordable Care Act in 2010. … More

Starting Off The New Year With Work: How CMS’ “Work and Community Engagement” Policy Change Could Affect Stakeholders

We hope you enjoyed the holidays and New Year and are getting back into the swing of work.  Speaking of work: Medicaid.  We have previously covered on this blog (here) the Trump Administration’s growing departure from the Obama Administration with respect to the Medicaid program, but now the departure has become increasingly palpable.  On January 11, 2018, CMS announced a new policy supporting states seeking to adopt work and community engagement requirements (together hereinafter referred to as “work requirement”) as part of their Medicaid programs through section 1115 waivers.  … More