Tag Archives: Medicaid

CMS Releases Long-Awaited Proposed Rule to Ease Medicaid Enrollment Burdens

Before delving into CMS’ long-awaited proposed rule to ease Medicaid enrollment burdens, Medicaid and the Law would like to formally introduce its readers to Kian Azimpoor, a Law Clerk in the Washington, DC office who will serve as a regular contributor to the blog. Using his experiences from Capitol Hill and the MD Anderson Cancer Center, Kian looks forward to exploring the far-reaching impact of Medicaid and Medicare law.

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On September 7,… More

Enforcing Medicaid’s Requirements in the Federal Courts

The Supreme Court has announced that it will consider a case next term that has the potential to upend several decades of jurisprudence involving the Medicaid program.  It involves a complicated area of the law, and in writing about this topic in the past, we have described the developments in this area of the law as a “saga.”  In granting review in the case of Health and Hospital Corporation of Marion County v.… More

Averting a Medicaid Coverage Cliff: CMS’s Continuous Enrollment Unwinding Guidance

Bracing for the inevitable end of the COVID-19 Public Health Emergency (PHE), CMS has begun issuing voluminous guidance to states on unwinding Medicaid’s continuous enrollment requirement without precipitating a calamitous drop in coverage. We’ve previously discussed the continuous enrollment requirement here, here and here.

By way of background, section 6008 of the Families First Coronavirus Response Act (FFCRA),… More

Summary and Considerations on CMS’ RFI on ‘Access to Coverage and Care in Medicaid & CHIP’

The Medicare and Medicaid programs themselves are not old enough to qualify for Medicare coverage (quick history lesson: President Lyndon Johnson signed the Social Security Amendments into law on July 30, 1965, and the Medicaid program launched on January 1, 1966; note that CMS traces the origin of its programs back to President Theodore Roosevelt’s advocacy for social insurance).  Over the past half-century (and then some),… More

Oregon’s New Waiver Request to Exclude Accelerated Approval Drugs from Medicaid Coverage

Hello readers! Today’s post focuses on a topic we’ve touched on a few times in the past – Medicaid drug formularies.

Back in December 2021, the state of Oregon released a draft Medicaid waiver proposal that caught the attention of many stakeholders. In the draft proposal, Oregon stated that it was considering asking CMS for approval to a) adopt a commercial-style closed drug formulary and b) exclude from Medicaid coverage certain drugs approved via the accelerated approval pathway “with limited or inadequate evidence of clinical efficacy.” Oregon proposed to “use its own rigorous review process to determine coverage of new drugs and to prioritize patient access to clinically proven,… More

New State Health Official Letter Extends Post-PHE Processing Timelines, Implements Redetermination Requirement

We’ve previously discussed the numerous flexibilities CMS offered state Medicaid programs to respond to local outbreaks and address health concerns associated with the COVID-19 public health emergency (PHE).

Back in March 2020 (which feels like ages ago, right?) my colleague Tom discussed the enhanced 6.2% Federal Medical Assistance Percentage (FMAP) funding—authorized by the Families First Coronavirus Response Act (FFCRA) and amended by the CARES Act—including the continuous-enrollment requirement for beneficiaries who had been enrolled in Medicaid on or after March 18,… More

‘Objective Falsity’ and the FCA: An Ongoing Circuit Split

The False Claims Act (“FCA”) is a Federal statute originally enacted in 1863 as a response to fraud from defense contractors during the American Civil War. Under the FCA (31 U.S.C. §§ 3729 – 3733), it is a crime for any person to knowingly submit false or fraudulent claims for payment to the United States government.  Those who violate the FCA are liable for treble damages plus a per-claim monetary penalty (calculated to align with inflation). … More

New House of Representatives COVID Relief Bill Contains Multiple Medicaid Provisions

Here at the Medicaid and the Law Blog, we’ve spent the past couple of days going through the American Rescue Plan Act, legislation introduced in the U.S. House of Representatives last Friday that is the latest attempt by Congress to respond to the COVID-19 pandemic.  There are several provisions of the legislation that would revise and expand the Medicaid program, and we thought it would be of interest to highlight them here. … More

CMS Indicates Reversal of Medicaid Work Requirements

On Friday, February 12, the Centers for Medicare and Medicaid Services (CMS) took a first step to ending Medicaid work requirements.  Acting CMS Administration Elizabeth Richter sent letters to Medicaid Directors in states which had previously received  1115 waiver approvals to implement so-called “community engagement” requirements, explaining CMS now does not believe that requiring employment as a condition for Medicaid coverage promotes the program’s objectives and intends to commence a process of determining whether to withdraw the waiver approvals. … More