When most people think about Medicaid, they focus on the financial component — income and asset limits that determine eligibility. For some Medicaid programs, however, the focus needs to be on both financial and clinical...more
Pursuant to an October 29, 2025, press release, Governor Tim Walz has directed the Minnesota Department of Human Services (“DHS”) to audit fourteen Medical Assistance (“Medicaid”) services identified as high-risk for billing...more
Since 2020, two important changes to the Medicaid program have been looming on the horizon for applicants and recipients of community-based Medicaid benefits (including home care services, coverage for care provided in...more
In a unanimous decision on September 2, 2025, the Ohio Supreme Court delivered a major win to nursing home operators by ordering the Ohio Department of Medicaid (ODM) to recalculate the quality incentive payments for nursing...more
New York State’s Medicaid Homecare program pays for in-home personal care services. New York’s program has long been the best in the country. One underlying policy behind the program was that people should have every...more
The U.S. Department of Health and Human Services Office of Inspector General (OIG) has recently issued two audit reports revealing substantial improper Medicaid fee-for-service (FFS) payments for Applied Behavior Analysis...more
Among the many sweeping changes to the Medicaid program included in the One Big Beautiful Bill Act (“OBBBA”), Congress established new statutory caps on state-directed payments (“SDPs”) in Medicaid managed care. SDPs have...more
CMS announced this month that it does not anticipate using federal funds to match state funds for designated state health programs (DSHP) and designated state investment programs (DSIP) under its section 1115 demonstration...more
Many seniors prefer to age in place with home care assistance. Medicaid can provide financial assistance for home care, but eligibility requirements vary by state and can be complex....more
New Mexico recently became the latest state to receive Centers for Medicare & Medicaid Services (CMS) approval to expand the state’s behavioral health service offerings through mobile crisis intervention teams. Under...more
On January 29, 2023, a Florida Magistrate Judge recommended denying the State of Florida’s Motion for Preliminary Injunction and granting CMS’s Motion to Dismiss in connection with the implementation and enforcement of its...more
At the onset of the COVID pandemic in March of 2020, Congress made an important policy decision: continued access to health coverage was crucial, especially because, at the time, it was uncertain how the economy would...more
On May 3, 2023 the Centers for Medicare & Medicaid Services (CMS) published the proposed rule Medicaid Program; Ensuring Access to Medicaid Services. The proposed rule seeks to increase transparency in payment rates,...more
Lots of Healthcare Activity in Congress - Activity in Congress focusing on healthcare issues has increased over the last few weeks and is not slowing down anytime soon. This week, the Senate Health, Education, Labor, and...more
Family Health Centers of San Diego (Health Center) operates a federally qualified health center (FQHC) that has 49 locations throughout San Diego County, California, and provides a comprehensive range of primary and...more
The COVID-19 pandemic has seen a wave of telehealth policy changes across the nation at both federal and state levels. Such changes have expanded access to health care and addressed underutilization in chronic disease...more
On December 4, 2020, the Supreme Court agreed to hear arguments to decide the legality of the Department of Health and Human Services’ (HHS’s) authorization for states to incorporate work requirements into their Medicaid...more
UPDATE: Our July 28, 2020, post informed you that the Wisconsin Medicaid divisor would remain unchanged in 2020...more
The first ever VIRTUAL Managed Care Compliance Conference will have the great speakers and content you have come to expect from the in-person event. Each year, we look forward to hosting compliance professionals at our...more
The pandemic has also overhauled how physicians and health care providers practice in North Carolina, with many offices switching to virtual exams to help stop the spread of the coronavirus. North Carolina Medical Board's...more
Every year before July 1st, Wisconsin publishes an updated Medicaid divisor to be in effect starting on July 1st of that year until June 30th of the next year. This year, Wisconsin has not yet updated its Medicaid divisor due...more
Federal enforcers typically announce (formally as well as informally) work plans or focus areas for the upcoming year that can provide some guidance as to where providers might anticipate enforcement action and, where they...more
Medical providers are sometimes faced with the difficult scenario of a minor (under 18 years of age) requesting medical or mental health treatment without a parent's or legal guardian's consent. This situation often arises in...more
On Thursday, Jan. 30, the Centers for Medicare and Medicaid Services (CMS) released the Healthy Adult Opportunity initiative, long-awaited guidance that would enable states to convert Medicaid funding into a block grant for...more
This week the Department of Justice reported it recovered $3 billion from False Claims Act cases in 2019. Of that recovery amount, $2.1 billion resulted from whistleblower, or qui tam, actions. In addition, 633 new qui tam...more