Healthcare Dive

MARCH 10, 2025

Excluding large health insurance programs, spending under the House Energy and Commerce Committee's purview falls far short of the budget blueprint’s $880 billion goal for cuts.

Medicaid 279

Medicaid Medicaid Health Insurance 279

HealthIT Answers

MAY 7, 2025

By Shannon Smith - With volatility in Medicaid reimbursement as well as both administrative and medical costs continuing to rise rapidly, health plans need to be as strategic as possible when it comes to allocating resources if they are to serve members well while remaining financially solvent.

Health Insurance 59

Health Insurance Medicaid Medicaid 59

Healthcare Dive

MAY 25, 2022

The proposal, signaling growing support for expansion among state lawmakers after years of opposition, would add 600,000 low-income adults to the safety net health insurance program.

Medicaid 246

Medicaid Medicaid Health Insurance 246

Healthcare Dive

SEPTEMBER 4, 2024

Chief financial officer Mark Keim is taking the reins of the health insurer’s bread-and-butter business — Medicaid — along with a growing marketplace division.

Medicaid 167

Medicaid Medicaid ACA Health Insurance 167

Healthcare Dive

OCTOBER 3, 2023

The health insurer expected to be offered a contract to manage the care of Medicaid seniors in a new long-term services and supports program, but wasn’t able to stand up a dual-eligible special needs plan in time.

Medicaid 167

Medicaid Medicaid Health Insurance 167

HIT Consultant

NOVEMBER 22, 2024

What You Should Know: – A new report from the Commonwealth Fund reveals that despite significant progress in expanding health insurance coverage under the Affordable Care Act (ACA), millions of Americans still lack adequate and affordable healthcare.

ACA 98

ACA Health Insurance Medicaid Medicaid 98

HIT Consultant

MARCH 17, 2025

What You Should Know: – Proposed work requirements for Medicaid could lead to millions of Americans losing their health insurance, according to a new analysis by the Urban Institute with support from the Robert Wood Johnson Foundation. – The analysis projects that 4.6

Medicaid 52

Medicaid Medicaid Health Insurance 52

Fierce Healthcare

SEPTEMBER 19, 2024

Major Indiana managed care organizations and health systems are blamed for defrauding the state Medicaid system by tens, if not hundreds, of millions of dollars, says a newly unsealed whistleblower | A newly unsealed lawsuit alleges major health insurers and health systems defrauded Indiana Medicaid by hundreds of millions of dollars, with the government (..)

Medicaid 137

Medicaid Medicaid Fraud Hospitals 137

Center for Health Insurance Reform

FEBRUARY 27, 2023

After a three-year pause on Medicaid redeterminations, states can begin the process of removing residents from their rolls beginning on April 1. Many people who are terminated from Medicaid will be eligible for free or low-cost plans through the Affordable Care Act’s Marketplaces.

Health Insurance 92

Health Insurance Medicaid Medicaid 92

Bill of Health

APRIL 13, 2022

The COVID-19 Public Health Emergency (PHE) expires at the end of this week, with Department of Health and Human Services (HHS) Secretary Xavier Becerra expected to renew the PHE once more to extend through mid-July. This policy improves coverage and helps reduce churn , which is associated with poor health outcomes.

Medicaid 147

Medicaid Medicaid COVID-19 Public Health 147

HIPAA Journal

APRIL 6, 2022

An audit of Connecticut’s Health Insurance Exchange, Access Health CT, by the state auditor has revealed Access Health CT suffered 44 data breaches over the last 3.5 Access Health CT said it is also strengthening its internal purchasing policies and procedures and will be revising its contract procurement policy.

Health Insurance 138

Health Insurance HIPAA Medicaid Medicaid 138

Fierce Healthcare

JULY 12, 2024

Colorado stands out among the 10 states that have disenrolled the highest share of Medicaid beneficiaries since the U.S. Colorado stands out among the 10 states that have disenrolled the highest share of Medicaid beneficiaries since the U.S.

Medicaid 119

Medicaid Medicaid Health Insurance Governance 119

Kaiser Health News

JANUARY 12, 2024

Still, “we know from surveys and other data that, even 10 years on, a lot of people are unaware there are premium subsidies available through ACA marketplaces,” said Sabrina Corlette , co-director of the Center on Health Insurance Reform at Georgetown University. 1 and runs until Jan. 16 in most states.

Health Insurance 140

Health Insurance ACA Medicaid Medicaid 140

Bill of Health

OCTOBER 17, 2024

Finally, SB 1120 limits the degree to which health insurers can use AI to determine medical necessity for member health care services. SB 1223 amended the California Consumer Privacy Act of 2018 to include neural data as sensitive personal information, whose collection and use companies can be directed to limit.

Medicare 150

Medicare Medicare Health Insurance Licensing 150

HIT Consultant

NOVEMBER 8, 2021

Jessica Altman, Pennsylvania’s insurance commissioner sums it up well : “When we talk about bringing something back to state control, that is a real narrative that can appeal to both sides of the aisle. There is nothing political about making health insurance more affordable.”.

Health Insurance 98

Health Insurance Medicaid Medicaid Governance 98

Fierce Healthcare

MARCH 27, 2024

The Centers for Medicare & Medicaid Services (CMS) released a final rule Wednesday to help individuals obtain and retain Children's Health Insurance Program (CHIP) coverage. | In a final rule set to take effect in two months, CMS is streamlining its Medicaid and CHIP eligibility, enrollment and renewal processes.

Medicaid 111

Medicaid Medicaid Health Insurance Medicare 111

HealthIT Answers

JUNE 7, 2024

By Chris Emper - On April 22, CMS released an 895-page final regulation titled, “Medicaid and Children’s Health Insurance Program Managed Care Access, Finance, and Quality.” The post New CMS Regulation Establishes Maximum Appointment Wait Time Standards for Medicaid appeared first on Health IT Answers.

Medicaid 105

Medicaid Medicaid Health Insurance Compliance 105

Healthcare It News

DECEMBER 16, 2022

The Medicaid and CHIP Access to Prescription Digital Therapeutics Act seeks to expand care options that can help improve health outcomes and quality of life for those facing barriers to healthcare. The act would also define "prescription digital therapeutic" in Medicaid and allow U.S. WHY IT MATTERS. THE LARGER TREND.

Medicaid 258

Medicaid Medicaid COVID-19 Health Outcomes 258

Center for Health Insurance Reform

JUNE 3, 2022

Our colleagues at the Georgetown Center for Children & Families examine the new marketplace network adequacy standards and how they compare to Medicaid's standards. Continue reading → The post Standards for Provider Network Adequacy in Medicaid and the Marketplaces appeared first on Center on Health Insurance Reforms.

Medicaid 98

Medicaid Medicaid Health Insurance 98

Center for Health Insurance Reform

MARCH 31, 2023

The Affordable Care Act (ACA) recently celebrated its 13th anniversary with historic enrollment growth in the health insurance Marketplaces and the lowest-ever recorded uninsured rate.

Health Insurance 97

Health Insurance ACA Medicaid Medicaid 97

Center for Health Insurance Reform

APRIL 15, 2022

A recently published report from Georgetown's Center on Health Insurance Reforms and Center for Children & Families finds significant differences in standards for network adequacy between Medicaid and Marketplace plans, as well as gaps in oversight.

Medicaid 96

Medicaid Medicaid Health Insurance 96

HIPAA Journal

MAY 1, 2025

More than 450,000 individuals had their information exposed in the incident.

HIPAA 108

HIPAA Fraud Licensing Health Insurance 108

Center for Health Insurance Reform

MAY 16, 2023

The Affordable Care Act established health insurance Marketplaces to facilitate enrollment in comprehensive and affordable health insurance. Most states rely on the federal government to run their Marketplace, but recently, several states have expressed interest in taking over Marketplace operations.

Health Insurance 98

Health Insurance Governance Medicaid Medicaid 98

Center for Health Insurance Reform

APRIL 20, 2022

It will be "all hands on deck" for state officials once the public health emergency ends and up to 16 million people face the loss of their Medicaid coverage.

Public Health 104

Public Health Health Insurance Medicaid Medicaid 104

HIT Consultant

JULY 16, 2024

Anish Sebastian, CEO and Co-founder, Babyscripts A discussion of technology and the Medicaid population inevitably raises the topic of the digital divide — that is, the gap between people who have access to modern information and communications technology (ICTs) and those who don’t. “We But there’s a lot of reasons to be optimistic.

Medicaid 105

Medicaid Medicaid Health Insurance Health Outcomes 105

Center for Health Insurance Reform

AUGUST 8, 2022

Many of those losing their Medicaid eligibility after the COVID-19 public health emergency will have illnesses or conditions requiring uninterrupted access to health care services.

Medicaid 98

Medicaid Medicaid COVID-19 Public Health 98

Center for Health Insurance Reform

MARCH 20, 2023

As states resume conducting Medicaid and CHIP re-determinations of eligibility, the U.S. As millions of people transition from Medicaid to private insurance coverage, they could experience disruptions in critical health care services.

Medicaid 94

Medicaid Medicaid Health Insurance Public Health 94

HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. Five state Medicaid programs, two Medicare Administrative Contractors, and two private health insurers were tricked into changing the bank account details for payments. million, and $6.4 million, and $6.4

Medicaid 101

Medicaid Medicaid Medicare Medicare 101

HIPAA Journal

JUNE 8, 2023

The Iowa Department of Health and Human Services has announced there have been three separate breaches of the protected health information of Iowa Medicaid recipients in the past two months – two hacking incidents and an impermissible disclosure, all three of which involved third-party contractors.

Medicaid 98

Medicaid Medicaid Ransomware Health Insurance 98

HIPAA Journal

APRIL 14, 2023

The Iowa Department of Health and Human Services (DHHS) has confirmed that the personal information of 20,800 Iowans who receive Medicaid was exposed in a cyberattack at a subcontractor of one of its business associates between June 30, 2022, and July 5, 2022. It is currently unclear how many individuals have been affected.

Medicaid 113

Medicaid Medicaid Ransomware HIPAA 113

Center for Health Insurance Reform

MARCH 24, 2022

CHIR and our colleagues at the Center for Children and Families (CCF) have published two new resources examining state-level preparations for the end of the COVID-19 public health emergency and the redetermination of the Medicaid eligibility of close to 85 million people.

ACA 95

ACA Medicaid Medicaid COVID-19 95

HIT Consultant

APRIL 14, 2025

In response, UnitedHealth Group, the nation’s largest health insurer, offered approximately $9B in loans to help these struggling entities stay afloat. Mazzola clarified that these withheld funds were reimbursements owed from New Jersey Medicaid plans.

Health Insurance 98

Health Insurance Medicaid Medicaid 98

Modern Healthcare

AUGUST 18, 2022

States would have to track Medicaid and Children's Health Insurance Program quality metrics starting in fiscal 2024.

Medicaid 84

Medicaid Medicaid Health Insurance 84

Bill of Health

JUNE 15, 2023

Merck alleges that the price negotiation program operates as a price control because it effectively requires manufacturers to accept the maximum fair price as a condition of participation in Medicare and Medicaid. Merck can avoid price regulation by opting out of Medicare and Medicaid altogether.

Medicare 195

Medicare Medicare Medicaid Medicaid 195

Compliance Now

AUGUST 10, 2023

As background, according to federal Health Insurance Portability and Accountability Act (HIPAA) rules, individuals have 60 days from losing CHIP and Medicaid eligibility to elect coverage under their group plan. The real potential of this number growing daily is what has prompted the Agencies to issue this “request.”

Medicaid 100

Medicaid Medicaid COVID-19 Compliance 100

Compliance Now

AUGUST 10, 2023

As background, according to federal Health Insurance Portability and Accountability Act (HIPAA) rules, individuals have 60 days from losing CHIP and Medicaid eligibility to elect coverage under their group plan. The real potential of this number growing daily is what has prompted the Agencies to issue this “request.”

Medicaid 100

Medicaid Medicaid COVID-19 Compliance 100

Healthcare IT News - Telehealth

OCTOBER 21, 2020

Data released this past week from the Centers for Medicare and Medicaid Services show that more than 34.5 million services were delivered via telehealth in Medicare and in the Children's Health Insurance Program from March through June. As of June 2020, said CMS, more than 91.8 ON THE RECORD.

Medicaid 214

Medicaid Medicaid Medicare Medicare 214