The current administration is placing a new emphasis on potential fraud in Medicaid. The Centers for Medicare and Medicaid Services (CMS’) current efforts are focused on Minnesota and four other states (three with Democratic governors – California, Maine, and New York and one with a Republican governor – Florida). The House Committee on Energy and Commerce has also sent requests for information about potential Medicaid fraud to 11 states (the 4 CMS is focused on and 7 others, including 2 with Republican governors). CMS has historically partnered with states to identify and resolve issues of fraud, waste, and abuse, and denied the federal share of Medicaid spending when fraud has been identified by an audit, investigation, or reported by the state. However, CMS has recently announced a new approach to fraud that will rely more heavily on options to pause or withhold significant amounts of federal funding in cases of potential fraud, which could have broad implications for states and enrollees.

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1 in 5 Who Use AI for Health Cite Affordability and Access Concerns as Major Reasons, Including Larger Shares of Young and Lower Income People

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GLP-1s, a class of drugs used to treat type 2 diabetes, obesity, cardiovascular disease, and other conditions, have exploded in popularity in recent years due to their demonstrated effectiveness, but are often not covered by insurance, particularly for the treatment of obesity. According to KFF polling, about half (56%) of GLP-1 users say these drugs were difficult to afford, including one in four who say they were “very difficult” to afford. The Trump administration is pursuing various approaches to lowering the cost and expanding coverage of these medications.

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The Trump administration has signaled a willingness to halt billions of dollars in federal health payments to multiple states, mirroring moves they made against Minnesota.

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Introduction

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The Medicaid program finances about 4 in 10 births in the U.S. Federal law requires states to provide pregnancy-related Medicaid coverage through 60 days postpartum. After that period, some postpartum individuals may qualify for Medicaid through another pathway, but others may lose coverage, particularly in non-expansion states. To help improve maternal health and coverage stability and to help address racial disparities in maternal health, a provision in the American Rescue Plan Act of 2021 gave states a new option to extend Medicaid postpartum coverage to 12 months via a state plan amendment (SPA). 

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Conservative lawmakers in multiple states are pushing legislation drafted by an anti-abortion advocacy group to increase protections for crisis pregnancy centers, organizations that provide some health-related services but also work to dissuade women from having abortions.

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Medicaid is the primary program providing comprehensive coverage of health and long-term care to 83 million low-income people in the United States and accounts for one-fifth of health care spending. Medicaid is jointly financed by states and the federal government but administered by states within federal rules. The recently passed House budget resolution targets cuts to Medicaid of up to $880 billion or more over a decade. While several options appear to be under consideration to significantly reduce Medicaid spending, President Trump publicly said recently about Medicaid, “We are not going to touch it. Now, we are going to look for fraud.” Speaker Johnson has said, “Medicaid is hugely problematic because it has a lot of fraud, waste, and abuse.” 

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Health care affordability is top of mind for many Americans, rising well above other necessities based on recent KFF polling.

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It’s open enrollment season for Medicare Advantage, when people currently enrolled in private managed-care plans can either sign up for a new one or switch to original Medicare through March 31.

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