Category: CMS News

Alternative Headline: 15 States Gain Medicaid Boost

[MM Curator Summary]: Medicaid providers in 15 states will receive up to $9 billion in supplemental funding through newly approved federal agreements.

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Hospitals, physician groups, and nursing homes across 15 states will receive billions of dollars in extra Medicaid funding this year thanks to federal health care officials signing off on new agreements.

In almost all of the new agreements, states will pay health care providers average commercial prices to treat Medicaid patients — a boon for providers that often decry Medicaid as one of their worst-paying insurers.

The influx of recently approved Medicaid funds, known as state directed payment arrangements, highlights how the industry and state leaders of all political stripes have tapped a lucrative well within Medicaid. And the race is on to get more agreements across the finish line before Congress or the White House intervenes. 

https://www.statnews.com/2025/06/13/medicaid-state-directed-payments-9-billion-supplemental-funds-hospitals-doctors-nursing-homes/

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Alternative Headline: CMS Tackles Medicare Fraud Modernization

[MM Curator Summary]: CMS is modernizing its data systems – integrating clinical data using cloud analytics and metadate tools – to prevent Medicare fraud as new rules increase data complexity and risk.

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Fraud, waste and abuse of the Medicare system have always been challenging to get under control. Although no precise measure of health care fraud exists, those who exploit federal health care programs can cost taxpayers billions of dollars, according to a Centers for Medicare and Medicaid Services report, while putting beneficiaries’ health and welfare at risk. The impact of these losses and risks magnifies as Medicare continues to serve a growing number of beneficiaries.

CMS’ Center for Program Integrity (CPI) plays a key role in managing this challenge by detecting, preventing and combating fraud, waste and abuse across CMS and other federal health programs. Beyond that, the organization is tasked with strengthening and expanding the scope of integrity programs, and integrating technological improvements like AI to reduce fraud, waste and abuse, and streamline operations.

In a time when efficiency has become top-of-mind for most agency and department heads, optimizing CPI’s ability to catch fraud, waste and abuse will play a key role in the federal government’s larger push to streamline operations and costs. The challenge is only getting bigger as CMS continues to modernize and reshuffle the way it handles patient data.

Meeting the needs of patients

To meet the expectations of patients and provide them with the value-based care experience they deserve, CMS is continually adapting its systems to mirror the greater healthcare industry. But doing that can create some hurdles in the fight against fraud, waste and abuse, including new interoperability rules that will fundamentally change the type of data coming into the agency.

In March, CMS finalized an interoperability rule to improve health information exchange and ensure patients’ access to their health records. While the new initiative, which goes into partial effect next year, is an important step toward creating a more efficient healthcare system, it requires CMS to ingest and merge a more diverse set of data than ever before. Formerly, CMS only dealt with administrative information like claims, but with the new streamlined process, the agency will also have to take in clinical data and account for all the new data classes that come along with it.

The reality of the situation is that once CMS starts bringing in data from hundreds of new partners there will be quality issues and a lot of noise. Put simply, when the aperture opens, there is a lot more opportunity for fraud. To combat this, CPI will need to lean on new technology that can sift and analyze this new massive influx of data.

Drilling down on data

Data management and analytics within the fraud, waste and abuse process will play a huge role in bolstering detection and prevention. Through cloud-based analytics platforms and a comprehensive data management plan, CPI will be able to gain actionable insights like identifying patterns related to how bad actors are defrauding CMS.

Technology has come a long way with analytics. It used to be that data management was limited to creating platforms for users. Now that has expanded to include enhancing data discoverability, supporting advanced analytic solutions and intertwining data quality within the data pipelines while securing the data in transit and at rest.

This all starts with establishing processes like a comprehensive collection mechanism for metadata at various stages of the data flow and developing tools to create a data discovery catalog. This leads to metadata visualization maps that can help CMS understand its data footprint. Without this kind of visibility, the agency will be flying blind as new data types and categories begin flowing in the next year. Once those steps are taken, CMS can continue to build that foundation. That means implementing a data quality framework and interlacing it with data pipelines to monitor the accuracy of data coming into the system.

Managing stakeholders and collaborators

Finding the people to help CMS and CPI in their journey is as important as the technology component. Stakeholder engagement and collaboration are key to successful program integrity. To that end, CMS needs to find the right partners to support fraud, waste and abuse detection and prevention.

Trusted partners that know CMS’ mission, problems and constraints are necessary for the successful implementation of next-generation data management solutions. Those with a history of fulfilling CMS needs will provide better cost-effective solutions as opposed to large data management solutions that are both costly and don’t tailor to the needs of the federal space.

Beyond that, CMS should seek out organizations with experience in solving an array of use cases for the federal government. A partner with experience in policy, analytics and technology will approach data management solutions with the intended goal of meeting the federal government’s mission.

In 2023, CMS spent $1.0298 trillion on Medicare and $871.7 billion on Medicaid. Medicare processes over one billion fee-for-service claims per year.   Strengthening and enhancing fraud, waste and abuse activities will go a long way to making government operations more efficient and effective. Doing that won’t be easy, but the recommendations above will help level up CPI’s ability to root out these cases, allowing for a modernized CMS to serve patients more efficiently.

Michelle Atkins is vice president of program integrity services at RELI Group. Ken Hofgesang is vice president of health at RELI Group.

Copyright © 2025 Federal News Network. All rights reserved. This website is not intended for users located within the European Economic Area.

https://federalnewsnetwork.com/commentary/2025/06/as-cms-modernizes-data-management-will-be-key-to-fraud-waste-and-abuse-prevention-detection/

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Alternative Headline: Medicaid OUD Tracker Funded

[MM Curator Summary]: The Foundation for Opioid Response Efforts granted $250K to the Urban Institute to build a dashboard tracking Medicaid coverage of opioid treatment medications.

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The Foundation for Opioid Response Efforts (FORE) today announced a $250,500 grant to the Urban Institute to build and maintain a public-facing data dashboard that will track Medicaid coverage of medications used to treat opioid use disorder (OUD) and reverse opioid overdoses. As Medicaid is the largest payer of OUD treatment in the United States, changes to the program could impact recent progress in reducing overdose deaths by approximately 25% over the past year.

"As the single largest payer of OUD treatment, Medicaid is a lifeline for many individuals, including low-income youth, pregnant and parenting patients, justice-involved populations, and historically underserved communities,” said Karen A. Scott, MD, MPH, President of FORE. "This dashboard will provide actionable data that helps decision-makers respond effectively to maintain access to lifesaving medications.”

"The opioid and overdose crisis remains a pressing public health emergency, and policymakers need timely, transparent data to understand how policy decisions affect access to treatment,” said Lisa Clemans-Cope, PhD, Principal Research Associate at the Urban Institute. "Our goal is to provide a trusted resource that helps ensure people continue to get the care they need, when they need it.”

This effort builds on FORE’s broader work related to Medicaid. Earlier this year, FORE hosted a national webinar, Medicaid’s Ongoing Critical Role in the U.S. Response to the Opioid and Overdose Crisis, which explored the program’s essential contributions to prevention, treatment access, and recovery services.

Additional tools and insights-including webinar recordings, policy briefs, and research-are available in this Medicaid Resources document, offering stakeholders practical guidance for navigating and shaping Medicaid policy.

In addition to the dashboard, the Urban Institute will publish a series of issue briefs to inform federal and state Medicaid policymakers, congressional staff, managed care plans, and other stakeholders about the evolving landscape of OUD medication access. This grant is part of FORE’s commitment to advancing policy solutions that expand access to effective OUD treatment nationwide.

About the Foundation for Opioid Response Efforts (FORE)

Founded in 2018, FORE is a national 501(c)(3) grant-making foundation dedicated to addressing the nation’s opioid crisis. Through strategic grantmaking, convening stakeholders, and developing informational resources, FORE supports patient-centered, innovative solutions that drive long-term change. To date, FORE has awarded 119 grants totaling $47.7 million to 102 organizations. Follow us on LinkedIn, Instagram, and X (Twitter) for updates.

https://www.manilatimes.net/2025/06/11/tmt-newswire/globenewswire/foundation-for-opioid-response-efforts-awards-grant-to-urban-institute-for-new-effort-on-medicaid-and-access-to-opioid-use-disorder-medications/2131732

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Alternative Headline: Arkansas DHS Leadership Shifts

[MM Curator Summary]: Arkansas DHS Secretary Kristi Putnam will resign in July, with Medicaid chief Janet Mann set to take over as major Medicaid developments take place, including proposed work requirements and the end of Medicaid managed care for dental services. 

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Kristi Putnam, secretary of the state Department of Human Services, will depart late next month to return to Kentucky after 2½ years at the helm of the department, and Janet Mann, the department’s deputy secretary of programs and state Medicaid director, will become the department’s secretary upon Putnam’s departure, Gov. Sarah Huckabee Sanders announced Wednesday.

Putnam will depart as the department’s secretary on July 25 and Mann will then become secretary, the Republican governor said.

Putnam said in the governor office’s news release that "My whole career has focused on serving families, and this move back to Kentucky is so I can serve my own family in a bigger way.

"Janet is the absolute right person to step up as Secretary, is one of the most creative policy experts I have ever known, and will take DHS to new levels of success," she said.

Putnam said serving in Sanders’ administration has been the honor of a lifetime for her, and she is grateful and proud of "team DHS and all we have accomplished so far under this Governor’s bold leadership."

The state’s Medicaid program covers 869,833 people, including 415,672 children, 230,050 adults through the expansion program called ARHOME, and 224,111 other adults as of April 1, according to the department’s website ARHOME stands for Arkansas Health and Opportunity for Me.

The department’s current budget is $9.68 billion, of which $7.06 billion is federal funds in fiscal 2025 that ends June 30, said department spokesman Keith Metz.

Putnam’s salary is $236,385.14 a year, according to Arkansas’ Transparency website.

Mann’s salary is $191,598.58 a year in her current post and her new salary as the department’s secretary will be set a later date, said Sanders’ spokesman Sam Dubke.

Sanders said in the governor’s office news release that "Over the past two-and-a-half years, Kristi has overhauled DHS and brought much-needed reforms to the programs her agency oversees, including foster care, Medicaid, maternal health, food stamps, and more.

"My administration was extraordinarily lucky to have someone with her skill set and leadership in charge of one of the most critical agencies in state government," she said. "I am grateful that we have someone as qualified as Janet to take over for Kristi and seamlessly continue to make positive changes at DHS. Janet has an encyclopedic knowledge of her agency and I know she is the exact right person to lead DHS into the future."

Mann said she is honored by the governor’s decision to select her for this role and is excited to continue the great work that she and Putnam have been able to accomplish in this administration.

"We have made enormous progress in providing support to Arkansans who need it and also in working with other agencies for all Arkansans who want a path to economic independence," she said. "Under Governor Sanders’ leadership, DHS will continue to deliver for the people of Arkansas."

Mann has more than 20 years of experience in health care and health care finance in state government and the corporate sector, according to the governor’s office. This includes several roles at Arkansas DHS as chief financial officer and director of Division of Medical Services as well as the deputy administrator for the Mississippi Medicaid program.

In addition, she has worked in the private sector consulting with multiple states’ Medicaid agencies on finance, reporting, managed care, program integrity, organizational assessments and eligibility, according to the governor’s office. Mann holds a bachelor of science degree in accounting from the University of Alabama and is a certified public accountant.

In March of this year, Arkansas sent the federal government its request to add a work requirement to the state’s Medicaid expansion program.

If approved by the U.S. Centers for Medicare and Medicaid Services, the requirement would be added through a "Pathway to Prosperity" amendment to the federal waiver authorizing the Medicaid expansion program, ARHOME.

ARHOME participants ages 19 to 64 would have to be working, enrolled in school, volunteering or caring for a dependent child, an elderly parent or a person with a disability to be considered "on track" with the requirement. The department would work with those Medicaid recipients and their health plans, including by the establishment and monitoring of a "personal development plan," the proposal states.

That plan would include "success coaching" through agencies such as the state Division of Workforce Services, the Division of Career and Technical Education and local community partners, Mann said earlier this year.

Those who "refuse to cooperate" will have their ARHOME coverage suspended, but it can be restored if the recipient "chooses to get ‘on track’" with the personal development plan, the department said.

In June of 2024, DHS announced it would end its Medicaid managed care dental program and return beneficiaries who qualify for dental coverage to the Medicaid fee-for-service program starting in November 2024.

The announcement came more than a month after department officials decided to pull down the department’s procurement for Arkansas Medicaid dental managed care services and review options to either rebid the procurement or to move beneficiaries back to fee-for-service.

Department officials decided to pull down the procurement in late April 2024, after some state lawmakers questioned whether department officials followed their request for proposals for Medicaid dental managed care services, although the state’s procurement director in January 2024 rejected a protest filed by Delta Dental of Arkansas that the department failed to adhere to the procurement rules set forth in the request for proposals. The dental managed care program within Arkansas Medicaid has been in effect since Jan. 1, 2018.

During a six-month period in 2023, Arkansas’ total Medicaid enrollment declined by about 257,000 as the department said it successfully completed eligibility redeterminations on Medicaid beneficiaries whose coverage was extended because of special rules that have been in effect during the federal government’s covid-19 public health emergency.

The continuous enrollment requirement during the federal public health emergency prevented DHS from removing most ineligible individuals from Medicaid, but normal eligibility rules resumed April 1, 2023, the department said.

On Oct. 1, 2023, Medicaid’s total enrollment was 868,059, DHS spokesman Gavin Lesnick said in October 2023. That included 388,117 children, 240,519 adults in ARHOME, and 239,423 other adults, he said.

In contrast, the department reported total enrollment of 1,125,871 on April 1, 2023, when normal Medicaid eligibility rules resumed. At that point, the department said 469,142 children were Medicaid beneficiaries, 334,866 adult beneficiaries were on ARHOME, and 321,863 other adults were Medicaid beneficiaries.

https://www.arkansasonline.com/news/2025/jun/11/state-department-of-human-services-chief-leaving/

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Alternative Headline: Planned Parenthood Fights Medicaid Ban

[MM Curator Summary]: Planned Parenthood is suing to block Medicaid defunding tied to abortion affiliations in Trump’s new law.

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BOSTON — Attorneys for Planned Parenthood clinics nationwide argued in federal court Friday that cutting off Medicaid funding to its abortion providers would hurt vulnerable patients who already have limited health care options.

Planned Parenthood Federation of America and its affiliates in Massachusetts and Utah are fighting to block part of President Donald Trump’s tax bill they say is designed to target their clinics. The provision would end Medicaid payments to abortion providers like Planned Parenthood that primarily offer family planning services — things like contraception, abortion and pregnancy tests — and received more than $800,000 from Medicaid in 2023.

Although Planned Parenthood is not specifically named in the statute, which went into effect July 4, the organization’s leaders say it was meant to affect their nearly 600 centers in 48 states. However, a major medical provider in Maine and likely others have also been hit.

“It’s the affiliation provision that makes this rotten to the core,” said Planned Parenthood attorney Alan Schoenfeld during Friday’s hearing in Boston.

The plaintiffs have filed their federal lawsuit against Health and Human Services Secretary Robert F. Kennedy Jr.

So far, the provision has been on hold after U.S. District Judge Indira Talwani in Boston granted a temporary restraining order blocking the cuts for two weeks. That order expires July 21, when Talwani has said she will decide whether to grant a motion for a preliminary injunction against the funding cuts while the lawsuit plays out.

On Friday, Talwani was particularly focused on getting a definition of what constituted an affiliation and what a Planned Parenthood health center would have to do to qualify for Medicaid funding, quizzing the federal government’s attorneys if stopping abortions would be enough or if they would have to completely severe all ties.

Emily Hall, an attorney representing HHS, said Friday that the federal government needs more information about Planned Parenthood’s structure and time to finalize interpretations of the law.

“It depends on the nature of the corporate relationship, which I don’t have,” Hall said.

Fears of pending cuts to Planned Parenthood further escalated this week after a Planned Parenthood office in Ohio announced Tuesday that it was closing two health clinics — in Hamilton and Springfield, north of Cincinnati — due to state and federal cuts.

“Make no mistake: This is not a decision made by Planned Parenthood of Southwest Ohio Region,” President and CEO Nan Whaley, a one-time Democratic gubernatorial nominee, told reporters. “We took every possible step to keep these centers open, but the devastating impact of state and federal political attacks has forced us into this very difficult position.”

The centers provide preventive health care, including testing for sexually transmitted diseases, birth control and wellness exams.

Medicaid is a government health care program that serves millions of low-income and disabled Americans. Nearly half of Planned Parenthood’s patients rely on Medicaid.

https://abcnews.go.com/US/wireStory/planned-parenthood-seeks-medicaid-funds-flowing-legal-fight-123870106

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Alternative Headline: ICE to Use Medicaid Data

[MM Curator Summary]: Director Todd Lyon’s supports agents’ use of masks to protect their identity, and confirms that ICE will use Medicaid and federal data to track immigrants amid increased deportation efforts and public scrutiny.

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Washington — In an exclusive interview, Todd Lyons, the acting director of U.S. Immigration and Customs Enforcement, told CBS News he’s not a "proponent" of agents wearing masks during arrest operations, but said he will allow the practice to continue due to concerns about his officers’ safety.

He also confirmed ICE plans to use data from government programs like Medicaid to locate immigrants suspected of living in the U.S. illegally, including those with criminal histories. 

Pressed on concerns about masked ICE officers and the possibility that imposters could exploit the practice by posing as immigration agents, Lyons said, "That’s one of our biggest concerns. And I’ve said it publicly before, I’m not a proponent of the masks."

"However, if that’s a tool that the men and women of ICE to keep themselves and their family safe, then I will allow it," Lyons said during his first television network sit-down interview at ICE headquarters in Washington. "I do kind of push back on the criticism that they don’t identify themselves."

Asked if he will allow ICE personnel to wear masks, Lyons said, "I will."

More of the interview with Lyons will air on "Face the Nation with Margaret Brennan" on Sunday, July 20, at 10:30 a.m. ET.

Lyons cited the increase in attacks faced by agents at ICE, the agency at the center of President Trump’s promise of carrying out the largest deportation operation in American history. 

The Department of Homeland Security has said attacks against ICE officials have increased by more than 800% this year compared to the same time period in 2024. Numerous instances of violence directed at ICE agents and facilities have occurred in recent weeks, including an armed attack against a detention center in Texas earlier this month that has led to more than a dozen arrests.

Lyons agreed the increase in attacks faced by ICE agents could be partially attributed to the dramatic expansion in immigration arrests under the second Trump administration, acknowledging that the agency is "more visible in the community."

But he argued his agents are being forced to go into communities more often to arrest individuals living in the U.S. illegally, including those with criminal records, because more cities and states have adopted "sanctuary" policies that limit local law enforcement cooperation with ICE. Those policies lead many jurisdictions to refrain from notifying ICE when they release inmates who are also in the U.S. illegally.

"So you are seeing us out more, and I think there is more of a tension," Lyons added. "The immigration mission is one of the forefront of this administration, so it is a lot of scrutiny and publicity to it."

Lyons says Medicaid data will be used to "locate" those in the U.S. illegally.

CBS News also asked Lyons about a report from the Associated Press that an inter-agency agreement had granted ICE access to the personal information of millions of Medicaid enrollees, including names, addresses, Social Security numbers and data on patients’ race and ethnicity.

Lyons said ICE is "working with all of our other federal partners to try to gain intelligence, to locate these individuals that have been ordered deported by a judge or have been released from a sanctuary jurisdiction like we talked about. That is what ICE is using that data for."

He cited the "many" so-called "got-ways" who entered the U.S. illegally without getting caught under the Biden administration and "just totally disappeared off the grid."

Lyons suggested ICE would use different datasets, including from the Departments of Labor and Health and Human Services, to locate the "worst of the worst" and those ordered deported from the U.S. 

https://www.cbsnews.com/news/ice-todd-lyons-interview-masks-medicaid/

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Alternative Headline: Disabled Families Fear Medicaid Cuts

[MM Curator Summary]: Medicaid cuts may endanger critical home care services for disabled Americans despite federal claims to the contrary.

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The White House says roughly $1 trillion in Medicaid cuts won’t limit home- and community-based care. Health care experts disagree. 

It takes round-the-clock care to keep 10-year-old June Rice alive.

Her ileostomy bag needs to be emptied multiple times a day, and the exposed end of her intestine must be inspected. Her body has to be regularly repositioned in her wheelchair so that she won’t get sores. Her saliva needs to be suctioned from her mouth to prevent aspiration, and her food and medication must be administered through a gastric tube.

June has rare diseases that affect her intestines and brain. Her parents do what they can for her, but they have jobs and two other children — they can’t do it all. What allows June to live at home, go to school and hang out with friends is a Medicaid program in Utah that provides in-home nurses, a type of benefit called home- and community-based care.

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Alternative Headline: Work Requirements Threaten Coverage

[MM Curator Summary]: Medicaid work requirements and strict income thresholds are pushing vulnerable workers like James off the eligibility cliff — where they must choose between lying about earnings or losing life-saving healthcare.

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As congressional Republicans finalized Medicaid work requirements in President Donald Trump’s budget bill, one man who relies on that government-subsidized health coverage was trying to coax his old car to start after an eight-hour shift making sandwiches.

James asked that only his middle name be used to tell his story so that he wouldn’t lose health coverage or be accused of Medicaid fraud. He found his food service gig a few weeks into an addiction treatment program. The man in his late 30s said his boss “hasn’t been disappointed.”

“I’m a good worker,” he said with a grin.

James can get the prescription drugs that help him stabilize his life and hold down that job through Medicaid, the state-federal insurance program that covers people with low incomes or disabilities. Those drugs curb his desire for alcohol and treat long-standing conditions that exacerbate his addiction, including bipolar and insomnia disorders.

But he hasn’t qualified for the program in months, ever since his work hours increased and he received a raise of about $1 an hour. He exceeds his income eligibility limit of about $21,000 per year by roughly $50 a week.

James said that despite his raise, he’s struggling to cover routine expenses, such as keeping his car running and paying his phone bill. He said he can’t afford the care he needs even on the cheapest insurance plan available to him through the Affordable Care Act’s marketplace or through his job’s health insurance plan. Even paying $60 a month for his sleep medications — one of six prescriptions he takes daily — is too expensive.

“I only saw one option,” James said. “Fudge the numbers.”

James hasn’t reported his new income to the state. That puts him at odds with congressional Republicans who justified adding hurdles to Medicaid by claiming the system is rife with waste, fraud, and abuse. But James isn’t someone sitting on his couch playing video games, the type of person House Speaker Mike Johnson and other people said they would target as they sought work requirements.

Medicaid provides health coverage and long-term care to more than 70 million people in the United States. Those who study safety-net systems say it’s extremely rare for enrollees to commit fraud to tap into that coverage. In fact, research shows swaths of eligible people aren’t enrolled in Medicaid, likely because the system is so confusing. And nearly two-thirds of people on Medicaid in 2023 had jobs, according to an analysis by KFF, a health information nonprofit that includes KFF Health News.

Those transitioning off Medicaid may qualify for other subsidized or low-priced health plans through the Affordable Care Act’s marketplace. But, as in James’ case, such plans can have gaps in what care is covered, and more comprehensive private plans may be too expensive. So James and an unknown number of other people find themselves caught between working too much to qualify for Medicaid but earning too little to pay for their own health care.

James considers himself to be a patriot and said that people shouldn’t “use government funding to just be lazy.” He agrees with the Republican argument that, if able, people should work if they receive Medicaid. Hiding his hours on the job from the government bothers him, especially since he feels he must lie to access the medical care that enables him to work.

“I don’t want to be a fraud. I don’t want to die,” James said. “Those shouldn’t be the only two options.”

On July 4, Trump signed into law the major tax and spending bill that makes it harder for low-income workers to get Medicaid. That includes requiring beneficiaries to work or go to school and adding paperwork to prove every six months they meet a minimum number of hours on the job.

“It’s going to hurt people, whether they’re playing by the rules or not,” said Ben Sommers, a health economist at Harvard University. “We see this vilification of mostly very hard-working people who are really struggling and are benefiting from a program that helps them stay alive.”

James said he initially declined his raise because he worried about losing Medicaid. He had previously been kicked off the coverage about a month into his rehab program after finding work. To stay in the sober-living program he otherwise couldn’t afford, James said, he dropped just enough hours at work to requalify for Medicaid and then soon picked up hours again. If he didn’t earn more, he said, he had no chance of saving enough money to find housing after graduating from the treatment program.

“They’ll give you a bone if you stay in the mud,” James said. “But you have to stay there.”

That problem — becoming just successful enough to suddenly lose Medicaid — is common. It’s called a benefit cliff, said Pamela Herd, who researches government aid at the University of Michigan.

“It just doesn’t make any sense that someone gets a dollar pay raise and all of a sudden they lose all access to their health insurance,” Herd said.

She said a partial fix exists called continuous eligibility, which guarantees an individual’s Medicaid coverage for a specific period, such as a year or longer. The goal is to give people time to adjust when they do earn more money. Continuous eligibility also helps maintain coverage for low-income workers with unpredictable hours and whose pay changes month to month.

But Congress has moved in the other direction. Under the new law, policymakers limited windows of eligibility for able-bodied adults to every six months. That will put more people on the program’s eligibility cliff, Herd said, in which they must decide between losing access to coverage or dropping hours at work.

“It is going to be a nightmare,” Herd said.

Those federal changes will be especially difficult for people with chronic conditions, such as James in Montana.

Not that long ago, James wouldn’t have been breaking the rules to access Medicaid because his state had 12-month continuous eligibility. But in 2023, Montana began requiring enrollees to report any change in their income within 10 days.

James is proud of how far he’s come. About a year ago, his body was breaking down. He couldn’t hold a spoon to eat breakfast without whiskey — his hands shook too hard. He had alcohol-induced seizures. He said his memories from his unhealthiest times come in flashes: being put on a stretcher, the face of a worried landlord, ambulance lights in the background.

James recently graduated from his treatment program. He’s staying with a relative to save money as he and his girlfriend try to find an affordable place to rent — though even with Medicaid, finding housing feels like a stretch to him. He’s taking classes part-time to become a licensed addiction counselor. His dream is to help others survive addiction, and he also sees that career as a way out of poverty.

To James, all his progress rides on keeping Medicaid a bit longer.

“Every time I get a piece of mail, I am terrified that I’m gonna open it up and it’s gonna say I don’t have Medicaid anymore,” he said. “I’m constantly in fear that it’s gonna go away.”

As of mid-July, officials hadn’t noticed the extra $50 he makes each week.

https://missoulacurrent.com/medicaid-rules/

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Alternative Headline: Abortion Funding Ban Challenged

[MM Curator Summary]: A legal challenge to Michigan’s Medicaid abortion funding ban is headed for appeal after the state court dismissed it on procedural grounds.

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An appeal is coming in a lawsuit against Michigan’s ban on using state dollars to fund abortion care.

The YWCA of Kalamazoo, which brought the lawsuit with the help of the ACLU of Michigan, argues the ban could prevent Medicaid recipients from accessing an abortion.

The groups say that’s an issue since a state constitutional amendment passed in 2022 guarantees a right to abortion care in Michigan.

“Michigan must fulfill the guarantees of the Reproductive Freedom Amendment for all Michiganders, regardless of how much money they make or the type of health insurance they have," ACLU attorney Ryan Mendias said in a press release. "The court must vindicate the rights that Michiganders voted for and strike down the state’s ban on Medicaid coverage of abortion, which unconstitutionally puts this essential care out of reach for far too many low-income people in Michigan.”

The Michigan Court of Appeals dismissed the case earlier this month after ruling that the YWCA of Kalamazoo didn’t have sufficient legal interest in the matter to bring the lawsuit in the first place.

“An actual controversy does not exist between the YWCA and defendants. The essence of the YWCA’s complaint was not to seek a declaration of rights as between the YWCA and defendants. Instead, the YWCA seeks a declaration of its potential future clients’ rights to public funding for abortion care relative to defendants,” Judge Brock Swartzle wrote in his opinion.

Swartzle did not address the matter of whether the 2022 abortion rights amendment should invalidate the public funding abortion ban.

In announcing its appeal, the YWCA of Kalamazoo argued it does have legal standing in the case. That’s partially because of its work to help residents who rely on Medicaid.

https://www.michiganpublic.org/criminal-justice-legal-system/2025-07-25/appeal-coming-after-dismissal-of-medicaid-abortion-ban-case

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Alternative Headline: CMS Hiring Amid Job Loss Claims

[MM Curator Summary]: CMS is hiring 100 new staff to support its healthcare agenda, but former employees say they were told not to reapply.

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Officials with the Centers for Medicare and Medicaid Services have announced on social media that the agency is hiring for dozens of new positions to help realize its Make America Healthy Again agenda.

“The CMS Innovation Center is hiring passionate leaders eager to make meaningful change in the healthcare delivery and outcomes in Medicare and Medicaid,” Director of Patient Care Models Group at the Innovation Center, Sarah Fogler, wrote on LinkedIn last week. Several employees at the Innovation Center posted the same message on the jobs social media site.

The Innovation Center, formally known as the Center for Medicare and Medicaid Innovation, will hire roughly 100 positions, according to one current and one former employee at CMS granted anonymity to discuss internal operations. The center is expected to post some jobs through the USA Jobs site, the staff member said. Meanwhile, on LinkedIn, the Center’s employees are asking interested parties to email resumes to them directly.

https://subscriber.politicopro.com/article/2025/07/medicare-medicaid-agency-is-hiring-to-enhance-preventive-care-after-laying-off-employees-00464114

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A specific topic that seems to be different than other topics = BLUE