State News – Mostly Medicaid

Posted on September 8, 2025 by Sarai McDowell

STATE NEWS – Goliad County approves charity care policy for EMS services

Alternative Headline: Goliad adopts EMS charity policy

[MM Curator Summary]: Goliad County approved a charity ambulance care policy and partnered with Emergicon to maximize Medicaid reimbursements while protecting emergency access for uninsured patients.

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The Goliad County Commissioners Court unanimously approved a new charity care policy for ambulance services on Aug. 11, along with an agreement amendment with Emergicon, LLC, aimed at helping the county recover funds for uninsured patient care through the Texas Ambulance Supplemental Payment Program.

The policy allows Goliad County EMS to waive ambulance transport fees for patients who are unable to pay due to circumstances beyond their control. Patients with private insurance, Medicare, Medicaid or the ability to pay are not eligible for charity care under the policy.

As part of the plan, Goliad County EMS will work with Emergicon to handle ambulance billing, Medicaid and charity care reimbursements, and reporting requirements for the state-administered program. Emergicon will analyze billing data, prepare state and federal cost reports, and act as a liaison with the Texas Health and Human Services Commission to help the county maximize reimbursements.

Under the agreement, Emergicon will also help the county qualify for the Medicaid Average Commercial Rate Supplemental Payment Program, which could increase Medicaid reimbursement rates for ambulance services.

The county will pay Emergicon a contingency fee based on the amount of new Medicaid and uninsured care revenue generated, ranging from 6% for more than $2 million in annual claims to 15% for less than $500,000.

Goliad County EMS Director Holli Gregory told the court the initiative is designed to ensure that uninsured and underinsured residents continue to have access to emergency transport while helping offset the cost burden on county taxpayers.

https://www.southtexasnews.com/goliad_advance_guard/goliad-county-approves-charity-care-policy-for-ems-services/article_676bc498-37bc-430a-a501-2754d196b7bf.html

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Posted on September 8, 2025 by Sarai McDowell

STATE NEWS – What changes to Medicaid and ACA could mean for health care in Virginia

Alternative Headline: Virginia faces steep Medicaid cuts

[MM Curator Summary]: Virginia health leaders warn of massive coverage losses and funding cuts from new federal Medicaid reforms, while Gov. Youngkin frames them as necessary changes.

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Dr. Basim Khan has worked at Neighborhood Health, an Alexandria-based federally qualified health center, for 15 years. He got his start in primary care at Neighborhood Health’s Casey Health Center, and he still practices there — in addition to his duties as Neighborhood Health’s CEO, overseeing the organization’s 15 clinics across Northern Virginia.

“I love the communities we serve. I love the patients,” he says.

Khan is proud of Neighborhood Health’s role as a social safety net provider, serving uninsured and insured patients alike. And he’s proud of the organization’s growth, from a small practice in an apartment building serving women and children 25 years ago to what it is now: a network of health centers offering a wide range of medical, dental, and mental health services to more than 40,000 patients.

At Casey, that expansion is on full display. The center, which is right next to the Inova Hospital campus off of Seminary Road, includes an in-house pharmacy and lab, on-site mental health clinicians, and space for staff from the Alexandria Health Department to help people with their benefits. A baby crying in an exam room reminds Khan to talk about the center’s efforts to provide some limited ultrasound services for pregnant patients and their ability to offer joint appointments for mothers and newborns.

“We’re able to have mother-baby visits after delivery where we see both a postpartum visit in addition to a newborn visit,” he says. “Oftentimes those visits are really late, right? But with increasing maternal mortality and morbidity, you want to try to get them in as early as possible.”

The goal of all of it, Khan says, is to make it as easy as possible for patients to get the health services they need. But now he’s worried Neighborhood Health may be forced to pull back on the array of services they offer — and perhaps even close locations. The organization’s largest single source of revenue is payments from Medicaid, the federal program that insures low-income people. The reconciliation bill passed by congressional Republicans in July is set to pull federal funds back from Medicaid and make changes to the Affordable Care Act.

“We’ve been growing the safety net to be able to provide many aspects of health care to our population that really needs it. And we’ve had support at the policy level, because we’ve moved things in the right direction over time,” Khan said. “That’s my fear right now, that for the first time in a substantial way, that support is going to recede.”

What exactly the new law will mean for Virginia is still coming into focus for state lawmakers and healthcare providers like Khan. Some early estimates suggest that hundreds of thousands of Virginians could lose their health insurance as a result.

But Virginia Republicans, including Gov. Glenn Youngkin, foresee a less dire scenario, pointing to the law’s large infusion of cash for rural healthcare as an opportunity for the commonwealth.

Virginia-specific impacts

A key part of Neighborhood Health’s expansion was Virginia’s 2019 decision to expand Medicaid under the Affordable Care Act. For the first time, that made it possible for non-elderly adult patients without children to access Medicaid coverage. Currently, nearly 700,000 Virginians have health insurance as a result of the expansion.

Many of the reconciliation bill’s biggest changes will affect that group of people. The bill institutes work requirements for adults with children over 14, asking them to work, volunteer, or go to school 80 hours per month. They’ll be required to prove they did so to the state in order to access benefits.

The bill cuts back on “provider taxes,” which states levy on hospitals and nursing homes – money which they then use to increase federal matching funds for Medicaid, a tactic that helps reimburse providers. It also limits so-called “state directed payments,” eventually pushing the reimbursement rates of Medicaid patient care down to base Medicare rates instead of matching private insurance levels. That change could result in a $26 billion reduction in funding for health providers in Virginia, according to one estimate.

Those three major changes will land especially hard in Virginia, some experts believe. Modeling from KFF, an independent health research group, suggests that Virginia could lose just over a fifth of the Medicaid funding it currently receives from the federal government over the next ten years — one of the steepest reductions faced by any state in the country.

“In all of the different ways that the bill singles out different types of states — there’s three different big buckets, and Virginia meets all three of those,” said Alice Burns, associate director at KFF’s program for Medicaid and the Uninsured. She added that about half of the bill’s cuts target the expansion population.

Burns KFF model found that changes to Medicaid, the ACA, and expiring ACA tax credits would translate to about 350,000 people in Virginia no longer being insured.

Changes to Medicaid will roll out gradually over the next several years, with work requirements set to take effect in 2027.

But other changes will come more quickly. Congress did not extend the so-called “enhanced premium tax credits,” subsidies passed by the Biden administration to reduce costs for people who pay for health insurance on the Virginia Affordable Care Act marketplace. They will expire at the end of this year. Some state officials say that could lead as many as 100,000 Virginians to drop their health insurance, as costs for premiums rise. (KFF modeling found the change might affect about 40,000 people, Burns said.)

“We are concerned that enrollment decreases will be in line with those increases that we’ve seen in Virginia,” said Kevin Patchett, the director of the Virginia Health Benefits Exchange, at a meeting of the House Emergency committee studying the impact of federal cuts.

Some families could see a doubling of their monthly premiums, depending on their income bracket, Patchett estimated.

If the state were to fund the tax credits itself, that would come with a steep price tag: about $250 million annually, according to committee staff. Lawmakers would have to act in the next month to prevent price hikes for patients starting in January, Patchett said.

Dr. Basim Khan. Tyrone Turner / WAMU

Khan said Neighborhood Health and other social safety net providers in Virginia were already facing a difficult landscape, with the end of COVID-era federal and state support, healthcare staffing shortages, and rising costs. Now, he wonders how they will keep up with a possible influx of uninsured patients, even as the organization loses the Medicaid funding that enabled it to serve uninsured people to begin with.

“It’s something that keeps me up at night, trying to figure out how we as a community here in Northern Virginia are going to take care of all of these patients,” he said.

Debate over work requirements

Youngkin has defended the changes to Medicaid as a necessary right-sizing for the program and a return to its original focus on families with small children, disabled people, and elderly adults in long-term care facilities. He told the General Assembly’s Joint Money Committees, to whom he will submit his final state budget later this year, that he supports the work requirements.

“I believe this is fair. It will ensure we strengthen and protect the program for the people it was designed for, but it also opens up an avenue to dignity, to get a job, to go to school, or to volunteer in our communities,” he said at a meeting in mid-August.

Youngkin took issue with language and estimates suggesting Virginians will lose coverage as a result of the changes to Medicaid.

“I do want to be clear, changes to Medicaid are not taking coverage away from anyone,” he said. “I want to say that again: Not a single Virginian is losing access to Medicaid or getting kicked off the program.”

Research from the Urban Institute suggests that about 70% of Medicaid expansion recipients nationwide are already working or going to school.

Youngkin and other Virginia Republicans have pointed to a 2018 analysis from the Joint Audit and Legislative Review Commission which looked at the possible impact of instituting work requirements in Virginia, as proposed in a bill introduced by then-Del. Jason Miyares, the current Virginia Attorney General. That analysis found that about 7% of Medicaid enrollees would be deterred from signing up or maintaining their Medicaid eligibility as a result, though the study was based on projections for the Medicaid expansion population, since it came before the commonwealth expanded Medicaid. Another analysis of Miyares’ bill differed from that estimate, finding instead that somewhere between 10% and 22% of recipients would drop off of the program, depending on how difficult providing the state with evidence of hours worked would be.

Youngkin has also touted a fund in the reconciliation bill designed to shore up rural health providers, which often serve many patients on Medicaid. That will provide Virginia’s rural hospitals between $500 million and $1 billion dollars in the next five years. Youngkin issued an executive order to direct state agencies to get Virginia ready to compete for federal money for rural health systems in early August, and Roberts said the department will begin having conversations with stakeholders in rural parts of the commonwealth.

Choices for state policymakers ahead

Federal guidance is still forthcoming, but Virginia officials think they will likely have some latitude in how they choose to implement the new federal law. Their choices on things like how to define what qualifies as work for the new work requirements, how to verify applicants’ incomes, and what state and local governments can do in the way of outreach to help people navigate the new system could help ease some of the impact.

There will be “big decisions we’ll have to make on policy decisions, asset verification process, and obviously outreach,” Virginia Department of Medicaid Services director Cheryl Roberts told the House Emergency committee.

Roberts said the state may also be able to make its own decisions about granting short-term exemptions to the work requirements for people who are hospitalized or in crisis.

“Those are things that we would work together on as Virginians,” Roberts said. “We decide on what that list looks like.”

Roberts noted that the new law restricts some of Virginia’s decisions about how to operate Medicaid, too. The state currently reimburses newly-qualified recipients for medical care going back 90 days, but that will soon be limited to one month for the expansion population and two months for everyone else. It will also require state and local governments to perform eligibility checks for recipients twice a year, instead of annually.

Khan called on state leaders to approach implementation with an eye to ensuring ease of access for patients.

“I’ve seen how paperwork and red tape can lead to people not following through, not getting coverage when they desperately need it, and then ultimately lead to poor health outcomes down the road because they weren’t able to see a doctor or get a medicine,” he said. “What I’d urge people at the state level to do is to keep that in mind as you design your work requirements to really ensure that people do not unnecessarily lose coverage.”

This story has been updated with revised analysis from KFF.

https://wamu.org/story/25/08/20/va-medicaid-affordable-care-act-health-care-changes/

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Posted on September 8, 2025 by Sarai McDowell

STATE NEWS – Vance sharpens GOP’s sales pitch, defends Medicaid cuts at Georgia campaign stop

Alternative Headline: Vance defends GOP bill

[MM Curator Summary]: Vice President J.D. Vance defended Republicans’ “Big Beautiful Bill,” saying it protects Medicaid for citizens while excluding undocumented immigrants.

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PEACHTREE, GEORGIA – Vice President J.D. Vance championed Republicans’ “Big Beautiful Bill” during a Thursday stop at an industrial refrigeration plant, pushing back against criticism ofMedicaid cuts by arguing the bill protects benefits for American citizens while denying access to illegal immigrants.

“The only people that we say should not get free government healthcare benefits are illegal aliens and those that refuse to even try to look for a job,” Vance said during the question-and-answer portion of the rally to a round of applause.

In response to a reporter’s question highlighting concerns from Georgia Republicans that the GOP bill could push more than 100,000 people off Medicaid, Vance said the Trump administration has an “open door” to work with state leaders of both parties to ensure voters keep access to health benefits.

Vance added that many reforms will be phased in over several years to minimize disruption, while underscoring that undocumented immigrants should not receive taxpayer-funded coverage.

“We want to work with people to make sure that American citizens get what they’re entitled to. What we do not want is people who have no legal right to be here to benefit from the generosity of the American taxpayer and bankrupt those programs,” Vance said.

https://www.washingtonexaminer.com/news/3777754/vance-defends-medicaid-cuts-georgia-campaign-stop/

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Posted on September 8, 2025 by Sarai McDowell

STATE NEWS – Kentucky Democrats raise concerns about Medicaid cuts’ impact on families

Alternative Headline: Kentucky Democrats Warn Trump’s Medicaid Cuts Could Hurt Families

[MM Curator Summary]: Kentucky Democrats warn that Trump’s Medicaid cuts could undermine maternal and child health, while Republicans argue reforms will improve efficiency.

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(LEX 18) — Kentucky Democrats are voicing concerns that Medicaid cuts in President Donald Trump’s One Big Beautiful Bill could make it harder for Kentucky families to have and raise children.

During a press conference in Louisville on Thursday, Democratic leaders highlighted statistics showing that half of all births in Kentucky are covered by Medicaid, raising alarm about the potential impacts on women’s and children’s health.

"One out of every two kids born in the state is born because it’s covered by Medicaid," Representative Morgan McGarvey said.

McGarvey argued that cutting this funding would directly impact the health of Kentucky women and children. He also pointed out that as birth rates drop worldwide, Medicaid cuts could worsen the demographic trend.

"These cuts to Medicaid, they are making it harder for people to have families. They are making it harder to have children," McGarvey said.

Maternal health advocates are also raising concerns about how the cuts might limit healthcare workers’ ability to provide comprehensive care to their patients.

"It’s impacting the care that we are able to provide. It puts limitations on being able to care for people when they are showing up at your doorstep due to the systematic barriers that they have," Dr. Ana’Neicia Williams, a maternal health advocate, said.

However, not all lawmakers share this perspective.

Rep. Andy Barr has repeatedly stated that Trump’s legislative package will strengthen Medicaid by eliminating fraud and abuse, ensuring that people who need Medicaid resources will receive them.

https://www.lex18.com/news/state-of-the-commonwealth/kentucky-democrats-raise-concerns-about-medicaid-cuts-impact-on-families

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Posted on September 8, 2025 by Sarai McDowell

STATE NEWS – Oregon’s health care program for low-income people is in ‘crisis,’ leaders say

Alternative Headline: Oregon Medicaid Faces Funding Crisis

[MM Curator Summary]: Oregon’s Medicaid system faces a crisis as major coordinated care organizations report hundreds of millions in losses and threaten to exit due to underfunding.

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Much publicized federal cuts haven’t even kicked in yet. But the state’s health care system for 1.4 million low-income people is already bleeding red ink, and leaders of the care organizations in the Oregon Health Plan say they can’t afford to keep delivering care at a huge loss.

This article has been updated.

The federal cuts that have been dominating headlines for months haven’t even rolled out yet — but according to those administering the program that 1.4 million low-income Oregonians rely on for free health care, the system is already in “crisis.”

The situation risks complicating or blocking care for many of the one in three Oregonians who get medical, dental and behavioral health services through the Medicaid-funded Oregon Health Plan.

Over the past year, some of the organizations paid by the state to oversee and direct care in the program have experienced massive losses. Now, some of their leaders are now considering pulling out of the program entirely, The Lund Report has learned.

The Medicaid executives’ concern? That if they keep delivering care to low-income people they’ll be hit with even larger losses due to the low reimbursement rates Oregon health officials are proposing to pay them in 2026.

Top state officials have extended a key deadline to allow talks to continue. But the crisis is coming at a time when the Oregon Health Authority is already wrestling with cost overruns. It doesn’t yet have a plan to deal for when federal cuts and costly administrative measures take effect thanks to HR 1, the federal budget plan spearheaded by Republicans in Congress.

“This is before the federal changes hit,” one longtime observer of the system told The Lund Report. “This is bad.”

State health officials charged with maintaining the integrity of the state’s Medicaid system declined to comment or confirm basic facts other than to say they were continuing to discuss the situation with CCO leaders. Citing what they called pending negotiations, a spokesperson for Gov. Tina Kotek’s office declined to comment on the situation.

Tight deadline for a deal

Things are happening fast. The groups, known as coordinated care organizations, must give notice next month of whether they intend to pull out of the Oregon Health Plan starting Jan. 1. As of now, some of them apparently would leave the program rather than renew their contracts.

To allow talks to continue, Oregon Health Authority Director Sejal Hathi notified the CCO leaders last week that the state was extending the deadline to commit by more than two weeks.

“The timelines are very tight,” Hathi wrote in an Aug. 14 email to them, obtained under Oregon Public Records Law. She noted the agency has “limited authority” to push things back further due to an Oct. 1 deadline to submit CCO rates to federal regulators for review.

The time will allow state officials to try to boost the CCO rates and consider program changes to cut costs, records show. The new deadline is Sept. 18 for the organizations to say whether they’ll stick around.

As things stand, 11 organizations oversee 16 regions in the state. If they pull out of any of those regions it could create chaos and disruptions for large numbers of people who live there, making it harder for them to get care at a time when many providers are already scarce and overbooked.

“Oregon’s coordinated care model has been a national leader, and it depends on strong, financially sustainable CCOs,” said a spokesperson for CareOregon, a nonprofit that oversees care for 500,000 Oregonians, including many in greater Portland. “If major CCOs were to withdraw, it would create instability for hundreds of thousands of members and providers and could jeopardize the coordinated model itself. That’s why we are raising these concerns now: to ensure Oregon can sustain a strong, stable Medicaid system for our members who depend on it.”

Careoregon reported losses of $200 million last year, and the spokesperson says its losses this year could exceed $300 million. That’s big even for a nonprofit organization that was holding more than $1 billion in reserves.

Like CareOregon, PacificSource ‚ which oversees care in Central Oregon, the Columbia Gorge, Marion, Polk and Lane counties —has also suffered major losses. Both organizations serve more urban populations and have seen behavioral health needs skyrocket.

Jim Havens, a PacificSource executive vice president, told The Lund Report in an email that “Like other payers in Oregon, PacificSource is facing serious financial challenges related to Medicaid. Enrollment has surged and costs have risen sharply, far outpacing the state rates meant to cover them. We project operating losses of up to $100 million in 2025, after $40 million in losses in 2024. Losses in 2026 could be significantly higher.”

Even relatively small Yamhill Community Care is worried. Its CEO, Seamus McCarthy, has been a spokesman of sorts for the Medicaid managed care groups. “Oregon’s health care system is approaching a crisis point," he said in a statement. "We hope solutions can be reached before a catastrophic event—such as a CCO not renewing its contract—forces drastic changes to the Oregon Health Plan.”

State payments trail cost trends

The prospect of CCOs pulling out of contracts to care for low-income people is prompted by the state’s proposed increases to their reimbursements averaging 6.8% — far lower than what they considered necessary to account for massive increases in people accessing health care and higher costs.

Federal funds pay for the majority, but the state also has to chip in significant funds. The Oregon Health Authority’s approved budget has to cover that, but faces numerous other cost pressures. The agency also needs to prepare for things to get worse:: observers in Salem expect state goverment revenue projections to drop substantially due to massive layoffs at Nike and Intel.

In contrast to the reimbursement increases of 6.8%, underlying costs for Medicaid insurers and others in health care are going up far more quickly — close to10% a year or more in Oregon and around the country, according to informed observers and nationally reported data.

Similar cost trends in the commercial health insurance market have led Oregon insurance regulators to preliminarily approve average premium increases of 9.7% for individual market insurers, and 11.5% for plans serving small businesses.

The projected losses cited by Oregon’s care organizations would come on this year, when payments made by the state of Oregon did not cover costs. Earlier this year, because behavioral health needs outstripped the health authority’s rate-making assumptions, Oregon lawmakers had to slip a $30 million payment into the state budget to cover some CCO losses.

On June 11, on behalf of the care organizations, McCarthy of the Yamhill nonprofit documented their concerns in a letter to Oregon Medicaid Director Emma Sandoe, saying similar messages had been shared with top agency leaders for several months.

“Underfunding by the state is threatening the health system, particularly for Oregon’s most vulnerable situations,” the letter said.

It noted that many of the groups were spending close to 100% or more of their revenue on medical expenses. That’s way over the minimum benchmark of 85% required for medical spending, a federal benchmark intended to allow 15 % to cover administrative costs and some profit. The letter said the state faced an “impending crisis.”

Sandoe declined to comment on the letter.

Oregon is among the states most reliant on managed care organizations to operate its Medicaid program. A few states barely use outside managed care organizations or insurers.

In Connecticut, officials years ago fired the health insurers they used to contract with and claimed they saved money by setting up new nonprofits to handle adminstrative services. Some longtime Oregon health care executives say it’s unclear how transferable that model is to Oregon given the geographic and democraphic disparities between states.

Past is prologue

For Oregon historians, the current situation might seem familiar. The birth of the Oregon Health Plan in 1993 came in response to what lawmakers at the time considered a crisis — insurers pulling out of the Medicaid market citing insufficient payments. The goal was to ensure adequate funding and community based care.

Since then, the late state representative, Mitch Greenlick, pushed the state to take measures to make it hard for the care organizations and their reserves to leave the program, to no avail. Former Gov. John Kitzhaber and others — including then-House Speaker Tina Kotek — have pushed the Legislature to similarly take steps to keep Medicaid profits in the state’s health care system.

None of that happened. The state has no leverage to keep care organizations and the reserves they amass from leaving the program.

Meanwhile, over the last 15 years, the work of the state office that sets rates to care organizations in the Medicaid-funded program has repeatedly come into question.

When it comes to health coverage, rates are supposed to approximate costs plus an acceptable amount of overhead. But prior to major reforms in 2012, the Oregon Health Authority used to simply tell managed care organizations how much it could afford to pay them.

Critics, including former Gov. John Kitzhaber, have noted that the system rewards inefficiencies, promoting waste. But reforms intended to change things ran into federal laws, and so did Oregon’s practices.

In 2014, federal health officials demanded Oregon Health Authority officials overhaul practices that appeared to flagrantly violate legally required actuarial rules governing rate-setting for Medicaid programs.

Two years later, care organizations, which were supposed to have rates that allowed a 2% profit margin, instead reported profits of as much as 27%, causing the state’s then-Medicaid director to advise the Oregon Health Authority’s public relations staff to kill a press release bragging about their financial health.

In 2022, the Oregon Health Authority agreed to a $22.5 million settlement with FamilyCare, a care organization that cited expert testimony to blame poorly calculated rates for its decision to leave the state Medicaid program in 2018 and take more than $100 million in reserves from its operations with it. (FamilyCare had contributed to The Lund Report, as has the group to which it donated much of its reserves, the Heatherington Foundation for Innovation and Education in Health Care. Neither entity participates in Medicaid or is affected by the current rate flap.)

In 2024, state officials appeared to admit in press release that they tried to keep reimbursement increases in Medicaid as close as possible to 3.4% — the state’s cost-growth target — despite federal rules requiring rates to reflect cost trends, not an abstract target.

Jeff Heatherington, the former CEO of FamilyCare, told The Lund Report that care organizations can leave the program, as the nonprofit he headed did, if they feel the state’s rates are unfair or not a good return on investment. He’s not sure he completely buys the most recent complaints, since some of the care organizations are dominated by hospitals that can manipulate reimbursements to “upcode” or otherwise inflate revenue or costs.

That said, the state’s reimbursement rates appear to be way too low given the losses being reported, he added. If any CCOs pull out, it could threaten access for patients and drive up costs for the state because people can’t get primary care providers and go to the emergency rooms and urgent care instead.

“You would have, I think, a real health problem” for affected members, he said.

https://www.thelundreport.org/content/oregons-health-care-program-low-income-people-crisis-leaders-say

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Posted on September 8, 2025September 8, 2025 by Sarai McDowell

STATE NEWS- Autism therapy providers warn of crisis amid Medicaid changes

Alternative Headline: Florida Autism Therapy Providers Say Medicaid Transition Puts Kids at Risk

[MM Curator Summary]: ABA therapy providers in Florida warn that Medicaid’s switch to managed care is causing massive payment delays, denials, and cuts that threaten children’s access to autism care.

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Companies that provide therapy to children with autism are speaking out, saying they may have to stop serving some of Florida’s most vulnerable children if problems with a new Medicaid reimbursement system aren’t resolved.

Autism therapy providers warn of crisis amid Medicaid changes

“They owe us a lot of money. And it’s not just us. It’s statewide. It’s across the board,” said Alicia Anthony-Zabala, who owns Missing Piece ABA in Tampa.

“The clients we serve are in jeopardy of losing their services,” said Sara Beeler of Mindful Masterpieces in Naples.

The ABC Action News I-Team has learned the issues started in February, when Florida’s Medicaid program transitioned to a managed care system.

Providers say since that transition, payments have been delayed or denied, putting businesses, children and families at risk.

Thousands of Florida children receive ABA through Medicaid

For Anthony Meoni, who has been diagnosed with autism spectrum disorder, Missing Piece ABA offers what his family believes is his best chance to thrive.

Anthony struggles with communication and social interaction.

He’s not alone.

According to the CDC, the prevalence of autism spectrum disorder nationwide has grown from 1-in-150 children in 2000 to 1-in-31 today.

That represents about 3.1 percent of all children.

Anthony is among an estimated 41,000 Florida children who receive ABA, or Applied Behavioral Analysis therapy through Medicaid.

“ABA is the only approved scientifically-based documented treatment for autism,” Anthony-Zabala said.

ABA therapy uses positive reinforcement and consistent practice to change children’s negative behaviors.

“A lot of these kids can’t go to school”

“Some of our companies are the only lifeline these parents have to kind of work through some of these behaviors,” said Aerial Lufkin, of Sunshine ABA in Orlando.

“The majority we service are all day every day,” Beeler said. “It’s very important because the majority of clients we have don’t have other options as far as attending school or a regular daycare because they don’t provide the types of therapy they need.”

“A lot of these kids can’t go to school. Or they do go to school and they get sent home because of their behavior. Parents are having to pick them up,” said Anthony-Zabala.

Representatives of four ABA providers recently told the I-Team their businesses are struggling after Medicaid changed to a statewide managed care program in February.

“People weren’t fully prepared for a big transition like this. This is very huge and it’s really affected everyone in the state,” Lufkin said.

They say the problems stem from the way Sunshine Health, the company that administers Medicaid claims for the state, pays providers.

“Prior to this, every Thursday we would get a lump-sum deposit. So we would bill and pretty much get what we billed,” Anthony-Zabala said.

“It’s created a huge spiral in my finances”

Providers say now payments are sporadic.

“Because the payments are so spaced out, it makes it impossible to budget because you don’t know how much money you’re getting and when you’re getting it,” said Pearson Klein of Behavior Modification Solutions ABA in Ocala.

“We’ve seen no payments on some of the claims for many weeks now,” Beeler said.

Some claims submitted in February and March are still listed as “pending”.

Anthony-Zabala says claims she submitted for a single client were approved in some cases and denied in others.

“We were only reimbursed 8 out of 34 claims. And when we went back into the portal, the system, it just said that they were being denied due to no Medicaid ID… even though the Medicaid ID was on the denial,” Anthony-Zabala said.

“They’ll say a Medicaid number isn’t listed on the paperwork, but on the denial, it’s clearly listed,” Beeler said.

And providers say getting answers about the denials isn’t easy.

Alicia Anthony-Zabala

“We will sit on the phone for hours and generally get no resolution to the reason why we were calling,” Beeler said.

Under the new system, providers say reimbursement rates were also cut by 20 percent, even though they have to pay their staff the same amount.

Some companies say they’re on the brink of having to close.

“Most of us are four to six weeks away. If this continues… the lack of reimbursement… four to six weeks,” Anthony-Zabala said.

She estimates she is owed about $80,000 for claims she has submitted to Sunshine Health but haven’t been paid.

“It’s just created a huge spiral in my finances,” Klein said.

He said if his business shut down, 35 to 40 people would lose their jobs.

If ABA companies close, parents would also be impacted.

“Likely they would have to quit their jobs. Someone would have to make the decision to say home. Or hire some private care,” Beeler said. “It’s very expensive.”

Response to providers’ concerns

We contacted Florida’s Agency for Healthcare Administration, or AHCA, about the providers’ issues but have not heard back.

We also reached out to a spokesperson from Sunshine Health.

She emailed the following statement, which addresses concerns we forwarded to the company about patient privacy and reimbursement:

“Sunshine Health takes its responsibility to protect member and provider information seriously, maintaining strict compliance with HIPAA regulations to ensure all protected health information (PHI) is handled securely and appropriately.

“Access to our Provider Portal is restricted to Providers who are Covered Entities and/or their Business Associates who are authorized to handle PHI under the terms of our access agreement. Users are required to only access records for which they have a legitimate business need. The identity verification data requested reflects information typically received by providers at the point of service and is designed to help return member information efficiently and without limiting the ability of members to get the care they need when they need it.”

“Sunshine Health partners closely with our valued network of providers to deliver high quality care to our members. The state of Florida transitioned Behavioral Analysis (BA) services to managed care health plans on Feb. 1, 2025, and we have invested significant effort into making this transition as seamless as possible for both our members and provider partners. As a managed care health plan for the State of Florida, we adhere to all state requirements about how services can be billed. In an effort to be a good partner, we have been working closely to educate providers on these processes through Provider Town Hall trainings, Provider Engagement Team outreach, and quick resource guides to ensure they understand any requirements in order to deliver the best care to our members.”

Anthony-Zabala worries if the program isn’t fixed, Anthony and the other children her company cares for could be at risk of losing the progress they’ve made.

“Every small achievement, no matter how small, is a milestone. That’s why you get up every day and you believe in it. And you believe in these kids and you fight for them,” she said.

https://www.newsbreak.com/tampa-bay-28-563666/4182961849225-autism-therapy-providers-warn-of-crisis-amid-medicaid-changes

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Posted on September 8, 2025 by Sarai McDowell

STATE NEWS – Rosen Delivers Floor Speech Highlighting Devastating Impacts in Nevada of Washington Republicans’ Medicaid Cuts

Alternative Headline: Rosen Slams Medicaid Cuts

[MM Curator Summary]: After speaking with health care leaders from multiple medical care centers in Nevada, Senator Jacky Rosen warned that Republican Medicaid cuts will devastate Nevada hospitals and harm families’ access to health care.

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WASHINGTON, DC – Today, U.S. Senator Jacky Rosen (D-NV) delivered a floor speech highlighting her visits to multiple medical care centers in Nevada and her conversations with health care leaders about the devastating impacts of Washington Republicans’ cuts to Medicaid. In August, Senator Rosen visited health care centers in Lovelock, Reno, and Las Vegas where she heard first-hand how they’re being hurt by the steep cuts in Medicaid funding.

Transcript of Senator Rosen’s speech:

Last month, I traveled up and down my state to speak directly with Nevadans about how Washington Republicans’ devastating cuts to Medicaid will hurt our communities.

From the University Medical Center in Las Vegas to Northern Nevada HOPES in Reno, I heard firsthand from medical providers about how worried they are about the cuts being made to their funding by the Republican budget law.

According to a report, Nevada hospitals are set to lose up to half a billion dollars from the Republican “Big Beautiful Bill” at a time when our state is already facing a dire shortage of doctors and nurses.

And remember, Washington Republicans did this so they could pay for even more tax breaks for billionaires.

In Las Vegas, I met with doctors and leaders of the only Level One trauma center in the entire state of Nevada.

Our conversation made it clear: these Medicaid cuts will be devastating for the hospital’s finances and they’ll make patients less likely to seek preventative health care – often waiting until it’s too late.

This will strain our hospitals’ resources even more and could have terrible consequences for families.

It was a similar story in Reno, where I visited Northern Nevada HOPES, a nonprofit community health center that serves families in need.

The staff painted a harrowing picture: when Medicaid is cut and people don’t have access to health insurance, they delay care, minor conditions become severe, emergency rooms overflow, and the financial and human cost escalates.

As their CEO Sharon Chamberlain said, “This is not a budget issue. It’s a public health emergency. And let’s be clear: No amount of innovation, no amount of efficiency, can fully offset the damage caused by policies that strip coverage of those that need it most.”

M. President, these are not abstract worries. They reflect real fear and urgent concern from families, medical staff, and local leaders.

And what’s worse: these stories aren’t unique to Nevada. This looming crisis is going to hurt communities all across the country.

Republicans, time after time, put politics and tax cuts for billionaires over people’s health.

Make no mistake, people will die because of these Republican cuts – It doesn’t have to be this way.

I’ve joined my Democratic colleagues in helping to introduce a bill to overturn the cruel Republican Medicaid cuts and protect Nevadans’ access to health care.

Our hospitals and community clinics – the people on the frontlines of our health care system – they are sounding a wake-up call. It is not just their fight. It is our fight.

Now, let’s pass that bill and repeal the damage being made to our health care system before it’s too late.

The health of Nevada families is on the line.

Senator Rosen has strongly opposed Washington Republicans’ extreme budget law that cuts Medicaid to give more tax breaks to billionaires. In July, she condemned the Senate Republicans’ passage of the extreme so-called “Big Beautiful Bill” and she spoke on the Senate floor to oppose this dangerous legislation, warning of its devastating impact on access to health care in Nevada and across the nation. In August, she helped introduce legislation to overturn the Medicaid cuts that are taking away care from millions of Americans.

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https://www.rosen.senate.gov/2025/09/04/rosen-delivers-floor-speech-highlighting-devastating-impacts-in-nevada-of-washington-republicans-medicaid-cuts/

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Posted on September 4, 2025 by Sarai McDowell

STATE NEWS – Louisiana Medicaid Increased Physician Reimbursement Rates Beginning July 1, 2025

Alternative Headline: Louisiana Boosts Medicaid Pay

[MM Curator Summary]: Louisiana will raise Medicaid physician reimbursement rates to 85% of Medicare levels starting July 2025.

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– The Louisiana Department of Health (LDH) announced an increase in Medicaid reimbursement rates for physicians through funding authorized by Act 306 of the 2024 Regular Legislative Session and appropriated in House Bill 1 of the 2025 Session.

Effective July 1, 2025, Medicaid physician reimbursement rates will increase to 85% of the March 2024 Region 99 Medicare rates for applicable services. Reimbursements at or above this threshold will remain the same.

To implement the new rates, LDH has initiated the formal rulemaking process and submitted a state plan amendment to the Centers for Medicare and Medicaid Services (CMS). An emergency rule was published in the July 2025 edition of the Louisiana Register with the effective date of July 1, 2025, allowing the rate increase to take effect while the final rule is being finalized.

What Providers Need to Know:

No action is required from providers. All eligible Medicaid claims with service dates on or after July 1, 2025, will be automatically recycled by LDH and the managed care organizations (MCO) to reflect the updated reimbursement amounts.
A revised Medicaid fee schedule will be posted on LDH’s website by September 30, 2025.
Once the fee schedule is published, MCOs will have 30 calendar days to implement the new rates.
LDH will issue an informational bulletin with additional details before the online posting of the revised fee schedule.

For updates and more information, providers are encouraged to monitor LDH communications.

https://ldh.la.gov/news/7537

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Posted on September 4, 2025 by Sarai McDowell

STATE NEWS – Vance brazenly lies about cuts to Medicaid in his home state

Alternative Headline: Vance Defends Medicaid Cuts

[MM Curator Summary]: JD Vance falsely claimed most Ohioans will retain Medicaid under Trump’s new policy, despite analysis showing massive coverage losses.

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The wildly unlikeable Vice President JD Vance returned to his home state of Ohio on Monday, speaking at a steel plant in Canton. When asked about the “hundreds of thousands of Ohioans” whose Medicaid coverage is in jeopardy as a result of President Donald Trump’s “One Big, Beautiful Bill,” Vance simply lied.

A cartoon by Clay Bennett.

“Well, what I’d say to those Ohioans is one: Don’t believe every false media report that you’ve heard because our explicit goal in the Trump administration is to protect people’s health care, so long as they’re working hard, playing by the rules,” he claimed.

He then went on to make a false assertion about who will lose their Medicaid.

“Now, there have been a lot of lies out there. And if, for example, you’re an able-bodied person and you’re searching for work, you still got access to Medicaid. If you’re a single mom and you need access to that health care to make sure your kids can go see a doctor, you’re still going to have access to that Medicaid,” Vance said. “Who’s not going to have access to that Medicaid is people who are in the United States illegally and people who refuse to even look for a job."

Meanwhile, an analysis from the Ohio-based Center for Community Solutions found that up to 450,000 Ohio residents are at risk of losing their health insurance once the GOP’s Medicaid work requirement waiver takes effect.

The policy resembles Arkansas’ failed 2018-2019 experiment, which not only failed to boost employment but also increased red tape, causing more than 18,000 people to lose their health insurance.

The conservative myth that millions of people live comfortably by lazily subsisting off of meager entitlements has been debunked repeatedly. But now the Trump administration is pushing a new myth: that citizens will work low-wage jobs—vacant due to the mass deportations of immigrant workers—in exchange for the poor and often inaccessible health insurance available to farmworkers.

We’ll see how that works out.

https://www.dailykos.com/stories/2025/7/28/2335623/-Vance-brazenly-lies-about-cuts-to-Medicaid-in-his-home-state

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Posted on September 4, 2025 by Sarai McDowell

STATE NEWS – Losing bidders accuse state officials of mishandling Medicaid contracts

Alternative Headline: Georgia Medicaid Contract Controversy

[MM Curator Summary]: Georgia’s Medicaid contract awards face legal protests amid claims of misconduct, favoritism, and transparency violations.

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A bidding war for a massive contract to manage the state’s multibillion-dollar Medicaid health insurance program has devolved into allegations of misconduct against state officials.

The losing companies, Amerigroup and Peach State Health Plan, filed complaints with the state’s contracting office and with the Fulton County Superior Court.

Peach State Health Plan accuses the former commissioner of the Department of Community Health, Russel Carlson, of violating a strict period of silence meant to keep all bidders on an even footing.

The companies also accuse the department of withholding documents that it should have produced under the state’s transparency laws.

At stake, they say, is the fairness and legality of doling out a major state contract.

“The State’s procurement was mismanaged, rife with errors and reckless practices,” Peach State said in a December letter protesting the decision.

State officials contacted by The Atlanta Journal-Constitution did not address the allegations or say whether the contract would be rebid, citing the pending procurement process.

Carlson, who recently left his job with the state for an outside position, did not answer AJC reporters’ questions about the contract. In a joint statement, he and DCH said his departure was unrelated to the contract.

Georgia insures about 2.3 million people under Medicaid, a state-federal health insurance program for poor children and some poor, elderly and disabled adults. Since 2006 Georgia has outsourced the operation of the critical program to private health insurance companies under a handful of contracts.

In December, DCH awarded the contracts to four companies: CareSource, Humana Employers Health Plan of Georgia, Molina Health Care and United Health Care of Georgia. But those companies have not taken over the work while the protest plays out.

Whichever companies ultimately end up with the contract will be responsible for signing up doctors and hospitals to the company’s Medicaid plan, writing the checks for patient care and coordinating care for patients.

Amerigroup and Peach State Health Plan have held those contracts since the outsourcing began in 2006. Amerigroup manages the Medicaid insurance for about 460,000 Georgians, and Peach State Health Plan does it for about 700,000. The contract includes children in foster care as well as adult Medicaid recipients.

A third company, CareSource, covers 380,000 Georgians under the current contract. That company was selected to continue with the state and is not part of the protest.

Peach State alleges Carlson texted with a lobbyist for one of the competing bidders and offered to call him about the timing of the award. The contracting process was at that moment still in a “blackout period,” the complaint claims, meaning state officials were forbidden from discussing the contract with any of the bidders except through designated intermediaries.

In addition, the insurance companies allege the DCH violated the Georgia Open Records Act by failing to produce any text messages until prodded by a court filing, and then producing so few that the company says it was not a good faith effort.

As part of its protest, Amerigroup has accused Candice Broce, the commissioner of the Department of Human Services, of smearing its reputation and scapegoating the company. DHS is separate from DCH and determines eligibility for Medicaid. Amerigroup had sought to win a separate Medicaid contract that would allow the company to manage health care for children in foster care or otherwise under state custody.

The company referenced a letter Broce wrote to then-DCH Commissioner Caylee Noggle saying, “Amerigroup is often difficult to reach, even during normal business hours” and providers complain they do not get paid in a timely manner, prompting many to leave the network.

The state has postponed the contract start date until to 2026 while the protest plays out.

https://www.ajc.com/politics/2025/07/losing-bidders-accuse-state-officials-of-mishandling-medicaid-contracts/

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