Category: GHS

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STATE NEWS – Survey shows strong majority of Coloradans back Medicaid as GOP Congress weighs deep cuts to the program

STATE NEWS – Survey shows strong majority of Coloradans back Medicaid as GOP Congress weighs deep cuts to the program


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Alternative Headline: Coloradans Oppose Medicaid Cuts

[MM Curator Summary]:  A strong majority of Colorado voters oppose Medicaid cuts and support social safety programs amid GOP budget proposals.

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With millions of dollars in Medicaid on the table as Republicans solidify their budget bill, the majority of Coloradans say they don’t want the health program for low-income Americans to be cut.

Most Coloradans — 65 percent — oppose cuts to Medicaid, something that may happen if the budget bill passes, according to a new poll. The survey of 675 registered voters was conducted by Magellan Strategies for the health advocacy group Healthier Colorado.

“A majority have a positive regard for Medicaid. A majority think it’s important for their local community. A majority don’t want it cut,” said Jake Williams, Healthier Colorado’s CEO. “A majority are less likely to vote for a candidate who voted to cut Medicaid. So it’s a pretty clear result here.”

He said a proposal from President Donald Trump to raise taxes on those making over $2.5 million a year to help fund Medicaid is broadly popular among Coloradans.

Sixty-three percent of voters in hotly contested Congressional District 8 say they were less likely to vote for a candidate who voted to cut Medicaid, which is known as Health First Colorado.

“Cuts to Medicaid really aren’t showing any sort of support here, no matter really what the subgroup is,” said Courtney Sievers, Magellan’s director of survey research. 

The 8th district’s representative, Republican Gabe Evans, voted for the first version of the bill in the U.S. House, which makes deep cuts. He said he supports protecting Medicaid for vulnerable populations like pregnant women, kids and disabled people.

A spokesperson for Evans pointed out that it’s important to note that the polling also shows that some voters in the district who have an unfavorable view of Medicaid said there’s fraud, waste, and abuse in the Medicaid system and support undocumented people not receiving taxpayer-funded health care.

Pollsters wrote that “a dominant theme — especially among Republican and unaffiliated respondents — was anger or frustration over Medicaid being used for undocumented immigrants. Many said Medicaid should only be for U.S. citizens or legal residents, with some calling for stricter eligibility enforcement." 

Voters were asked if changes being proposed for Medicaid are “more about improving how the program works or more about taking money from Medicaid to use it for other purposes?” Sixty percent statewide and 51 percent in CD-8 said it was more about taking money to use for other purposes; that compared with 22 percent statewide and 29 percent in Evans’ district saying it was about improving how the program works for people.

“People aren’t buying the story that these Medicaid cuts are about making the program better, whether it’s work requirements or other forms of elimination of waste, fraud and abuse,” Williams said. 

Coloradans, including in CD-8, also expressed strong support for other government social safety net programs under threat from cuts in the Republican budget bill. Eighty-three percent statewide said they support the food assistance program called SNAP (Supplemental Nutrition Assistance Program). Eighty-two percent said they support Head Start, a free, federally funded program that provides early learning, health, nutrition, and support services to families with children from birth to age 5.

Most voters and those in CD-8 said they don’t want to see Congress make significant decreases in funding for those programs.

Voters weigh in on other issues

The poll also delved into other health-related questions on things like vaccines and social media.

  • 90% of voters in Colorado believe social media has had a negative impact on the youth mental health.
  • The percentage who believe the impact has been very negative has increased from 49% to 58% since December 2023.
  • 90% of Colorado voters believe there is a growing mental health crisis for children and youth.
  • The percentage who strongly agree has increased from 50% to 62% since December 2023.
  • 72% of voters in Colorado believe vaccines are safe and 76% believe they are effective; a majority (69%) said they do not believe that vaccines cause autism in children.
  • Just 5% of Colorado voters said the cost of childcare is affordable in their area.

https://www.cpr.org/2025/06/13/survey-strong-majority-coloradans-support-medicaid/




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STATE NEWS – Texas clarified when abortions are OK and aligned with RFK Jr. on health this legislative session

STATE NEWS – Texas clarified when abortions are OK and aligned with RFK Jr. on health this legislative session


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Alternative Headline: Texas Health Policy Shifts

[MM Curator Summary]: Texas passed major health bills in 2025, clarifying abortion rules, funding dementia research, and launching new Medicaid and nutrition initiatives.

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The 2025 Texas Legislature proved to be a session of re-calibration, where health care regulations were either tightened or loosened and attempts to delve further into some policy areas were left hanging until the next session.

The past two legislative sessions saw more seismic shifts: a near-total ban on abortion, a massive expansion of the state’s psychiatric hospital system, the teeniest of Medicaid expansions to offer one year of insurance coverage to new moms and a mental health budget boom following the tragic Uvalde school shooting.

That didn’t appear to leave much for the 89th Legislature to do on health, although lawmakers managed to approve a handful of intriguing bills and budget requests while killing other proposals.

Vaccine-hesitant parents successfully lobbied and won easier access to the vaccine exemption form and lawmakers narrowly clarified the state’s near-total abortion bans to give doctors more confidence in performing life-saving abortions.They also passed a historic $3 billion dementia research fund that awaits voter approval in November.

There were also a variety of bills signaling to the Trump administration, particularly U.S. Health Secretary Robert F. Kennedy Jr., that Texas was all on board his priorities to create transparency on food labeling and to stamp out chronic diseases.

The remaining health care cliffhanger is whether Gov. Greg Abbott signs or vetoes a hard-fought ban on THC products in the state. Abbott has until June 22 to veto any legislation passed this session. Otherwise, most of them will go into effect immediately or in September, even without his signature.

Here’s a rundown of how health care fared this past session.

Vaccine choice

House Bill 1586 allows anyone the ability to download a vaccine exemption vaccine exemption form at home. The form allows children to be exempted from being vaccinated to attend public schools. Currently, parents have to contact the Texas Department of State of Health Services and request the exemption form be mailed to them. Critics of the bill fear it would allow vaccine exemptions to flourish, as the state grapples with declining vaccination rates, but proponents say the bill is only meant to make it easier for parents to access a form.

Other vaccine skeptic measures that passed include HB 4076 which bars making patients ineligible as organ transplant recipients solely based on their vaccination status and Senate Bill 269 which requires providers to report patients’ vaccine complications to the national Vaccine Adverse Event Reporting System.

HB 4535 requires health care providers obtain informed consent from patients before a COVID-19 vaccine is administered and that patients receive notice about possible side effects.

Make Texas Healthy Again

Two nutrition bills dubbed Make Texas Healthy Again bills passed.

Texans who receive benefits through the federal Supplemental Nutrition and Assistance Program will no longer be able to purchase soda and candy with their Lone Star card following the passage of SB 379.

SB 25 requires food manufacturers to label foods by 2027 that contain any one of 44 additives or colorings not permitted in food sold in the United Kingdom, Australia, the European Union or Canada.

The state labeling requirements would take effect on Jan. 1, 2027 but a loophole exists that if on Dec. 31, 2026 a snack food producer wants to stick with its existing packaging for another decade, no warning label is needed because the new law “applies only to a food product label developed or copyrighted on or after January 1, 2027.”

The bill also requires elementary, secondary and postsecondary educational institutions to re-prioritize health and exercise. It also forces health professionals to take continuing education courses regarding nutrition and metabolic health. And it will require recess or physical activity for kids in charter schools – physical activity is already required in public schools.

HB 26 creates a pilot program within Medicaid to offer pregnant moms with nutritional counseling and medically-tailored meals.

Reproductive health

Texas banned all abortions three years ago, with a narrow exception that allows doctors to terminate a pregnancy only to save a pregnant patient’s life. Immediately, doctors and legal experts warned that this exception was too narrow and vaguely written, and the penalties were too severe, to ensure women could get life-saving care.

SB 31 says doctors need not wait until death is imminent to intervene, but affirms that the condition must be life-threatening to justify performing an abortion. It will also require doctors and lawyers to take continuing education courses on the nuances of the law.

Legislators passed a bill restricting cities, like Austin and San Antonio, from using taxpayer dollars to assist people who travel out-of-state to have an abortion. But the highest profile anti-abortion bill, SB 2880, which would have allowed anyone who manufactures, distributes, provides or prescribes abortion pills to be sued for $100,000 passed the Senate but stalled in the House.

Mental health

Lawmakers passed bills to expand crisis hotline services and provide loan reimbursement to address the mental health workforce shortage.

After a couple days of debate about the role of mental health professionals in Texas, lawmakers passed SB 646, which broadens eligibility for Texas’ loan repayment assistance program to include school counselors, marriage and family therapists, and other behavioral health professionals.

HB 5342 establishes the 988 Suicide and Crisis Lifeline Trust Fund, which will accept donations, grants and federal funds to maintain or improve the crisis line. Additionally, the bill mandates an annual report on the usage of the crisis centers participating in the 988 network.

Texas lawmakers imposed some restrictions on how minors accessed social media.

SB 2420 sets up requirements for age verification and parental consent before a minor is allowed to download or make purchases within software applications. Under this bill, developers must assign age ratings to their apps, disclose the reason for the rating, and notify the app stores of any significant changes.

Parental consent will not be required for specific emergency or educational applications, such as those providing access to crisis hotlines.

A bill to ban minors from social media altogether failed in the last few days of the legislative session.

Major budget items and agency changes

Several budget items involving health care and services for Texans were also approved.

Among them were an extra $100 million to fund child care scholarships to low income families on a waitlist for child care.

Nearly 95,000 Texas children are on a waitlist for child care scholarships at a time when facilities are closing and the cost of child care in Texas is making it difficult for working parents to make ends meet.

Last year, HHSC asked for $300 million worth of upgrades for its Medicaid and food stamps enrollment system but will? receive less than half that ask, about $139 million. The agency’s request came after Texas and the nation suspended Medicaid rules requiring participants to renew their applications more often during the pandemic and then removed nearly 2 million participants following the pandemic. The improvements will shorten the time between application for health care coverage and food assistance and activation of those benefits.

In Texas, Medicaid is mostly a children’s health insurance program. Only low income children, the elderly and new moms are covered by Medicaid in this state.

There is also a $18 million increase over the next two years for the state’s Early Childhood Intervention (ECI) services which assists families with children up to 36 months who have developmental delays, disabilities or certain medical diagnoses that may impact development.

A $60 million rider was put in to cover Texas’ costs of entering a federal summer lunch program in 2027. The 2023 program would give qualifying parents $120 over the summer months to help pay for lunches when school is out of session. More than 30 states now participate in the Summer Electronic Benefits Transfer program which also goes by the name Sun Bucks.

Lt. Gov. Dan Patrick championed the passage of Senate Bill 5, which creates the Dementia Prevention and Research Institute of Texas, to study dementia, Alzheimer’s disease, Parkinson’s disease and other brain conditions. Modeled after Texas’ cancer institute, the measure received bipartisan support. Abbott has signed the bill but the measure now goes before the voters to approve whether $3 billion in general revenue can be used to fund the project.

The Texas Health and Human Services Office of Inspector General’s office investigates health care and benefit fraud. This year, a handful of bills were passed to help streamline investigations by the office and update salary classifications for OIG officers to those of other Texas law enforcement officers, improving recruiting. This comes as the office has been instrumental in identifying fraud within some of the state’s health benefits systems, leading to firings of some agency employees.

https://www.newsfromthestates.com/article/texas-clarified-when-abortions-are-ok-and-aligned-rfk-jr-health-legislative-session





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FRAUD – Indian-origin pharma tycoon Tonmoy Sharma arrested in Los Angeles over $149 million healthcare fraud

FRAUD – Indian-origin pharma tycoon Tonmoy Sharma arrested in Los Angeles over $149 million healthcare fraud


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Alternative Headline: $149M Fraud by Rehab CEO

[MM Curator Summary]: Tonmoy Sharma was arrested for running a $149 million fraud scheme that lured in patients promising coverage, and then secretly using patient information to make false claims to Medicaid, and then the Affordable Care Act coverage.  


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Indian-origin doctor and businessman, the founder and former CEO of the now-defunct Sovereign Health Group, was recently arrested over $149 million medical fraud. The 61-year-old psychiatrist has been charged with four counts of wire fraud, one count of conspiracy and three counts of illegal remunerations for referrals to clinical treatment facilities.

    

What was the medical fraud? What was Sharma’s modus operandi?

Tonmoy Sharma’s Sovereign Health Group was a prominent addiction treatment provider throughout Southern California and several other states. According to court documents, the company billed private insurance companies for drug addicted and mentally ill patients at extremely high rates between 2014 and 2020.

Sovereign used to pursue patients aggressively through various forms of marketing forcing them to get admitted to the company’s treatment facilities. The patients were told that their treatment would be paid by a foundation funded by the donations from former SDpvereign patients. There was no such actual foundation and it was a ruse for Sovereign employees. They obtained patients’ names, date of birth and Social Security numbers and then obtained health insurance coverage on their behalf while the patients remained in the dark. Sovereign employees sometimes pretended to be the patients when calling into these insurance companies.


At Sharma’s direction, the court documents said, the employees claimed qualifying life events that had not happened in order to obtain new insurance outside the enrollment period and inflating or underreporting their income so the patients would qualify for Affordable Care Act government-subsidized private insurance instead of Medicaid, whose reimbursement rates were significantly lower than private insurers.

Sovereign also paid more than $21 million in illegal kickbacks for patient referrals to patient brokers.

Originally from Assam’s Dibrugarh, Sharma studied MBBS from Dibrugarh University. Sharma’s medical license was once revoked while he was practicing in the UK before he established his career in California.

https://www.msn.com/en-in/news/other/indian-origin-pharma-tycoon-tonmoy-sharma-arrested-in-los-angeles-over-149-million-healthcare-fraud/ar-AA1G9cyu






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PHARMA – The MAHA agenda won’t include expanding GLP-1 coverage — for now

PHARMA – The MAHA agenda won’t include expanding GLP-1 coverage — for now


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Alternative Headline: GLP-1 Coverage Faces Setback

[MM Curator Summary]:  PushbackThe Trump administration canceled a proposal to allow Medicare and Medicaid to cover GLP-1 obesity drugs, despite rising demand, but the discussion remains ongoing. 

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The GLP-1 boom isn’t slowing down anytime soon. Prescriptions for overweight or obese adults jumped almost 587% from 2019 to 2024, Healthcare Dive reported, and there’s still a huge untapped patient population representing more market upside.

As pharma’s pipeline explodes with more than 100 new drugs in various stages of development, one barrier to access has yet to be toppled. Medicare and Medicaid do not fully cover weight loss medications, with some exceptions, leaving out millions of potential users.

The Biden administration proposed ending this prohibition in late 2024, but the Trump administration recently axed the idea in April, stating it “did not intend to finalize” the proposed rule. A 2024 fact sheet about the proposal has also since been taken down by the Trump administration.

The move was a blow to the market, but health officials and the Centers for Medicare and Medicaid Services haven’t ruled out covering obesity medications at some point.

Obesity limitations

The government prohibition against covering obesity treatments has been the law of the land for the last 20 years, while states have been able to decide whether to cover these drugs in their Medicaid plans. Only 13 states covered GLP-1 drugs for obesity as of last year, but both Medicare and Medicaid cover GLP-1s for other approved indications, including diabetes or cardiovascular disease.

Allowing the expanded coverage would have cost the federal government $35 billion over 10 years, according to the Congressional Budget Office. Covering anti-obesity medications like GLP-1s would also result in some savings by preventing worsening health outcomes, but those savings would be less than the cost of the drugs, CBO said. 

Not everyone agrees the price isn’t worth it. 

“It does not align with the goal of reducing overall spending — it is penny wise but pound foolish.”

“Access to these drugs can meaningfully reduce the incidence of obesity, which is associated with significant improvements in overall health outcomes,” Wayne Winegarden, senior fellow and director of the Center for Medical Economics and Innovation at Pacific Research Institute, said via email. “Beyond the health benefits, some studies have found that covering obesity medications can reduce overall healthcare spending by reducing the need for expensive surgeries, hospital stays and other medical treatments.”


One 2023 estimate revealed Medicare could save between $175 billion to $245 billion in the first 10 years of covering weight loss drugs if private insurers similarly covered them. Another study found that average medical costs dropped by around $7,500 for patients after starting semaglutide drugs — well above the $5,600 that CBO estimated Medicare would spend on each weight loss drug user.

Market impact

Expanding GLP-1 coverage would also be a boost for obesity market leaders Eli Lilly and Novo Nordisk. Both pharma companies saw a dip in their stock prices when the Trump administration published its decision not to follow through on the proposal.

But that outcome was expected by some health policy experts and analysts, given the Trump administration’s short-term focus on cost-cutting measures across healthcare.

“It is not surprising in the sense that the administration appears to be under-appreciating the value created by innovative drugs,” Winegarden said. “It does not align with the goal of reducing overall spending — it is penny wise but pound foolish.”

Lilly has been pushing for broader coverage of its GLP-1 weight loss med Zepbound, which has helped the large pharma recently overtake Novo’s market leading position. Both companies have a list price of around $1,000 per month for their GLP-1s, making them hard to afford if insurers don’t offer coverage. The two companies are already competing head to head for market dominance by offering cheaper direct-to-patient vials via telehealth platforms and striking deals with pharmacy benefit managers.

Medicare also already has its sights on lowering costs for Novo’s suite of three semaglutide GLP-1 products, which were selected for its price negotiation program in 2027. But both companies are expanding their patient population through new indication approvals, including Novo’s nod for Ozempic in chronic kidney disease, while also developing new delivery methods through oral routes.

A path forward

While Medicare won’t be covering obesity meds in 2026, the Trump administration may take up the issue again down the road. CMS noted in April it was not finalizing the proposal, among others, “at this time,” but the agency also stated it “may address these proposals in future rulemaking, as appropriate.”

HHS Secretary Robert F. Kennedy Jr. also mentioned a potential “regulatory framework” to include coverage of these drugs in an April interview with CBS News. However, he said a change in diet and exercise would be a first-line treatment before people are entitled to an obesity medication. He also harped on the high cost of covering the drugs at the federal level.

But advocates have pointed out that Trump administration officials have made conflicting statements about their support of GLP-1s.

“To date, HHS leadership have sent mixed signals on the issue,” the American College of Gastroenterology said in April. “HHS Secretary [Kennedy] has criticized the drugs, while [Dr.] Mehmet Oz, administrator of [CMS], has praised the benefits of the treatments.”

FDA Commissioner Dr. Martin Makary, stated prior to taking the role that GLP-1s could cost Medicare “a fortune” and divert funds from other medical services, while Oz has promoted weight loss treatments, including GLP-1s, and stated it should be “easy” for people to access the medications.

If the recently published MAHA Commission report is any indication, the Trump administration won’t be pushing for a medication-first approach to tackle obesity anytime soon. While the report mostly focused on childhood chronic health issues, the sections regarding GLP-1s underscore the administration’s focus on dietary choices and food regulations as a first step.

The May report stated that “children are on too much medicine,” and included GLP-1s among a handful of drugs being more frequently used and potentially overtreated.

A handful of Democratic senators wrote to Kennedy in April urging him to reconsider Medicare and Medicaid coverage, calling such an expansion “a critical long-term investment” to improve obesity-related healthcare costs.

https://www.pharmavoice.com/news/maha-agenda-glp1-medicare-coverage-rfk-hhs/749455/





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STATE NEWS – Reps. Sewell, Figures introduce Bridge to Medicaid Act to cover uninsured Alabamians

STATE NEWS – Reps. Sewell, Figures introduce Bridge to Medicaid Act to cover uninsured Alabamians


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Alternative Headline: Bill Targets AL Medicaid Gap 

[MM Curator Summary]: The Bridge to Medicaid Act would provide temporary federal health coverage for Alabamians stuck in the Medicaid gap.

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Alabama U.S. Reps. Terri Sewell and Shomari C. Figures introduced the Bridge to Medicaid Act to finally provide health insurance to the more than 100,000 Alabamians in the coverage gap. The legislation would provide a temporary health care option for people in the Medicaid coverage gap until non-expansion states like Alabama finally expand Medicaid. 

“Improving access to quality, affordable health care is one of my top priorities in Congress,” said Rep. Sewell. “Because of the refusal by the State of Alabama to expand Medicaid, more than 100,000 low-income Alabamians who would otherwise qualify for health insurance coverage are being forced to go without care, putting their health and their lives at risk. If the State of Alabama won’t expand access to health care for our underserved communities, we in the federal government must take action. That’s why I’m proud to join Congressman Figures in introducing the Bridge to Medicaid Act which would help thousands of Alabamians see a doctor, obtain medications, and afford life-saving care.”

“Alabama’s failure to expand Medicaid has left more than 100,000 hardworking people—many of them in my district—without access to affordable, quality health care,” said Rep. Figures. “This bill will provide relief to people who would have health care coverage if Alabama would simply expand Medicaid, as 40 other states have already done.” 

The Bridge to Medicaid Act would extend subsidies to individuals who are in the coverage gap and who cannot afford insurance on the Marketplace for 3 years. Individuals in non-expansion states making between 100 percent and 138 percent of the federal poverty level would also qualify for these subsidies and enhanced plans.

Coverage details:

  • Beginning in 2026, current Affordable Care Act premium subsidies would be available to those below 138 percent of the federal poverty level.
  • In the first year, those under 138 percent of the federal poverty level would be eligible for plans with reduced deductibles and cost-sharing (defined as a 94 percent actuarial value).
  • In 2027 and 2028, these individuals would be eligible for further reductions in cost-sharing charges (plans would have a 99 percent actuarial value) so they can better afford to get care.
  • Continuous enrollment applies – once an individual is deemed eligible based on income, they can enroll at any time during the year. 
  • The Federal Medical Assistance Percentage for existing expansion populations in expansion states would be enhanced by 3 percent (from 90 percent to 93 percent) for the duration of the coverage gap policy (from 2026-2028).

Since coming to Congress, Rep. Sewell has championed federal efforts to expand health care access for Americans caught in the coverage gap, including the more than 100,000 Alabamians. In 2022, she led her colleagues of the New Democrat Coalition in a letter urging congressional leadership to close the coverage gap by enhancing Affordable Care Act tax credits. She has also sponsored legislation to create a Medicaid-like program in non-expansion states.

Bill text is available here.

The Alabama Political Reporter is a daily political news site devoted to Alabama politics. We provide accurate, reliable coverage of policy, elections and government.


https://www.alreporter.com/2025/05/09/reps-sewell-and-figures-introduce-bridge-to-medicaid-act-to-cover-uninsured-alabamians/





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STATE NEWS – Arizona Governor Katie Hobbs Vetoes Medicaid Fraud Prevention Bill Amidst Political Clash

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Alternative Headline: Hobbs Vetoes Fraud Bill

[MM Curator Summary]:  Governor Katie Hobbs vetoed a Medicaid fraud prevention bill, triggering political backlash over alleged $3 billion in improper payments.

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Arizona’s Medicaid program has become a battleground for differing political ideologies as Governor Katie Hobbs vetoes a bill targeting Medicaid fraud. According to a press release from the Arizona Legislature, House Majority Leader Michael Carbone criticized the governor for blocking HB2449, a bill he sponsored aimed at bolstering fraud prevention in the state’s Medicaid system. Carbone claims that the bill would have closed existing loopholes and required more frequent eligibility checks to root out waste and ensure assistance reaches those in need.

Carbone stated, “Governor Hobbs just vetoed my bill that would have rooted out fraud and abuse in Arizona’s Medicaid program, and protect public healthcare resources for those who truly need them,” as reported in a Arizona House of Representatives. He condemned the Arizona Health Care Cost Containment System for allegedly squandering over $3 billion  in improper Medicaid payments due to lax eligibility verification. In his push against the governor’s decision, Control, asserted that similar strategies had been implemented successfully in other states like Arkansas and Texas, claiming these measures did not incur additional state expenses.

In her defense, Governor Hobbs highlighted the potential costs of implementing such safeguards, a point of contention with Carbone’s interpretation. Carbone argued that Hobbs’ actions reflect a preference for protecting state bureaucrats from additional work over safeguarding taxpayer dollars. This latest dispute comes in the wake of a 2023 effort by the Republican legislature to expedite the removal of ineligible people from the Medicaid rolls, a move Carbone says saved the state substantial funds.

Carbone’s language reflects a deep frustration with the governor’s stance, underscoring a perceived gap between Hobbs’ rhetoric on government spending and her legislative actions. “Arizona voters sent a loud message in 2024 that they are tired of business as usual. Governor Hobbs talks a big game about cleaning up wasteful government spending, but her actions show, that it is all talk,” Carbone expressed in the legislative Arizona House of Representatives press release. As the House Majority Leader representing Legislative District 25, which spans parts of Yuma, Maricopa, and La Paz Counties, Carbone’s stance reflects a broader conservative concern over fiscal management in public programs.

At the heart of the matter is a disagreement over the balance between fiscal responsibility and the administrative burden such measures might impose. With elections always around the corner, and voter sentiment a priority for both parties, the debate over Medicaid fraud legislation in Arizona is far from over. As these events unfold, the true costs, whether measured in dollars, bureaucratic workload, or the welfare of those the system is meant to serve, remain at the forefront of this ongoing political discourse.

https://hoodline.com/2025/05/arizona-governor-katie-hobbs-vetoes-medicaid-fraud-prevention-bill-amidst-political-clash/

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FRAUD – Director of Arizona Medicaid agency resigns following fraud scheme response

FRAUD – Director of Arizona Medicaid agency resigns following fraud scheme response


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Alternative Headline: AZ Medicaid Chief Resigns

[MM Curator Summary]: Carmen Heredia, director of Arizona’s Medicaid agency, has resigned amid fallout from a $2 billion Medicaid fraud scheme targeting Native Americans and resulting in several deaths. 

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The director of Arizona’s embattled Medicaid agency resigned this week, just as she was expected to face questions from lawmakers about her handling of a massive fraud scheme that largely targeted Native Americans.

Gov. Katie Hobbs, a Democrat, announced Wednesday that she had accepted the resignation of Carmen Heredia, director of the Arizona Health Care Cost Containment System. The governor lauded Heredia’s leadership of the agency while blaming Republican lawmakers for politicizing the confirmation process, saying it had become clear they would not confirm Heredia’s nomination.

Sen. Jake Hoffman, a Republican and chair of the Senate’s Committee on Director Nominations, said in a statement that in responding to the fraud scheme, Heredia had “poorly executed” the suspensions of hundreds of behavioral health providers. Heredia had served as the head of AHCCCS without Senate confirmation since early 2023, several years after officials say the fraud likely began during the Republican administration of former Gov. Doug Ducey. In the year before Heredia became director, records show that officials were warned that the fraud was harming patients, but they struggled to respond and failed to alert the public, which Heredia did along with other state leaders in May 2023.

(Earlier this year, a spokesperson for Ducey did not comment on missed opportunities to stop the fraud but said that the former governor went to great lengths to assist in Hobbs’ transition.)

Under Heredia’s leadership, AHCCCS withheld payment to more than 300 businesses as the agency investigated allegations that they were fraudulently billing Medicaid for treatment services. Often, the services had not been provided, and business owners were accused of allowing patients to continue the substance use they had hoped to overcome through treatment.

In a statement, Heredia said she submitted her resignation with a heavy heart and expressed concern that a partisan agenda had resulted in professionals being dragged “through career damaging hearings.” Two years ago, Senate Republicans derailed the nomination of one of Hobbs’ previous picks to lead the health department.

Last September, more than a year after the crackdown began, the Arizona Center for Investigative Reporting and ProPublica reported that the suspensions had rendered patients homeless. Victims of the scheme, some from other states, were also left without access to the drug and alcohol treatment they were seeking.

Over several years, businesses across much of Arizona, but mostly in Phoenix, reaped huge Medicaid reimbursements by enrolling Native Americans in their programs and billing the state’s American Indian Health Program at exorbitant rates for services, like counseling sessions. (The AIHP is a Medicaid insurance option that, until the fraud was discovered, had no set limit on the amount of money providers could bill for services.)

At a news conference Thursday, Attorney General Kris Mayes, a Democrat, said there had been more than 100 indictments and 25 convictions so far related to the scheme. She also said she expected more indictments to come.

AHCCCS said over the past two years that officials’ top priority was patient safety, and in May 2023, the agency set up a hotline for victims. It provided brief hotel stays for people displaced from shuttered facilities. However, AHCCCS said last year that it had no record of what happened to a majority of the hotline’s then 11,400 callers, largely because after six months it had stopped tracking outcomes for people who did not stay in a hotel. According to available data, more than 575 people ended up without housing as of last September. AZCIR and ProPublica also found that at least 40 Indigenous residents of sober living homes and treatment facilities in the Phoenix area died as the state fumbled its response.

A handful of the suspended providers, out of hundreds investigated, were allowed to resume billing Medicaid after clearing allegations with the state. But they said the suspensions still pushed them to the brink financially and upended their patients’ care, AZCIR and ProPublica found. As a result, Heredia’s swift and aggressive response to the crisis — which authorities said was needed to root out fraud and save lives — caused concerns that behavioral health care, especially for Native Americans, was increasingly difficult to access.

“Under Katie Hobbs’ leadership, Heredia’s response has been incredibly disturbing, to say the least,” Hoffman said. “We are left with a broken system due to Heredia’s mismanagement, and our vulnerable populations are caught up in this collapse.”

A spokesperson for Senate Republicans declined a request for an interview with Hoffman.

While Hoffman’s statement mostly focused on the fraud scheme that authorities say cost the state $2 billion, he said he also took issue with other matters within AHCCCS involving long-term care.

In addition to Heredia’s resignation, Jennifer Cunico, the director of the Arizona Department of Health Services, also stepped down this week. Like Heredia, Cunico was set to appear before lawmakers for a confirmation hearing. Cunico said she was proud of her work at the department but made the difficult decision to withdraw her nomination after it became clear she wouldn’t be confirmed either. Her resignation comes two years after Hobbs’ previous pick to lead the health department withdrew her nomination following a heated confirmation hearing.

Hoffman said Cunico had defended public health officials’ pandemic response during meetings with lawmakers but did not provide details. Hoffman previously sponsored legislation that prohibited state and local agencies from enacting vaccine mandates.

The governor defended Heredia’s response to the fraud crisis and said both Heredia and Cunico had worked on a range of initiatives, including improving access to maternal health care.

“Carmen Heredia helped root out a multi-billion dollar wave of Medicaid fraud and the related humanitarian fallout which the previous administration ignored,” Hobbs said in a statement. “Her work to eliminate waste, fraud, and abuse in our healthcare system is a model for the nation, and she always ensured people who needed help continued to get it.”

She added, “The Senate’s unprecedented politicization of the director confirmation process has ended the directorship of two healthcare professionals who have made our state government run more efficiently and more effectively.”

Christopher Lomahquahu, an investigative reporter and Roy W. Howard fellow for AZCIR, contributed reporting.

This story was co-published with Arizona Center for Investigative Reporting.

https://www.tucsonsentinel.com/local/report/050525_heredia_resignation/director-arizona-medicaid-agency-resigns-following-fraud-scheme-response/




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STATE NEWS – New law raises Medicaid dental reimbursement rates in Arkansas for first time in 18 years

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[MM Curator Summary]: The new rates will add $22 million in annual Medicaid costs.

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LITTLE ROCK, Ark. – A new Arkansas law will require the Arkansas Medicaid Program to increase reimbursement rates for certain dental services.

The law looks to ensure that the underserved have the care they need and that dental providers continue accepting Medicaid by raising Medicaid reimbursement rates.

Terry Fiddler, the executive director of Arkansas Mission of Mercy, said his organization provides free dental clinics, most recently seeing hundreds of patients who need dental care.  

“The underserved individuals of Arkansas, the generational poverty,” Fiddler said. “With you and I, if we have a toothache, we go to the dentist and get taken care of. That’s not always possible for them.”

This law is tailored to boost reimbursement rates for oral surgeries, children and adults with special needs.

Fiddler said it’s been 18 years since a rate increase, leading to some dentists dropping Medicaid, but he hopes that it flips with this law.

“What’s going to happen, those providers who have dropped out of services, this will be an impetus for them to come back,” Fiddler said. “For those who have continued to do so but were on that ledge of dropping off, we’re hoping that all of these things will provide more to providers.”

A representative from the Division of Medical Services testified against the law earlier this month due to the fiscal impact. They said they’re not opposed to continuing to work with dentists to do targeted rate increases, but feel this law takes this out of their normal process.

They said this has a fiscal impact of about $7 million to the state share, with impact to the overall Medicaid budget being over $22 million.

“That’s a lot of money that we asked for, but they gave it to us, and I will promise you every penny will be well spent for the underserved of Arkansas,” Fiddler said.

Fiddler said on behalf of the underserved in Arkansas and the Arkansas State Dental Association, they thank Gov. Sarah Huckabee Sanders for signing this law.

https://www.kark.com/news/state-news/new-law-raises-medicaid-dental-reimbursement-rates-in-arkansas-for-first-time-in-18-years/