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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/