Medicare Medicaid Category

Medicare & Medicaid

News articles in this section include actions by federal regulators like the CMS and HHS, as well as information on Medicare and state Medicaid coverage and benefits.

Workplace Plans Paid More Than Medicare For Physician-Administered Drugs, Study Finds

Employer-sponsored health plans pay significantly more than Medicare for costly physician-administered drugs, threatening access to lifesaving treatments, according to a newly published analysis of claims data and Medicare files. What they found: Price markups increased between 2016 and 2020 for five of the top 10 drugs that account for the most spending and more than doubled ...

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The Pill Club Reaches $18.3 Million Medicaid Fraud Settlement With California

The Pill Club, an online women’s pharmacy, has reached an $18.3 million settlement with California authorities over claims it defrauded the state’s Medicaid program by prescribing birth control pills without adequate consultation and shipping tens of thousands of female condoms to customers who didn’t want them. Attorney General Rob Bonta announced the agreement Tuesday, a ...

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‘That’s Not A Republican Plan’: McConnell Distances GOP From Scott On Social Security, Medicare Sunset Plan

Senate Republican Leader Mitch McConnell said any idea on sunsetting Social Security and Medicare belongs to Sen. Rick Scott—not the GOP. “Unfortunately, that was the Scott plan, that’s not a Republican plan,” McConnell said on a Kentucky radio program. McConnell’s comments about Scott, a GOP rival, come as the White House continues to spotlight how Republicans heckled — and apparently committed ...

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CMS Seeks To Make Quality Measures More ‘Universal’ In Rollout Of New Program

Top Medicare and Medicaid officials want to create a “universal foundation” of quality measures aligned across all programs in a bid to ease reporting burdens and confusion. Officials with the Centers for Medicare & Medicaid Services called for aligning quality measures across more than 20 agency programs in a letter in The New England Journal of ...

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As Pandemic-Era Medicaid Provisions Lapse, Millions Approach a Coverage Cliff

States are preparing to remove millions of people from Medicaid as protections put in place early in the covid-19 pandemic expire. The upheaval, which begins in April, will put millions of low-income Americans at risk of losing health coverage, threatening their access to care and potentially exposing them to large medical bills.

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How Medicare And Social Security Benefits Factor Into The Kevin McCarthy Debt Ceiling Fight

Speaker Kevin McCarthy left his first White House visit with confidence that he and President Joe Biden could negotiate a spending deal, but the real test may come in negotiations with his own Republican conference. McCarthy, who had to bargain with hardline conservatives to win his speaker bid after 15 rounds of voting, leads a fractious caucus where some ...

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Insurance Lobby Blasts Medicare Advantage Audit Rule

Dive Brief: The AHIP insurance lobby blasted the Biden administration for finalizing a rule that seeks to claw back millions of dollars from health insurers through Medicare Advantage audits that will apply retroactively to payments beginning in 2018. AHIP called the final rule “unlawful” and “fatally flawed” in a Monday statement following the rule’s release. The lobby ...

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CMS Proposes Small Hike To Medicare Advantage, Part D Plan Payments In 2024 Amid Risk Adjustment Changes

The Biden administration is proposing to increase Medicare Advantage (MA) and Part D plan payments by 1.03% for 2024 amid other changes to the programs’ risk adjustment model. The Centers for Medicare & Medicaid Services (CMS) released the advance notice of methodological changes for MA capitation rates and payment policies for MA and Part D. ...

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California’s Resolve Questioned After It Grants Medi-Cal Contract Concessions

California’s decision last month to cancel the results of a long-planned bidding competition among commercial health plans in its Medicaid program has some industry insiders and consumer advocates wondering whether the state can stand up to insurers and force improvements in care for millions of low-income beneficiaries.

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McCarthy: ‘We won’t touch Medicare or Social Security’

Speaker Kevin McCarthy (R-Calif.) said on Thursday that House Republicans will not target Medicare or Social Security in their negotiations over the debt ceiling.

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