Drug pricing reform is a common Medicaid cost-containment strategy. Policymakers continue exploring expanded rebates, alternative purchasing models, and other approaches designed to reduce pharmacy spending and ease pressure on state budgets. Lower drug prices can generate meaningful savings. However, they address only part of Medicaid's financial...
As states begin planning for fiscal year (FY) 2027, Medicaid programs are entering a period of increasing financial constraint. Slower revenue growth, persistent healthcare cost inflation, and federal policy changes enacted through the 2025 budget reconciliation law are reshaping budget expectations. While enrollment growth has...
Medicaid COB has quickly become a focal point around program integrity and cost containment for plans. State Medicaid agencies are under mounting fiscal pressure, with many already cutting provider reimbursements and optional services to stay solvent. The Medicare Rights Center warns that these early reductions...
State governments are facing a fiscal reality they can no longer ignore: Medicaid is rapidly becoming one of their largest—and least controllable—budget items. With enrollment at record highs following years of Medicaid expansion and pandemic-era protections, the cost of maintaining the program is now consuming...
Medicaid funding is at risk. A new budget proposal in Congress could slash billions from state programs, putting essential healthcare services in jeopardy. To keep Medicaid strong, state agencies and Managed Care Organizations (MCOs) must act now to eliminate wasteful spending and protect every dollar. One...
Syrtis Solutions, a leading provider of real-time Other Health Insurance (OHI) coverage information for payers of last resort, recently accomplished a notable milestone by being named a preferred vendor for the Association for Community Affiliated Plans (ACAP). This achievement is a reflection of Syrtis Solutions'...
Medicaid has become an integral safety net program that offers access to health care for millions of Americans. Payment for this health care is either delegated to Medicaid or other third party insurance coverage. In 2012, 7.6 million people on Medicaid had other private insurance...