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...
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...
The reported government-wide improper payment rate of 3.97% in 2024 represents the lowest level in over a decade. But below the surface lies a complex reality that exposes systemic flaws in how improper payments are measured and controlled. These numbers, far from representing legitimate progress,...
Improper payments and fraud continue to be persistent and costly hurdles for Medicaid and other government-funded programs. The GAO defines improper payments as payments that should not have been made or that were made in an incorrect amount (including overpayments and underpayments) under statutory, contractual,...
America's most vulnerable populations depend on Medicaid and Medicare for vital healthcare services. Sadly, these programs lose billions of dollars on a yearly basis due to improper payments. Just recently, the Subcommittee on Oversight and Investigations delved into this pressing issue in a critical hearing...
A recent audit by the U.S. Government Accountability Office reveals that the government suffered a significant loss of $236 billion in 2023 as a result of improper payments. Medicaid and Medicare alone accounted for 43% of these payments, with Medicaid's improper payments reaching $50.3 billion....
Medicaid improper payments have caused the safety net program to be on the Government Accountability Office's High-Risk List since 2003. The GAO's list identifies government programs that involve significant resources and offer vital services to the public that are vulnerable to fraud, waste, abuse, and...
Improper claims payments are costing Medicaid billions of dollars every year. A frequent misconception is that these payments come from fraud and abuse when the bulk of them actually originate from mundane issues such as eligibility errors and antiquated data systems. Don't miss out on...
According to federal agency data from PaymentAccuracy.gov and the Office of Management and Budget, the federal government spent an estimated $247 billion in improper payments in 2022. The data also revealed that the Department of Health and Human Services' Medicaid program accounted for the majority...