Latest, page 2
- Published Oct 19
American Experiment Faults Klobuchar on Medical Device Tax, Medicaid Growth
In this American Experiment commentary, the author argues that Senator Amy Klobuchar should not claim credit for later softening the ACA's medical device tax because she voted for the underlying law that created it. The piece contends Minnesota device makers like Medtronic, Boston Scientific, and St. Jude absorbed hundreds of millions in annual tax costs, contributing to Medtronic's corporate inversion to Ireland, while other senators secured state-specific carve-outs during ACA negotiations. The author also claims Minnesota's Medicaid rolls expanded sharply post-ACA, now covering one-in-five residents, and asserts $9 billion was lost to fraud. The commentary frames these points as evidence against Klobuchar's record ahead of her reelection debates.
Why it mattersFor Minnesota Medicaid stakeholders, the piece links ACA-era eligibility expansion and program integrity concerns to a prominent state political debate shaping future Medicaid funding and oversight positions.
- Published Oct 19
Schutz Attacks Ellison's Medicaid Fraud Record in AG Race
Republican attorney general candidate Ron Schutz held a press conference challenging Minnesota AG Keith Ellison's fraud enforcement record, citing the Feeding Our Future scandal, a 2021 meeting with figures later indicted in that scheme, and subsequent campaign contributions Ellison received and later returned. Schutz also cited a KSTP investigation of 250 Medicaid Fraud Control Unit cases, claiming 144 resulted in stays of imposition and 70 in stays of adjudication, arguing plea deals let defendants avoid jail or lasting convictions. Schutz proposed pursuing parallel criminal and civil cases against both individuals and their companies if elected, promising tougher charging and no "sweetheart plea deals." The remarks come amid Minnesota's ongoing political fallout from large-scale Medicaid and federal nutrition program fraud schemes.
Why it mattersMinnesota's Medicaid Fraud Control Unit enforcement approach and leadership could shift substantially depending on the election outcome, affecting how aggressively providers and companies face prosecution for Medicaid fraud.
- Published Oct 19
SHADAC Publishes 2026 Directory of State Medicaid, CHIP Program Names
SHADAC has released its annual 2026 resource cataloging the official and colloquial names states use for Medicaid, CHIP, and state-based marketplace programs across all 50 states and D.C. The spreadsheet, compiled from verification contacts with state Medicaid staff in August and September 2026, notes wide variation, including Florida's four distinct CHIP program names and Washington state's nine separate public health insurance options. SHADAC provides these names to the U.S. Census Bureau for use in federal surveys like the Current Population Survey, aiming to improve accuracy of self-reported Medicaid participation relative to administrative records. The resource is available for download now and is updated annually.
Why it mattersResearchers, survey administrators, and state agencies rely on accurate program-name mapping to reduce the Medicaid undercount and correctly interpret self-reported coverage data in federal surveys.
- Published Oct 17
- Published Oct 17
Minnesota Revokes Licenses, Bars Medicaid Provider for 10 Years
Minnesota's Department of Human Services has revoked licenses for Metro Care Human Services and Home Sweet Home of Minnesota, two companies run by Arnold Kubei that collected a combined $36.2 million in Medicaid and other state-administered payments. The revocation orders, dated Oct. 7 and 8, bar both companies from participating in Minnesota Health Care Programs for 10 years effective Oct. 30. Correction orders issued this month also document 47 licensing violations at Metro Care's residential treatment facilities, including deficiencies in treatment plans, abuse prevention, staff training and handling of client funds. Metro Care has 10 calendar days from notice to appeal the licensing actions.
Why it mattersThe 10-year Medicaid program exclusion and license revocations cut off a $36.2 million taxpayer-funded provider, signaling heightened state scrutiny of residential treatment and home-based service billing in Minnesota's Medicaid program.
- Published Oct 16
- Published Oct 16
Minnesota Budget Project: MNsure Enrollment Fell 28% as Tax Credits Lapsed
In a Minnesota Budget Project analysis, the organization reports that after Congress allowed enhanced premium tax credits to expire at the end of 2025, MNsure premiums rose 30 percent and enrollment dropped 28 percent, about 41,000 fewer Minnesotans, in 2026. Nationally, marketplace enrollment fell by 3 million, and a KFF poll found roughly 1 in 10 2025 marketplace enrollees became uninsured in 2026. Affected groups include farmers, independent contractors, early retirees, and others without employer coverage; in 2025 about 92,000 Minnesotans used the credits to cut costs by about $360 a month. The piece also links the credit expiration to Medicaid eligibility and funding cuts enacted under H.R. 1, arguing both changes compound coverage losses and uncompensated care costs for hospitals.
Why it mattersHospitals and safety-net providers face rising uncompensated care costs as marketplace coverage losses compound with separate federal Medicaid eligibility and funding cuts.
- Published Oct 15
CMS Ends Marketplace Subsidies for 189,000 Dual Enrollees, Deceased
In a commentary piece, American Experiment reports on CMS's October 14, 2026 announcement ending Advance Premium Tax Credits for roughly 189,000 people enrolled in subsidized Federal Marketplace plans who also had Medicare, Medicaid, or CHIP coverage, or who had died. CMS estimates the action saves approximately $1.5 billion over the next year, building on a 2025 effort that ended duplicate subsidies for 551,000 Medicaid enrollees, for nearly $6 billion in combined savings. Flagged individuals get 30 days to dispute the match before subsidies stop, with appeals available afterward. The author argues this reflects restored Medicaid/CHIP Periodic Data Matching after a multi-year pause, and calls for states to apply similar verification to their own Medicaid rolls, citing Minnesota-specific findings of enrollees unaware they had coverage.
Why it mattersState Medicaid agencies and marketplaces must reconcile eligibility files against this federal data-matching action to avoid continued duplicate payments and exposure to program integrity audits.
- Published Oct 14
- Published Oct 13
- Published Oct 12
Minnesota DHS to Score Fraud Tips to Prioritize Investigations
Minnesota's Department of Human Services told KSTP it has hired an outside company to build a formula that assigns a risk score to every fraud tip it receives, aiming to prioritize investigative resources amid a surge in reports. The disclosure came in written answers after DHS declined an on-camera interview request with Inspector General James Clark, following months of criticism from lawmakers and the former commissioner over transparency and follow-through on fraud complaints. DHS says all tips undergo a preliminary investigation and credible allegations are referred for criminal prosecution, but has not detailed the scoring methodology or vendor. No timeline for rollout was given.
Why it mattersState agency use of automated risk-scoring to triage fraud tips raises compliance and transparency questions for Minnesota Medicaid providers and beneficiaries who may be flagged or deprioritized without clear criteria.
- Published Oct 12
- Published Oct 8
Minnesota Budget Project Opposes CMS Provider Tax Rule
In a comment letter to CMS, the Minnesota Budget Project argues that a proposed rule amending the indirect hold harmless threshold for health care-related taxes goes beyond what H.R. 1 requires and would make it harder for states to finance Medicaid and other affordable care programs. The group says the rule would broaden provider tax restrictions to cover certain health insurer taxes even when unrelated to Medicaid funding, add new quarterly reporting burdens, and impose harsher penalties requiring states to return all revenue and matching funds tied to a tax that exceeds permitted thresholds, rather than just the excess amount. The letter was submitted during the public comment period that closed September 18, 2026. The organization warns the changes could jeopardize coverage for Minnesota's roughly 1.3 million Medicaid and MinnesotaCare enrollees and strain other state services.
Why it mattersState Medicaid agencies face a narrower set of financing tools and steeper fiscal risk if the rule's expanded tax restrictions and all-or-nothing repayment penalty take effect as proposed.
- Published Oct 8
- Published Oct 6
- Published Oct 5
Minnesota DHS Demands CMS Evidence Behind $550M Funding Freeze
Minnesota's Temporary DHS Commissioner John Connolly sent a five-page letter Friday to CMS Administrator Mehmet Oz, disputing the basis for nearly $550 million in withheld Medicaid funding. The freeze has grown through three separate deferrals in 2026, starting with $260 million in February over fraud concerns in 14 programs, followed by $91 million in April and $199 million in July. Connolly argues CMS has identified 870 Minnesota providers as high-risk without explaining its methodology, and disputes that provider disenrollments during a revalidation effort prove fraud rather than administrative issues. The state says it has repeatedly requested supporting documentation from CMS and federal law enforcement but has not received it.
Why it mattersMinnesota's Medicaid program faces continued cash-flow disruption and potential further deferrals absent resolution, directly affecting state budgeting and provider payments tied to federal matching funds.
- Published Oct 5
Study Finds Coverage Gaps Persist, Reducing Health Care Access
A study published in Medical Care Research and Review by University of Minnesota SHADAC researchers found that despite historic coverage gains since the ACA, coverage gaps among non-elderly adults remained persistently high. Using MEPS-HC data spanning 2008 to 2022, the researchers found continuous coverage rose about 20% over the period, but an estimated 25.3% of adults, or 49 million people, still experienced a coverage gap in 2021-2022. People with coverage discontinuities were less likely to access routine care and prescriptions and more likely to report unmet health needs, an effect that grew larger over time. Gaps were more common among lower-income individuals and those living in the South.
Why it mattersThe findings underscore for state Medicaid agencies and health plans that eligibility churn and coverage transitions, not just uninsurance rates, drive gaps in care access and unmet need.
- Published Oct 2
- Published Oct 1
Fraud Expert Warns of Rising Medicaid Identity Theft Schemes
In a WDIO segment, fraud prevention consultant Jeff Leston of Castlestone LLC discusses why healthcare fraud, including Medicaid fraud, continues to rise. The piece notes Minnesota Attorney General Keith Ellison's recent announcement that nine people were federally charged for Medicaid program fraud totaling over $3 million, including a Duluth provider responsible for $2.2 million. Leston attributes much of the fraud to "zero-factor authentication" at the point of care, data breaches exposing insurance numbers across multiple systems, foreign actors who can quickly move stolen funds overseas, and AI-enabled creation of synthetic identities used to submit fraudulent claims. He urges consumers to report suspicious Medicaid or Medicare claims and calls on Congress and state legislators to strengthen post-breach identity protections.
Why it mattersState Medicaid agencies and MCOs face growing exposure to identity-based billing fraud and synthetic identity claims that existing point-of-care verification systems fail to catch.
- Published Oct 1
- Published Oct 1
Two Minnesota Men Plead Guilty in $500,000 Medicaid Housing Fraud
Ahmed Abdirashid Mohamed pleaded guilty in federal court in St. Paul to charges tied to a $500,000 Medicaid fraud scheme involving Minnesota's now-discontinued Housing Stabilization Services (HSS) program, becoming the 89th federal welfare fraud conviction in the state over the past four years. His co-defendant, Hassan Ahmed Hussein, pleaded guilty the prior week in the same case. The Department of Justice confirmed both pleas in a press release; sentencing for both men will be scheduled later. Separately, another defendant, Sharmaine Meadows, is currently on trial for an alleged $4 million fraud scheme also run through the HSS program.
Why it mattersThe convictions underscore sustained federal prosecution of Medicaid provider fraud in Minnesota's HSS program, signaling continued scrutiny that state agencies and managed care plans overseeing home and community-based service billing should anticipate.
- Published Sep 29
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