Medicaid news from every state
Medicaid reporting from more than 400 local newsrooms, public radio stations, advocates, attorneys general and state agencies, sorted into one feed per state and updated every four hours.
Medicaid stories from local newsrooms in every state, updated every four hours.
Latest from every state, page 27
- Published Oct 13
- Published Oct 13ME
Federal Delays Stall Maine Medicaid Fraud Cases Amid OIG Criticism
The Bangor Daily News and Maine Monitor report that two Maine fraud investigations involving nearly $2 million in potential MaineCare losses remain stalled with federal prosecutors, even as the Trump administration publicly criticizes the state for weak fraud enforcement. Attorney General Aaron Frey's office says it has made repeated inquiries but is still awaiting updates; the HHS Office of Inspector General's Maine field office has closed and its agents have departed, with no federal healthcare fraud case filed in the state since 2019. Federal rules bar state authorities from independently pursuing cases of federal interest until federal action is approved, leaving Maine's cases in limbo. The dispute coincides with a newly announced federal audit of MaineCare and public claims by CMS Administrator Mehmet Oz that Maine's billing fraud rate is far higher than state-reported improper payment data show.
Why it mattersThe staffing gap and case backlog show state Medicaid agencies can be constrained from pursuing fraud referrals even while facing federal pressure campaigns over enforcement performance.
- Published Oct 13
- Published Oct 13
- Published Oct 13
- Published Oct 13
- Published Oct 13
- Published Oct 13
- Published Oct 13
- Published Oct 13
- Published Oct 13
- Published Oct 13
- Published Oct 13AZ
Valleywise Health Wins Two SAMHSA Grants for Behavioral Health
Valleywise Health, a Phoenix-area safety-net health system, received two competitive federal grants from SAMHSA to expand behavioral health services. One award, $750,000 annually for five years, funds the MOSAIC program to expand medications for opioid use disorder through integrated, multidisciplinary care; Valleywise is one of four Arizona organizations and the sole Maricopa County recipient. The second grant, one of 12 awarded nationally, will enhance Valleywise's First Episode Centers over four years with trauma-informed screening, rapid diagnostic assessment and expanded referral pathways for adolescents and young adults at clinical high risk for psychosis. Both programs target safety-net populations that rely heavily on Medicaid coverage for behavioral health treatment.
Why it mattersExpanded federal funding for opioid treatment and early psychosis intervention at a major safety-net provider strengthens the behavioral health infrastructure that Arizona's Medicaid managed care plans depend on for member referrals and care coordination.
- Published Oct 12
- Published Oct 12
- Published Oct 12MN
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 12OR
Oregon Recruits Three Members for Medicaid Advisory Committee
Oregon Health Authority is recruiting for three open seats on its Medicaid Advisory Committee: a physician licensed under ORS chapter 677, preferably in primary care, and two members of the general public. Applications are due November 6, 2026, with appointments made by the Governor in early January 2027 for three-year terms. The committee is a federally mandated body that advises the Oregon Health Policy Board, OHA, and the Oregon Department of Human Services on the operation of the Oregon Health Plan, the state's Medicaid program. OHA is encouraging applicants from all areas of the state who are committed to reducing health inequities for OHP enrollees.
Why it mattersCommittee composition shapes the advisory input that informs Oregon Medicaid policy decisions affecting providers, enrollees, and health plans operating under the Oregon Health Plan.
- Published Oct 12
- Published Oct 12
- Published Oct 12
- Published Oct 12
- Published Oct 12
- Published Oct 12
- Published Oct 12
- Published Oct 12
- Published Oct 12RI
Rhode Island Projects 24,600 Could Lose Medicaid Under Work Rules
New national modeling summarized Thursday estimates up to 3.4 million young adults could lose Medicaid or subsidized Marketplace coverage by 2028 due to the federal work requirement. Rhode Island's own projections show roughly 24,600 Medicaid beneficiaries of all ages in the state are at risk of losing coverage under the new rules. The analysis highlights young adults as a population particularly vulnerable to coverage loss from the requirement's reporting and verification burdens. Implementation details and timing for Rhode Island's rollout were not specified in this coverage.
Why it mattersState Medicaid agencies and managed care plans in Rhode Island must prepare eligibility systems and member outreach for tens of thousands of beneficiaries facing potential disenrollment.
- Published Oct 12
- Published Oct 12AZ
Arizona's Four-Year Audit Lapse Puts $18.3B in HHS Funds at Risk
Arizona has missed the federal Single Audit deadline for four consecutive fiscal years (2022-2025) under Governor Katie Hobbs, prompting HHS officials to warn that enforcement actions could jeopardize billions in federal funding. The state spent about $28.6 billion in federal funds in fiscal year 2024, including $18.3 billion from HHS supporting AHCCCS Medicaid, ALTCS long-term care, behavioral health, SNAP, and child care programs. HHS called the state's response "inadequate" at a September 21 legislative hearing, and federal agencies have already withheld roughly $154 million in NIH funding from state universities over related compliance failures. The Arizona Department of Administration has proposed completing the overdue audit by December 30, 2026, but the state Auditor General disputes that timeline, projecting March 2027 instead, just weeks before the next audit deadline.
Why it mattersState Medicaid agency AHCCCS and its long-term care arm ALTCS could face federal payment withholding, cost disallowances, or award suspension if the audit noncompliance is not resolved, directly threatening funding for seniors, people with disabilities, and other vulnerable enrollees.
- Published Oct 12