Medicaid

A new CMS bulletin on spread pricing could pave the way for getting Medicaid managed care plans and pharmacy benefit managers to disclose spread-pricing amounts, according to Alex Shekhdar, founder of Sycamore Creek Healthcare Advisors.

The Oklahoma Supreme Court is preparing to weigh in on the validity of a proposed ballot measure that seeks to expand Medicaid in Oklahoma, and the legal fight turns on a question raised by a well-known bit of mathematical minutia in the Affordable Care Act: whether the Medicaid expansion eligibility ceiling is best understood as 133% of the federal poverty level or 138% of the federal poverty level.

CMS Administrator Seema Verma on Wednesday (May 22) said the agency is taking its time with a national Medicare coverage policy for new expensive hospital-administered cancer drugs, which was due to be published May 17 but was delayed, because the policy will affect coverage of drugs other than the two chimeric antigen receptor (CAR) T-cell therapies already on the market.

After legislative talks between House Speaker Nancy Pelosi (D-CA) and President Donald Trump ground to a halt Wednesday morning, Senate Finance Chair Chuck Grassley (R-IA), who is helping lead negotiations on health care policy, said the Senate was always in the driver’s seat in the drug-pricing debate.

A Georgetown University report released Wednesday (May 22) says expanding Medicaid is key to reducing maternal mortality and improving preventative care in women of childbearing age, a position shared by maternal health advocates who also say Medicaid coverage can be improved.

CMS Deputy Administrator and Director of the Center for Medicaid & CHIP Services Chris Traylor announced his departure from CMS Friday (May 17) months after taking on the role, making him the fourth person to leave the role in the last 18 months and the third departure of a top CMS official in the past couple of weeks.

Rep. Mark Green (R-TN) introduced a bill Tuesday (May 14) that would allow Medicaid enrollees to choose to use a pre-paid “swipe card” to purchase medical care -- a proposal Green said would drive down costs and introduce more competition into the health sector, but one policy analyst said might instead drive up costs.

The attorneys general for five states filed a lawsuit against the Trump administration on Monday (May 13) over a final rule issued earlier this month that repeals an Obama-era rule allowing union dues to be deducted from Medicaid payments made to independent home health workers.

CMS is considering whether to allow states that partially expand Medicaid to receive the enhanced federal funding historically reserved for full Medicaid expansion, CMS Administrator Seema Verma said Wednesday (May 8).