Latest news with #Medicaid-funded
Yahoo
28-05-2025
- Business
- Yahoo
Feds increase oversight of Medicaid benefits for ‘non-citizens'
May 27 (UPI) -- The Centers for Medicare & Medicaid Services is increasing its oversight of states to prevent misuse of Medicaid funding to provide services for those who unlawfully entered the United States. Federal Medicaid funding is only available for emergency medical services for "non-citizens with unsatisfactory immigration status" when they otherwise would qualify for Medicaid coverage, the Health and Human Services Department said in a news release shared with UPI. Some states, though, "have pushed the boundaries" and made taxpayers liable for benefits that are not allowed by federal law. "Medicaid is not and cannot be a backdoor pathway to subsidize open borders," CMS Administrator Dr. Mehmet Oz said. "States have a duty to uphold the law and protect taxpayer funds," Oz added. "We are putting them on notice - CMS will not allow federal dollars to be diverted to cover those who are not lawfully eligible." CMS is increasing federal oversight of Medicaid at the state level to identify and stop unlawful spending through: Focused evaluations of state Medicaid spending reports. In-depth reviews of states' financial management systems. Assessments of eligibility rules and policies to close loopholes. "Medicaid funds must serve American citizens in need and those legally entitled to benefits," said Drew Snyder, deputy administrator and director of the Center for Medicaid & CHIP Services. "If states cannot or will not comply, CMS will step in," Snyder said. Any unlawful spending of Medicaid dollars by states on "non-citizens" is subject to recoupment of the federal share of such expenses, according to the HHS Department. Snyder on Tuesday notified respective state officials of the increased oversight in a letter with the subject, "Ending taxpayer subsidization of open borders." He cited President Donald Trump's Feb. 19 executive order requiring federal agencies to uphold the rule of law, thwart the waste of taxpayer dollars and protect benefits for U.S. citizens. CMS "is committed to faithfully implementing the president's executive order," Snyder said. "The plain text of federal law ... generally prohibits illegal aliens from obtaining most taxpayer-funded benefits," he wrote. Federal law makes it national policy that "'aliens within the nation's borders not depend on public resources to meet their needs,'" and "'it is a compelling government interest to remove the incentive for illegal immigration provided by the availability of public benefits,'" Snyder said. He encouraged all states to review their policies, systems and internal controls to ensure each legally complies with federal law when claiming medical assistance and administrative expenditures. The Congressional Budget Office in October reported that the Biden administration's open-border policy cost taxpayers more than $16.2 billion to provide Medicaid-funded emergency services for "illegal aliens" after President Joe Biden took office.
Yahoo
23-05-2025
- Health
- Yahoo
Medicaid cuts threaten the rights and lives of North Dakotans with disabilities
(Photo via Getty Images) As executive director of The Arc of North Dakota, I've witnessed firsthand how essential Medicaid-funded services empower individuals with intellectual and developmental disabilities to live independently and engage fully in their communities. But today, that independence is under serious threat. On Thursday, the U.S. House of Representatives passed the 'One Big Beautiful Bill Act,' which includes sweeping cuts to Medicaid. For many in North Dakota, these cuts aren't abstract figures. They mean losing access to critical services that make daily life possible, like bathing, commuting to work, or attending community programs, robbing them of their place within the community. This threat to Medicaid is more than a fiscal issue. It's a rollback of decades of hard-won progress. In 1980, six North Dakota families partnered with The Arc to challenge the inhumane conditions at Grafton State School and San Haven State Hospital. That lawsuit led to the closure of San Haven, reduced the population at Grafton, and shifted our state toward more humane, community-based care. Now, that legacy is in danger of being erased. U.S. House Republicans push through massive tax and spending bill slashing Medicaid In addition to deep funding cuts, the legislation introduces policy changes that restrict access to care in multiple ways: Work requirements: The mandatory Medicaid work requirements start date has been moved to Dec. 31, 2026. Although people with intellectual and developmental disabilities are technically exempt, real-life implementation often fails to protect them. Many individuals with disabilities and their family caregivers get caught in confusing eligibility rules, risking wrongful loss of coverage. Increased costs: States can now charge Medicaid recipients up to $35 per service. Annual out-of-pocket costs could shoot up even for those near the poverty line, making necessary care unaffordable for many. Frequent eligibility checks: Medicaid eligibility will be reviewed every six months instead of annually. For people with limited access to technology or help navigating paperwork, this change drastically increases the risk of losing coverage due to missed notices or simple errors. Limits on provider taxes: New federal restrictions on provider taxes limit how states fund their Medicaid programs. This could reduce available dollars for crucial services, including supported employment, in-home care, and day programs. These services allow individuals with intellectual and developmental disabilities to live and thrive in their communities. While it's difficult to pinpoint precisely how many North Dakotans with intellectual and developmental disabilities will be affected, the overall impact is clear: Medicaid is the backbone of their support system. Even if some individuals are exempt from specific requirements, the broader funding cuts and program restrictions will limit access, increase delays, and force many to go without the help they need. Families are already facing long waitlists and strained service systems. These cuts will only make things worse. When services disappear, people don't just 'fall through the cracks'; they face real, lasting harm. Consider one individual with intellectual and developmental disabilities who's waited months for a supported employment slot. Without a job coach, they remain unemployed, despite being ready and eager to work. Medicaid cuts push that opportunity further out of reach for them and hundreds of others like them. And the alternative? Institutional care may sound like a backup plan, but it isolates people, limits opportunities, and costs the public far more. Supporting people in their communities is the right and the fiscally responsible choice. At The Arc, we believe people with disabilities deserve the supports they need to live full, meaningful lives. But today, families and providers are navigating a maze of shifting rules, disappearing services, and uncertain futures. The confusion alone makes it harder to get help when needed most. To pursue this direction is to court the resurgence of systems we consciously moved beyond. Our collective experience, however, and the resources now at our disposal, equip us to forge substantive improvements rather than reenact previous failings. North Dakotans of all abilities deserve more than just survival. They deserve a future built on dignity, inclusion, and respect.
Yahoo
21-05-2025
- Health
- Yahoo
Michigan health advocates slam Trump bill cutting down Medicaid
Nathan Dunbar, a mental health worker for Community Mental Health Authority of Clinton, Eaton, Ingham Counties speaks on a panel of health advocate in Lansing, Michigan about the importance of Medicaid on May 21, 2025 | Photo: Anna Liz Nichols Medicaid is not a burden on taxpayers or the government, it's a lifeline for families to live with dignity, Ruby Farmer told a panel of health advocates in Lansing on Wednesday. As Congress considers a bill backed by President Donald Trump that would cut hundreds of billions of dollars from Medicaid over the next decade, Farmer shared her concerns for Michigan's Medicaid-funded Home Health program, which has allowed her to care for her son Omar. Her goal was to help Omar, now 40 years old and living with autism, to live as independently as possible, Farmer said. It took years of patience and love, and he's learned many life skills to keep him healthy and happy, but Farmer said Omar will always depend on her and without Medicaid, families may not be able to tell their stories of triumph through care. 'Medicaid is part of many of the stories and we cannot allow them to lose their lifeline. To be a home care worker, you must understand and believe that the core that all people deserve, love, respect, dignity, health and opportunity to live their life on their own terms,' Farmer said. 'Care is a blessing, not a burden, and we are called to serve others. I wish more people understood, and that I wish more people felt the way that I do.' On Tuesday, Trump met with U.S. House Republicans, pushing a unified front for a speedy passage of legislation he has called a 'big, beautiful bill,'that would, amongst other financial reforms like extending his 2017 tax cuts, axe more than $800 billion in funding, slated to mostly come from Medicaid. House Speaker Mike Johnson has chosen Memorial Day as the deadline for the House to pass the bill off the floor, but a consensus amongst Republicans hasn't been reached yet. Talking to the media Tuesday on Capitol Hill, alongside Michigan U.S. Rep. Lisa McClain (R-Bruce Twp.), chair of the House Republican Conference, Trump stumped for his tax bill slamming the few Republicans that haven't backed the effort, namely Kentucky Republican U.S. Rep. Thomas Massie. 'We don't want any waste, fraud or abuse. It's very simple, waste, fraud, abuse, other than that we're leaving it, Medicare, we're leaving it,' Trump said Tuesday. Medicaid and Medicare are different programs, Michael Daeschlein, Long-Term Care Policy Specialist for Michigan Elder Justice Initiative said on the panel. Daeschlein pointed out Medicare, which provides health insurance for people who are 65 years old or older does not cover the long term care many Michiganders need as senior citizens, whereas Medicaid, which provides health care coverage for individuals with low-incomes, does cover such care. Michigan has an aging population, Daeschlein said, and many of the direct care worker jobs in the state are remaining open as those in the industry are doing the work of multiple professionals in an 'unsustainable' system. Medicaid covers three in five nursing home residents, or 33,000 Michiganders, Daeschlein said, which is many families' last option to ensure their loved ones are safe and taken care of. 'It's important to understand that over 300,000 Michiganders on Medicare rely on Medicaid to pay their out-of-pocket expenses, their co-pays, their deductibles… if it wasn't for Medicaid, 300,000 people wouldn't be able to make Medicare work for them,' Daeschlein said. Cutting Medicaid would perpetuate cycles of addiction and incarceration, working against efforts around the state to help Michiganders heal and contribute in their communities, Nathan Dunbar, a mental health worker with Community Mental Health Authority of Clinton, Eaton, and Ingham Counties said. By the time someone goes into rehab or goes to prison, they likely don't have a job anymore and will require Medicaid in order to access recovery resources to get their life back on track, Dunbar said. The best available access to treatment is through Medicaid, Dunbar said, adding that private insurance companies don't 'roll the dice' on people who are battling addiction. '…but those people still need help and those people's kids still need help,' Dunbar said. 'I resent people calling my fellow Michiganders waste, and I resent people calling my fellow Michiganders abuse, and I resent people calling my fellow Michiganders fraud. None of those things are what's happening. What is happening is our government is being unresponsive to the needs of its people.' SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Yahoo
08-05-2025
- Health
- Yahoo
Georgia woman charged with Medicaid fraud in Connecticut
WATERBURY, Conn. (WTNH) — A Georgia woman was arrested by the Coweta (Ga.) County's Sheriff's Office on a Connecticut warrant, and extradited to Connecticut for allegedly defrauding Medicaid by billing for services she did not provide. Brittany Gresham, age 36, of Senoia, Ga., was extradited by the Medicaid Fraud Control Unit in the Office of the Chief State's Attorney and charged with one count of first-degree larceny by defrauding a public community, one count of health insurance fraud, one count of conspiracy to commit first-degree larceny by defrauding a public community, and one count of conspiracy to commit health insurance fraud. Gresham allegedly enrolled as a Personal Care Assistant (PCA) in the Connecticut Medical Assistants Program (CMAP). The PCA program, providing an alternative to entering an assisted living facility, is a Medicaid-funded program which provides recipients who have permanent, severe, and/or chronic disabilities, funds to hire PCAs to physically assist them with daily self-care. According to the investigation by the Medicaid Fraud Control Unit, that between March 2021-July 2023, Gresham while living in Georgia, and the co-defendant, Tywan Marion, with Gresham's knowledge, allegedly completed a job application for Gresham and submitted time sheets on her behalf for PCA services she did not provide to a Connecticut recipient. Gresham allegedly received payment from Medicaid for the unrendered services and transfer some of the money to Marion. Gresham allegedly received a total of $44,476.57 from the scheme. Gresham was arraigned in Waterbury Superior Court on Wednesday and is being held on a $100,000 surety bond. Marion, who was previously arrested, is being held on a $200,000 surety bond. All charges are each classified as B felonies and punishable by up to 20 years in prison. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. For the latest news, weather, sports, and streaming video, head to
Yahoo
23-04-2025
- Health
- Yahoo
Governor Hochul weighs in on CDPAP complaints
ROCHESTER, N.Y. (WROC) — News 8 is continuing to cover the overhaul of the state's Medicaid-funded program which allows people living with disabilities the power to choose their own care providers. The Consumer Directed Personal Assistance Program (CDPAP) has been around for decades, however during last year's budget session, the Governor announced the massive restructuring, claiming fraud and waste have directly contributed to the ballooning costs, expected to have surpassed $11-billion in 2025. Previously, there were 600+ fiscal intermediaries, companies which handled administrative tasks, such as payroll, but now there is the sole, state-selected FI: Public Partnerships LLC (PPL). News8 has shared and received complaints regarding PPL's website crashing, calls not being returned, the app utilized for clock-in/out (Time4Care) not properly working, and more recently payments not being paid out properly. Georgia McCabe participates in CDPAP as she cares for her son, Brendan, who is legally blind, has cerebral palsy and epilepsy. She explains that she, along with the other care team members for her son, had wanted to wait a little bit in January after the rollout opened up to allow for any issues to be ironed over, however when she went to make the switch, the information was already obtained. 'All of the sudden one day I just got these email and text messages saying that everything had already been uploaded. And I'm like, I didn't do that but basically, they had all the information for the PA's, as well as my son, and that included his Medicaid number, his name, his address, his social security, etc.' McCabe says. She's now grown even more wary of any security protocol and says she's locked down her credit reports, signed up for identity guard, and even had title lock insurance. 'My biggest concern is what kind of compliance do they have from HIPPA; since it's Medicaid and it's health related information you know anyone who has access to that usually goes through some sort of training and there are best practices like, do the employees have background checks done on them, did they have any kind of verification, what kind of roll access do these people have? If they're working remote, I have even stronger concerns about the kind of cybersecurity practices they might have in place, or data protection compliance in terms of the various portals people would be utilizing,' McCabe says. During Governor Kathy Hochul's visit to Rochester on Monday to discuss the budget, which is now three weeks late, News8's Isabel Garcia asked why the administration remains committed to continuing the overhaul at this stage given all the concerns and reported issues: 'We've been talking about this for over a year – this is not an unexpected transition, it was passed in last year's budget so an entire year has passed where we started telling people that this is going to happen and your care will not be disrupted in the long term; a few hiccups early on, but taking care of — but basically starting in January people could transition, they had until April — now it's May 15 – but I will also tell you this, and I hope your reporting will investigate this: there are individual companies who have refused to turn over the information about their patients for the transition to be successful; we are not able to reach them and tell them what was necessary because they were saying, despite the law in the State of New York, they're being obstinate and not sharing that information so I think if you look at the cause for some of this disruption, it is at the hands of those who are intentionally trying to thwart our efforts to make sure we take care of our patients but also stop this wild abuse of taxpayer dollars,' said Governor Hochul. The NYS Dept. of Health set up hotline to assist with CDPAP inquiries: The agency also provided the following response when asked about security measures as it relates to PPL: 1-833-947-8666 Monday to Friday, 9:00 a.m. – 5:00 p.m. 'The Department continues to closely monitor this transition as part of its ongoing commitment to protecting access to care and supporting caregivers.' Additional Information: Regarding the contract, the qualifying language was approved by the State Legislature and the RFP was put out for public bid. The Department of Health followed the standard procurement process, reviewed over 100 responses, and scored each proposal based on the qualifying language, as per state law. At the end of that process, PPL scored the highest and was selected. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
