The CMS is ratcheting up scrutiny of state Medicaid programs.

The agency announced Tuesday that it is boosting audits to confirm that Medicaid beneficiaries are correctly identified as expansion or pre-expansion enrollees. States receive higher federal match rates of around 90% for expansion enrollees, while the match rate can be as low as 50% for pre-expansion enrollees.

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Even health insurers that don’t expect many of their plan members to drop insurance coverage after the individual mandate penalty is zeroed out still may have to raise individual market premiums in 2019 as their payments from the ACA’s risk adjustment program change thanks to the mandate loss.

Buffalo, N.Y.-based insurer Independent Health doesn’t expect a large number of its 5,000 ACA exchange members to drop their coverage when the individual mandate penalty is effectively repealed starting in 2019. Its population skews older and sicker, and most members need their insurance coverage. Its average member is about 49 years old, and about half receive federal premium subsidies.

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A bipartisan group of House lawmakers on Thursday moved to delay the health insurance tax for another year, triggering the next round of work to curb the Affordable Care Act’s taxes on the industry.

While the lawmakers aren’t proposing an all-out repeal of the tax, the measure would be the third delay of the assessment. Reps. Kristi Noem (R-S.D.) and Jackie Walorski (R-Ind.) co-sponsored the bill along with Reps. Kyrsten Sinema (D-Ariz.) and Ami Bera (D-Calif.).

Insurers have to pay the tax for 2018, though it was suspended in 2017 and Congress passed another moratorium for 2019. Insurers estimate it will cost them $14.3 billion this year.

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A Maine state judge said Thursday that Gov. Paul LePage’s administration has a “duty to enforce” a voter-passed law to expand Medicaid to low-income adults.

Kennebec County Superior Court Justice Michaela Murphy’s comment came during oral arguments in a lawsuit brought by advocacy groups to force the LePage administration to implement the Medicaid expansion overwhelmingly passed by Maine voters last November.

The judge did not indicate when she would issue a ruling, though it’s expected she will rule within a week or so. The losing side is almost certain to appeal.

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As unlikely as it seems that congressional GOP leaders will try once again to repeal and replace the Affordable Care Act, both Republican and Democratic political observers say there’s a small chance they refuse to rule it out.

Why? Conservatives remain furious that last year’s Obamacare repeal effort failed. And with midterm elections looming, the GOP needs to fire up right-wing voters to help maintain control of Congress.

Sen. Lindsey Graham (R-S.C.) said he hopes to revive a new version of the repeal bill he co-sponsored with Sen. Bill Cassidy (R-La.) that narrowly failed in the Senate last fall. It’s being developed by the Heritage Foundation and the Galen Institute, working with former Pennsylvania Sen. Rick Santorum.

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New York and Minnesota officials have settled a lawsuit against the Trump administration over its decision to slash federal funding for the states’ health plan programs that cover certain low-income people.

A federal judge in the U.S. District Court for the Southern District of New York dismissed the case after the HHS agreed to pay $151.9 million to New York and $17.3 million to Minnesota by May 14 to fund the states’ Basic Health Programs, which together cover 800,000 people.

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The Senate’s two top Republican proponents for individual market exchange stabilization measures are in talks with CMS Administrator Seema Verma about making 1332 state innovation waivers easier to obtain.

Early insurance rate filings from Maryland and Virginia have shown huge premiums spikes, leading Republicans and Democrats on Capitol Hill to question which party is to blame for the hikes months before midterm elections. Sen. Lamar Alexander (R-Tenn.) said he and Verma are discussing speeding up the waiver application process, although he conceded that most of the measures he and Sen. Susan Collins (R-Maine) proposed to keep rates in check for next year would need to be enacted by Congress.

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The CMS on Monday gave New Hampshire the green light to impose work rules for some adult Medicaid recipients. It’s the fourth state to win approval for that requirement.

The state’s Medicaid 1115 waiver will require adult beneficiaries between the ages of 19 and 64 to participate in 100 hours of “community engagement activities” a month to maintain eligibility for coverage. Community engagement is defined as having a job, being enrolled in school, participating in job skills training, or performing some sort of community service.

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Arizona has asked the CMS to allow it to end retroactive coverage for Medicaid beneficiaries.

If granted, the waiver request now under review at the CMS, would nix providers’ ability to bill for services provided in the three months before a beneficiary applies for Medicaid coverage, assuming the patient was eligible during that time.

Providers in the state had urged the state not to submit the waiver to the CMS because it could put hospitals in a difficult financial situation and limit access to care.

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The White House on Friday cleared the CMS to scale back efforts to evaluate Indiana’s conservative approach to Medicaid expansion. The move could prevent the agency from gathering adequate data to determine if the state’s method of expansion harmed access to care.

Some feel that even with a scaled-back study, the CMS could still glean pertinent information from Indiana about the impact its expansion approach has had on Medicaid beneficiaries.

“Surveys were just one element, and getting rid of them is not enough to make or break an evaluation” said Doug Badger, a senior fellow at the Galen Institute, a conservative think tank.

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