Managed Care

Audit Reveals $7 Million Overpay in PA Medicaid Drug Benefits for 2022
Management & Administration Audit Reveals $7 Million Overpay in PA Medicaid Drug Benefits for 2022

Delving into significant financial mismanagement uncovered by Pennsylvania Auditor General Timothy L. DeFoor, this article shines a light on the state's Medicaid prescription drug benefits. It underscores substantial fiscal oversight issues and calls for urgent reforms. The audit has revealed

August 30, 2024
Healthcare Payer Developments: Funding, Policy Changes, and Legal Actions
Management & Administration Healthcare Payer Developments: Funding, Policy Changes, and Legal Actions

The healthcare payer industry is continually evolving, driven by substantial funding rounds, significant policy changes, legislative enactments, and legal actions. Staying updated with these developments is crucial for stakeholders to navigate the complexities of the healthcare landscape. This

August 21, 2024
How Will Proposition 35 Reform Medi-Cal Funding in California?
Management & Administration How Will Proposition 35 Reform Medi-Cal Funding in California?

Proposition 35, appearing on the November 5 general election ballot, proposes significant changes to California's Medi-Cal program. Medi-Cal, the state's version of the federal Medicaid program, provides health insurance to low-income residents. This measure garnered widespread support

August 16, 2024
Can Steward Health Survive Bankruptcy by Selling Managed-Care Division?
Management & Administration Can Steward Health Survive Bankruptcy by Selling Managed-Care Division?

Steward Health Care System, a prominent Dallas-based healthcare organization, faces a critical financial juncture. The company is grappling with significant operational challenges, particularly within its hospital division. Recently, in a bid to stabilize its finances amid bankruptcy proceedings,

August 14, 2024
Virginia Medicaid's Managed Care Fails to Link Pregnant Women to Care
Management & Administration Virginia Medicaid's Managed Care Fails to Link Pregnant Women to Care

Medicaid is a pivotal safety net for millions of low-income and disabled Americans, providing access to critical health services, including prenatal care for pregnant women. Recent findings, however, have exposed glaring inefficiencies in Virginia's Medicaid managed care organizations (MCOs)

July 12, 2024
Cook Children’s Health Plan Fights Texas Medicaid Contract Cancellation
Management & Administration Cook Children’s Health Plan Fights Texas Medicaid Contract Cancellation

The Cook Children’s Health Plan (CCHP) has been a steadfast provider of Medicaid services to low-income families in North Texas for over two decades. Recently, however, it found itself in the throes of a heated dispute with the Texas Health and Human Services Commission (HHSC), which decided not to

July 9, 2024
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