States can align capitation withholds with value-based payment state-directed payment arrangements to incentivize managed care plans and providers to improve outcomes for dually eligible individuals.

The Deficit Reduction Act of 2005 provided the resources to establish the Medicaid Integrity Program (MIP), the first national strategy in the 40-year history of the Medicaid program to promote the ...

The buck stops here. We’ve got to clean up the system. With these words, Dr. Mehmet Oz, now at the helm of the Centers for Medicare and Medicaid Services (CMS), signaled a pivotal moment for Medicaid ...

Medicaid is the joint federal-state health insurance program that provides medical coverage to almost five million low-income, elderly, disabled Floridians and children. Although the federal ...

President Donald Trump signed into law H.R. 1 on July 4, 2025, major budget reconciliation legislation often referred to as the "One Big ...

Many healthcare delivery organizations have adopted some form of value-based payment model in recent years, shifting the healthcare focus from quantity of services to quality of outcomes. In a ...

On February 25, 2026, the Centers for Medicare & Medicaid Services (“CMS”) announced several program integrity actions impacting Medicaid funding and Medicare supplier enrollment, along with a request ...

As Medicaid programs continue to grow in size, cost, and complexity, program integrity can no longer function as a standalone role—it must be built into the fabric of how programs operate daily.

* * * Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program Notice for Proposed Rulemaking (CMS-2434-P) The Centers for Medicare & ...

Iowa has saved more than $23 million in cost avoidance or recoveries in the first year using a new Medicaid program integrity initiative, according to a news release. The state used a variety of ...