Medicaid reimbursement alerts

This transmittal updates Chapters 3, 4, and 5 of Publication 100-15, which governs Medicaid program guidance. Billing teams should review the specific chapter amendments for any changes to eligibility

This final rule prohibits Federal Medicaid and CHIP funding for sex-rejecting (gender-affirming) procedures for minors, effective October 13, 2026. States must amend their Medicaid and CHIP plans to e

CMS proposes to revise Medicaid health care-related tax standards by implementing new indirect hold harmless thresholds from the 'One Big Beautiful Bill Act,' replacing the current 6% net patient reve

CMS is soliciting public comments on generic information collection activities under the Medicaid and CHIP programs, covering state plan amendments, waivers, demonstrations, and reporting under OMB co

CMS is re-establishing a data matching program with the VA/VHA to verify whether individuals are enrolled in VA Minimum Essential Coverage (MEC). This data exchange supports CMS determinations of elig

The new rule streamlines the enrollment and eligibility processes for the Medicare Savings Programs, potentially increasing enrollment among eligible individuals and enhancing reimbursement effectiven

The proposed rule aims to close a loophole in Medicaid funding which has allowed higher tax rates on Medicaid taxable units than on non-Medicaid units. This change is expected to strengthen the redist

The new rule aims to preserve Medicaid funding by closing a loophole that allowed for unequal taxation on Medicaid versus non-Medicaid units. This regulatory change could impact reimbursement rates, p

The new rule under the Medicaid Drug Rebate Program will significantly impact billing and reimbursement processes by ensuring stricter compliance with drug classification and pricing integrity. This m

The new Medicaid and CHIP managed care rule aims to enhance access to care and improve health equity, which will likely streamline billing processes and reimbursement timelines. With the introduction

The new Medicaid rule streamlines application and eligibility processes, enhancing efficiency in billing and reimbursement for providers. It ensures timely redeterminations and reduces barriers, poten

The proposed rule aims to strengthen the Medicaid Drug Rebate Program by addressing drug misclassification and pricing data inaccuracies, which could lead to improved reimbursement accuracy and progra

The proposed Medicaid rule aims to enhance access to care and improve health outcomes through increased transparency and standardized monitoring. This could lead to significant changes in billing prac

This proposed rule would revise the Conditions for Coverage for Organ Procurement Organizations (OPOs) to clarify outstanding procedural questions and enable OP

This final rule addresses a loophole in a regulatory statistical test applied to State proposals for Medicaid tax waivers. The test is designed to ensure, as re

Medicaid Fraud Control Units Annual Report: Fiscal Year 2024 VideosJune 25, 2025

2025 National Health Care Fraud Takedown Media MaterialsJune 30, 2025

Combating Durable Medical Equipment Fraud VideosNovember 25, 2025

Acting Inspector General Juliet T. Hodgkins Remarks on the 2025 National Health Care Fraud Takedown VideosJune 30, 2025