Tag: Medicaid
Survey: Medicaid recipients unprepared for work requirements
October 21, 2026HME News Staff
ASHEVILLE, N.C. – Forty-four percent of Medicaid recipients are not prepared to submit the required documentation to meet new work requirements, according to a new survey from Aeroflow Health.
When these requirements take effect nationwide on Jan. 1, 2027, certain individuals will need to demonstrate their participation in "qualifying activities," such as employment, community service or work programs, to enroll in or maintain Medicaid coverage. The company says clear, individualized...
Fla. Medicaid integrity initiative shifts toward prevention
October 7, 2026HME News Staff
WEST PALM BEACH, Fla. – Florida Gov. Ron DeSantis said the state’s enhanced Medicaid program integrity efforts to combat fraud, waste and abuse are “delivering results.”
In June, DeSantis announced the most significant Medicaid integrity initiative in Florida history, shifting the state away from a “pay-and-chase” model toward preventing fraud before taxpayer dollars are spent.
The Agency for Health Care Administration (AHCA) strengthened provider screening...
North Carolina extends DME rate floor, but long-term funding concerns grow nationwide
August 28, 2026By Theresa Flaherty, Contributing Writer
RALEIGH, N.C. - A three-year extension of the DME rate floor for North Carolina Medicaid provides well-earned relief for providers, but industry stakeholders say reimbursement pressures continue to mount nationwide.
The North Carolina General Assembly has approved a state budget that extends the rate floor for Medicaid for an additional two years through June 30, 2029. In May, Gov. Josh Stein signed HB696 into law, providing an initial one-year extension through June 30, 2027.
“Our...
Prior authorization metrics provide new insight, KFF says
August 18, 2026HME News Staff
WASHINGTON – Medicare Advantage insurers denied 13% of standard prior authorization requests, Medicaid managed care insurers denied 14% and ACA Marketplace insurers denied 18%, according to a new analysis from KFF.
Insurers were required to post the first year of prior authorization metrics for the 2025 calendar year by March 31, 2026. KFF collected and analyzed these metrics from the largest insurers in most market segments for which reporting is required.
Other key takeaways from the...
California removes certain requirements for wheelchair repairs
August 4, 2026HME News Staff
SACRAMENTO, Calif. – The California Department of Health Care Services will not require treatment authorization requests (TARs) when the cumulative cost for wheelchair repair maintenance or replacement parts is less than or equal to $2,500 within a calendar month, the National Coalition for Assistive & Rehab Technology (NCART) has announced. “NCART members, consumers, and the California Department of Health Care Services have been meeting to improve the CRT benefit for California consumers,”...
In brief: VGM’s state payer hub, CMS’s fraud war room, Drive Medical’s IQ
July 31, 2026HME News Staff
WATERLOO, Iowa – VGM Government Relations has launched a State Payer Resources web page designed to give DMEPOS providers one place to find state-specific payer and regulatory information.
The centralized hub includes frequently used resources such as:
Medicaid policy manuals
Provider enrollment information
DMEPOS licensure requirements
State Medicaid contacts and websites
Links to state DME associations
VGM says the web page is intended to help providers more quickly...
CMS Medicaid fraud effort stops $203M in payments
July 29, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) says its Medicaid Fraud War Room has stopped more than $203 million in potentially improper Medicaid payments during its first 88 days. Launched April 23, the initiative brings together CMS, the HHS Office of Inspector General, state Medicaid agencies and federal law enforcement partners to identify high-risk providers and coordinate enforcement actions. CMS says the effort uses advanced analytics to detect suspicious billing patterns...
HHS, CMS pause $1B in federal matching funds to Medicaid programs in two states
July 22, 2026HME News Staff
WASHINGTON – The Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) have deferred more than $1 billion in federal Medicaid payments to California and Minnesota while the states provide additional documentation supporting certain claims. CMS says it is withholding approximately $867.5 million from California and $199 million from Minnesota following focused financial reviews that identified claims requiring further scrutiny. “CMS is done...
ACMESA secures extension of Medicaid fee schedule floor
July 8, 2026HME News Staff
RALEIGH, N.C. – The North Carolina General Assembly has approved the state budget, securing an additional two-year extension of the Medicaid fee schedule floor, the Atlantic Coast Medical Equipment Services Association (ACMESA) reports. The protection will now remain in effect through June 30, 2029. “This positive outcome was only possible through the hard work, relentless dedication, and strategic collaboration of our provider network, advocates, and lobbyists,” ACMESA said in...
In brief: Oxygen access issues, wearable adoption barriers, N.C. rate floor
July 2, 2026HME News Staff
WASHINGTON – Limited access to high-flow home oxygen is delaying hospital discharges and adding costs and risks for patients and the health care system, according to a national survey by the Pulmonary Hypertension Association (PHA). In the survey, 94% of 54 respiratory clinicians at 40 medical centers nationwide reported at least one discharge delay per month related to oxygen access issues. One-third reported six or more patients experiencing delays each month. Most delays added two or more...