| LTC Pharmacy News State News July 2025 |
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| The states have been active in pulling in the reins on PBMs, but the courts have intervened and we may have to keep our eyes on the Supreme Court which may be called on to determine whether states have the ability to regulate the middlemen.
How states respond to the Republicans' "Big, Beautiful Bill" will consume the legislatures around the country, as they react to changes in Medicaid. The fun never stops.
Paul |
| | No State Newsletter in August
Let's follow the lead of Congress and take August off. I will be back with more news in September as the state legislatures head for the finish line. |
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State Headlines
Reconciliation Bill Passed: Mixed Results for Nursing Homes
Republicans narrowly passed the reconciliation budget bill, cutting money from Medicaid, but the implementation of the cuts doesn't start for a couple years. Provider taxes, a maneuver states use to increase federal matching dollars, gets phased down for populations included in the ACA Medicaid expansion provisions, while nursing homes are exempt from the are exempt from cuts, but will remain frozen at current levels. for 10years.
KFF Summary
Judge Blocks Arkansas Law Prohibiting PBMs from Owning Drug Stores
The Arkansas legislature passed several laws regulating PBM practices, one of which prohibited PBMs from having an interest in drug stores (e.g., CVS). Federal judge stopped the law from taking effect in January, ruling that the law likely violates the Constitution's Commerce clause. More
Supreme Court Declines to Intervene in Oklahoma PBM Regulation
The PBM industry took legal action against Oklahoma's law regulating the more egregious practices of the PBM industry. The industry sued, and persuaded a judge that the state lacked authority to regulated the Medicare drug benefit and private health plans. The 10th Circuit Court of Appeals agreed, and now the Supreme Court has declined to review the case. Details
HHS Inspector General: PA Made $8.7 Million in Unallowable Capitation Payments
The Health and Human Services Inspector General has issued an audit report revealing the the Commonwealth of Pennsylvania made more than $8 million in unallowed capitation payments for enrollees with multiple Medicaid identification numbers.
See Report
CMS Finds Nearly 3 Million May be Enrolled in Multiple Medicaid/ACA Plans
The agency that oversees Medicare and Medicaid reports that it has identified 2.8 million Americans enrolled in more than one Medicaid or Affordable Care Act plan. HHS Secretary Robert Kennedy, Jr. casts blame on the Biden Administration for not catching on to people who enrolled in multiple programs in multiple states.
CMS Press Release
CMS Tightens Oversight of Medicaid
CMS announced that it would be more vigilant in its oversight of Medicaid to enable the program to be more focused in the truly needy and to ensure resources are used as the law requires. Special emphasis will be placed on continuous eligibility and on workforce initiatives. |
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| | | | Arkansas Medicaid Waiver Approved
Arkansas was approved for a 1115(a) waiver by CMS. The waiver allows Arkansas to test transition-related strategies for people coming from mental health institutions back to the community. The waiver is approved for a 5-year period. Approval Letter
California State Senate Approves PBM Restrictions
The state senate passed SB 41, which prohibits spread pricing, and other issues. The legislation is now in the Assembly Appropriations Committee.
Florida Moves to Require Managed Care for IDD Enrollees
People with Intellectual and Developmental Disabilities in Medicaid will be enrolled in managed care plans if the federal government approves the state's 1915(c) waiver request. There is currently a pilot program in place, which the state would like to expand to be able to cull the waiting list for home and community-based care. More
KFF: Reconciliation Bill Impacts States Unequally
The Republicans' "Big Beautiful Bill" will impact states, and some more than others, according to an assessment published by KFF. More
States Go to Work to Shield Hospitals from Medicaid Cuts
States are responding to President Trump's signing of the "Big Beautiful Bill Act" by implementing, or planning, such tactics as ramping up hospital reimbursement in advance of the implementation date, and cutting down on supplemental benefits in Medicaid managed care plans. More.
Hello Veg, Goodbye Smile
Eating more vegetables is good for you. Don't take my word, just ask your Mom. A new study exposes the dark side of plant-based diets; your teeth may be at risk. It turns out that microscopic particles act as abrasives, attacking the enamel of the teeth, exposing the pulp and dentin to more damage, Perhaps the case of "no good diet goes unpunished". Newsweek |
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