The hottest Medicaid Substack posts right now

And their main takeaways
Category
Top Health Politics Topics

One Bad Idea After Another

Can We Still Govern? • 320 implied HN points • 17 Mar 26
🇺🇸 U.S. Politics Medicaid
  1. The administration is using broad, often misleading fraud claims to justify cutting Medicaid and withholding funds from blue states. Those moves risk denying care to eligible people while serving political goals.
  2. Actual data show Medicaid payment errors are low and Minnesota has been effective at controlling waste, and when fraud occurs it’s usually by large providers or organized actors, not everyday beneficiaries. This means the scare over widespread beneficiary fraud is misplaced.
  3. The fraud push looks politically motivated and hypocritical given pardons, conflicts of interest, and weakened enforcement, and it’s creating new paperwork and barriers that will reduce access to services more than stop real fraud.

Ten States Have Held Out on Medicaid Expansion. It's Left Millions of Americans Without Health Coverage.

HEALTH CARE un-covered • 439 implied HN points • 23 Sep 24
🏥 Health Politics Medicaid
  1. Ten states have not expanded Medicaid, leaving millions of people without health coverage. These states have some of the highest rates of uninsured residents.
  2. Many people in the coverage gap are working but still can't afford health insurance. Their incomes are too high for Medicaid but too low for ACA subsidies.
  3. The refusal to expand Medicaid often comes from political choices, not a lack of need. Many residents want the expansion, but their state governments are not listening.

Medicaid Data Dump: Billing Codes Explode Up to 10,000%, LA Mental Health Dept. Highest Biller in the Nation

OpenTheBooks Substack • 429 implied HN points • 21 Feb 26
🏥 Health Politics Medicaid
  1. A new HHS data release shows over 270 million Medicaid payments from 2018–2024 totaling more than $1 trillion, with monthly spending rising sharply after 2020.
  2. One billing code, T1019 for personal/home care, accounts for a huge share of spending and grew about 144% from 2018 to 2024, with a few organizations (mostly in New York) collecting over $1 billion each.
  3. Dozens of other billing codes ballooned—some up hundreds to over 10,000%—largely for home-based and coordinated care, concentrating large sums quickly and raising questions about oversight and possible fraud.

New Netflix Horror Flick “The Deliverance” Tackles Medicaid Troubles, Medical Debt

HEALTH CARE un-covered • 599 implied HN points • 05 Sep 24
🏥 Health Politics Medicaid
  1. The movie 'The Deliverance' highlights the struggles of a family facing both a demonic presence and real-life issues with the U.S. healthcare system. It shows how complicated and scary healthcare can feel for many families.
  2. Many healthcare providers are dropping Medicaid patients, making it harder for those in need to find care. The film illustrates the true horror of loved ones having to pay medical bills out-of-pocket when Medicaid support is unavailable.
  3. Medical debt is a serious problem in the U.S., affecting countless families. The film ends with the family battling real financial burdens, reminding viewers that there's no easy fix for medical bills.

The Wall Street Journal follows my scoop on autism therapy providers taking billions from Medicaid

Unreported Truths • 39 implied HN points • 11 Mar 26
🏥 Health Politics Medicaid
  1. A Medicaid reimbursement loophole let autism therapy providers bill extremely high hourly rates, which made state spending on these services skyrocket in a short time.
  2. Companies were able to charge far more than they paid frontline therapists, creating huge profits that translated into significant personal wealth for some owners.
  3. Even after states tightened reimbursement rules, low training requirements and legal billing structures leave the system vulnerable to costly, potentially abusive practices even when services are technically provided.
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Medicaid and Medicare Claims Managed by Insurers Are Rising. Why Aren’t They Worried About Their Profits?

HEALTH CARE un-covered • 819 implied HN points • 11 Jun 24
🏥 Health Politics Medicaid
  1. Insurers are seeing more claims for Medicaid and Medicare, but they aren't worried about profits. This is surprising to many people looking at the rising costs.
  2. Insurance companies can limit patient care by using tactics like prior authorization, which makes it hard for people to get needed treatment. This helps them keep their profits high.
  3. Medicare Advantage plans allow insurers to charge seniors more out-of-pocket costs. Insurers do this to maximize their profits while still getting a steady payment from the government.

Measles reaches highest number since elimination. Start of a Covid wave? Incoming Medicaid cuts, GAVI, and some good news

Your Local Epidemiologist • 1988 implied HN points • 07 Jul 25
🏥 Health Politics Medicaid
  1. Measles cases in the U.S. have hit their highest level since it was declared eliminated in 2000. This is mostly due to falling vaccination rates, as measles is extremely contagious.
  2. There are signs of a possible Covid-19 summer wave, particularly in states like Nevada and Texas. Factors like indoor gatherings and waning immunity could contribute to this increase.
  3. Recent Medicaid cuts could affect millions, leading to a loss of coverage for many people. It's important to inform and support those in need as these changes roll out.

Medicaid cuts: The how and why

Your Local Epidemiologist • 1849 implied HN points • 09 Jul 25
🏥 Health Politics Medicaid
  1. Congress has made huge cuts to Medicaid, which provides health insurance to many low-income Americans. These changes could lead to millions losing their coverage and could harm vulnerable communities.
  2. Medicaid cuts involve stricter work requirements and more paperwork, making it harder for people to keep their insurance. Many who already work might still lose coverage due to this added complexity.
  3. The changes will particularly hurt hospitals and nursing homes, especially in rural areas, as they rely heavily on Medicaid funding. This could lead to more uninsured people and even hospital closures.

BIG INSURANCE 2023: Revenues reached $1.39 trillion thanks to taxpayer-funded Medicaid and Medicare Advantage businesses

HEALTH CARE un-covered • 779 implied HN points • 02 Apr 24
🏥 Health Politics Medicaid
  1. Health insurance companies in the U.S. made $1.39 trillion in revenue last year. A lot of this money came from government programs like Medicaid and Medicare Advantage.
  2. The Affordable Care Act (ACA) helped many people get insurance but also allowed insurers to profit tremendously. This has led to higher out-of-pocket costs for consumers and medical debts for many families.
  3. Big insurance companies have grown a lot over the last decade, and their executives are making huge salaries. Reform is needed to control these companies and make healthcare more affordable for everyday people.

UnitedHealth Group, the Biggest Private Health Insurer on the Planet, Made $8.5 Billion in Profits in Q1 2024

HEALTH CARE un-covered • 619 implied HN points • 16 Apr 24
🏥 Health Politics Medicaid
  1. UnitedHealth Group made $8.5 billion in profits in the first quarter of 2024, showing strong financial growth despite recent challenges. Their revenues have tripled over the last decade, indicating a significant increase in business.
  2. A big part of their success comes from government programs like Medicare and Medicaid, where enrollment has jumped in recent years. This growth has helped them dominate the market alongside a few other large competitors.
  3. Despite their financial success, many healthcare providers are struggling due to a cyberattack on a subsidiary. Advocates are concerned that profit-focused practices may lead to patients not receiving necessary care.

A big discovery, Medicaid cuts, states removing fluoride, drug price questions, and more.

Your Local Epidemiologist • 1287 implied HN points • 19 May 25
🏥 Health Politics Medicaid
  1. A recent breakthrough in genetics used new tools to fix a baby's rare disease by editing their DNA. This could lead to treatments for many other genetic disorders.
  2. Florida is removing fluoride from drinking water, which could affect many people's dental health. This decision might inspire other states to follow suit.
  3. Proposed cuts to Medicaid could leave 8.6 million people without health coverage, highlighting the importance of contacting lawmakers about healthcare access.

It's not just Minnesota. Or just daycares. The deepest government honeypot is blue-state Medicaid.

Unreported Truths • 117 implied HN points • 29 Dec 25
🏥 Health Politics Medicaid
  1. Medicaid and other big government health programs have become massive targets for waste, fraud, and abuse, far exceeding smaller examples like daycare fraud. The sheer amount of money makes them especially vulnerable.
  2. New York is an extreme case, now spending roughly $120 billion on Medicaid and far more per person than decades ago. Federal backstops and political incentives have driven much of this growth.
  3. Growing Medicaid spending doesn’t clearly improve patient health and risks unsustainable costs for taxpayers, with absurd billing examples highlighting broken incentives. This dynamic can worsen care quality while expanding taxpayer burdens.

Medicaid fraud and abuse are hitting unthinkable levels

Unreported Truths • 53 implied HN points • 09 Jan 26
🏥 Health Politics Medicaid
  1. Medicaid-funded behavioral autism programs have exploded in cost in some states, creating very high per-child spending and attracting documented fraud schemes.
  2. These programs are easy to abuse because they pay high hourly rates, require minimal training or oversight for providers, and many listed providers aren’t even operational.
  3. Medicaid’s huge size makes fraud hard to detect and prosecute, so waste persists and risks undermining public trust and the justification for costly programs with mixed evidence of benefit.

HHS Open data is here. They will pay you if you find fraud.

Steve Kirsch's newsletter • 8 implied HN points • 15 Feb 26
🏥 Health Politics Medicaid
  1. HHS has released aggregated monthly Medicaid claims data that anyone can download and analyze using tools like Google BigQuery and the Medicaid Data Explorer.
  2. A federal whistleblower program offers up to a 30% bounty for recoveries when people report Medicare/Medicaid fraud through the FinCEN whistleblower portal.
  3. The claims data shows about a fourfold increase in high‑level emergency ambulance transports (A0433) and in EEG code 95812 across many states, suggesting either a real rise in severe emergencies or potential billing anomalies that merit investigation.

[VIDEO] Poor Americans to feel the burn from health insurer Elevence's decision in Medicaid dispute

HEALTH CARE un-covered • 519 implied HN points • 28 Aug 23
🏥 Health Politics Medicaid
  1. Elevance is a health insurer with high denial rates for claims, affecting patients' access to necessary treatments. Many poor Americans are struggling because of this.
  2. In Ohio and Virginia, there's a conflict between Elevance and a major hospital system, leading to unpaid claims amounting to $100 million. This dispute means Medicaid patients may need to find different hospitals for care.
  3. Lawmakers need to step in and address the unfair practices of health insurers like Elevance. This is crucial for protecting low-income Americans who rely on Medicaid services.

Elevance and other for-profit insurers find new scrutiny from lawmakers over their denials of care for Medicaid patients

HEALTH CARE un-covered • 419 implied HN points • 17 Aug 23
🏥 Health Politics Medicaid
  1. Elevance and other for-profit insurers are denying many care requests for Medicaid patients. In fact, Elevance has a denial rate over 34%, which is really high.
  2. Lawmakers are starting to investigate these denial practices more closely. Congress is looking into how insurers use 'prior authorization' to say no to needed treatments.
  3. In Ohio, Elevance is having contract disputes with hospitals, impacting Medicaid patients' access to care. This means patients might struggle to find alternative hospitals that will cover their treatments.

Are Medicare and Medicaid Patients Required to Weigh-In?

Weight and Healthcare • 199 implied HN points • 09 Nov 22
🏥 Health Politics Medicaid
  1. Medicare and Medicaid do not require patients to weigh-in at their appointments, despite common misconceptions.
  2. Physicians are incentivized to discuss weight and create treatment plans for patients with a BMI over 24.9 due to quality score impact on reimbursement.
  3. Patients on Medicare/Medicaid can opt-out of weigh-ins, and providers must exclude them from performance calculations, even though technical challenges may arise.

A CLOSER LOOK: The Mid Year Earnings of 7 Big For-Profit Insurance Companies

HEALTH CARE un-covered • 219 implied HN points • 16 Aug 22
🏥 Health Politics Medicaid
  1. The largest for-profit insurance companies made $43.8 billion in profits and had $620.6 billion in revenue, mostly from taxpayer money. This shows how much they benefit financially from government programs.
  2. Three major insurers control 80% of the pharmacy benefit market. This means they have a huge influence over how prescription medications are managed and priced.
  3. A large number of Americans are underinsured, with 43.4% lacking sufficient coverage. This highlights a growing issue in healthcare, where many people struggle to afford medical care despite having insurance.

Big insurer Anthem took in $38 billion in the first 3 months of 2022. Most of it by far came from taxpayers.

HEALTH CARE un-covered • 199 implied HN points • 28 Apr 22
🏥 Health Politics Medicaid
  1. Anthem's revenue has shifted significantly, with most of its income now coming from taxpayer-funded programs like Medicare and Medicaid rather than private-paying customers.
  2. The employer-based health insurance system is declining rapidly as many employers can no longer afford to provide coverage, affecting the number of private-paying customers.
  3. Despite growing profits largely from private-paying clients, many of Anthem's customers are struggling to afford out-of-pocket costs, leading to increased financial hardships.

UnitedHealth Group has fewer private paying customers than in 2012, but its remaining customers are paying way more in premiums and deductibles

HEALTH CARE un-covered • 79 implied HN points • 18 Oct 22
🏥 Health Politics Medicaid
  1. UnitedHealth Group has fewer private customers than it did ten years ago, but the ones it has are paying significantly more in premiums and deductibles.
  2. The average family plan has become much more expensive, and employees are shouldering more of the costs than they used to.
  3. As insurance companies keep raising prices while offering less coverage, people are essentially paying more for fewer benefits over time.

Anthem, the USA’s second biggest insurer, has had spectacular growth over the past 10 years.

HEALTH CARE un-covered • 0 implied HN points • 23 Jul 21
🏥 Health Politics Medicaid
  1. Anthem, a major health insurer in the USA, has seen huge growth, mainly from government programs like Medicaid and Medicare. This means more taxpayers are funding their rise.
  2. Over the past decade, most new members in Anthem's plans came from government programs instead of private insurance. This shift highlights how the Affordable Care Act helped many people gain health coverage.
  3. Even with rising costs for their customers, Anthem continues to profit well by purchasing its own stocks. This move benefits investors more than it helps the people who need health insurance.