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Medicaid & the Law

Legal, regulatory and strategic advice regarding America's largest health insurance payer, and one of the most complicated and least understood areas of healthcare law.

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Oregon's New Waiver Request to Exclude Accelerated Approval Drugs from Medicaid Coverage
Blog March 01, 2022
Hello readers! Today's post focuses on a topic we've touched on a few times in the past – Medicaid drug formularies. Back in December 2021, the state of Oregon released a draft Medicaid waiver proposal that caught the attention of many stakeholders. In the draft proposal, Oregon stated that it was considering asking CMS for approval to a) adopt a commercial-style closed drug formulary and b) exclude from Medicaid coverage certain drugs approved via the accelerated approval pathway “with…
CMS Releases the New Medicaid Managed Care Final Rule
Blog November 13, 2020
On November 9, 2020, the Centers for Medicare and Medicaid Services (CMS) announced it finalized the Medicaid and Children's Health Insurance Program (CHIP) Managed Care final rule (“2020 final rule”). According to CMS, the 2020 final rule advances CMS's efforts to streamline the Medicaid and CHIP managed care regulatory framework and “reflects a broader strategy to relieve regulatory burdens; support state flexibility and local leadership; and promote transparency, flexibility, and…
Latest HHS Financial Report Highlights Medicaid Eligibility Errors  and Foreshadows Future Actions
Blog November 25, 2019
On November 19, 2019, CMS announced key results from the 2019 HHS Agency Financial Report, which generally provides fiscal and high-level performance data for HHS for the reporting period of October 1, 2018 through September 30, 2019. While CMS leads off its press release with the good news payment error rates in the Medicare fee-for-service program are at their lowest level since FY 2010…
Tennessee Announces First-in-Nation Block Grant Proposal
Blog September 20, 2019
On September 17, 2019, Tennessee released its proposal to block grant most of the funding the states Medicaid program (TennCare) receives from the Federal government. If approved by CMS, the amendment to the states longstanding 1115 waiver program would make Tennessee the first state in the nation to move to a true block grant format for Medicaid funding. A draft of the proposed waiver is available on the states website…
CMS Clarifies Spread Pricing Reporting Requirements for Medicaid MCOs
Blog June 05, 2019
We have talked previously on this blog about ongoing efforts by the Administration to reform drug pricing, including efforts to dramatically revamp the way in which health plans and their PBMs (including Medicaid MCOs) negotiate drug discounts. At the state level, PBMs have been under fire in recent years, with several State Medicaid agencies alleging a lack of transparency in contracts with the states…
HHS Prescription Drug Rebate Rule Has Medicaid Implications
Blog February 04, 2019
On January 31, 2019 the HHS Office of Inspector General (OIIG) issued a proposed rule that will be published in the Federal Register on February 6.  The proposed rule has the potential to fundamentally re-structure the prescription drug marketplace in the United States by dramatically altering the economics of pharmaceutical pricing.  Although much of the attention surrounding the rule has been focused on its effect on the Medicare Part D prescription drug program…
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Blog Editors

About Our Blog

Foley Hoag has a unique team of healthcare lawyers and specialists with decades of experience in statutory and regulatory analysis, compliance, government investigations, litigation and corporate transactions. Most of our lawyers and healthcare policy specialists have had a direct hand in shaping virtually every healthcare law and regulation enacted over the past four decades, including:

  • The Patient Protection and Affordable Care Act of 2010
  • The Medicare Modernization Act of 2003
  • The Food and Drug Administration Modernization Act of 1997
  • The Balanced Budget Act of 1997
  • The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
  • Budget reconciliation laws of the 1980s

Medicaid is also, by far, the largest health insurance payer in the United States and has even surpassed Medicare in terms of the number of enrollees. Medicaid is a crucial component in America’s health care system.


Our focus includes:

  • Medicaid coverage and reimbursement issues for innovative pharmaceutical products
  • Legal, regulatory and strategic advice for Medicaid mental health providers and payers
  • Medicaid waivers
  • State coverage of the Medicaid expansion population
  • State-specific Medicaid issues
  • Medicaid financing
  • Medicaid and long-term care

Blog Editors