Blog

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.

This is the image text
CMS Approves Two New Medicaid Waivers to Expand Coverage, Provide Flexibilities
Blog October 04, 2022
On September 28, 2022, the Centers for Medicare Medicaid Services (CMS) issued approval letters for Section 1115 Medicaid demonstration applications previously submitted by Oregon and Massachusetts.  Section 1115 waivers allow the Secretary of Health and Human Services to waive certain provisions of the Medicaid law to provide states with additional flexibilities to design and improve their Medicaid programs through experimental, pilot, or demonstration projects…
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…
Georgia Files Suit Against CMS for “Regulatory Bait and Switch” Over its Expansion Population
Blog February 02, 2022
Before jumping into the latest litigation over Medicaid waivers, Medicaid and the Law would like to introduce its readers to Adam Schilt. Adam is a healthcare associate in the Washington, DC office and will be a regular contributor to the blog. In a past role, he's written pieces of legislation that have been enacted into the Medicaid statute and continues to be very passionate about the subject…
Advocates File Suit Over Tennessee Waiver  Dissecting the Complaint
Blog April 23, 2021
On April 22, 2021 the Tennessee Justice Center and the National Health Law Program, representing thirteen (13) aggrieved Medicaid beneficiaries in the state of Tennessee, filed suit in the U.S. District Court for the District of Columbia against the U.S. Department of Health and Human Services (HHS) seeking to block the implementation of the TennCare III modified block grant 1115 waiver approved in the waning days of the Trump Administration…
CMS Begins Internal Purge of Trump-Era Medicaid Policies
Blog February 23, 2021
While CMS has been relatively quiet as of late from a public-facing perspective as it waits for new political leadership to arrive (including newly announced CMS Administrator, Chiquita Brooks-LaSure), a recent review by your Editors at www.MedicandandtheLaw.com of CMS website indicates a fast-paced effort to roll back a number of Trump-era Medicaid policies, particularly around waiver flexibilities. As I recently mentioned…
BREAKING: CMS Withdraws Letter of Agreements to States Establishing Additional Procedures for Waiver Withdrawals
Blog February 13, 2021
This just in as previously discussed, on January 4, 2021 CMS Administrator Seema Verma sent a letter (available here) to State Medicaid Directors requesting they sign a Letter of Agreement “as soon as possible” establishing new procedural rights for any future waiver withdrawals by CMS. Acting CMS Administrator Elizabeth Richter on Friday February 12th sent a letter to states that had signed the Letter of Agreement (including Tennessee) advising them that CMS is now retracting these…
1 of 8

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