Early modeling put sickle cell gene therapy coverage near 11 cents per member per month.
Feature|Articles|July 14, 2026
Medicaid Fraud Crackdown Intensifies, But Is It Solving the Right Problem?
Author(s)Pearl Steinzor
Fact checked by: Maggie L. Shaw
CMS's enforcement surge has put every Medicaid Fraud Control Unit under review, but experts say the bigger driver of coverage loss may be red tape.
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In January 2026, Minnesota received a letter from CMS announcing it would begin withholding $515 million in quarterly federal Medicaid payments, citing unresolved program integrity concerns.1 The state sued. A federal court dismissed the case on procedural grounds in April, and even after CMS accepted Minnesota's corrective action plan the following month, the withheld funds were not released.2 By May, CMS had gone further still, deferring $1.3 billion in federal Medicaid funding to the state—the largest deferral action in the agency's history.3
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Cost and access, not side effects, drive GLP-1 discontinuation, and obesity should be covered like diabetes, says Fatima Cody Stanford, MD.
At AMCP Nexus 2026, payers said evidence, differentiation, and delivery now matter as much as FDA approval.
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