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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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How Pfizers Warranty Program Gets Around Best Price?
Blog October 14, 2021
On October 13th our friends over at STAT  broke the news [sorry, Paywall] about a warranty pilot program from Pfizer that offers both patients and health plans (including Medicare Part D plans) the opportunity to receive a refund for any amounts paid to purchase the companys longstanding oral lung cancer therapy XALKORI when use is discontinued in the first three months for clinical reasons…
Paying for Value in Medicaid Prescription Drug Coverage
Blog July 05, 2020
My colleague Ross Margulies has already told our readers about a provision of the new proposed Medicaid regulation governing how the program pays for outpatient prescription drugs under the Medicaid Drug Rebate Program, or MDRP.  Today, we turn our attention to another provision of that proposed rule, and that is CMS's attempts to permit pharmaceutical manufacturers, states, and commercial payers to enter into value based payment arrangements for covered outpatient drugs…
CMS Issues Long-Awaited Decisions on MassHealth Prescription Drug Request
Blog June 27, 2018
It was a busy day for CMS today. After keeping everyone in suspense for months, CMS finally issued its decision on the Massachusetts state Medicaid program waiver request that proposed to limit access to covered outpatient drugs to Medicaid (in Massachusetts, called “MassHealth”) enrollees.  As many observers predicted, CMS did not approve the state's request.  Notably, however, the CMS response letter provided a pathway for Massachusetts to achieve a substantially similar result…
MassHealth Leads The Way Towards Addressing Cell and Gene Therapy Reimbursement
Blog February 03, 2018
Since August, 2017, a new class of transformative therapies referred to as cell therapies or gene therapies have been approved by the US Food and Drug Administration (FDA).  These new cell and gene therapies are typically administered once, as opposed to repeatedly over the course of the patient's lifetime. Payers, providers, and manufacturers have been considering how existing payment systems – particularly Medicare and Medicaid – can recognize the value of these new treatments…
Medicaid Directors: Trump Administration Should Formally Include States in Development of Medicaid Regulations
Blog January 09, 2017
Over the course of the last several blog posts, we've discussed how the Medicaid program could potentially be transformed under the incoming Trump Administration.  We also described the central role that state-led demonstration waivers would play in defining the parameters of this transformation.  Now, the association for State Medicaid directors is weighing in on precisely this issue…
CMS Announces new Medicare-Medicaid ACO Model
Blog December 31, 2016
Currently, nearly 10 million Americans are dually-eligible for both Medicare and Medicaid. These dual eligibles are low-income seniors and individuals with disabilities who are separately eligible for and receive coverage under both the Medicare and Medicaid programs.  In general, Medicare acts as the primary payer for dual-eligibles, while Medicaid provides wrap-around coverage for these individuals, helping with some out-of-pocket costs (such as premiums, copayments and deductibles) and…

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