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JD Vance is ending the Medicaid gravy train
The Centers for Medicare and Medicaid Services may have just signaled the beginning of the end for one of California’s most aggressive Medicaid financing schemes.
In late May, CMS proposed a rule that would limit many Medicaid payment arrangements to Medicare-equivalent reimbursement levels while targeting the financing mechanisms that shift excessive costs onto federal taxpayers.
The more states spend, the more federal money they receive.
The proposal specifically highlights intergovernmental transfers and similar arrangements that have allowed states to inflate federal reimbursement claims.
This rule comes as California health officials are asking CMS to approve a set of pending state plan amendments that would further expand reimbursement arrangements built around intergovernmental transfers — the very type of financing mechanism now facing increased scrutiny from federal regulators.
For years, states have exploited these loopholes in Medicaid’s financing rules to draw down more money from Washington. CMS now appears ready to put some limits on that practice.
Vice President JD Vance and CMS Administrator Mehmet Oz deserve credit for cracking down on these kinds of abuses. Vance said the administration is withholding $1.3 billion in Medicaid reimbursements from California because the state does “not take Medicaid fraud very seriously.”
Oz warned that states have exploited “the cracks and crevices” between state and federal systems — describing California as a member of the “varsity team” of fraud alongside Massachusetts and New York.
The proposed rule makes the fate of California’s pending SPAs clear: They cannot survive. Approving them would directly contradict a rule CMS has already put forward, expanding the exact reimbursement scheme the agency has identified as a threat to Medicaid program integrity.
The only question now is whether CMS will formalize what its own rulemaking has already decided.
At the center of the IGT problem is Medicaid’s open-ended reimbursement structure. States spend money, and the federal government reimburses a percentage of those expenditures. Public entities recycle funds through multiple agencies to trigger larger federal Medicaid matching payments.
The more states spend, the more federal money they receive.
These arrangements may technically comply with federal rules, but they function as financial engineering schemes rather than legitimate health care financing. Medicaid was designed to fund health care for vulnerable Americans, not maximize revenue for governments and health care bureaucracies.
California’s ambulance reimbursement system provides a textbook example of the kind of payment arrangement CMS now appears determined to rein in.
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Jim Lo Scalzo/EPA/Bloomberg/Getty Images
Under current rules, a public fire district can hold an emergency medical services franchise while subcontracting the actual ambulance operations to a private company.
Even though the private contractor performs the transport itself, the public entity can still bill Medi-Cal at the elevated IGT reimbursement rate — around $1,168 per transport in 2024, with a proposed increase to nearly $1,600.
If that same private ambulance provider billed Medi-Cal directly, that $1,600 would become roughly $339 under the standard fee schedule.
Federal taxpayers are therefore paying nearly five times the normal reimbursement rate for operationally identical services, simply because the billing structure has been routed through a government intermediary eligible for enhanced federal matching funds. For ACA expansion enrollees, a large share of Medi-Cal, Washington covers 90% of that already inflated cost.
The fire district keeps the difference between the inflated Medi-Cal reimbursement and the private contractor’s actual operating payment. Taxpayers finance the excess.
Unlike these existing payment arrangements that may eventually be required to conform to the new federal standards, California’s pending ambulance SPAs have not yet been approved. Federal regulators should not authorize an expansion of a reimbursement model they have already identified as inconsistent with Medicaid’s future direction.
CMS has now made clear that payment arrangements built around inflated reimbursement rates, intergovernmental transfers, and excessive federal matching dollars are no longer business as usual. States have been put on notice.
California’s pending ambulance SPAs should be among the first tests of whether the agency intends to enforce the principles it has now announced. If CMS truly believes Medicaid exists to fund patient care rather than reimbursement gamesmanship, these proposals should not survive review.
Serial rapist immigrant sentenced to nearly 300 years in prison — he found some victims on Muslim dating sites
An immigrant was sentenced to 291 years in prison after being convicted for raping seven women, some of whom he found on Muslim dating websites.
St. Louis County Circuit Judge Ellen Ribaudo sentenced 30-year-old Yahya Maly to spend the rest of his life in the Missouri Department of Corrections.
'I've been here 19 years, and I've never seen a sentence like this.'
Maly expressed no remorse and continued to maintain his innocence while claiming that the case was a setup.
Prosecutors said Maly used the name "John" to lure women to his apartment on Log Trail Drive in Ballwin, where he sexually assaulted them. The crimes began in February 2023 and continued for two years until February 2025 when he was arrested.
The seven women Maly raped testified at trial, and two of them were present at his sentencing.
One of the women said she was raped by Maly after he forced her into his apartment, and then later she returned to his apartment, where he raped her again, according to prosecutors.
Another woman told prosecutors he forced her into numerous sexual acts while he kept her at his apartment for seven hours.
One woman who was Muslim testified that he took her hijab without her consent and claimed she was his wife in order to rape her. He told her she needed to perform her "wifely duties" or risk going to hell.
"I was confused," she testified. "This felt like the weirdest misunderstanding ever."
She claims that she was raped by Maly twice and decided to return a third time in order to kill him. He raped her a third time.
"Life felt like it was already over," she said.
A jury recommended 319 years in prison for Maly, but the judge decided on a slightly shorter sentence.
"I've been here 19 years, and I've never seen a sentence like this," St. Louis County Prosecuting Attorney Melissa Price Smith said after Maly was sentenced.
Maly is an immigrant from Finland and became a naturalized U.S. citizen. He was studying at the Logan Chiropractic College when he was arrested.
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"I was actually thinking about not coming into it because of just putting my energy out there. Then I knew I had to be brave enough and then come out and actually be able to have this closure within this as well. So, it was very important for me," said one victim, who wished to remain anonymous.
"These women are no longer victims of Yahya Maly or anyone," Price Smith continued. "Justice has been served, and I am so proud of these amazing women."
An attorney for the convicted rapist released a brief statement.
"Mr. Maly maintains a firm belief in his innocence and intends to appeal his conviction," he said in part.
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Iranian soccer club in Los Angeles reflects divided views on Team Melli during World Cup
Australia to Begin Mass Aerial Slaughter of Wild Horses from Helicopter Gunships
A mass shooting of thousands of wild horses from helicopter gunships in the Snowy Mountains of Australia is set to start this week as protesters cry for an end to the practice that delivers death from above in a bid to protect "indigenous plants."
The post Australia to Begin Mass Aerial Slaughter of Wild Horses from Helicopter Gunships appeared first on Breitbart.
Hungarian Parliament Approves Constitutional Amendment to Ban Orban From Returning to Power
The Hungarian parliament approved a constitutional amendment this week that is set to prevent former leader Viktor Orbán from standing again for prime minister.
The post Hungarian Parliament Approves Constitutional Amendment to Ban Orbán From Returning to Power appeared first on Breitbart.
Spanish Far-left MEP Irene Montero Sings ‘Happy Birthday Mr. Genocide’ to Trump at E.U. Parliament
Spanish far-left MEP Irene Montero of the Podemos Party on Tuesday protested against President Donald Trump at the European Parliament by singing a modified version of the "Happy Birthday" song, calling him "Mister Genocide."
The post Spanish Far-left MEP Irene Montero Sings ‘Happy Birthday Mr. Genocide’ to Trump at E.U. Parliament appeared first on Breitbart.
5 chilling details from the alleged White House attack plot tied to UFC event
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‘Epic levels of terminal TDS’: The most American event ever just BROKE ‘The View’ co-hosts’ brains
As expected, President Trump’s White House UFC celebration sent liberals into meltdown mode, with the women of “The View” hysterically calling the event a “desecration” of the White House.
“We are talking terminal cases of Trump derangement syndrome all across the country with the libs,” BlazeTV host Sara Gonzales says before playing a clip of the angry hosts.
“I don’t know how MMA or cage fighting is emblematic of our country,” Sunny Hostin said to the rest of the panel. “I just don’t understand how that sort of reflects American culture.”
“This doesn’t feel like a sport. This feels like you’re trying to show us who we’re supposed to be,” Whoopi Goldberg chimed in, before Ana Navarro added that it was evidence of the "continued desecration of the White House.”
“They’re concerned about the desecration of the White House because they believe that the White House should be respected, is what I’m hearing,” Gonzales says, pointing out that under the Biden administration, they had no issues with Biden essentially turning the White House into a Pride flag.
“You guys are prancing trannies around on the White House lawn. You want to talk about desecrating the White House? Give me a break,” she continues. “How about Joe Biden desecrating Easter Sunday, calling it Trans Visibility Day and hosting the event at the White House?”
Gonzales illustrates her point with a clip of a transgender woman on the White House lawn, pulling down his shirt to flash his fake breasts to the camera.
“That’s what happened on the White House lawn under Joe Biden’s tenure,” she says. “I’m not going to be lectured by these people. I’m not going to listen to these people claim that they care about desecration of the White House because it’s just such an esteemed place.”
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