CMS is expected to issue guidance addressing key implementation questions for the medical frailty exemption from Medicaid work requirements. States are currently developing operational plans but face uncertainty about eligibility criteria, documentation requirements, and assessment processes. The guidance will likely clarify how states should identify and exempt medically frail beneficiaries from work requirements. This affects managed care organizations that may need to modify enrollment processes, develop screening tools, and adjust member engagement strategies based on final CMS standards.
Managed Care
CMS released a notice seeking comment on the 2028 Home and Community-Based Services Quality Measure Set, proposing mandatory and voluntary quality measures for state Medicaid HCBS programs. The proposal includes new requirements for states to report stratified data by rural/urban status and other factors, along with specific reporting schedules and calculation methodologies. States and managed care organizations operating HCBS programs must review which measures become mandatory, what populations require reporting, and how stratification requirements affect current data collection systems. Comments are due on the proposed measure set, data collection methods, stratification factors, and reporting timelines.
LTSS · Managed Care
The Medicaid and CHIP Payment and Access Commission released its March 2026 report to Congress recommending increased wage transparency for home- and community-based services workers. The report also examines behavioral health service delivery in Medicaid and CHIP. MACPAC's recommendations typically inform future CMS policy direction and congressional action on Medicaid financing and program design. Managed care organizations with HCBS and behavioral health contracts should review the full report for potential regulatory or contractual implications.
LTSS · Behavioral Health · Managed Care
CMS has announced a 6-month nationwide moratorium on enrollment of new hospice providers in Medicare, Medicaid, and CHIP. The temporary suspension prevents new hospice agencies from enrolling or re-enrolling during the moratorium period. Existing hospice providers can continue operations and current Medicaid managed care networks are unaffected. The action reflects CMS efforts to address fraud, waste, and abuse in hospice services, which may impact managed care organizations' ability to contract with new hospice providers during this period.
LTSS · Managed Care
The Medicaid and CHIP Payment and Access Commission announced its analytic agenda for the 2025-2026 meeting cycle, focusing on enrollment and eligibility issues and community engagement requirements. MACPAC's research and recommendations influence congressional appropriations and CMS policy development. The agenda signals potential legislative activity in these areas, particularly relevant for managed care organizations navigating state contract requirements and federal compliance expectations. Plans should monitor MACPAC proceedings for early signals on regulatory direction.
Managed Care · CHIP
CMS has released its quarterly compilation of manual instructions, regulations, and Federal Register notices published from January through March 2026 affecting Medicare, Medicaid, and other CMS-administered programs. This index provides a consolidated reference for all policy guidance issued during the quarter, helping managed care organizations and state agencies track regulatory changes across multiple program areas. The listing includes substantive and interpretive regulations that may affect MCO operations, compliance requirements, and state plan administration. Compliance officers should review the index to identify any guidance affecting their contracts or service areas that may have been issued during the first quarter.
Managed Care
The Centers for Medicare & Medicaid Services is requesting public comment on information collection activities under its generic Paperwork Reduction Act clearance process (control number 0938-1148). The umbrella approval, last renewed in April 2021, covers voluntary, low-burden data collection related to Medicaid and CHIP state plan amendments, waivers, demonstrations, and reporting. CMS is inviting stakeholders to comment on burden estimates, necessity of proposed collections, and opportunities to reduce administrative requirements. Comments are particularly relevant for states and managed care organizations that submit routine program updates and compliance documentation to CMS.
Managed Care · CHIP
CMS has announced a 6-month nationwide moratorium on the enrollment of new home health agencies in the Medicare program. The moratorium applies to HHA enrollment applications and prevents new agencies from billing Medicare during the suspension period. This action follows established regulatory authority to impose temporary enrollment moratoria when fraud, waste, or abuse concerns exist. The moratorium affects providers seeking Medicare participation but does not directly impact Medicaid managed care plans, though dual-eligible care coordination and LTSS network adequacy planning may be indirectly affected in markets with limited HHA capacity.
LTSS
CMS is reopening the comment period for 12 days on a previously published information collection notice after discovering an error in posting the S89 citizenship and noncitizen eligibility template under Medicaid State Plan Eligibility. The original notice published April 22, 2026, with a 14-day comment period. This affects state Medicaid agencies and managed care organizations that rely on these standardized templates for eligibility determinations and enrollment processes. The reopening provides stakeholders additional time to review the corrected template and submit comments on its operational impact.
Managed Care
The Medicaid and CHIP Payment and Access Commission issued an RFI seeking vendors with experience securely managing and analyzing administrative data for government clients. MACPAC is looking for firms that can handle federal and state Medicaid data sources. This procurement signals MACPAC's ongoing work to strengthen its analytic capacity for monitoring Medicaid program performance, access, and payment policy—work that often informs Congressional deliberations and CMS policy development affecting managed care organizations.
Managed Care · Finance
The Medicaid and CHIP Payment and Access Commission released its June 2025 Report to Congress with recommendations to improve care transitions from pediatric to adult providers for Medicaid-covered children and youth with special health care needs. The report addresses a longstanding gap in continuity of care that often results in disrupted treatment and emergency department utilization when beneficiaries age out of pediatric services. Managed care plans should review their pediatric-to-adult transition protocols and network adequacy standards, as Congress may direct CMS to implement new transition requirements following MACPAC's advisory guidance.
Managed Care · CHIP · Maternal
KFF has released a new tracker documenting federal policy actions during President Trump's second term affecting mental health and substance use services. The tracker shows the administration emphasizing law-and-order approaches while scaling back certain mental health and substance use services, though some treatment-focused initiatives continue. The tool organizes policies chronologically and by category including mental health, opioids/SUD, federal infrastructure, and gun violence. This matters for Medicaid MCOs as federal policy changes in behavioral health directly impact covered services, reimbursement structures, and compliance requirements for mental health and substance use disorder benefits.
Behavioral Health · Managed Care
The National Academy for State Health Policy (NASHP) is hosting a collaborative learning session on rural payment and delivery reform for state officials on Thursday, May 21 from 2-3 p.m. ET. The session will focus on innovative payment models and delivery strategies for rural healthcare providers. State Medicaid directors and managed care organizations operating in rural markets may gain insights into emerging payment reform approaches and delivery innovations that could inform future contract negotiations and provider network strategies.
Managed Care · Finance
The Centers for Medicare & Medicaid Services has announced the inaugural meeting of the Healthcare Advisory Committee (HAC) scheduled for May 18, 2026. The Committee will advise the HHS Secretary and CMS Administrator on healthcare system improvements pursuant to an Executive Order establishing the President's Make American Healthy Again Commission. The virtual meeting is open to the public. While the Committee's scope appears broad, its recommendations could influence future Medicaid managed care policy directions including quality measures, value-based payment models, and program integrity standards.
Managed Care
Advocacy groups are urging Congress to include statutory restrictions in fiscal year 2027 appropriations bills to prevent executive branch holds on federal Medicaid funding. The push responds to administration actions that have delayed or withheld appropriated funds across federal agencies. For Medicaid managed care organizations, appropriations language could affect the timing and certainty of federal matching payments to states, potentially impacting capitation payment schedules and state budget cycles. Any restrictions would take effect with the FY 2027 appropriations process beginning in fall 2026.
Managed Care · Finance
CMS issued final 2027 benefit and payment parameters for federally-facilitated exchanges, modifying risk adjustment methodology, HHS-RADV processes, and user fee rates for QHP issuers. The rule codifies expanded hardship exemption eligibility, establishes new provider access and essential community provider standards for QHP certification, prohibits routine non-pediatric dental services as essential health benefits, and allows catastrophic plans with up to 10-year terms. Changes take effect for plan year 2027. While focused on individual and small group exchange markets, provisions affecting network adequacy standards, civil money penalties, and broker oversight may inform state Medicaid managed care oversight frameworks.
Managed Care · Dental
Nationwide SNAP enrollment declined by 3.5 million people (9 percent) between July 2025 and February 2026 following enactment of Republican legislation restricting food assistance eligibility. The enrollment drop affects Medicaid managed care organizations that serve dual-eligible populations and coordinate care for members who rely on both health coverage and nutrition assistance. MCOs should monitor member churn, assess social determinants of health screening protocols, and prepare for increased emergency department utilization among food-insecure enrollees.
Managed Care
Increased immigration enforcement operations are creating emergency custody situations that could disrupt Medicaid coverage for children whose parents are detained. Several states are enacting protective measures for these children, but guardianship complications may affect enrollment continuity. Child welfare agencies and MCOs must coordinate to maintain coverage during family separations. This impacts Medicaid managed care plans serving populations with mixed immigration status families.
Managed Care · CHIP
The Government Accountability Office found that VA has implemented 9 of 13 cybersecurity recommendations made in September 2025 to protect veterans' health information in the Million Veteran Program system. While VA's business associate agreements with external entities fully comply with HIPAA Privacy Rule requirements, GAO identified deficiencies in asset management, configuration management, and access controls that reduced assurance of data confidentiality. The improvements are significant given that MVP contains sensitive health data for approximately 1 million veterans in the nation's largest veteran biorepository. GAO continues monitoring VA's progress on the remaining four recommendations.
Managed Care
The Centers for Medicare & Medicaid Services has published a Federal Register notice announcing a proposed information collection activity under the Paperwork Reduction Act of 1995. The agency is soliciting public comments on burden estimates, necessity and utility of the proposed collection, accuracy of burden estimates, and ways to enhance data quality or reduce reporting burden through automation. Comments are due 60 days from publication. This matters for MCOs because information collection requirements often translate to new reporting obligations, quality measure submissions, or encounter data specifications that affect plan operations and compliance costs.
Managed Care
CMS announced a Federal Register notice seeking public comment on a proposed information collection under the Paperwork Reduction Act. The agency is soliciting feedback on burden estimates, necessity of the collection, and ways to streamline reporting requirements. Comments are due 60 days from publication. This notice matters to Medicaid managed care organizations because PRA collections often involve reporting requirements for health plans, including quality measures, encounter data, or network adequacy documentation that affect operational compliance costs.
Managed Care
The Centers for Medicare & Medicaid Services is soliciting public comment on a proposed information collection under the Paperwork Reduction Act. The 60-day comment period allows stakeholders to weigh in on burden estimates, necessity of the collection, and potential use of automation to reduce reporting burden. CMS has not specified which programs or reporting requirements are affected in this notice. Managed care organizations should monitor the Federal Register for details on whether MCO reporting, quality measures, or network adequacy documentation are subject to this collection.
Managed Care
The Centers for Medicare & Medicaid Services is soliciting public comments on proposed information collection activities under the Paperwork Reduction Act. This notice provides a second opportunity for stakeholders to comment on reporting burden estimates, data collection utility, and potential automation of collection processes. Comments are being accepted for submission to the Office of Management and Budget. Managed care organizations should review whether any proposed collections affect their existing reporting obligations or create new compliance requirements.
Managed Care
CMS has published a Federal Register notice announcing a second public comment opportunity for proposed information collection activities under the Paperwork Reduction Act of 1995. The notice invites stakeholders to comment on burden estimates, necessity and utility of the proposed collections, and ways to reduce reporting requirements through automation or other means. Comments must be submitted to OMB during the specified comment period. This routine procedural notice affects Medicaid managed care organizations only if the specific information collection relates to MCO reporting, quality measurement, or compliance documentation.
Managed Care
The Centers for Medicare & Medicaid Services has published a Federal Register notice announcing a proposed information collection activity under the Paperwork Reduction Act of 1995. The agency is seeking public comment on burden estimates, necessity and utility of the collection, and ways to enhance data quality or reduce reporting burden through technology. The 60-day comment period is now open. This procedural notice affects any entities subject to CMS reporting requirements, though the specific collection instrument and affected programs are not identified in this excerpt.
Managed Care
CMS announced a Federal Register notice seeking public comment on proposed information collection activities under the Paperwork Reduction Act of 1995. The notice covers proposed extensions or reinstatements of existing data collection requirements and invites feedback on burden estimates, necessity of the collections, and ways to reduce reporting burden through automation or other means. Comments are being solicited during the OMB review period. This is a routine procedural notice that may affect MCO reporting requirements if specific collections relate to managed care data submissions.
Managed Care
The Centers for Medicare & Medicaid Services has published a Federal Register notice announcing a proposed information collection activity under the Paperwork Reduction Act of 1995. CMS is seeking public comment on burden estimates, necessity and utility of the data collection, and methods to minimize reporting burden. The 60-day comment period is now open for stakeholders to submit feedback on the proposed collection, extension, or reinstatement. Managed care organizations should review the specific collection requirements to assess potential reporting obligations.
Managed Care
CMS is seeking public comment on proposed information collection activities under the Paperwork Reduction Act of 1995. The notice provides stakeholders an opportunity to comment on burden estimates, necessity of data collection, and potential ways to streamline reporting requirements. Comments may address accuracy of estimated burden, methods to enhance data quality, and use of automated collection techniques. This affects any entities required to submit data to CMS, including managed care organizations subject to reporting requirements.
Managed Care
The Trump Administration has issued multiple executive orders reshaping federal operations, with several facing legal challenges for alleged statutory violations. Actions include workforce reductions and changes to federal service delivery. Medicaid managed care organizations should monitor ongoing litigation and potential operational impacts to programs relying on federal oversight, technical assistance, or partner agencies. Legal outcomes will determine which policy changes remain in effect.
Managed Care
CMS issued a correction notice for technical and typographical errors in the FY 2027 Hospital Inpatient Prospective Payment System proposed rule published April 14, 2026. The correction addresses errors in the original proposed rule covering Medicare payment rates for acute care hospitals and long-term care hospitals, along with quality program requirements. Stakeholders reviewing the proposed rule for comment should incorporate these corrections when preparing submissions. While this is a Medicare-focused rule, Medicaid managed care organizations with dual-eligible populations or Medicare Advantage Special Needs Plans should monitor for cross-program policy implications affecting hospital contracting and quality metrics.
Managed Care
CMS announced a public meeting of the Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests for September 15-16, 2026. The panel will review and recommend payment methodologies (crosswalking or gapfilling) for laboratory tests that lacked applicable pricing data during the May-July 2026 reporting period under the Clinical Laboratory Fee Schedule. Public stakeholders may present payment recommendations and supporting data before the panel advises CMS on Medicare reimbursement rates. While this concerns Medicare fee-for-service laboratory payments, Medicaid managed care organizations should monitor these rate-setting discussions as Medicare pricing often serves as a benchmark for Medicaid supplemental payments and influences lab contract negotiations.
Managed Care · Finance