States are implementing eligibility changes mandated by H.R. 1, including work requirements, immigration-related restrictions on federal Medicaid funding, elimination of retroactive coverage, and transition to six-month renewals for certain populations. The resource provides key implementation dates as states adopt these coverage restrictions. These changes will result in disenrollment for beneficiaries who do not meet work requirements or fall under new immigration-related funding restrictions. Managed care organizations must prepare for member turnover, adjust enrollment forecasting, and modify care management workflows to account for shortened coverage periods and new eligibility criteria.
Why it matters for managed care
MCOs face significant enrollment volatility, revenue impact from member loss, and operational changes to accommodate new eligibility verification, six-month renewals, and the elimination of retroactive coverage.
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.
States with approved Section 1115 work requirement waivers are developing processes to identify and exempt medically frail beneficiaries from compliance, but face operational questions about eligibility criteria, screening tools, and documentation requirements. CMS is expected to issue guidance addressing these implementation challenges. Early state approaches vary widely in how they define medical frailty beyond the statutory ACA definition, who conducts assessments, and how exemptions are renewed. The guidance will affect MCO responsibilities for identifying exempt members and coordinating with state eligibility systems.
Why it matters for managed care
MCOs operating in work requirement states need clear federal standards for medical frailty screenings, assessment protocols, and member notification obligations to avoid coverage disruptions for vulnerable enrollees.
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.
CMS published a notice with comment period proposing the 2028 Home and Community-Based Services Quality Measure Set, which establishes nationally standardized quality measures for Medicaid-funded HCBS programs. The proposal includes mandatory and voluntary measures, specifies data collection and reporting requirements, and requires stratified reporting by factors including rural/urban status for certain measures. CMS seeks comment on which measures should be mandatory versus voluntary, how states should collect and calculate measure data, which populations should be included in reporting, and the proposed reporting schedule. The measure set aims to enable cross-state quality comparisons and drive improvement in HCBS care and outcomes.
Why it matters for managed care
Managed care organizations operating HCBS programs will face new quality reporting obligations and performance benchmarking as states implement these federal measures, affecting care management infrastructure, data systems, and contract performance requirements.
CMS published a proposed rule on May 22, 2026, that would impose payment limits on additional state directed payments in Medicaid managed care and establish caps on targeted fee-for-service reimbursement rates. The rule draws authority from section 71116 of H.R. 1 (the "One Big Beautiful Bill Act") and presidential directive. States and managed care organizations would face new constraints on supplemental payment arrangements that exceed baseline rate structures. The proposal represents a significant shift in federal oversight of state payment flexibility in both managed care and FFS delivery systems.
Why it matters for managed care
Payment caps on state directed payments would directly limit MCOs' ability to receive supplemental payments from states for network providers, potentially affecting provider contracting, network adequacy, and the financial viability of SDP-dependent arrangements.
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.
macpac.gov →LTSS · Behavioral Health · 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 in Medicaid and other program issues. MACPAC's recommendations are advisory to Congress and do not carry immediate regulatory force, though they often influence future legislative and CMS policy direction. The wage transparency recommendation responds to ongoing HCBS workforce shortages that affect MCO network adequacy and long-term services delivery.
Why it matters for managed care
Future CMS guidance or statutory changes requiring HCBS wage reporting could affect MCO rate submissions, network adequacy standards, and pass-through payment requirements in states with managed long-term services and supports programs.
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.
CMS has announced a 6-month nationwide moratorium on new hospice provider enrollment in Medicare, effective immediately. The moratorium applies to all new hospice provider enrollment applications and prevents new hospice providers from entering the Medicare program during this period. The action is taken under CMS authority to impose temporary moratoria when necessary to prevent or combat fraud, waste, or abuse. Medicaid managed care organizations with Medicare-Medicaid dual eligible members may see impacts to hospice network capacity and coordination of care for enrollees requiring end-of-life services.
Why it matters for managed care
Medicaid MCOs serving dual eligible populations must coordinate hospice benefits with Medicare and may face network adequacy challenges if existing hospice providers cannot meet demand during the enrollment freeze.
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.
The Medicaid and CHIP Payment and Access Commission has published its analytic agenda for the 2025-2026 meeting cycle. The agenda includes work on enrollment and eligibility issues, community engagement requirements, and other Medicaid policy areas that will inform congressional recommendations. MACPAC's upcoming meetings will examine these topics through data analysis and stakeholder input. The Commission's findings typically influence federal Medicaid policy development and congressional action.
Why it matters for managed care
MACPAC recommendations often shape federal Medicaid policy and CMS guidance that directly affect managed care operations, network adequacy requirements, and state contract terms.
The Medicaid and CHIP Payment and Access Commission released its latest MACStats: Medicaid and CHIP Data Book showing national and state-level enrollment data. The data confirm Medicaid and CHIP enrollment declined for the second consecutive year following the end of the COVID-19 continuous coverage provision. The data book provides comprehensive national and state-specific metrics on enrollment, spending, benefits, and program operations. This resource tracks the ongoing impact of Medicaid unwinding and disenrollment trends affecting managed care plan membership.
Why it matters for managed care
Enrollment declines directly affect MCO capitation revenue, provider networks, and medical loss ratio calculations as member populations shift.
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.
CMS released its quarterly compilation of manual instructions, regulations, and Federal Register notices published between January and March 2026 affecting Medicare, Medicaid, and other CMS-administered programs. This reference document consolidates all policy guidance, regulatory updates, and program instructions issued during the quarter in a single indexed listing. The compilation serves as an administrative record of policy activity but does not introduce new requirements. Managed care organizations should review the listing to identify any Q1 issuances affecting their contracts, compliance obligations, or operational requirements that may have been issued outside of major rulemaking.
Why it matters for managed care
This quarterly index helps MCOs systematically track the full scope of CMS policy activity, including technical guidance and manual updates that may not receive standalone attention but still create compliance obligations.
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.
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.
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.
CMS is reopening the comment period for 12 days on its Medicaid and CHIP Generic Information Collection Activities notice, originally published April 22, 2026. The reopening addresses an inadvertent issue with posting the revised S89 template for Citizenship and Noncitizen Eligibility under Medicaid State Plan Eligibility. The original notice provided a 14-day comment period, and CMS is adding 12 days to account for the period when the template was incorrectly posted. This affects states and managed care organizations that rely on standardized eligibility templates for enrollment and compliance documentation.
Why it matters for managed care
MCOs processing eligibility and enrollment must track federal template changes that affect citizenship verification workflows and state plan amendment requirements.
CMS has announced a 6-month nationwide moratorium on the enrollment of new home health agencies in Medicare. The moratorium applies to Medicare enrollment only and does not directly affect existing Medicaid managed care network contracts with currently enrolled HHAs. The action is typically taken to address fraud and abuse concerns in the home health sector. Medicaid MCOs should monitor whether states implement parallel enrollment restrictions and assess potential network adequacy implications if the moratorium affects HHA availability in their service areas.
Why it matters for managed care
The Medicare enrollment freeze may reduce HHA capacity in markets where Medicaid MCOs rely on Medicare-certified agencies for LTSS and home health services, potentially affecting network adequacy and care coordination for dual-eligible members.
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.
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.
The Medicaid and CHIP Payment and Access Commission released its June 2025 Report to Congress with recommendations aimed at improving care transitions from pediatric to adult services for Medicaid-covered children and youth with special health care needs. The report addresses a longstanding gap in continuity of care that affects beneficiaries aging out of pediatric systems. MACPAC's recommendations are advisory and require Congressional action to implement. The proposals target improved coordination and care continuity for a vulnerable population that often experiences disruptions when moving from child-focused to adult-oriented providers and services.
Why it matters for managed care
Managed care organizations serving children with complex needs should review MACPAC's recommendations as potential future policy changes that could require enhanced care coordination protocols, network adequacy adjustments, and transition-of-care programs for adolescents aging into adult coverage.
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.
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.
KFF has released a tracker documenting federal policy actions on mental health and substance use during President Trump's second term. The tracker shows the administration has emphasized law enforcement approaches while scaling back certain mental health and substance use services, though some treatment-focused initiatives continue. The tool organizes actions chronologically and by category: Mental Health, Opioids/Substance Use Disorder, Federal Infrastructure/Data/Guidance, and Gun Violence. Medicaid managed care organizations can use this resource to monitor federal policy shifts affecting behavioral health services, which represent a significant portion of MCO spending and member needs.
Why it matters for managed care
Medicaid MCOs need to track federal behavioral health policy changes because they directly affect coverage requirements, reimbursement structures, and member access to mental health and substance use disorder treatment services.
The Medicaid and CHIP Payment and Access Commission has issued a request for proposals for an Indefinite Delivery Indefinite Quantity task order contract to perform computing and data analysis services using the Transformed Medicaid Statistical Information System and other datasets. The RFP is available on sam.gov. MACPAC uses T-MSIS data to analyze Medicaid program performance, utilization patterns, and payment policy across states. Contract awards will support the Commission's ongoing research and policy recommendations to Congress.
Why it matters for managed care
MACPAC's T-MSIS analyses directly inform federal Medicaid policy recommendations that shape managed care rate-setting methodologies, benefit design requirements, and quality measurement standards.
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.
The Centers for Medicare & Medicaid Services 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 consistent with a presidential executive order. The virtual meeting is open to the public. This represents a new federal advisory structure that may influence future Medicaid policy direction and program reforms.
Why it matters for managed care
A new federal advisory committee reporting directly to the CMS Administrator could shape future Medicaid managed care policy priorities, regulatory frameworks, and program requirements affecting MCO operations.
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.
A policy analysis calls for Congress to include government-wide funding guardrails in 2027 appropriations bills in response to recent Trump Administration actions affecting federal funding. The piece does not specify Medicaid-related impacts or timing for appropriations deliberations. It advocates for legislative constraints on executive branch funding authority but does not detail how these would apply to Medicaid managed care or Section 1115 waivers. The relevance to Medicaid managed care operations depends on whether future appropriations language would affect CMS authority over capitation rates, waiver funding, or state plan amendments.
Why it matters for managed care
Appropriations riders or funding restrictions could affect CMS flexibility to approve Medicaid waivers, approve state plan amendments, or adjust managed care payment methodologies.
A House bill would make it easier for the executive branch to block federal funding for programs including Medicaid and CHIP. The legislation comes amid Trump Administration actions that have restricted access to basic needs programs. The proposal would affect payment flows to states and managed care organizations for programs serving low-income populations. The measure threatens funding stability for programs that help people afford essentials including health care, food assistance, and other basic needs.
Why it matters for managed care
The bill could introduce new uncertainty into Medicaid and CHIP payment streams to states and managed care organizations, potentially disrupting capitation payments and program operations.
The Medicaid and CHIP Payment and Access Commission (MACPAC) has awarded a 10-year Indefinite Delivery Indefinite Quantity (IDIQ) contract to the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota for survey data analysis covering fiscal years 2026–2035. The contract will support MACPAC's ongoing analysis of Medicaid and CHIP access, enrollment, and coverage data. SHADAC specializes in health insurance coverage surveys and state-level data analysis. This contract ensures continuity in the data infrastructure that informs MACPAC's annual recommendations to Congress on Medicaid policy, payment rates, and program design.
Why it matters for managed care
MACPAC's data analysis informs congressional action on Medicaid payment policy, managed care rate setting, and program expansions that directly affect MCO contracts and capitation rates.
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.
CMS issued its final 2027 Notice of Benefit and Payment Parameters, adjusting risk adjustment methodology, setting user fee rates for Federally-facilitated Exchanges, and codifying expanded hardship exemption eligibility. The rule modifies QHP certification standards, prohibits routine non-pediatric dental services from counting as Essential Health Benefits, allows cost-sharing flexibility for catastrophic and bronze plans, and revises Basic Health Program payment calculations. Changes take effect for plan year 2027. While focused on the ACA individual and small group markets, the rule's risk adjustment and payment methodologies may inform Medicaid managed care rate-setting and actuarial approaches in integrated or dually eligible programs.
Why it matters for managed care
Risk adjustment and payment parameter changes in commercial markets often influence Medicaid rate-setting methodologies, particularly for integrated products serving dually eligible beneficiaries or in states operating Basic Health Programs that bridge Medicaid and Marketplace coverage.
The number of children receiving SNAP food assistance has declined sharply following implementation of H.R. 1, according to recent data. The law created cost shifts and access barriers that were not originally intended to target child eligibility but have nonetheless reduced enrollment among low-income children. The decline represents an unintended consequence of the federal policy changes that altered program administration and state funding responsibilities. The reduction in food assistance may affect health outcomes and social determinants of health for Medicaid-enrolled children whose families lost SNAP benefits.
Why it matters for managed care
Medicaid MCOs serving dual-eligible populations may see increased utilization and costs related to food insecurity among children who lost SNAP benefits, particularly for behavioral health and chronic disease management.
The Medicaid and CHIP Payment and Access Commission (MACPAC) has issued a solicitation for a multiple-award Indefinite Delivery Indefinite Quantity (IDIQ) contract. The request for proposal is available on the System for Award Management (SAM) at www.sam.gov under NAICS code 541720. MACPAC is a nonpartisan legislative branch agency that advises Congress on Medicaid and CHIP policy issues. The solicitation represents a re-bid of an existing contract vehicle.
Why it matters for managed care
MACPAC contract awards shape the research and analysis that inform Congressional Medicaid policy decisions affecting managed care organizations, including financing, quality measurement, and access requirements.
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.
SNAP participation declined by 3.5 million people (9 percent) nationwide between July 2025, when Republican legislation took effect, and February 2026. The enrollment drop reflects implementation of new eligibility restrictions or work requirements enacted in the legislation. The changes primarily affect low-income individuals who may also be eligible for Medicaid, creating potential dual-eligibility concerns for managed care organizations tracking member food security status.
Why it matters for managed care
Medicaid MCOs serving dual-eligible populations may see increased health utilization and social determinants of health screening needs as SNAP disenrollment affects food security among shared beneficiaries.
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.
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.
The FDA extended its decision deadline for AstraZeneca's experimental breast cancer pill following an advisory panel vote against approval. The agency's action delays a final determination on the drug, which targets a specific breast cancer patient population. The extension gives FDA staff additional time to review clinical data after the panel raised efficacy and safety concerns. While this affects a cancer medication rather than Medicaid-covered services directly, coverage and prior authorization decisions for specialty oncology drugs ultimately impact managed care pharmacy spending and member access.
Why it matters for managed care
Delays in FDA oncology drug approvals affect Medicaid MCO pharmacy benefit planning, specialty drug budget forecasting, and prior authorization protocol development timelines.
The Government Accountability Office reports that the Veterans Health Administration has fully implemented nine and partially implemented three of 13 cybersecurity recommendations made in September 2025 to protect veterans' protected health information in the Million Veteran Program system. GAO originally identified deficiencies in asset and risk management, configuration management, identity and access management, and continuous monitoring. All 73 reviewed VA business associate agreements met HIPAA Privacy Rule requirements for PHI use and disclosure. GAO will continue monitoring VA's progress on the remaining recommendations.
Why it matters for managed care
This GAO update demonstrates federal oversight of HIPAA-covered entity cybersecurity practices and sets expectations for systematic remediation of control deficiencies that Medicaid MCOs may face in their own compliance audits.
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.
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.
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.
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.
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.
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.
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.
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.
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.
CMS is soliciting public comment on a proposed information collection under the Paperwork Reduction Act of 1995. This notice provides a second opportunity for stakeholders to comment on burden estimates, necessity and utility of the proposed collection, and ways to reduce reporting burden through automation or other means. The notice does not specify which data collection is under review, when comments are due, or which CMS programs are affected. Managed care organizations should monitor the Federal Register for details on the specific collection instrument and program area.
Why it matters for managed care
Information collection requirements can impose new reporting burdens on MCOs when they affect managed care contracts, quality reporting, or encounter data submission — but this notice lacks sufficient detail to assess operational impact.
CMS announced a 60-day public comment period under the Paperwork Reduction Act for a proposed information collection activity. The agency is seeking feedback on burden estimates, necessity and utility of the collection, accuracy of estimated burden, and ways to improve data quality and reduce reporting burden through technology. Comments are due 60 days from Federal Register publication. The notice does not specify which CMS programs or forms are affected by the proposed collection.
Why it matters for managed care
Managed care organizations should monitor which specific information collections are included in this notice, as changes to reporting requirements could affect administrative burden, compliance costs, and data submission processes for MCO contracts.
The Centers for Medicare & Medicaid Services has published a Federal Register notice announcing an opportunity for 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 comments on burden estimates, necessity and utility of the collections, accuracy of burden estimates, and ways to enhance data quality or reduce collection burden through automation. Comments are being solicited as part of CMS's statutory obligation to provide a second public comment period before submitting information collection requests to the Office of Management and Budget for approval. This is a routine administrative notice; specific collections subject to comment are not detailed in the provided text.
Why it matters for managed care
Managed care organizations should monitor which specific information collection activities CMS is proposing, as new or revised reporting requirements could affect administrative burden, compliance costs, and data submission processes for MCO contracts and quality reporting.
The Centers for Medicare & Medicaid Services has published a Federal Register notice announcing a proposed information collection and requesting public comment under the Paperwork Reduction Act of 1995. The notice opens a 60-day comment period for the public to weigh in on burden estimates, necessity and utility of the proposed collection, accuracy of estimated burden, and ways to enhance data quality or reduce collection burden through automation. The notice does not specify which programs or collection activities are subject to this comment period.
Why it matters for managed care
Managed care organizations should monitor the specific collection requirements once identified, as PRA notices often precede new reporting obligations, survey requirements, or quality measure submissions that affect MCO administrative burden and compliance costs.
The Centers for Medicare & Medicaid Services has published a Federal Register notice announcing a second public comment period on a proposed information collection under the Paperwork Reduction Act of 1995. The notice invites stakeholders to comment on burden estimates, necessity and utility of the proposed data collection, accuracy of burden estimates, and methods to reduce reporting burden through automation or other means. Comments may address how the information collection affects agency operations and whether alternative collection methods could reduce administrative burden. This is a standard procedural notice required before OMB can approve federal data collection activities.
Why it matters for managed care
Managed care organizations subject to federal reporting requirements can comment on burden estimates and propose alternative collection methods before OMB finalizes data collection requirements that may affect operational and compliance costs.
The Centers for Medicare & Medicaid Services has published a Federal Register notice announcing a second public comment opportunity for a proposed information collection activity under the Paperwork Reduction Act of 1995. The notice invites stakeholders to comment on burden estimates, necessity and utility of the collection, accuracy of burden calculations, and ways to improve data quality and reduce reporting burden through automation or other means. This represents the standard OMB review phase following initial Federal Register publication. The specific collection instrument and deadline are detailed in the full Federal Register notice.
Why it matters for managed care
Managed care organizations should review the specific collection referenced in the Federal Register to assess new or modified reporting requirements that may affect administrative burden, data systems, or compliance processes.
The Centers for Medicare & Medicaid Services published a Federal Register notice announcing a proposed information collection under the Paperwork Reduction Act. The agency is seeking public comment on burden estimates, necessity and utility of the collection, and ways to minimize reporting requirements. Comments are due 60 days from publication. This standard PRA notice indicates CMS plans to collect data from stakeholders, though specific forms, reporting requirements, or affected programs are not detailed in this announcement.
Why it matters for managed care
Managed care organizations should monitor the full Federal Register posting to determine if the proposed collection affects MCO reporting requirements, quality measures, or administrative burden.
The Centers for Medicare & Medicaid Services is soliciting public comment on proposed information collection activities under the Paperwork Reduction Act of 1995. The agency is seeking feedback on burden estimates, necessity and utility of the proposed collections, accuracy of burden calculations, and ways to improve data quality and reduce reporting burden through automation. The public has 60 days to submit comments on the proposed collections, which may affect reporting requirements for Medicare and Medicaid programs. The notice does not specify which particular collections are subject to this comment period.
Why it matters for managed care
Changes to CMS information collection requirements can directly affect MCO reporting obligations, administrative burden, and compliance costs if the collections include managed care encounter data, quality measures, or plan oversight documentation.
The Centers for Medicare & Medicaid Services has published a Federal Register notice announcing a proposed information collection under the Paperwork Reduction Act of 1995. The notice opens a 60-day public comment period for stakeholders to weigh in on burden estimates, necessity, accuracy, and implementation of the proposed collection. CMS is seeking feedback on ways to enhance the quality and utility of the information to be collected and minimize administrative burden through automated collection techniques. The notice does not specify which programs or data elements are subject to the proposed collection.
Why it matters for managed care
Managed care organizations may face new reporting requirements or administrative burden if the proposed information collection affects Medicaid managed care programs, contracts, or quality reporting.
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.
The Trump Administration has issued multiple executive actions aimed at restructuring federal agencies and programs. The measures include policy changes affecting various federal services and agency operations. Implementation timelines vary by action, with some taking effect immediately and others requiring rulemaking or agency review. Medicaid managed care organizations should monitor for specific directives affecting CMS operations, Medicaid eligibility rules, and program funding.
Why it matters for managed care
Executive actions affecting CMS, Medicaid funding, or eligibility policy could alter MCO contract terms, capitation rates, covered populations, and compliance requirements.
The Center on Budget and Policy Priorities published recommendations urging Congress to include robust guardrails in 2027 appropriations bills to prevent executive branch interference with federal funding. CBPP analysts highlighted concerns about House legislation that would make blocking federal funds easier, amid administration attempts to restrict funding for basic needs programs. The organization also published health policy analysis on marketplace enrollment. The recommendations apply to federal programs broadly, including Medicaid and other health and human services funding streams that support managed care operations.
Why it matters for managed care
Appropriations guardrails and federal funding restrictions could directly affect Medicaid managed care payments, administrative funding, and program stability if Congress acts on these recommendations.
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.
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.
CMS will convene the Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests on September 15-16, 2026, to establish payment rates for laboratory tests lacking sufficient data from the May-July 2026 reporting period. The public may present crosswalking or gapfilling recommendations during the meeting. The Panel will then advise the Secretary and CMS Administrator on appropriate payment amounts for these tests under the Clinical Laboratory Fee Schedule.
Why it matters for managed care
Medicaid managed care organizations with delegated laboratory arrangements or full-risk contracts should monitor Medicare payment methodology changes, as many state Medicaid programs benchmark lab reimbursement to Medicare CLFS rates.
CMS issued a correction to the FY 2027 Medicare Hospital Inpatient Prospective Payment System (IPPS) proposed rule published April 14, 2026. The correction addresses technical and typographical errors in the original proposed rule, which covers payment rates for acute care hospitals and long-term care hospitals, along with quality program requirements. The correction does not alter substantive policy proposals or comment deadlines. This is a routine administrative correction to ensure accuracy in the proposed regulatory text.
Why it matters for managed care
While this Medicare correction does not directly affect Medicaid managed care organizations, MCOs with dual-eligible populations or Medicare Advantage contracts should monitor IPPS changes for hospital payment trends that may influence supplemental payment methodologies and cross-program rate negotiations.
The Center on Budget and Policy Priorities warned that House Republicans may use budget reconciliation to enact additional cuts to federal safety net programs. CBPP President Sharon Parrott stated these cuts would harm families struggling with basic needs. Separately, CBPP highlighted that 76% of low-income renters who need federal rental assistance do not receive it, and noted Congress could address housing affordability in 2027 appropriations legislation. The timing and scope of potential reconciliation cuts remain uncertain.
Why it matters for managed care
Budget reconciliation cuts to safety net programs could reduce Medicaid eligibility or benefits, affecting MCO enrollment and revenue while increasing uncompensated care for remaining members.
The Centers for Medicare & Medicaid Services finalized a rule modifying Affordable Care Act marketplace standards that critics say will steer enrollees toward plans with higher cost-sharing and lower actuarial value. The rule affects millions of marketplace enrollees but does not directly govern Medicaid or CHIP programs. Implementation timing was not specified in the available text. The changes apply to qualified health plans sold through federally facilitated and state-based exchanges, affecting commercial coverage purchased by individuals and families who may be near Medicaid eligibility thresholds.
Why it matters for managed care
Medicaid managed care organizations with dual marketplace participation or serving near-eligible populations should monitor whether marketplace plan design changes affect churn patterns, provider network overlap, or member cost-sharing expectations during coverage transitions.
The Medicaid and CHIP Payment and Access Commission awarded Indefinite Delivery Indefinite Quantity contracts to five research organizations—Abt Global, Acumen, American Institutes for Research, Altarum Institute, and a fifth unnamed firm—covering fiscal years 2026 through 2035. These contractors will support MACPAC's statutory mission to provide policy analysis and recommendations to Congress on Medicaid and CHIP. The awards follow a solicitation posted to SAM on May 7, 2025. MACPAC research informs federal policymaking on access, payment, and program design affecting managed care plans.
Why it matters for managed care
MACPAC research and recommendations directly shape congressional action on Medicaid managed care policy, including rate-setting methodologies, quality measurement, and program integrity requirements that affect MCO operations and reimbursement.
The Kaiser Family Foundation published a research brief examining health care affordability among Medicare beneficiaries, including younger adults with long-term disabilities. The analysis draws on multiple data sources to assess out-of-pocket costs, premium burdens, and financial challenges facing the Medicare population. While the brief focuses on the traditional Medicare program rather than Medicaid managed care, it provides context on affordability pressures affecting dual-eligible beneficiaries who are enrolled in both Medicare and Medicaid. The findings may inform discussions about supplemental coverage and cost-sharing for individuals enrolled in Medicare-Medicaid Plans (MMPs) and other integrated care arrangements.
Why it matters for managed care
Dual-eligible beneficiaries represent a significant portion of Medicaid managed care enrollment, and understanding Medicare affordability challenges helps MCOs manage coordination of benefits, supplemental coverage design, and member cost-sharing in integrated models.
CMS issued a proposed rule modifying limits on state directed payments in Medicaid managed care and establishing new limits on certain targeted payments in fee-for-service Medicaid. The rule invokes actuarial soundness requirements under section 1903(m)(2)(A)(iii) for managed care SDPs and section 1902(a)(30)(A) for FFS targeted payments. The proposed changes would affect how states structure supplemental payments to providers through MCO contracts and direct FFS arrangements. This rule represents CMS's most significant intervention in state payment flexibility since the 2016 managed care rule established the current SDP framework.
Why it matters for managed care
The proposed limits would constrain states' ability to use SDPs to supplement capitation payments and could force MCOs to renegotiate provider contracts if current SDP arrangements exceed new federal caps.
The Medicaid and CHIP Payment and Access Commission released its March 2025 report recommending improvements to external quality review processes in Medicaid managed care, enhanced access to home- and community-based services, and reduced administrative burdens for states and CMS. The recommendations target managed care transparency and accountability mechanisms that directly affect MCO operations and oversight. MACPAC reports to Congress typically influence future CMS rulemaking and state policy decisions. Managed care organizations should review the full report for potential operational and compliance implications.
The Medicaid and CHIP Payment and Access Commission released its March 2025 Report to Congress containing recommendations to improve transparency in Medicaid managed care, enhance access to home- and community-based services, and reduce administrative burdens for states and the federal government. The recommendations include reforms to external quality review processes. The report provides policy guidance that may inform future CMS rulemaking and state contracting practices. MACPAC reports typically influence federal policy development and state Medicaid program design over 12-24 month timeframes.
Why it matters for managed care
MACPAC recommendations on managed care transparency and external quality review often become the basis for CMS regulatory requirements and state contract standards that directly affect MCO reporting obligations and oversight processes.
The National Academy for State Health Policy will host a state-only webinar on May 20 covering state approaches to pharmacy benefit manager oversight and federal policy developments. The session targets state officials working on PBM regulation and oversight strategies. The webinar will likely address emerging state legislative and regulatory approaches to PBM transparency, contracting practices, and oversight mechanisms. This matters for Medicaid managed care organizations as states increasingly scrutinize PBM practices that affect prescription drug costs and access in Medicaid programs.
The National Academy for State Health Policy released guidance on aligning community supervision agencies with health service providers to support individuals reentering communities after incarceration. The resource outlines coordination strategies states can use to reduce recidivism and improve public safety through integrated health and supervision services. Many states are expanding Medicaid eligibility for justice-involved populations, making coordination between correctional agencies and managed care plans increasingly important. The guidance addresses how states can structure partnerships between probation/parole agencies and health plans to ensure continuity of behavioral health, substance use treatment, and primary care services during reentry.
Why it matters for managed care
Medicaid managed care organizations increasingly serve justice-involved populations under Section 1115 waivers and reentry initiatives, requiring operational coordination with community supervision agencies to manage behavioral health needs, reduce emergency department utilization, and meet contractual quality metrics for this high-risk population.
States are implementing eligibility changes mandated by H.R. 1, including work requirements for Medicaid beneficiaries, immigration-related funding restrictions, elimination of retroactive coverage, and transition to six-month renewals for certain populations. The resource provides key implementation dates as states operationalize these federal policy changes. Managed care organizations should prepare for enrollment volatility, increased disenrollment, and potential changes to capitation rates as states comply with these new requirements. MCOs will need to coordinate with states on member outreach, data reporting for work requirement verification, and network adequacy planning for smaller enrolled populations.
Montana is implementing federal Medicaid work requirements six months ahead of the federal deadline as the state faces budget constraints for health services. The accelerated timeline affects Medicaid beneficiaries who will need to meet work requirements sooner than originally planned. Montana joins several other states experiencing financial pressures while implementing these federal policy changes. The early implementation may impact managed care organizations' member enrollment and administrative processes as they prepare systems and provider networks for potential coverage changes.
MassHealth has implemented a sub-capitation program that uses tiered primary care payments to increase integrated behavioral health access. The program creates financial incentives for primary care providers to build advanced behavioral health capacity within their practices. This approach represents a significant shift in how states can structure payment mechanisms to promote behavioral health integration. The model could serve as a template for other state Medicaid programs seeking to improve behavioral health access through innovative payment arrangements.
MassHealth implemented a sub-capitation program that uses tiered payments to primary care practices based on their level of behavioral health integration. The program creates financial incentives for practices to advance from basic screening and referral capabilities to full on-site behavioral health services. Primary care practices receive higher per-member-per-month payments as they achieve higher tiers of integration, measured by staffing, workflows, and service capacity. The model aims to expand behavioral health access by embedding services in primary care settings where Medicaid members routinely receive care.
Why it matters for managed care
This tiered sub-capitation approach provides a replicable model for MCOs to expand behavioral health network capacity and meet integration requirements through differential primary care payments tied to practice capabilities.
nashp.org →Behavioral Health · Managed Care · Finance
A resource page provides an interactive map showing which states have adopted, rejected, or are considering the Affordable Care Act's Medicaid expansion. The map tracks the current status of all state decisions regarding expansion eligibility for adults up to 138% of the federal poverty level. This affects managed care organizations by indicating potential market opportunities in expansion states and enrollment growth projections. The resource includes additional links to Medicaid expansion policy materials.
States are implementing comprehensive strategies to improve maternal health outcomes by expanding perinatal care services, extending postpartum coverage periods, and developing cross-sector partnerships. These initiatives affect Medicaid managed care organizations through enhanced coverage requirements for maternal health services and coordination with community-based organizations. Implementation varies by state based on existing policy frameworks and waiver authorities. These changes require MCOs to adapt network adequacy standards, care coordination protocols, and quality metrics to support comprehensive perinatal and postpartum care delivery.
States are increasingly using Medicaid reimbursement for certified nurse midwives (CNMs) to expand access to maternal care services and improve perinatal outcomes. This coverage strategy allows states to address provider shortages in maternal health while potentially reducing costs compared to physician-delivered care. The approach is particularly relevant for rural and underserved areas where obstetricians may be limited. For Medicaid managed care organizations, CNM coverage presents opportunities to expand provider networks and develop innovative maternal health programs while managing costs.
The National Academy for State Health Policy published an overview of how states structure Medicaid reimbursement for certified nurse midwives (CNMs) to expand maternal care access. The analysis examines state-level payment policies and credentialing requirements that determine CNM participation in Medicaid programs. States use varying reimbursement methodologies — some paying CNMs at the same rate as physicians, others at reduced percentages — which directly affects provider network composition and beneficiary access to midwifery services. The resource is intended to help state Medicaid programs evaluate their maternal health provider networks.
Why it matters for managed care
CNM reimbursement policy directly affects managed care network adequacy for maternity services and the availability of alternative delivery models that can reduce cesarean rates and improve birth outcomes for Medicaid enrollees.
The National Academy for State Health Policy will host a state-only webinar on May 20, 2025, from 3–4 p.m. ET covering pharmacy benefit manager oversight strategies and recent federal policy developments. The session is designed for state officials working on PBM regulation and transparency initiatives. The webinar will examine state-level approaches to PBM oversight alongside evolving federal policy in this area.
Why it matters for managed care
Medicaid MCOs operating under pharmacy carve-in models must navigate state PBM oversight requirements that increasingly affect rebate pass-through obligations, spread pricing restrictions, and pharmacy network adequacy standards.
States are implementing strategies to strengthen perinatal health care systems through expanded postpartum coverage, enhanced care coordination, and cross-sector partnerships addressing social determinants of health. Initiatives include extending Medicaid postpartum coverage beyond 60 days, integrating behavioral health services into perinatal care, and developing maternal health task forces. These strategies aim to reduce maternal mortality and morbidity rates, particularly among populations with documented disparities. State Medicaid agencies are partnering with managed care organizations to implement these expanded services and coordinate care across the prenatal, delivery, and postpartum continuum.
Why it matters for managed care
Managed care organizations must prepare for expanded postpartum coverage mandates, integrate behavioral health into maternity care pathways, and develop cross-sector partnerships to address maternal health quality metrics and Star ratings.
nashp.org →Maternal · Behavioral Health · Managed Care
The Kaiser Family Foundation maintains an interactive map tracking Medicaid expansion status across all 50 states and DC under the Affordable Care Act. As of the latest update, 40 states and DC have adopted expansion, while 10 states have not expanded. The tracker provides current adoption status and links to additional expansion resources. This information is essential for MCOs evaluating market entry opportunities, understanding enrollment projections, and planning network adequacy in states where expansion policies may change.
Why it matters for managed care
Medicaid expansion status directly affects MCO market size, membership mix, revenue projections, and network adequacy requirements in each state.
Five states have joined the National Academy for State Health Policy's new Medicaid Policy and Strategy Learning Collaborative to address sustainability challenges. The initiative focuses on helping states navigate ongoing fiscal pressures and upcoming changes from the Older Americans and Better Benefits for All Act (OBBBA). The collaborative will provide states with policy guidance and peer learning opportunities to strengthen their Medicaid programs. This matters for managed care organizations as state sustainability strategies directly impact MCO contracts, rate setting methodologies, and program requirements.
The National Academy for State Health Policy (NASHP) has launched a Medicaid Policy and Strategy Learning Collaborative with five participating states. The collaborative aims to address Medicaid sustainability challenges amid outcomes-based beneficiary budget authority (OBBBA) implementation and broader fiscal pressures facing state programs. The initiative will focus on strategic planning and policy development to maintain program viability. This represents a coordinated multi-state effort to navigate federal policy changes and budget constraints affecting Medicaid programs.
Why it matters for managed care
State strategies developed through this collaborative may influence Medicaid managed care contract requirements, payment methodologies, and benefit design as states seek to control costs while implementing outcomes-based approaches.
NASHP published guidance on how states can coordinate community supervision and health services to support individuals reentering communities from correctional facilities. The collaboration aims to reduce recidivism and improve public safety through aligned health and supervision services. States can use these strategies to better serve justice-involved populations who often qualify for Medicaid upon release. This matters for Medicaid managed care organizations because justice-involved individuals represent a high-need, high-cost population requiring coordinated behavioral health, substance abuse, and primary care services.
The National Academy for State Health Policy is hosting a collaborative learning session on rural payment and delivery reform on May 21, 2–3 p.m. ET. The session is designed for state officials interested in advancing payment models and delivery system reforms in rural areas. While the brief announcement does not specify which states are participating or what specific models will be discussed, rural delivery system reform is relevant to Medicaid managed care organizations operating in rural markets or states with rural penetration requirements.
Why it matters for managed care
MCOs with rural contracts or network adequacy obligations in rural counties may see new state expectations or payment model changes emerge from states participating in this learning collaborative.
States are implementing a national strategy to support family caregivers through enhanced services, protections, and care integration initiatives. The strategy focuses on better coordination between formal care systems and family caregivers who provide unpaid support to Medicaid beneficiaries. Implementation varies by state but includes caregiver assessments, respite services, and training programs. This matters for Medicaid MCOs because family caregivers are critical partners in long-term services and supports delivery, and better caregiver support can improve member outcomes while potentially reducing institutional care costs.
States are implementing elements of the National Strategy to Support Family Caregivers through new services, workplace protections, and care coordination improvements. Implementation approaches vary by state and include respite care expansion, caregiver assessment protocols, and integration with existing health and social service systems. The strategy aims to address the growing reliance on unpaid family caregivers who provide essential support for aging and disabled populations. These initiatives intersect with Medicaid-funded long-term services and supports, where family caregivers often supplement or enable community-based care delivery.
Why it matters for managed care
State caregiver support initiatives directly affect LTSS delivery models and care coordination requirements for Medicaid MCOs serving dual-eligible and high-need populations.
Proposed federal legislation would make it easier for the administration to block funding for programs including Medicaid, SNAP, and housing assistance. The bill affects state-administered programs where states rely on federal matching funds and federal payment systems. Critics argue the measure could disrupt payments to eligible beneficiaries under the guise of fraud prevention, potentially affecting Medicaid managed care capitation payments and beneficiary enrollment. The timing and specific legislative text remain unclear from this excerpt.
New federal legislation (H.R. 1) has resulted in a sharp decline in the number of children receiving SNAP food assistance, despite children not being an explicit target of the policy changes. The law has created cost shifts and access barriers at the state level that are reducing participation among low-income children. The changes affect dual-eligible families who often qualify for both SNAP and Medicaid, creating potential coordination issues for managed care organizations serving mothers and children. States must navigate new administrative requirements that may complicate enrollment processes for families receiving multiple benefits.
A new litigation tracker aggregates ongoing federal court cases involving abortion bans, restrictions, and FDA regulation of mifepristone and other reproductive health matters. The tracker covers both state and federal reproductive rights litigation currently moving through the courts. This litigation could impact Medicaid managed care organizations' coverage obligations and provider networks, particularly for family planning services, emergency contraception, and pregnancy-related care depending on court outcomes and state policy responses.
The Kaiser Family Foundation maintains an ongoing tracker of reproductive health litigation in federal courts, covering challenges to state abortion bans, restrictions, and FDA approval of mifepristone. The tracker aggregates information about active cases involving abortion access and related federal regulations. This resource provides a consolidated view of litigation that may affect Medicaid coverage policies, managed care network adequacy requirements, and MCO benefit design obligations related to reproductive health services.
Why it matters for managed care
Medicaid managed care organizations must monitor reproductive rights litigation to ensure network adequacy, comply with state coverage mandates, and adjust benefit administration as court decisions alter the legal landscape for abortion and contraceptive services.
The Medicaid and CHIP Payment and Access Commission (MACPAC) has issued a request for proposals for an indefinite delivery indefinite quantity (IDIQ) task order contract focused on survey data analysis and technical assistance. The RFP is available on www.sam.gov. MACPAC is an independent legislative branch agency that advises Congress on Medicaid and CHIP policy. This procurement supports MACPAC's ongoing work analyzing access, quality, and payment issues in Medicaid managed care and fee-for-service programs.
The Medicaid and CHIP Payment and Access Commission awarded a decade-long indefinite delivery indefinite quantity contract for survey data analysis to the State Health Access Data Assistance Center at the University of Minnesota. The contract runs from fiscal years 2026 through 2035 and will support MACPAC's congressional reporting on Medicaid and CHIP access and enrollment trends. This contract supports the data infrastructure behind MACPAC's annual reports to Congress that influence federal managed care policy and payment methodologies.
Drew Altman, founding CEO of KFF (Kaiser Family Foundation), announced his retirement after nearly 40 years leading the health policy research organization. Larry Levitt and Mollyann Brodie will assume joint leadership roles in 2024, bringing six decades of combined experience at KFF. The transition affects one of the most influential health policy research organizations that regularly produces Medicaid analysis, polling, and policy briefs. The leadership change may influence the organization's future research priorities and policy positions on Medicaid managed care issues.
The National Academy for State Health Policy will host a state-only webinar examining private equity ownership patterns in hospitals and provider groups across four states on May 19. The analysis focuses on ownership structures that could affect provider networks and care delivery. State officials will review findings relevant to network adequacy monitoring and provider stability oversight. The research provides insights for states managing Medicaid managed care networks where private equity-backed providers participate.
The National Academy for State Health Policy (NASHP) is hosting a state-only webinar on Tuesday, May 19, from 3–4 p.m. ET examining private equity ownership in hospitals and provider groups across four states. The webinar will present analyses of private equity penetration in healthcare delivery systems. Attendance is restricted to state officials and policymakers. The session aims to inform state approaches to monitoring and regulating private equity involvement in healthcare.
Why it matters for managed care
Private equity ownership of provider networks affects MCO network adequacy, provider stability, and access to care for Medicaid enrollees, particularly as states consider new oversight mechanisms.
Drew Altman, founding president and CEO of KFF (Kaiser Family Foundation), announced his retirement after nearly 40 years leading the organization. KFF's board appointed Larry Levitt and Mollyann Brodie as the next leadership team, effective next year. Levitt and Brodie have each spent approximately 30 years at KFF in senior roles overseeing policy research and public opinion polling. The transition marks a leadership change at one of the most influential health policy research organizations in the United States.
Why it matters for managed care
KFF produces widely cited Medicaid research, state-level managed care data, and policy analysis that informs federal and state decision-making affecting MCO operations and policy development.
The Medicaid and CHIP Payment and Access Commission has issued a solicitation for a multiple-award Indefinite Delivery Indefinite Quantity contract. The request for proposal is available on SAM.gov under NAICS code 541720 (Research and Development in the Social Sciences and Humanities). This procurement may signal MACPAC's research priorities for analyzing Medicaid managed care policy, payment methodologies, and access issues. Firms providing Medicaid research and technical assistance should review the solicitation details on SAM.gov for submission requirements and deadlines.
The Trump administration has proposed $50 billion in new rural health funding, but the initiative is not expected to help reopen closed rural hospitals like Martin County, North Carolina's shuttered facility. The funding mechanism and eligibility criteria remain undefined, and local officials report that existing rural hospital closure challenges—including provider shortages, declining Medicaid reimbursement, and inadequate infrastructure—are unlikely to be addressed by the proposal. The announcement lacks implementation details, including whether funds would support capital projects, operational subsidies, or workforce development. Rural hospital closures disproportionately affect Medicaid managed care network adequacy in underserved counties.
Why it matters for managed care
Rural hospital closures directly threaten Medicaid MCO network adequacy requirements and beneficiary access to emergency and inpatient services in counties where providers are already scarce.
RaDonda Vaught, a nurse convicted of negligent homicide for accidentally dispensing a deadly drug to a patient, now speaks publicly about hospital safety in the era of automation and AI. Her case highlights systemic issues in medication safety protocols that could affect patient care quality in Medicaid managed care networks. Healthcare organizations are increasingly focused on preventing similar incidents through improved safety systems and technology. This case serves as a reminder for MCOs to ensure their provider networks maintain robust medication safety protocols and error prevention systems.
Former President Trump purchased stock in Eli Lilly while his administration implemented policies that benefited the pharmaceutical company. The investment timing coincided with regulatory decisions favorable to drugmakers. This highlights ongoing concerns about potential conflicts of interest between policymakers and pharmaceutical companies. Medicaid managed care organizations should monitor how political relationships may influence drug pricing and coverage policies.
New research identifies additional medical screenings and treatments that may provide limited benefit for older patients. The findings could influence clinical guidelines and coverage decisions for Medicare Advantage and dual-eligible special needs plans. Healthcare providers and managed care organizations serving older populations should review their care protocols and utilization management policies. The research adds to growing evidence supporting age-appropriate care that avoids unnecessary interventions for elderly beneficiaries.
HCA Healthcare has implemented AI solutions across its health system operations through a systematic approach involving clinician engagement from development through deployment. The health system focuses on careful testing and customization of AI tools for clinical care and hospital operations, with nurses and physicians serving as primary end users throughout the process. This represents a scaled approach to healthcare AI implementation that other health systems and managed care organizations are watching for operational efficiency and care quality improvements. The initiative demonstrates how large healthcare organizations are integrating AI into everyday clinical workflows.
The FDA has extended the decision deadline for AstraZeneca's experimental breast cancer pill following an advisory panel's negative vote on the drug's approval. The delay affects potential formulary decisions for Medicaid managed care organizations that cover cancer treatments. Medicaid MCOs should monitor the FDA's final decision timeline as it will impact prior authorization protocols and specialty pharmacy networks for oncology services. The extension creates uncertainty for health plans developing 2024 drug coverage policies.
HCA Healthcare is implementing artificial intelligence tools across its health system for clinical care and hospital operations. Dr. Michael Schlosser, the system's Chief Transformation Officer, describes an approach that emphasizes testing, customization, and early engagement of clinicians and nurses as end users. The deployment represents a large-scale integration of AI into everyday hospital workflows. HCA's methodology focuses on deliberate implementation rather than rapid adoption.
Why it matters for managed care
Health systems integrating AI into clinical workflows may affect care delivery models, prior authorization processes, and utilization management approaches that Medicaid MCOs negotiate in provider contracts.
Several states are enacting legislation to address guardianship and custody issues for children whose parents are detained by immigration authorities during mass deportation operations. The laws aim to establish procedures for temporary custody when family members or friends are unavailable. Immigration enforcement activity has accelerated under the Trump administration's deportation initiative. The legislation addresses legal guardianship complications that arise when parents are detained without advance planning for their children's care.
Why it matters for managed care
States with significant Medicaid managed care enrollment may see disruptions in pediatric continuity of care and eligibility verification when immigrant families are separated, affecting MCO membership stability and care coordination obligations.
Researchers have identified three medical routines that may provide limited benefit for older adults: routine cancer screenings in patients with limited life expectancy, bone density testing in low-risk older adults, and certain cardiovascular screenings in asymptomatic elderly patients. The findings add to growing evidence about low-value care in geriatric populations. This research does not establish new clinical guidelines or coverage policies. The findings may eventually inform quality measurement or prior authorization protocols in Medicare Advantage and Medicaid managed long-term care plans serving dual-eligible populations.
Why it matters for managed care
Quality measurement and utilization management strategies for MLTSS and dual-eligible special needs plans may eventually need updating as evidence on appropriate care for older adults evolves.
Documents reveal President Trump purchased stock in Eli Lilly while administration policies provided benefits to the pharmaceutical company. The timing and nature of the stock purchase raise questions about potential conflicts of interest in healthcare policy decisions. The disclosure comes amid ongoing scrutiny of pharmaceutical industry relationships with government officials. This development may prompt increased oversight of executive branch financial interests in healthcare sectors.
Why it matters for managed care
Medicaid MCOs contracting with Eli Lilly for pharmacy benefits may face heightened regulatory scrutiny of drug pricing and rebate arrangements if federal enforcement priorities shift in response to conflict-of-interest concerns.
RaDonda Vaught, a nurse convicted of negligent homicide after accidentally administering a deadly drug to a patient, now delivers speeches on hospital safety focused on automation and artificial intelligence risks. The case involved a fatal medication error that led to criminal prosecution. Vaught's conviction highlighted systemic safety concerns in healthcare settings increasingly reliant on automated dispensing systems and technology-driven workflows. Her speaking engagements address lessons learned from the incident and emerging safety challenges in modern hospital environments.
Why it matters for managed care
This case underscores medication safety protocols and staff training requirements that Medicaid managed care organizations must enforce in contracted hospitals and care facilities, particularly as automation expands.
The Center on Budget and Policy Priorities released multiple analyses warning that Trump Administration actions to block or redirect federal appropriations could disrupt Medicaid and other safety net programs. CBPP researchers called for Congressional appropriations guardrails in 2027 bills to prevent executive interference with enacted funding levels. The organization also flagged House legislation that would make it easier to withhold federal funds from states and programs. These budget control efforts could affect Medicaid managed care organizations through delayed capitation payments, withheld administrative funding, or disrupted federal match for state programs.
Stanford Health Care has implemented a patient engagement process to gather feedback before deploying new artificial intelligence tools in clinical settings. The health system is soliciting patient perspectives on proposed AI applications to identify concerns and implementation challenges before rollout. This approach represents an emerging practice in health system governance as AI tools become more prevalent in clinical workflows. For Medicaid managed care organizations, patient engagement protocols for AI adoption may become relevant as plans evaluate clinical decision support tools, prior authorization algorithms, and utilization management systems.
Stanford Health Care has established a patient advisory process for evaluating artificial intelligence tools before clinical deployment. The health system is soliciting patient input on AI applications ranging from diagnostic imaging to clinical decision support to identify concerns about accuracy, bias, and appropriate use cases. Patient feedback has surfaced questions about algorithm transparency, data privacy, and whether AI recommendations might override clinical judgment. The initiative reflects growing recognition that patient perspectives can reveal implementation risks that clinicians and administrators may overlook.
Why it matters for managed care
Medicaid managed care organizations deploying AI for utilization management, care coordination, or predictive analytics may face similar patient trust and transparency challenges that could affect member satisfaction scores and regulatory scrutiny.
Senator Dick Durbin criticizes the Trump administration for allegedly allowing tobacco companies to market nicotine products to children. The opinion piece focuses on regulatory enforcement gaps rather than specific policy changes affecting Medicaid programs. While youth nicotine addiction can lead to long-term health consequences that may increase Medicaid costs, this op-ed does not address managed care operations, coverage policies, or state program administration. The piece represents political commentary on federal tobacco regulation rather than actionable guidance for Medicaid plans.
Senator Dick Durbin published an opinion piece criticizing the Trump administration's approach to tobacco regulation, arguing it has exposed children to nicotine addiction from Big Tobacco marketing. The piece represents congressional Democratic perspectives on federal tobacco policy but does not announce new legislation, regulatory action, or policy changes. It is an opinion commentary on existing regulatory posture rather than a policy development. No immediate action items or compliance deadlines are triggered by this opinion piece.
Why it matters for managed care
This opinion piece has no direct operational impact on Medicaid managed care organizations but reflects ongoing congressional concern about youth tobacco use, which could inform future Medicaid coverage policy for cessation services or substance use disorder treatment benefits.
A KFF brief examines health care affordability for Medicare beneficiaries, including younger adults with long-term disabilities. The analysis draws on multiple data sources to document out-of-pocket costs, premium burdens, and financial strain across traditional Medicare and Medicare Advantage populations. While not directly about Medicaid, the findings are relevant for dual-eligible special needs plans (D-SNPs) and state programs serving Medicare-Medicaid enrollees. Plans serving dual eligibles should consider how Medicare cost-sharing affects their members' total cost of care and care-seeking behavior.
The Medicaid and CHIP Payment and Access Commission awarded indefinite delivery indefinite quantity contracts to five research firms—Abt Global, Acumen, American Institutes for Research, Altarum Institute, and one additional organization—covering fiscal years 2026 through 2035. These contractors will provide analytic support, data analysis, and policy research to inform MACPAC's congressional recommendations on Medicaid and CHIP. The awards position these firms as primary sources of evidence and analysis that will shape federal Medicaid policy recommendations over the next decade, including managed care delivery system design and payment policy.
The Center on Budget and Policy Priorities cautioned that House Republicans may use budget reconciliation to enact spending cuts affecting families struggling with basic needs, including housing assistance. CBPP noted that 76% of low-income renters eligible for federal rental assistance currently receive no aid. The organization called for Congress to increase affordable housing resources in upcoming 2027 appropriations legislation. While not Medicaid-specific, reconciliation processes have historically been used to restructure Medicaid financing and eligibility.