Federal Policy
6Federal Policy·7:31 AM MT
CMS has created the Office of Health Technology and Products (OHTP) to lead enterprise-wide healthcare technology modernization and digital transformation across Medicare, Medicaid, CHIP, and other CMS programs. The office will oversee digital products and platforms in coordination with the CMS Chief Information Officer, who retains governance authority over IT infrastructure, cybersecurity, and enterprise architecture. The organizational change takes effect immediately through this statement of delegations. The new structure may affect how states and managed care organizations interact with CMS technology systems and digital service delivery initiatives.
Why it matters for managed careOHTP's creation signals potential changes to CMS technology platforms that managed care organizations use for enrollment, reporting, data exchange, and program administration across Medicaid and CHIP.
Federal Policy·7:30 AM MT
State-level enrollment data through April 2026 from Arkansas, Colorado, Maryland, Massachusetts, New Mexico, and New York show significant coverage losses as enrollees canceled plans or stopped paying premiums following the expiration of enhanced ACA subsidies. Georgetown University analysis indicates attrition rates exceed initial federal projections. Congress did not renew the enhanced subsidies that had been in place, resulting in higher premium costs for marketplace enrollees. The coverage losses could affect Medicaid managed care organizations in states with integrated or coordinated care models between marketplace and Medicaid coverage.
Why it matters for managed careMCOs operating in states with marketplace-Medicaid coordination may see increased emergency department utilization and uncompensated care as formerly insured individuals lose coverage, and some newly uninsured individuals may become Medicaid-eligible if income changes trigger eligibility.
Federal Policy·1:30 PM MT
A January 2025 GAO report found that the Department of Justice does not set measurable near-term goals for its adult human trafficking survivor assistance program, unlike HHS programs and DOJ's minor survivor program which follow leading performance assessment practices. In fiscal year 2025, HHS awarded $7.5 million across two programs serving approximately 2,600 survivors, while DOJ awarded $45 million across two programs serving approximately 11,300 survivors. The report identifies provider shortages and other access barriers for behavioral health services. GAO recommends DOJ establish measurable near-term goals with targets and timeframes to better assess program effectiveness and progress toward supporting adult trafficking survivors.
Why it matters for managed careMedicaid managed care organizations are the primary payers for behavioral health services for trafficking survivors enrolled in Medicaid, and understanding federal grant program performance standards and access barriers helps MCOs coordinate with federal grantees and address network adequacy for specialized trauma services.
Federal Policy·1:30 PM MT
SAMHSA announced eight grant programs totaling $40 million to fund addiction prevention, behavioral health workforce development, child trauma services, and suicide prevention efforts. The funding opportunities are now open for application by eligible providers and organizations. Awards will support expanding access to behavioral health services and building provider capacity in underserved areas. For Medicaid managed care organizations, these grants may strengthen network adequacy by increasing the supply of behavioral health providers and services in their markets.
Why it matters for managed careGrant-funded provider capacity expansion and new behavioral health programs in MCO service areas may improve network adequacy, reduce waitlists, and support compliance with MHPAEA and access standards.
Federal Policy·1:30 PM MT
The Government Accountability Office projects that under current spending and revenue policies, federal debt held by the public will reach 106% of GDP by 2029 and 251% of GDP by 2056. Projected deficits are driven primarily by growth in Social Security, Medicare, and other federal health care programs, with net interest costs becoming the fastest-growing portion of the federal budget. GAO recommends Congress and the administration establish fiscal rules, build consensus on deficit reduction, and address Social Security and Medicare trust fund shortfalls before depletion in 2032 and 2033. The report emphasizes that delayed action will require more dramatic policy changes.
Why it matters for managed careMedicaid managed care organizations face heightened federal budget pressure on health care spending as Congress and CMS seek cost containment measures, potentially affecting rate adequacy, payment timing, and program design.
Federal Policy·1:30 PM MT
A federal court deadline on Monday could make mailing abortion pills illegal nationwide. The ruling would affect telemedicine providers who prescribe mifepristone and misoprostol to patients across state lines, including for medication abortion and miscarriage management. Providers currently rely on FDA guidance allowing direct-to-patient mailing of abortion medications approved during the COVID-19 public health emergency and maintained afterward. If the deadline results in restrictions, it could eliminate a key access pathway for medication abortion in states where in-person abortion services are limited or banned.
Why it matters for managed careMedicaid managed care organizations covering maternity benefits would see increased demand for in-person pregnancy-related services if telemedicine abortion medication access is eliminated, particularly in states with abortion restrictions where members have relied on out-of-state prescribers.
State Policy
3State Policy·7:31 AM MT
Child enrollment in Medicaid and CHIP has declined by more than 2 million since January 2025, according to Georgetown University's Center for Children and Families. The declines vary significantly by state and affect children in working families who often lack access to affordable employer-sponsored coverage. The enrollment losses represent a continuation of coverage instability following the end of the Medicaid continuous enrollment provision. These drops matter because many affected children become uninsured rather than transitioning to other coverage.
Why it matters for managed careSharp enrollment declines directly reduce MCO premium revenue and can destabilize risk pools, particularly in plans with significant pediatric membership or CHIP contracts.
State Policy·RI·7:30 AM MT
Rhode Island is considering whether to maintain Medicaid coverage for GLP-1 medications used to treat obesity, amid national debate over cost and access. The state has historically prioritized public health initiatives addressing health disparities and nutrition. The decision affects coverage policy for medications like Wegovy and Zepbound for Medicaid beneficiaries with obesity. Rhode Island's choice will impact managed care organizations' pharmacy benefits and utilization management protocols for this high-cost drug class.
Why it matters for managed careGLP-1 obesity coverage decisions directly affect MCO pharmacy budgets, prior authorization protocols, and financial risk under capitated arrangements, with significant implications for care management strategies and medical loss ratios.
State Policy·PA·7:30 AM MT
Pennsylvania has lost over 1,000 pharmacies since 2020, prompting state lawmakers to pursue legislative action targeting pharmacy benefit managers. A Pennsylvania Department of Human Services official expressed skepticism about a legislative proposal to hire a PBM to oversee other PBMs. The legislative effort aims to address pharmacy closures attributed to PBM practices, though specific proposals and timelines are not detailed in the available information.
Why it matters for managed carePennsylvania Medicaid MCOs rely on PBM networks for pharmacy services, and widespread pharmacy closures can affect network adequacy, member access to prescriptions, and compliance with state contract requirements.