The Medicaid and CHIP Payment and Access Commission (MACPAC) released its June 2026 Report to Congress with recommendations on six policy areas affecting Medicaid managed care operations. The report addresses automation in prior authorization processes, managed care accountability measures, and access to residential treatment services, among other topics. The recommendations also cover community engagement requirements, services for youth with special health care needs, and the Program of All-Inclusive Care for the Elderly (PACE). These recommendations typically inform congressional legislation and CMS policy development over the following 12-24 months.
Why it matters for managed care
MACPAC recommendations frequently shape CMS rulemaking and congressional action on managed care oversight, prior authorization requirements, and quality measurement—areas with direct compliance and operational implications for MCOs.
macpac.gov →Managed Care · Behavioral Health · Long-Term Care
The National Health Law Program released a report examining how electronic asset verification systems in Medicaid create enrollment barriers for rural residents, particularly Black rural populations. The report identifies gaps in rural banking infrastructure and property transfer documentation that interfere with automated eligibility systems. The analysis focuses on how Medicaid agencies' reliance on electronic verification tools may disproportionately delay or deny coverage for applicants in areas with limited financial institution networks and informal property arrangements. The report provides recommendations for state Medicaid programs to address these verification challenges.
Why it matters for managed care
State Medicaid agencies using electronic asset verification may need to modify eligibility procedures to prevent rural enrollment barriers that could affect MCO membership and risk adjustment, particularly in states with rural Medicaid expansion populations.
HHS Secretary Robert F. Kennedy Jr. sent a June 11 letter to the editor-in-chief of Toxicology Reports demanding justification for the removal of a 2021 study linking vaccines to sudden infant death syndrome. Kennedy has cited this research in support of proposed changes to childhood immunization schedules. The retraction raises questions about the scientific basis for potential federal policy shifts affecting Medicaid-covered pediatric vaccine programs. No timeline has been announced for HHS policy changes to childhood vaccination requirements.
Why it matters for managed care
Medicaid MCOs cover nearly half of U.S. births and fund childhood vaccines through EPSDT — any federal changes to immunization schedules would require immediate operational, provider education, and quality measure adjustments across pediatric networks.
Senate Democrats released a policy blueprint proposing measures to lower prescription drug costs ahead of the midterm elections. The proposals aim to address voter concerns about drug affordability and provide a counter-message to White House voluntary pricing initiatives. The blueprint reflects ongoing bipartisan interest in drug pricing reform but does not specify legislative text, implementation timelines, or comment periods. For Medicaid managed care organizations, potential reforms could affect pharmacy benefit management, capitation rate calculations, and prescription drug rebate programs.
Why it matters for managed care
Drug pricing legislation could reshape Medicaid pharmacy benefit structures, rebate arrangements, and MCO capitation methodologies if any proposals advance to enacted law.
Medicare will begin covering weight loss medications starting next month through a program designed as temporary but expected to face political pressure for permanence. The coverage represents a significant policy shift for Medicare, which has historically excluded anti-obesity drugs from its formulary. The program's implementation comes as GLP-1 medications like Wegovy and Zepbound have demonstrated clinical efficacy for weight management but carry substantial cost implications. While positioned as temporary, the coverage expansion may prove difficult to reverse once beneficiaries begin accessing these medications.
Why it matters for managed care
While Medicare-specific, this coverage expansion could create precedent and political pressure for similar Medicaid coverage mandates, affecting managed care pharmacy budgets and utilization management strategies for high-cost weight management drugs.
CMS has issued a proposed rule to codify the Medicare Drug Price Negotiation Program and establish new policies for both the Negotiation Program and the Medicare Prescription Drug Benefit Program as required by the Inflation Reduction Act of 2022. The rule also proposes modifications to the fixed combination drug policy. The Negotiation Program allows Medicare to negotiate prices for certain high-cost drugs, which could affect formulary dynamics and pricing strategies for Medicare Advantage plans that include prescription drug coverage. The proposed rule sets the framework for how negotiated prices will be implemented and administered.
Why it matters for managed care
While this rule directly affects Medicare Part D plans, dual-eligible beneficiaries enrolled in Medicaid managed care plans may see pharmacy benefit coordination changes, and negotiated drug prices could create pressure for similar Medicaid supplemental rebate strategies.
The FDA approved Colorado's Section 804 importation program, allowing the state to import certain prescription drugs from Canada to reduce costs for residents. This marks the first operational approval under the 2020 FDA guidance that permits states to seek authorization for Canadian drug importation. The approval comes after years of state planning and federal review. Colorado must now finalize vendor contracts and operational logistics before importing drugs, with implementation timeline still uncertain.
Why it matters for managed care
This precedent-setting approval may prompt other states to pursue importation programs that could affect Medicaid pharmacy benefit design, formulary management, and pharmaceutical cost containment strategies for managed care organizations.
Rural communities face significant healthcare access barriers due to transportation fragmentation. The article argues for reframing transportation as critical healthcare infrastructure rather than an ancillary support service, requiring standardization and investment comparable to other care delivery components. This shift would establish consistent quality standards, accountability measures, and integration with care coordination systems. For Medicaid managed care organizations serving rural populations, this perspective highlights the need to elevate non-emergency medical transportation from administrative function to strategic infrastructure investment.
Why it matters for managed care
MCOs with rural service areas must evaluate whether their NEMT programs are structured as infrastructure capable of supporting care coordination, quality outcomes, and member retention, or whether fragmented transportation services undermine value-based care goals.
Missouri has eliminated Medicaid coverage for chiropractic services following state budget cuts, reversing a 2018 legislative expansion that added chiropractors as covered providers. The change affects access to non-opioid pain management services for Medicaid enrollees. The elimination comes despite earlier projections that chiropractic coverage would reduce overall Medicaid costs. The policy change takes effect immediately as part of broader Medicaid budget reductions.
Why it matters for managed care
Managed care organizations in Missouri must remove chiropractic services from covered benefits and may see increased utilization of more expensive pain management alternatives, including emergency department visits and opioid prescriptions.
Washington state faces litigation over budget cuts that reduced tens of millions in state funding for assisted living facilities serving Medicaid patients. Democratic lawmakers made the cuts to address a budget shortfall this year. The lawsuit challenges the state's decision to reduce payments to these facilities. The cuts affect assisted living providers that rely on Medicaid reimbursement for long-term care services.
Why it matters for managed care
State funding cuts to assisted living facilities can reduce provider network adequacy, force facility closures, and shift higher-acuity patients to managed care plans' responsibility for alternative placement or higher-cost institutional care.
A KFF analysis published in The Milbank Quarterly documents how state-level policy decisions create significant variation in reproductive healthcare access across the United States. The research examines state choices on contraception coverage, abortion restrictions, and maternal health programs that directly affect Medicaid beneficiaries. State policy differences impact managed care organizations' benefit design, network requirements, and care coordination obligations. The analysis highlights how states' Medicaid program structures and regulatory frameworks shape reproductive health service delivery and access for MCO enrollees.
Why it matters for managed care
State policy variation on reproductive health directly affects MCO benefit design, provider network adequacy requirements, and utilization management protocols for pregnancy-related and family planning services.
Multiple states are introducing legislation affecting immigrants' access to state-funded health coverage and services during the 2025-2026 legislative sessions. The actions include both expansions and restrictions to coverage eligibility, with direct implications for Medicaid and CHIP programs that serve immigrant populations. Changes vary by state and may affect enrollment, eligibility verification processes, and state budget obligations. Medicaid managed care organizations should monitor state-level developments that could alter their member demographics, revenue streams, and compliance requirements for serving immigrant populations.
Why it matters for managed care
State legislative changes to immigrant eligibility directly affect MCO enrollment volumes, capitation revenue, network capacity planning, and compliance with evolving state contract requirements for serving diverse populations.
Express Scripts and the Pharmaceutical Care Management Association filed lawsuits challenging Tennessee's FAIR Rx Act, which mandates the separation of pharmacy benefit managers from retail pharmacies. The law, passed earlier this year over strong PBM industry opposition, aims to prevent vertical integration practices that critics argue drive up drug costs and limit pharmacy access. The litigation follows similar legal action by CVS Caremark. The outcome will affect how Medicaid managed care plans structure pharmacy benefits and contract with PBMs in Tennessee and potentially influence similar legislative efforts in other states.
Why it matters for managed care
Most Medicaid MCOs contract with national PBMs for pharmacy benefits management, and vertical integration restrictions could force contract restructuring, affect pharmacy network adequacy requirements, and alter drug pricing arrangements.
A federal judge on Friday vacated the majority of CMS's 2025 ACA enrollment and eligibility rule, delivering a win for insurance advocates who challenged the regulation. The vacated provisions included controversial changes to enrollment processes and eligibility verification requirements. However, many of the rule's provisions have been incorporated into the GOP's reconciliation bill currently moving through Congress, limiting the practical impact of the court decision. The ruling does not affect state-based marketplaces or Medicaid operations directly.
Why it matters for managed care
Medicaid MCOs operating in dual-eligible or marketplace-adjacent programs should monitor whether state Medicaid agencies adopt similar enrollment or verification policies that were part of the vacated federal rule.
Centene Corporation confirmed it is offering a voluntary separation program to most employees as part of a broader repositioning effort. The managed care giant stated the program aims to deliver a simpler experience for members and partners while adapting to current healthcare market conditions. The announcement affects Centene's workforce across its health plan operations, though specific numbers of affected employees and program details were not disclosed. The timing follows industrywide pressure on managed care margins and administrative cost reduction initiatives.
Why it matters for managed care
As the nation's largest Medicaid managed care organization, Centene's workforce restructuring may signal broader cost pressures facing Medicaid MCOs and could affect state contract execution, member services, and provider network management.
Elevance Health has outlined three strategic priorities for artificial intelligence deployment: simplifying member interactions, improving provider workflows, and enabling employees to access timely information. The health plan is integrating AI tools across its operations to enhance user experience and operational efficiency. These initiatives reflect broader industry investment in technology to manage administrative burden and member engagement. The timeline and specific implementation details were not disclosed.
Why it matters for managed care
Elevance's AI strategy signals where major health plans are directing technology investment, which may influence competitive positioning, vendor partnerships, and expectations for how managed care organizations deploy automation to reduce administrative costs and improve HEDIS and star ratings outcomes.