Daily Briefing, 2026-06-17 | Medicaid Monitor

The complete record

12 stories, Wednesday, June 17, 2026

Federal Policy

HHS Announces $708 Million in Behavioral Health Funding Opportunities

HHS Secretary Robert F. Kennedy, Jr. announced $708 million in new funding opportunities for behavioral health programs, including $96 million for the STREETS (Safety Through Recovery, Engagement, and Evidence-based Treatment and Support) program targeting mental illness, addiction, and homelessness, plus $612 million for additional behavioral health initiatives. The funding opportunities are now posted and available for application. This represents significant new federal investment in community-based behavioral health infrastructure and services that Medicaid managed care organizations often coordinate or deliver.

Why it mattersThese federal grants will fund behavioral health services and infrastructure that MCOs typically integrate into their networks, creating opportunities for partnership and potentially shifting service delivery models in states that receive awards.

USSAMHSA1:30 PM MT

Behavioral Health · Managed Care

FDA Approves Third Over-the-Counter Naloxone Nasal Spray

The FDA approved Rextovy, a 4mg naloxone nasal spray, for over-the-counter sale in pharmacies, convenience stores, and online for emergency treatment of opioid overdose. This is the third OTC naloxone product approved by FDA. The approval expands consumer access to overdose reversal medication without a prescription. For Medicaid managed care organizations, this may affect pharmacy benefit management, member education strategies, and harm reduction program design, particularly for plans serving populations with substance use disorders.

Why it mattersIncreased OTC naloxone availability may shift dispensing patterns, require updates to formulary management and prior authorization protocols, and create new opportunities for MCO-led overdose prevention initiatives.

USThe Hill7:30 AM MT

Behavioral Health · Pharmacy · Managed Care

Uninsured Population Grew in 2024, First Increase Since 2019

The number and share of Americans without health insurance increased in 2024, marking the first rise since 2019, according to KFF's analysis of American Community Survey data. The growth in uninsured individuals follows the end of Medicaid continuous enrollment protections that expired in March 2023, resulting in millions of eligibility redeterminations across states. The increase reverses a five-year trend of declining uninsurance rates and signals potential coverage losses that disproportionately affect low-income populations eligible for Medicaid. This shift has immediate implications for uncompensated care costs and emergency department utilization that MCOs and safety-net providers must absorb.

Why it mattersRising uninsured rates following Medicaid unwinding indicate MCOs face shifting enrollment patterns, increased churn, and potential uncompensated care exposure as previously covered populations lose eligibility or fail to reenroll.

USKFF Research7:30 AM MT

Managed Care · Finance

Managed Care

3 storiesManaged Care section →

Medicaid MCOs Prepare for 2027 Community Engagement Requirements Under HR 1

The Reconciliation Act (HR 1) established community engagement requirements for non-elderly, nonpregnant Medicaid adults effective 2027. CMS has released an implementation framework detailing how states must operationalize work requirements for beneficiaries aged 19-64. Health plans cannot contract directly with states to administer these requirements, but managed care organizations are developing member engagement and support strategies to maintain enrollment and help beneficiaries comply. The requirements will affect eligibility determination, member outreach, and care coordination workflows across Medicaid MCOs.

Why it mattersMedicaid MCOs must redesign member engagement strategies, care coordination processes, and reporting systems to support beneficiaries in meeting community engagement requirements while managing potential enrollment volatility and revenue impact starting in 2027.

USBecker's7:30 AM MT

Managed Care

National Survey Finds Medicaid Patients Report Worse Pregnancy Outcomes Than Privately Insured

A nationwide survey of over 3,800 people who gave birth in 2023-2024 found Medicaid enrollees reported worse pregnancy and delivery outcomes compared to those with private insurance. The Listening to Mothers survey documented limited access to care, with pregnant Medicaid patients frequently reporting feeling unheard and disregarded during pregnancy and labor. The findings highlight persistent quality and access gaps in maternal care delivery for Medicaid-covered pregnancies. Survey results reflect care delivered across 2023-2024.

Why it mattersThese findings expose quality and patient experience gaps that directly affect managed care star ratings, HEDIS maternal health measures, and state contract performance requirements for MCOs covering pregnant enrollees.

USstateline.org1:30 PM MT

Maternal · Managed Care

CDC Reports Infant Mortality Rate Falls to Record Low in 2025

The CDC's National Vital Statistics System reported that infant mortality rates in the United States reached an all-time low in 2025, based on provisional death and birth data. The infant mortality rate measures deaths under age one per 1,000 live births. Final figures will be released later this year. The decline continues a multiyear trend in improved birth outcomes, though racial and geographic disparities persist.

Why it mattersDeclining infant mortality affects maternal and child health quality measures, HEDIS scores, and performance-based payments tied to birth outcomes in Medicaid managed care contracts.

USBecker's1:31 PM MT

Maternal · Managed Care

State Policy

2 storiesState Policy section →

Connecticut Faces Loss of 110,000 Adult Medicaid Enrollees

Connecticut anticipates approximately 110,000 low-income adults could lose Medicaid coverage, prompting state officials to develop strategies to prevent increased uninsured emergency department utilization. The coverage losses stem from ongoing Medicaid redeterminations following the end of continuous enrollment protections. State officials are working to transition affected enrollees to alternative coverage options and prevent gaps in care. The unwinding creates operational challenges for Connecticut managed care organizations managing member retention and care continuity.

Why it mattersConnecticut MCOs face significant enrollment volatility and must implement retention strategies, coordinate with alternative coverage pathways, and prepare for increased emergency department utilization as members lose coverage.

CTctmirror.org7:30 AM MT

Managed Care · Finance

Tennessee Pharmacies Dispense High-Dose Ivermectin Under Standing Order Law

Since Tennessee enacted the nation's first law in 2021 allowing pharmacies to sell ivermectin without patient-specific prescriptions, dozens of pharmacies now dispense highly concentrated ivermectin pills under standing orders, many facilitated by a single anti-vaccine physician. The law permits pharmacies to dispense prescription drugs through protocol agreements with physicians rather than individual patient prescriptions. This arrangement allows pharmacies to sell potent formulations of ivermectin directly to consumers under medical standing orders, bypassing traditional prescribing requirements.

Why it mattersMedicaid MCOs in Tennessee must manage pharmacy benefit exposure and utilization management protocols for ivermectin dispensed under standing orders, which may increase inappropriate utilization and pharmacy spending outside normal prior authorization controls.

TNKFF Health News7:31 AM MT

Pharmacy · Managed Care

Legal

3 storiesLegal section →

DOJ Sues New York DOH and PPL Over CDPAP Fiscal Intermediary Fraud Allegations

The U.S. Department of Justice filed a lawsuit Tuesday against the New York Department of Health and Public Partnerships LLC (PPL), alleging fraud in the state's transition of the Consumer Directed Personal Assistance Program (CDPAP) to a single fiscal intermediary. DOJ claims the arrangement was designed to extract millions from New York's Medicaid program through improper payments. The lawsuit targets both the state agency that selected PPL and the fiscal intermediary itself. CDPAP allows Medicaid beneficiaries to direct their own long-term care services, with fiscal intermediaries handling payroll and administrative functions.

Why it mattersManaged care organizations operating in New York with CDPAP members or LTSS contracts face potential operational disruption, increased federal scrutiny of fiscal intermediary arrangements, and possible retroactive claims adjustments if DOJ prevails.

NYHome Health Care News7:30 AM MT

LTSS · Managed Care

Olmstead Decision Marks 27 Years as Community Integration Faces Medicaid Budget Threats

The 27th anniversary of Olmstead v. L.C. arrives as the landmark Supreme Court decision establishing the right to community-based services faces new challenges from proposed Medicaid cuts. The 1999 ruling required states to provide services in the most integrated setting appropriate to individuals' needs, fundamentally reshaping long-term services and supports delivery through Medicaid managed care. Current budget proposals threaten funding for home and community-based services that emerged from Olmstead's community integration mandate, potentially reversing decades of progress in moving individuals out of institutional settings.

Why it mattersOlmstead remains the legal foundation for HCBS programs that many Medicaid MCOs administer, and proposed federal cuts could force plans to revisit institutional versus community-based care models with significant network and service delivery implications.

USNational Health Law1:31 PM MT

LTSS · Managed Care

Legal Aid Groups Convene on Medicaid Cuts and Automated Eligibility Denials

Legal advocates gathered at the ABA/NLADA Equal Justice Conference in Charlotte to address threats to Medicaid from proposed federal budget cuts and automated eligibility systems. The National Health Law Program highlighted concerns about the One Big Beautiful Bill Act, which proposes significant Medicaid spending reductions, and automated systems that are denying coverage to eligible beneficiaries. The conference focused on legal strategies to protect Medicaid access and eligibility processes. No specific implementation dates or regulatory actions were announced.

Why it mattersAdvocacy efforts against federal budget cuts and automated eligibility challenges could influence future Medicaid managed care enrollment levels, revenue stability, and compliance requirements for eligibility redeterminations.

USNational Health Law1:31 PM MT

Managed Care · Finance

Industry

1 storyIndustry section →

Seven Rural Kansas Hospitals Form Clinically Integrated Network

Seven independent rural hospitals in Kansas have formed the Kansas High Value Network, a clinically integrated network serving approximately 190,000 patients. The founding member hospitals represent a combined net revenue of $545 million. The network aims to support value-based care delivery and reduce purchasing costs through collective contracting and operational coordination. The formation reflects broader consolidation trends among rural providers seeking scale to participate in value-based payment arrangements.

Why it mattersRural provider consolidation through clinically integrated networks can affect MCO network adequacy, contract negotiations, and value-based care implementation in rural Kansas markets.

KSBecker's1:31 PM MT

Managed Care