Federal Policy
4Federal Policy·1:31 PM MT
The Centers for Medicare and Medicaid Services will host a webinar on July 9, 2026 from 12-1 p.m. ET to discuss an interim final rule on Medicaid community engagement requirements. The webinar follows CMS's issuance of new federal regulations governing work and community engagement provisions in state Medicaid programs. The session will provide technical guidance on the rule's implementation requirements and compliance expectations. Managed care organizations operating in states pursuing community engagement waivers will need to understand reporting, enrollment, and member communication obligations under the new federal framework.
Why it matters for managed careMCOs in states with active or pending community engagement waivers must understand federal reporting requirements, member notification protocols, and disenrollment protections to ensure contract compliance and avoid federal disallowances.
Federal Policy·WA·7:30 AM MT
CMS will launch the WISeR (Worthy of Individual Systematic Exemption and Review) gold-carding exemption program on July 6, 2026, in Washington state, with quarterly rollouts planned for five additional states. The program exempts certain high-performing providers from prior authorization requirements based on performance metrics. Medicaid managed care organizations operating in Washington and the subsequent rollout states will need to implement gold card criteria and modify prior authorization workflows. The initiative aims to reduce administrative burden for providers with strong approval track records while maintaining utilization management oversight for other providers.
Why it matters for managed careMedicaid MCOs in participating states must redesign prior authorization systems, update provider communications, and ensure compliance with new gold card exemption criteria while maintaining appropriate utilization controls.
Federal Policy·7:31 AM MT
The Georgetown University Center for Children and Families held a webinar on June 30, 2026 covering foundational Medicaid financing concepts. The session explained the federal-state partnership structure, mandatory federal funding not subject to annual appropriations, and state financing mechanisms for their matching share. The webinar targeted audience members seeking to understand basic Medicaid funding mechanics. A recording will be made available on Georgetown's website.
Why it matters for managed careThis educational resource provides foundational knowledge on Medicaid financing structure that informs how managed care organizations understand capitation funding flows and state budget constraints.
Federal Policy·7:30 AM MT
The American Hospital Association submitted comments June 30 to the House Ways and Means Committee opposing H.R. 9504, the Tax-Exempt Hospital Transparency Act, ahead of a scheduled July 1 markup. The bill would add reporting requirements to hospitals' Schedule H IRS forms, affecting nearly two-thirds of all hospitals. While the AHA acknowledged improvements from an earlier draft — including removal of a parallel for-profit tax calculation and inclusion of standardized definitions — it maintains serious concerns about administrative and financial burdens, particularly requirements focused on financial assistance reporting that exclude Medicaid shortfall and other community benefit components. The bill includes carve-outs for small facilities but still requires eventual compliance.
Why it matters for managed careMedicaid managed care organizations contracting with safety-net hospitals should monitor this legislation because increased IRS reporting burdens on tax-exempt hospitals could affect their financial viability and willingness to participate in Medicaid networks, particularly for smaller facilities already operating on tight margins.
State Policy
5State Policy·NJ·7:30 AM MT
New Jersey lawmakers approved legislation imposing fees on employers with at least 50 workers enrolled in Medicaid, projected to generate $145 million in state revenue. The fee targets companies whose employees rely on public coverage, effectively shifting costs to employers for their workforce's health benefits. The measure now heads to the governor for signature. This represents a novel state financing mechanism that could affect Medicaid managed care enrollment patterns and employer benefit decisions.
Why it matters for managed careThe employer fee could drive benefit design changes that shift workers from Medicaid managed care plans to commercial coverage, affecting MCO membership mix and risk profiles.
State Policy·WI·7:30 AM MT
Wisconsin's 12-month postpartum Medicaid coverage extension becomes effective July 1, 2026, extending coverage from the previous 60-day limit. The state became the 49th to adopt the extension when legislation was signed in March 2026. The Wisconsin Department of Health Services estimates the policy will provide continuous coverage to approximately 16,000 mothers annually. The extension addresses maternal health outcomes and coverage continuity for postpartum enrollees in Wisconsin's Medicaid program, including managed care plans.
Why it matters for managed careWisconsin Medicaid MCOs must implement 12-month postpartum coverage immediately, affecting member attribution, risk adjustment, and care coordination protocols for an estimated 16,000 postpartum members annually.
State Policy·MT·7:30 AM MT
Montana's health department has not hired the staff needed to review work requirement applications and lacks access to claims data required to verify medical exemptions as implementation approaches. The state only recently identified qualifying diagnoses for exemptions. These operational gaps raise questions about the state's readiness to administer work requirements without inappropriate coverage losses. The timing and specific effective date are not specified in the available content.
Why it matters for managed careMCOs operating in Montana will need to coordinate with an unprepared state system on member eligibility verification, exemption documentation, and potential coverage transitions as work requirements take effect.
State Policy·CA·7:31 AM MT
Five years after Governor Gavin Newsom launched an initiative to center mental health services in California public schools, many schools have struggled to implement the program and hundreds have not yet begun participation. The initiative aimed to transform schools into hubs for youth mental health services, but implementation challenges have delayed rollout across the state. The slow adoption affects access to behavioral health services for Medicaid-eligible children who rely on school-based care. No specific timeline for expanded implementation was reported.
Why it matters for managed careDelayed school-based mental health implementation affects Medicaid managed care organizations' ability to coordinate behavioral health benefits and may increase demand for community-based services as school capacity lags.
State Policy·WA·7:30 AM MT
Washington's WA Cares Fund, the nation's first publicly administered long-term care insurance program, begins providing coverage on July 1, 2026. The program offers eligible workers up to $36,500 in lifetime benefits for long-term services and supports, funded through a 0.58% payroll tax. Dozens of applications have already been submitted. The launch follows years of legislative debate and program delays since the payroll tax collection began in 2023.
Why it matters for managed careWashington MCOs must understand how WA Cares benefits interact with Medicaid LTSS eligibility and coverage, particularly regarding spend-down requirements and coordination of benefits for dual-eligible populations.