A KFF Health Tracking Poll released July 16, 2026, shows that 55% of Republican voters consider addressing fraud in government health programs, including Medicaid and Medicare, extremely important for candidates in the 2026 midterms. Most voters perceive at least some fraud in government health programs, though voters report higher fraud concerns in the tax system, defense, and foreign aid. The poll indicates health care costs remain the top health priority overall. The findings suggest fraud and program integrity messaging may gain prominence in congressional campaigns as midterm elections approach.
Why it mattersHeightened voter concern about Medicaid fraud signals potential for increased congressional and state-level scrutiny of MCO claims audits, provider network screening, and program integrity reporting requirements post-election.
Managed Care · Finance
Two Trump administration health nominees—Erica Schwartz for CDC Director and Sean Kaufman for an HHS position—faced Senate scrutiny on July 15, 2026, over their willingness to challenge administration positions on vaccines. Both Democrats and some Republicans expressed concern about the nominees' reluctance to break with administration policy. The hearing centered on whether the nominees would maintain agency independence on vaccine policy and public health guidance. Confirmation votes have not been scheduled.
Why it mattersCDC leadership changes affect Medicaid managed care organizations through VFC program oversight, immunization quality metrics in managed care contracts, and federal vaccination guidance that shapes HEDIS measures and state MCO performance requirements.
Managed Care
The Centers for Medicare & Medicaid Services has released the 2027 Notice of Benefit and Payment Parameters (NBPP). The NBPP sets annual requirements for qualified health plans offered through the ACA marketplaces, including actuarial value standards, cost-sharing limits, and payment methodologies. While the NBPP primarily governs marketplace plans, provisions may affect Medicaid managed care organizations that operate dual marketplace and Medicaid lines of business, particularly regarding quality measurement alignment, rating approaches, and administrative standards. The final rule typically takes effect for the plan year beginning January 1, 2027.
Why it mattersMCOs operating both marketplace and Medicaid plans must assess whether quality reporting, actuarial, or network adequacy provisions in the NBPP create operational or compliance alignment opportunities or conflicts across product lines.
Managed Care
Six health plan trade associations, including MHPA and ACHP, jointly urged Congress to extend funding for the Affordable Connectivity Program (ACP), which provides broadband subsidies to low-income households. The program's funding is set to expire, threatening internet access for eligible Medicaid beneficiaries. The associations argue that loss of broadband connectivity would undermine telehealth access, care coordination, and health plan communications with members. Congressional action is needed to continue the subsidy program.
Why it mattersACP expiration would eliminate broadband subsidies for millions of Medicaid enrollees, directly impacting MCO telehealth utilization, member engagement strategies, and care management workflows that depend on digital connectivity.
Managed Care
The American Hospital Association submitted comments July 15 responding to a CMS request for information on potential modifications to the Affordable Care Act's Essential Health Benefits framework. AHA supported updating EHBs to reflect changes in healthcare delivery but warned against changes that would reduce coverage adequacy. The association emphasized that affordability requires adequate benefits, not just lower premiums, and cautioned that reduced benefits, narrower standards, or increased cost-sharing would increase patient financial exposure. CMS is reviewing the EHB framework, which establishes minimum coverage requirements for comprehensive insurance.
Why it mattersAny CMS modifications to Essential Health Benefits standards would affect benchmark plans that many state Medicaid programs use to define alternative benefit packages for expansion populations, potentially requiring managed care organizations to adjust covered services and prior authorization protocols.
Managed Care
The Centers for Medicare and Medicaid Services has proposed significant changes to how it pays for remote patient monitoring (RPM) and clinical artificial intelligence tools. The proposal would restructure payment models for these technologies under Medicare. The changes affect how health plans and providers bill for AI-enabled clinical decision support and remote monitoring services. CMS has opened the proposal for public comment, with implementation timing to be determined following the comment period.
Why it mattersPayment model changes in Medicare often signal future Medicaid policy direction, particularly for managed care organizations investing in digital health infrastructure and value-based care arrangements that rely on RPM and AI tools.
Managed Care
The Centers for Medicare & Medicaid Services announced plans to develop a standardized payment framework for clinical software and artificial intelligence tools that incorporates patient outcome measures. The proposed structure would establish consistent reimbursement methodology across Medicare and Medicaid for digital health technologies currently paid through fragmented billing codes or bundled into other services. CMS has not specified an implementation timeline or comment period. For Medicaid managed care organizations, this signals potential changes to how digital therapeutics, clinical decision support tools, and AI-driven care management platforms are covered and reimbursed under capitated arrangements.
Why it mattersMedicaid MCOs will need to assess how standardized software and AI payment structures affect capitation rate adequacy, prior authorization workflows, and existing value-based care contracts that incorporate digital health tools.
Managed Care
Acting Attorney General Todd Blanche told Republican senators he will prioritize stopping abortion medication from being mailed to patients if confirmed. Blanche specifically opposes the Biden-era policy that permitted mail distribution of mifepristone but did not detail enforcement mechanisms or timeline. The commitment signals potential federal action against telehealth abortion services and mail-order pharmacy dispensing of medication abortion. Any DOJ enforcement action could affect Medicaid managed care plans that cover telehealth reproductive services and pharmacy benefits including mifepristone.
Why it mattersFederal restrictions on mailing mifepristone could require Medicaid MCOs to revise pharmacy networks, update prior authorization protocols, and modify telehealth abortion coverage policies to ensure compliance with new distribution requirements.
Managed Care · Maternal · Pharmacy