CMS issued a proposed rule on July 21, 2026, implementing two of three provider tax restrictions from H.R. 1, which limits states' ability to use provider taxes to finance their Medicaid share. The rule prohibits new provider taxes and increases in existing taxes. This affects state Medicaid financing strategies and budget planning, with implications for how states fund their programs and potential pressure on state general funds. The proposal will proceed through standard notice-and-comment rulemaking.
Why it mattersThis rulemaking constrains a core state Medicaid financing mechanism, forcing state agencies to identify alternative revenue sources or reduce program spending.
Finance
The Centers for Medicare & Medicaid Services has proposed a new process requiring hospitals to submit provider-based attestations for off-campus hospital outpatient departments, converting what was previously a voluntary submission into a mandatory requirement. The proposed rule establishes a compliance framework for hospitals operating off-campus HOPDs under provider-based status. CMS has not specified an effective date or comment deadline in the available information. This change affects hospitals billing Medicare and Medicaid for services delivered at off-campus locations under provider-based arrangements, requiring new administrative processes to maintain compliance and avoid potential payment denials.
Why it mattersMandatory attestation requirements will impose new administrative burdens on hospitals with off-campus sites and could affect Medicaid reimbursement if attestations are not submitted or if facilities lose provider-based status.
Managed Care · Finance
The Health Resources and Services Administration's Rural Maternity and Obstetrics Management Strategies Program (RMOMS) improved prenatal and postpartum care access for more than 8,600 women through networks in Minnesota, Missouri, and West Virginia, according to a 2026 program report covering the second cohort. The program addresses maternal care gaps in rural areas where provider shortages and hospital closures limit access to obstetric services. RMOMS networks coordinate care across providers, implement telehealth, and expand midwifery services to maintain maternal health infrastructure in underserved communities. For Medicaid agencies and managed care organizations covering rural populations, the program demonstrates models for sustaining maternal care capacity where traditional hospital-based delivery is no longer viable.
Why it mattersMedicaid covers approximately 42% of all births nationally and a higher share in rural areas where RMOMS operates, making federal maternal health infrastructure investments directly relevant to state Medicaid program design, MCO network adequacy obligations, and value-based maternity care contracting in underserved regions.
Maternal
The Department of Health and Human Services filed an appeal to reinstate portions of a 2025 Affordable Care Act rule that a federal judge invalidated in June 2026. The invalidated provisions include shortened enrollment periods and stricter eligibility verification requirements for marketplace coverage. The appeal seeks to restore these requirements, which originally applied to ACA marketplace plans beginning with the 2026 plan year. The outcome affects marketplace operations and enrollment procedures, with potential implications for Medicaid-marketplace coordination on eligibility determinations and transitions between coverage types.
Why it mattersThe appeal affects how state Medicaid agencies coordinate eligibility determinations with marketplace exchanges, particularly for individuals transitioning between Medicaid and subsidized marketplace coverage during modified enrollment windows.
Managed Care
The FDA and physicians are expressing concern about compounded versions of GLP-1 drugs like Ozempic, which patients are increasingly using as cheaper, more accessible alternatives. These compounded formulations, while easier to obtain, carry serious safety risks according to medical experts. The issue affects Medicaid beneficiaries who may turn to compounded versions due to cost or access barriers with brand-name GLP-1s. This raises questions for state Medicaid programs about coverage policies, prior authorization criteria, and quality oversight for diabetes and weight management drugs.
Why it mattersState Medicaid agencies and managed care plans must balance beneficiary access to GLP-1 therapies against safety concerns about compounded alternatives, with potential implications for pharmacy benefit design, prior authorization protocols, and member education.
Pharmacy · Managed Care