Federal Policy
6Federal Policy·1:01 PM MT
CMS published the 2027 Physician Fee Schedule proposed rule on July 16, proposing to make 340B claims data reporting mandatory for covered entities participating in Medicare Part D, converting what was previously a voluntary submission. The proposal would require 340B covered entities to submit Part D claims data to the Medicare Part D Claims Data 340B Repository starting in 2027. This change affects hospitals, federally qualified health centers, and other 340B covered entities that dispense drugs under Medicare Part D, requiring new compliance infrastructure and potentially increasing administrative burden for entities that have not voluntarily reported to date.
Why it mattersMandatory 340B reporting creates new compliance obligations for Medicaid managed care organizations and providers operating 340B programs, particularly those that have avoided voluntary reporting and may lack the data systems to meet CMS requirements.
Federal Policy·1:00 PM MT
The HHS Office of Inspector General has initiated an audit examining whether the Department of Health and Human Services has established adequate governance for developing and deploying artificial intelligence tools across its operations. The audit will assess compliance with federal requirements, including National Institute of Standards and Technology AI risk management standards and departmental policies. The review covers AI governance structures affecting HHS agencies including CMS. The audit's scope and timeline for completion have not been publicly specified.
Why it mattersThe audit may influence how CMS implements AI tools in Medicaid program integrity, eligibility systems, and managed care oversight, potentially leading to new compliance requirements for state agencies and health plans using AI-driven administrative systems.
Federal Policy·7:01 AM MT
On July 1, 2026, CMS proposed enrollment-related policy changes under the Home Health Prospective Payment System aimed at reducing improper Medicare payments and protecting beneficiaries. The proposed rule introduces new enrollment requirements and fraud deterrence measures for home health providers. While the rule targets Medicare home health providers, states with Medicaid home health programs or 1915(c) waiver programs providing home and community-based services may see similar enrollment standards adopted or referenced in future Medicaid guidance. CMS has not specified a comment deadline or effective date in the summary provided.
Why it mattersStates with Medicaid LTSS or HCBS waiver programs often align provider enrollment standards with Medicare requirements, and new fraud controls may inform future Medicaid compliance expectations for home health agencies.
Federal Policy·7:00 AM MT
CMS published its quarterly compilation of manual instructions, regulations, and Federal Register notices issued between April and June 2026 for Medicare, Medicaid, and other CMS-administered programs. This is a routine administrative notice that compiles previously issued guidance and rulemakings from the quarter into a single reference document. The listing provides a consolidated index of policy issuances for stakeholders tracking program changes. This quarterly publication serves as an administrative record and reference tool rather than announcing new policy.
Why it mattersThis compilation helps state Medicaid agencies and managed care plans track what guidance and rules CMS issued during Q2 2026, though it contains no new policy itself.
Federal Policy·1:01 PM MT
CMS proposed removing 638 procedures from the Medicare Inpatient Only List in the CY 2027 OPPS/ASC Proposed Rule, effective January 1, 2027. This follows removal of 285 procedures in CY 2026. The broader scope includes surgical services beyond the 2026 focus on musculoskeletal procedures. The removals affect whether procedures must be performed in inpatient settings or can shift to outpatient settings under Medicare payment rules.
Why it mattersMedicaid managed care plans that follow Medicare payment methodologies or use Medicare's IPO List for prior authorization criteria will need to update utilization management protocols and network adequacy assessments as services shift from inpatient to outpatient settings.
Federal Policy·1:00 PM MT
ACA Marketplace enrollment declined nationwide in 2026 for the first time in seven years following the expiration of temporary enhanced premium tax credits, with all states except New Mexico experiencing enrollment losses. Enrollment fell 15% on the federal marketplace (HealthCare.gov), while state-based marketplaces saw smaller declines averaging 6%, particularly in states that partially offset the federal subsidy loss with state funds. The enhanced subsidies, which had driven enrollment growth since their introduction, expired at the end of 2025.
Why it mattersLower marketplace enrollment may increase Medicaid churn and enrollment as subsidy-eligible individuals lose affordable coverage options and potentially qualify for Medicaid instead, affecting state program costs and managed care plan enrollment.
State Policy
4State Policy·IN·1:00 PM MT
Indiana received CMS approval to implement a statewide provider certification and enrollment moratorium for multiple Home- and Community-Based Services (HCBS) 1915(c) waiver provider types. The moratorium takes effect August 1, 2026, and will initially remain in place for six months. The action halts new HCBS provider certifications and enrollments across Indiana's waiver programs during this period. Indiana Medicaid managed care organizations will be unable to contract with new HCBS providers in the affected categories while the moratorium is in effect, potentially limiting network expansion and member access to services.
Why it mattersMCOs operating Indiana HCBS waivers must immediately halt new provider contracting in affected categories, requiring network adequacy contingency planning and potential member access mitigation strategies during the six-month freeze.
State Policy·GA·7:01 AM MT
Georgia's proposed Medicaid work requirement does not include HIV on its list of conditions qualifying beneficiaries as medically frail, meaning low-income Georgians living with HIV would need to meet work requirements to maintain coverage. The proposal is still under consideration by state officials. Advocates are questioning the exclusion, which could affect eligibility for vulnerable populations. The decision stands in contrast to other states that have included HIV in medically frail definitions for work requirement waivers.
Why it mattersState decisions on medically frail criteria directly determine which beneficiaries face work requirements versus exemptions, affecting coverage continuity for chronic condition populations and MCO enrollment stability.
State Policy·NM·1:01 PM MT
New Mexico Department of Health reported that its 2022 Medicaid postpartum coverage extension doubled medical visits among new mothers, according to preliminary evaluation results. The extension, implemented in 2022, expanded postpartum Medicaid coverage beyond the standard 60-day period. State officials cite the increased utilization as evidence the policy may help reduce maternal mortality. The evaluation is ongoing and final results have not been released.
Why it mattersThe doubling of postpartum visits demonstrates that extending Medicaid coverage beyond 60 days drives measurable increases in care utilization, providing data points for other states weighing similar maternal health extensions under the American Rescue Plan Act option.
State Policy·AL·7:01 AM MT
Former U.S. Senator Doug Jones, now the Democratic nominee for Alabama governor, delivered a policy speech Monday calling for Medicaid expansion alongside other reforms including a lottery vote and broader government participation measures. The speech outlined what Jones described as 'three real opportunities' for Alabamians, with Medicaid expansion positioned as part of his health policy agenda. Alabama remains one of the states that has not expanded Medicaid under the Affordable Care Act. The policy positions represent a traditional Democratic platform in a state where Medicaid expansion has faced consistent Republican opposition.
Why it mattersAlabama's gubernatorial election could determine whether the state joins Medicaid expansion, affecting coverage for an estimated 300,000 low-income adults and bringing significant federal funding to hospitals and health plans.