Federal Policy
6Federal Policy·6:00 AM MT
CMS issued a final rule prohibiting federal Medicaid and CHIP matching funds for gender-affirming care for minors, including puberty blockers, hormone therapy, and related surgeries such as mastectomies. The rule takes effect October 13, 2026. States will no longer receive federal financial participation for these services furnished to children enrolled in Medicaid or CHIP. The policy represents a federal prohibition on a category of care previously covered under state Medicaid programs' Early and Periodic Screening, Diagnostic and Treatment benefit and other authorities.
Why it mattersState Medicaid agencies must immediately revise benefits, notify affected enrollees, terminate or modify managed care contracts covering these services, and prepare for potential litigation and coverage continuity challenges by October 13.
Federal Policy·12:00 PM MT
Brookings Institution researchers have publicly criticized the data and assumptions CMS used to support its Medicaid work requirements rule, which imposed stricter documentation standards for enrollees claiming medical exemptions from work mandates. The rule, already facing litigation, required beneficiaries to provide more extensive proof of illness or disability to qualify for exemptions than stakeholders anticipated. The Brookings critique alleges CMS misrepresented or manipulated data to justify the policy. This matters because if the agency's analytical foundation is undermined, courts may be more likely to vacate the rule, and CMS may face pressure to withdraw or revise the policy.
Why it mattersIf courts find CMS relied on flawed data, the work requirements rule could be vacated, forcing states and MCOs to halt implementation and unwind exemption verification processes already in place.
Federal Policy·MA·6:01 AM MT
Massachusetts is mailing notices to MassHealth members this week informing them of federal eligibility requirement changes and actions needed to maintain coverage. Governor Healey characterized the federal requirements as burdensome. The notices aim to help members understand how the changes affect them and what steps they must take to avoid coverage loss. The campaign reflects state efforts to minimize enrollment disruption from new federal compliance mandates.
Why it mattersState agencies nationwide face similar member communication challenges when federal eligibility rules change, making Massachusetts' approach relevant for other states navigating federal compliance while protecting enrollment.
Federal Policy·2:15 PM MT
CMS issued an advisory requiring certain alternative payment model participants to update taxpayer identification numbers by October 13, 2026, to receive APM incentive payments for the 2026 payment year based on 2024 performance. The agency could not identify valid TINs for some participants after processing payments. Clinicians who fail to submit updated billing information by the deadline will forfeit their APM incentive payments for this payment period.
Why it mattersMedicaid managed care organizations with value-based payment arrangements tied to APM participation need to verify that participating providers update their billing information to avoid forfeited payments that could undermine shared savings calculations and provider engagement.
Federal Policy·10:41 AM MT
On August 7, 2024, CMS issued a notice with comment period proposing the Regulatory Alignment for Predictable and Immediate Device (RAPID) Coverage Pathway. The pathway would accelerate Medicare coverage for medical devices receiving FDA breakthrough designation by aligning CMS coverage review with FDA premarket review before market authorization. The proposal aims to reduce the gap between FDA approval and Medicare coverage determinations for qualifying devices. Comments are due following standard notice procedures.
Why it mattersThis pathway could accelerate Medicaid access to innovative medical devices in states that follow Medicare coverage policies or reference Medicare determinations in their own coverage frameworks.
Federal Policy·6:00 AM MT
A March of Dimes report finds that 5.8 million women live in counties without full access to maternity care, with one-third of U.S. counties classified as maternity care deserts — areas lacking hospitals or birth centers offering obstetric services. The report highlights geographic disparities in prenatal and delivery care access nationwide. These gaps affect Medicaid-covered pregnancies, as Medicaid finances approximately 42% of births nationally and faces network adequacy and provider participation challenges in underserved areas.
Why it mattersStates and managed care plans must address maternity care network gaps to meet federal access standards and improve maternal health outcomes for Medicaid beneficiaries, who represent the largest payer source for births.
State Policy
7State Policy·WV·12:01 PM MT
West Virginia's Medicaid work and volunteer requirements will take effect January 1, 2027, according to a briefing to state lawmakers by the Department of Human Services. An initial analysis found approximately 33,000 current Medicaid beneficiaries are neither meeting the federal work or volunteer requirements nor automatically exempt from them. The requirements were authorized under federal law and will require affected beneficiaries to demonstrate compliance to maintain coverage. This implementation affects a substantial segment of West Virginia's Medicaid population and follows years of legal challenges to work requirements nationwide.
Why it mattersWest Virginia is implementing work requirements despite previous federal rollbacks, creating operational challenges for the state Medicaid agency around compliance tracking, eligibility verification, and potential coverage loss for tens of thousands of beneficiaries.
State Policy·IN·6:01 AM MT
Indiana's Medicaid work requirement takes effect January 1, 2027, affecting an estimated 300,000 low-income enrollees. State officials confirmed the mandate applies to new applicants and existing members renewing coverage in January, but compliance systems and exemption procedures remain incomplete with the first deadline less than two months away. The requirement will impact non-exempt adults enrolled in Indiana's Medicaid expansion population. State agencies and managed care plans must finalize tracking, verification, and disenrollment protocols before implementation.
Why it mattersIndiana health plans and state Medicaid staff face immediate operational pressure to build work verification and exemption systems for 300,000 members before a January deadline with unfinished compliance infrastructure.
State Policy·NY·6:01 AM MT
New York's Department of Health received CMS approval to implement a plan revamping the state's Medicaid provider enrollment and revalidation processes. The changes aim to improve oversight of New York's Medicaid program. The announcement follows a McDermott Will & Emery client alert from August 4, 2026, addressing Medicaid moratorium and ownership change issues in the state. The timing and scope of implementation will affect providers seeking enrollment or ownership changes in New York's Medicaid program.
Why it mattersNew York Medicaid providers and potential acquirers face new enrollment and revalidation requirements that will affect onboarding timelines, ownership transactions, and ongoing compliance obligations in the nation's largest state Medicaid program.
State Policy·NV·6:00 AM MT
Nevada legislators discussed health policy priorities for the 2027 legislative session at an interim Health and Human Services committee meeting on August 12, 2026. The agenda includes a maternal health "momnibus" bill with multiple pregnancy and postpartum protections, enhanced Medicaid fraud investigation capacity, and streamlined state health agency reporting requirements. Child welfare funding reforms were deferred despite prior discussion. These proposals would affect Nevada Medicaid operations, managed care oversight, and provider compliance once the 2027 session convenes.
Why it mattersNevada's 2027 legislative agenda could expand Medicaid maternal health coverage requirements for health plans, increase state fraud enforcement capacity affecting MCO and provider audits, and alter state agency reporting obligations.
State Policy·NC·6:00 AM MT
North Carolina hospitals are implementing "I Gave Birth" wristbands to identify recent mothers and encourage emergency care-seeking when postpartum complications arise. The initiative is expanding across multiple states as the Trump administration pursues Medicaid cuts that threaten to reduce postpartum coverage. The wristbands aim to address maternal mortality by prompting clinical staff to recognize and treat postpartum complications. The timing coincides with growing concerns about access to postpartum care under proposed federal Medicaid reductions.
Why it mattersFederal Medicaid cuts could eliminate or reduce the ARP-mandated 12-month postpartum coverage extension in states that adopted it, making low-cost interventions like wristbands critical for maternal safety as coverage gaps widen.
State Policy·KS·12:01 PM MT
Kansas reduced its Supplemental Nutrition Assistance Program (SNAP) error rate below 12% following passage of the One Big Beautiful Bill Act in 2025, but the state still faces a potential $20.6 million federal penalty. The penalty relates to error rate thresholds established under federal law. State officials have not indicated when the penalty determination will be finalized or whether Kansas plans to contest it. The development affects state budget planning and SNAP administrative operations.
Why it mattersFederal SNAP error rate penalties directly impact state Medicaid agencies because both programs often share eligibility systems, staff, and administrative resources — a large penalty can affect overall state health and human services budgets.
State Policy·7:57 AM MT
The Cato Institute released a report analyzing nearly 130 studies on certificate of need (CON) laws, which require healthcare providers to obtain state approval before constructing new facilities or adding services. The report concludes that CON laws restrict healthcare access and competition. CON laws remain in effect in approximately 35 states and directly affect Medicaid beneficiaries' access to nursing homes, dialysis centers, home health agencies, and other services that require state approval before expansion. The analysis adds to ongoing state-level debates over repealing or reforming CON requirements.
Why it mattersCON laws in 35 states directly determine whether Medicaid beneficiaries can access new nursing homes, dialysis centers, and other certificate-required services, making this research relevant to state Medicaid agencies evaluating provider network adequacy and access.