Former CMS Administrator Seema Verma published commentary calling for improved healthcare data connectivity, marking one year since CMS launched its "Kill the Clipboard" initiative. The initiative aims to reduce administrative burden by enabling electronic data exchange across healthcare systems. Verma argues that while healthcare has been digitized, meaningful interoperability remains incomplete. For Medicaid programs, improved data exchange could streamline eligibility verification, care coordination across MCOs and providers, and integration of clinical and administrative data systems.
Why it mattersEnhanced interoperability directly affects Medicaid programs' ability to reduce administrative costs, improve care coordination for complex populations, and meet federal data exchange requirements under the CMS Interoperability and Patient Access final rule.
Managed Care
CDC data for the 2025-26 school year shows kindergarten vaccination coverage for measles, mumps, and rubella (MMR) dropped to 92.4%, down from 92.5% the prior year and below the 95% herd immunity threshold recommended by public health officials. Exemption rates reached a record 4.2%. The decline in vaccination rates raises public health concerns about potential disease outbreaks and may affect Medicaid EPSDT compliance, as childhood immunizations are a required preventive service under Early and Periodic Screening, Diagnostic and Treatment benefits for children enrolled in Medicaid and CHIP.
Why it mattersLower vaccination rates increase disease outbreak risk and may affect Medicaid managed care plans' HEDIS measures for childhood immunization status, EPSDT compliance, and quality bonus payments tied to immunization performance.
Maternal · CHIP · Managed Care
The Office of the National Coordinator for Health Information Technology (ONC) published a notice on August 17, 2026, requesting public comment on a three-year data collection initiative for the Trusted Exchange Framework and Common Agreement (TEFCA). The proposed collection would gather routine feedback on service delivery and program performance from Qualified Health Information Networks (QHINs). Comments are due under standard federal notice procedures. For Medicaid programs increasingly reliant on interoperability for care coordination, managed care reporting, and health information exchange, this reflects ONC's evolving oversight approach for the national framework governing health data exchange among QHINs.
Why it mattersMedicaid managed care organizations and state agencies participating in or contracting with QHINs for data exchange should monitor this feedback framework, as ONC's monitoring approach may inform future TEFCA compliance expectations and performance standards affecting Medicaid health information exchange obligations.
Managed Care
House Democrats introduced the Medicare At Home Act, legislation that would add a home care benefit to Medicare Part B. The bill follows a Democratic policy framework released two months earlier. If enacted, the legislation would expand Medicare coverage to include home care services currently excluded from the program. The bill does not directly affect Medicaid managed care operations, though state Medicaid agencies managing dual-eligible populations and Medicare-Medicaid Plans would need to coordinate benefits if the legislation advances.
Why it mattersState Medicaid agencies and Medicare-Medicaid Plans would face new care coordination requirements for dual-eligible beneficiaries if Medicare expands home care coverage, potentially shifting some cost and service responsibility from Medicaid LTSS programs to Medicare.
LTSS · Managed Care
The Centers for Medicare & Medicaid Services has issued a proposed rule to codify regulations for the Medicare Drug Price Negotiation Program established under the Inflation Reduction Act. The American Hospital Association submitted comments on August 17, 2026, urging CMS to require manufacturers to make negotiated maximum fair prices available at point-of-sale rather than through retrospective rebates. AHA expressed concern that allowing retrospective price adjustments could encourage manufacturers to shift the 340B drug discount program from upfront discounts to rebates. The proposal affects how Medicare Part D beneficiaries and covered entities access negotiated drug prices.
Why it mattersThough focused on Medicare Part D, the pricing mechanism CMS adopts could establish precedent for Medicaid rebate structures and threaten the upfront discount model that safety-net hospitals and FQHCs rely on under 340B, which serves many Medicaid beneficiaries.
Pharmacy