KFF's latest survey of state Medicaid home care programs provides updated data on waiting lists for home- and community-based services (HCBS) spanning 2016 to 2026. The data note explains that waiting lists are an incomplete measure of unmet need, since states vary widely in how they manage, screen, and report individuals awaiting services. KFF cautions that figures are not necessarily comparable across states or over time, even after efforts to standardize the data collection. The note is aimed at helping policymakers and researchers interpret trends in access to long-term services and supports more cautiously.
Why it mattersState Medicaid agencies and LTSS stakeholders rely on this data to gauge unmet demand for home care, but KFF's caveats mean the figures should not be used alone to benchmark state performance or justify funding decisions.
LTSS
KFF's issue brief presents findings from its most recent survey of state Medicaid home care programs, focusing on how states use program integrity tools such as electronic visit verification and other monitoring mechanisms. The brief covers the range of approaches states report using to detect and prevent improper payments in home and community-based services. It draws on survey responses collected across state Medicaid agencies rather than describing a single new policy action. The findings are relevant to states, managed care plans, and providers involved in administering or delivering home care services under Medicaid.
Why it mattersState Medicaid agencies and MCOs overseeing home care benefits rely on this data to benchmark their own program integrity practices, such as electronic visit verification compliance, against national trends.
LTSS
A new research brief analyzes 2024 Uniform Data System figures showing community health centers served more than 32 million patients across medically underserved urban and rural areas. The brief covers who health centers serve, the range of services they provide, and how those services are financed, including the role of Medicaid as a key payer. It draws on national UDS data compiled for calendar year 2024. The report provides a baseline snapshot of health center capacity and reliance on public funding sources.
Why it mattersState Medicaid agencies and managed care plans rely on health centers as safety-net providers, so shifts in their patient volume and financing mix directly affect network adequacy and access for low-income enrollees.
Managed Care · Finance
In remarks from HHCN's FUTURE conference, Careforth CEO and Elara Caring chairman Paul Kusserow argues the home health industry must shift from a visit-based clinical model to one blending skilled care, trained family caregivers, technology and value-based risk arrangements. Kusserow, former Amedisys CEO, says chronic disease and an aging population make recurring hospitalizations unsustainable for health plans and government payers, pushing providers to take on higher-acuity, disease-specific care in the home. He cites Careforth's approach of identifying and paying family caregivers of Medicaid waiver recipients ($50/day for 24/7 care) alongside training, technology and clinical backup as a model for sustainable caregiving. Kusserow frames data collection and community-based support as essential to scaling value-based, longer-term home care.
Why it mattersMedicaid LTSS programs and managed care plans relying on self-directed and family caregiving models will face growing pressure to fund caregiver compensation, training and technology as an alternative to costlier institutional and hospital-based care.
LTSS · Managed Care
Sen. Bernie Sanders rallied in Bakersfield on Oct. 4 for Randy Villegas, the progressive Democratic challenger seeking to unseat Republican Rep. David Valadao in California's 22nd Congressional District, a toss-up race in the Central Valley. Villegas criticized Valadao for supporting Medicaid and nutrition assistance cuts in the federal budget bill and for accepting campaign contributions from corporations including UnitedHealthcare. The event drew hundreds of supporters and highlighted Democrats' bet that progressive messaging, including universal healthcare, can resonate in a historically conservative, low-turnout district ahead of the November midterms.
Why it mattersThe outcome in this swing district could shift the House majority that determines future federal Medicaid funding and eligibility policy.
Managed Care
In a MedCity News commentary, the author argues that access to allergy diagnosis and care is unequal, with rural patients, Medicaid enrollees, and patients from underrepresented racial and ethnic groups more likely to go undiagnosed, be misdiagnosed, or rely on emergency departments instead of allergist visits. The piece frames this diagnostic gap as a broader health equity issue tied to specialist shortages and access barriers facing underserved populations. No specific policy, funding, or regulatory action is described; the commentary instead highlights disparities as a call to attention for the health care field.
Why it mattersMedicaid managed care plans and state agencies face persistent specialist-access and emergency-utilization cost pressures tied to the same rural and demographic disparities highlighted here.
Managed Care
Moody's Ratings affirmed Ascension's "Aa3" rating and stable outlook in an Oct. 1 report, citing the health system's leading market positions and scale efficiencies. The agency noted Ascension's $3.9 billion Amsurg acquisition, completed in June, should boost margins by expanding non-acute service lines, though leverage remains high with cash-to-adjusted-debt near 150-160%. Moody's flagged near-term pressure from rising uncompensated care tied to expiring enhanced ACA subsidies and declining Medicaid eligibility, plus added strain beginning in 2028 from Ascension's "heavy reliance" on Medicaid supplemental funding programs. Ascension narrowed its fiscal 2026 operating loss to $120 million from $491 million the prior year.
Why it mattersAscension's credit profile and reliance on Medicaid supplemental payments signal broader exposure for large hospital systems as Medicaid eligibility declines and supplemental funding faces future cuts.
Finance
In a Peterson-KFF Health System Tracker analysis, researchers report that healthcare has added 372,000 jobs (up 2.0%) since September 2025, while the rest of the economy added just 124,000 jobs (up 0.1%), based on BLS data. The piece notes healthcare now represents an all-time-high 11.7% share of total US employment, driven by an aging population, chronic disease prevalence, and jobs that resist automation. It also flags downside risk: CBO projects over 10 million more uninsured people by 2036 due to ACA and Medicaid policy changes, which could strain hospital revenues and slow healthcare job growth, particularly given hospitals' obligation to treat emergency patients regardless of ability to pay.
Why it mattersCoverage losses projected from Medicaid and ACA policy changes could squeeze hospital and provider revenues and reverse a decade-long trend of healthcare employment growth that states and plans rely on for workforce and economic planning.
Finance
Becker's Hospital Review profiles WVU Medicine's provider-sponsored health plan, Peak Health, which now covers more than 80,000 lives across Medicare Advantage, an administrative services organization business, and a planned ACA marketplace product. CFO Nick Barcellona says the system deliberately runs Peak as a cost center rather than a profit center, and all member hospitals operate with Peak on a capitated basis, putting the system at financial risk for population health rather than volume. The design has cut administrative friction, including denials and prior authorizations, and the system is consolidating care navigator roles across plan and hospital sides. Peak plans to add a dual special needs plan next year and expand into the ACA marketplace, while leadership stresses population-health strategies must be tailored locally rather than applied uniformly.
Why it mattersThe capitated, cost-center model signals how provider-sponsored plans can realign payer-provider incentives around population health rather than volume, a structure other health systems weighing payer strategies and state Medicaid managed care partners will watch closely as Peak expands into dual-eligible and marketplace coverage.
Managed Care · Finance
In its Hidden Help investigative series, Tradeoffs and KFF Health News report that 44% of 166 Texas nonprofit general and children's hospitals reviewed will bill patients before screening them for financial aid eligibility, rather than using presumptive eligibility to proactively reduce or erase bills. The analysis found wide variation in screening timing, with some hospitals screening after one bill and others sending multiple bills and using collection agencies first; only 10 of 166 hospitals guarantee full refunds to patients later found eligible, and some large systems don't notify patients when debt is automatically forgiven. The findings arrive as Texas lawmakers consider legislation requiring nonprofit hospitals to use presumptive eligibility before billing. The Texas Hospital Association defended current practices, saying hospitals first seek other payment sources like Medicaid before offering charity care as a "relief of last resort."
Why it mattersState Medicaid agencies and managed care plans should note that delayed financial-aid screening can push eligible low-income patients toward medical debt or uncompensated care before Medicaid or safety-net coverage is identified, a gap pending Texas legislation aims to close.
Finance
York (Maine) Hospital officially became MaineHealth's 10th hospital on Oct. 1, joining the system's Southern region after signing a letter of intent in October 2025. The 79-bed hospital cited rising labor and pharmaceutical costs, increasing payer denials, and its ineligibility for federal safety-net programs like critical access hospital designation and 340B drug pricing as reasons for seeking affiliation. MaineHealth and York Hospital plan to maintain inpatient services while strengthening primary care and expanding specialty access through the larger network. CEO Patrick Taylor said the deal preserves the hospital's community focus while adding system-level support.
Why it mattersThe consolidation reflects broader financial pressures pushing smaller, ineligible-for-safety-net-designation hospitals into larger systems, which can affect Medicaid managed care network contracting, rate negotiations, and service-line availability in the region.
Finance
Keith Mueller, PhD, longtime director of the Rural Policy Research Institute (RUPRI) at the University of Iowa, died September 26 following a brief illness. Over more than three decades, Mueller advised federal agencies including CMS, testified repeatedly before Congress, led the National Rural Health Association, and published over 220 scholarly works on rural health policy. Colleagues credit him with building RUPRI's reputation for nonpartisan, evidence-based analysis that lawmakers from both parties relied on consistently. He also served as interim dean of the University of Iowa College of Public Health and mentored generations of rural health researchers.
Why it mattersMueller's death marks a significant loss for rural health policy research infrastructure that state Medicaid programs and rural providers have relied on for nonpartisan analysis of access and reimbursement issues.
Patrick Frias, MD, who became CEO of Children's Healthcare of Atlanta in August after returning from Rady Children's Health in San Diego, is pursuing a strategy called "More Than Possible" to put pediatric services within 30 minutes of every family in metro Atlanta. The system has opened a new primary care office in Adamsville that has served 500 new patients since late June, purchased land in Sandy Springs for future growth, and is expanding into rural Georgia through a partnership with Mercer University School of Medicine including a scholarship program for medical students committing to rural pediatric practice. Mental health is a defined pillar of the strategy, with the system citing more than 300 care team members in what it calls the largest pediatric mental health workforce in Georgia. The strategy also includes research partnerships with Emory University and Georgia Tech and a cellular and gene therapy program.
Why it mattersProviders and state health officials tracking pediatric access gaps should note how a major children's hospital system is deploying primary care expansion, rural workforce pipelines, and behavioral health staffing to close care deserts that often overlap with Medicaid- and CHIP-covered populations.
Behavioral Health · CHIP · Maternal
KFF Health News compiled a roundup of recent media appearances by its journalists. Sarah Jane Tribble discussed KFF-AP polling on rural support for the Make America Healthy Again movement on NPR's Morning Edition, tied to a co-reported piece finding rural MAHA followers say Trump health policies haven't reached their communities. Céline Gounder appeared on CBS News programs to discuss a new GLP-1 weight loss drug, RFK Jr.'s MAHA summit remarks, and how AI tools from Anthropic might aid gene-editing research. Renuka Rayasam discussed the Rural Health Transformation Program on Georgia public radio.
Why it mattersStakeholders tracking rural health policy and the Rural Health Transformation Program can find original reporting and expert commentary consolidated through these media appearances.
LTSS
In an opinion piece, an Alabama Reflector columnist argues that after reviewing over 200 campaign websites and Facebook pages from Alabama state candidates, several political patterns emerged ahead of 2026 elections. The author notes bipartisan support for repealing the state's 2% grocery tax, with a Republican legislator reportedly drafting repeal legislation for the next session, and highlights Democratic candidates increasingly calling for a state minimum wage. The piece also observes that Republican candidates are distancing themselves from Trump messaging in general election materials, and that Democrats are fielding more, though often inexperienced, legislative candidates than in 2022. No Medicaid-specific policy action is reported.
Why it mattersState tax and legislative control trends, including potential grocery tax repeal and minimum wage debates, could shape future state budget capacity available for Medicaid funding decisions.
Finance
In its weekly hospital M&A roundup, Becker's Hospital Review reports nine health system transactions completed or announced during the week of Sept. 28. Highlights include HealthPartners and Essentia Health's plan to combine into a 22-hospital Minnesota system by January 2027, and UPMC's completed acquisition of Steubenville, Ohio-based Trinity Health System from CommonSpirit Health, marking UPMC's entry into Ohio. Other deals include WVU Health System's acquisition of Independence Health System's five hospitals with an $800 million modernization commitment, Orlando Health's acquisition of an Alabama hospital, and the University of Kansas Health System's move to take full ownership of a Topeka hospital from Ardent Health. Several deals took effect Oct. 1, while others remain pending regulatory approval.
Why it mattersContinued hospital consolidation reshapes provider networks and bargaining leverage that Medicaid managed care plans must account for in contracting, network adequacy filings, and rate negotiations across affected states.
Managed Care
A KFF-Associated Press survey of more than 2,000 rural voters conducted in August finds rural America divided on whether President Trump's immigration enforcement has helped or hurt their communities, with about a third saying it was positive, a third saying negative, and roughly three in ten reporting no impact. Despite this split, about 7 in 10 rural voters say immigrants with legal status and seasonal agricultural workers are important to their local economies. Rural voters are less likely than the general public to believe Trump has "gone too far" on immigration enforcement, with only about 4 in 10 saying so compared to 55% of U.S. adults overall. A Harvard health policy researcher cited in the poll noted that research shows immigrants use less healthcare than native-born Americans, countering claims that immigration strains the healthcare system.
Why it mattersImmigration enforcement patterns affect rural healthcare workforce availability and the economic base supporting rural hospitals and providers that serve Medicaid populations.
CommonSpirit Health will consolidate its five regions into three service areas, West, Central and East, effective in January, CFO Michael Browning announced on the system's fiscal 2026 earnings call. The restructuring replaces the California, Central, South, Mountain and Northwest regions created after a 2024 portfolio review and aims to cut duplication, management layers and complex legal structures. CommonSpirit is also consolidating acute care entities into a single entity per state, unifying 27 critical access hospitals under one rural operating model, and in-sourcing its revenue cycle after ending its Conifer contract. The moves are part of Project ImpACT, a five-year initiative targeting $6 billion in financial improvement, including more than $1 billion in fiscal 2027 efficiency gains.
Why it mattersProviders and plans contracting with CommonSpirit across 24 states should expect shifting negotiating structures and leadership contacts as the system consolidates legal entities and management layers to cut costs.
Finance
Novant Health is selling 36 South Carolina urgent care centers to Prisma Health as it shifts strategy toward virtual care, the Post and Courier reported Oct. 4. The centers were mostly acquired in Novant's November 2024 purchase of UCI Medical Affiliates from Blue Cross and Blue Shield of South Carolina, which included 52 urgent care sites and 20 physical therapy practices. Physical therapy locations are not part of this deal and their future is unclear. The sale closes Nov. 1, more than doubling Prisma's urgent care footprint and transferring about 500 employees, as Novant expands 24/7 virtual care and specialty services instead.
Why it mattersThe divestiture reshapes access to urgent care across South Carolina at a time when Prisma reports rising numbers of uninsured and Medicaid-reliant patients seeking care.
Managed Care
UPMC has launched UPMC Your Care, a home care program designed to coordinate services for Medicare Advantage members with complex chronic conditions during transitions between care settings. The program pairs eligible members with a dedicated care manager who coordinates medical, behavioral health and social needs directly in the home, creating a single point of entry rather than requiring patients to navigate the system on their own. Jennifer Vennare, VP of population health and president of UPMC at Home Services, described the approach as proactive rather than reactive, aiming to reduce avoidable emergency visits and hospital admissions. The launch comes as several health systems have closed or scaled back home-based care programs in 2026, highlighting divergent strategies in the sector.
Why it mattersHealth plans and integrated delivery systems weighing investment in home-based transitional care models can look to UPMC's approach as a counter-trend to industry-wide pullbacks, with implications for utilization management and cost containment strategies.
Managed Care
University Hospitals Rainbow Babies & Children's Hospital in Cleveland and Nationwide Children's Hospital in Columbus are expanding a pediatric affiliation that began in 2015 with the Congenital Heart Collaborative. The two systems will jointly recruit staff, invest in shared facilities and services, and develop pediatric-specific ambulatory offerings to attract talent and serve Northeast Ohio. Marissa Kiefer will continue as president of UH Rainbow and UH MacDonald Women's Hospital while overseeing day-to-day operations of the collaborative. The organizations will now begin operational planning, including building shared workflows and processes.
Why it mattersThe expanded pediatric network could reshape referral patterns, capacity, and specialty access for children's Medicaid and CHIP beneficiaries across Northeast and Central Ohio.
CHIP · Maternal
In a roundup on revenue cycle leadership trends, Becker's Hospital Review reports that hospital revenue cycle executive roles are becoming more specialized and strategically central in 2026, even as fewer health systems create chief-level titles. Becker's tracked only two chief revenue officer and one chief revenue cycle officer appointment in 2026, down sharply from 2025, with most of 39 tracked moves occurring at the vice president or executive director level. New titles increasingly describe narrower functions (revenue realization, revenue integrity, net revenue management) or combine revenue cycle with finance or payer strategy. Leaders say automation of payer claims review, silent downcoding, and staff upskilling gaps are now core parts of the job, alongside succession planning.
Why it mattersHealth systems and Medicaid MCOs alike should expect more sophisticated provider-side AI defenses against claims denials and downcoding, raising the stakes for payer automation and claims-review strategy on both sides.
Finance
In a Becker's Hospital Review commentary, the author argues that hospital pharmacy leaders focus too narrowly on visible staffing and contract labor costs while underestimating the larger financial toll of unfilled pharmacy and technician vacancies. The piece cites ASHP data showing technician turnover above 20%, vacancy rates up to 40% in some settings, turnover costs of $25,000-$35,000 per technician, and pharmacist burnout rates around 64%. It contends that unfilled roles push pharmacists into technician-level tasks, increase overtime and burnout, and trigger attrition cycles that cost more than strategic staffing investment. The author recommends evaluating vacancy cost alongside staffing cost rather than treating hourly rates as the primary savings lever.
Why it mattersHospital and health-system pharmacy directors managing Medicaid patient populations face higher long-term costs and care-access risks from chronic vacancies than from the staffing spend typically targeted in budget cuts.
Pharmacy
In its Weekly Hospital Real Estate Briefing, Hall Render compiles a range of recent developments: medical office building cap rates held steady at 6.7% through mid-2026 per Revista data, while per-square-foot prices rose; Phil and Penny Knight pledged $1.1B to Providence St. Vincent for a new women's hospital and cardiovascular expansion; EvergreenHealth received a $100M estate gift; Piedmont Healthcare and Sarasota Memorial announced major facility investments; and the University of Kansas Health System will acquire full ownership of Topeka's St. Francis Campus from Ardent Health by year-end 2026. The briefing also notes eight states enacted laws in 2026 expanding oversight of private equity health care transactions, and federal lawmakers introduced legislation to bar private equity and insurers from owning physician practices.
Why it mattersHealth systems, investors and hospital real estate stakeholders need to track capital deployment trends and the expanding patchwork of state and federal restrictions on corporate and private equity ownership of clinical operations.
In her "The New Old Age" column for The New York Times and KFF Health News, Paula Span discusses "deprescribing", the practice of reviewing and reducing unnecessary or harmful medications in older patients. Span, who also appeared on WAMU's Health Hub, cites geriatrician K. Eric De Jonge noting that patients on six or seven prescriptions face nearly a 100% chance of side effects or drug interactions. The piece flags benzodiazepines, antibiotics, and daily aspirin as commonly overused drugs among older adults, and urges patients and caregivers to proactively ask doctors whether long-standing prescriptions are still appropriate given evolving medical evidence.
Why it mattersMedicaid managed care plans serving dual-eligible and aging populations face real exposure to polypharmacy-driven hospitalizations and adverse drug events that deprescribing and medication therapy management programs are designed to prevent.
Pharmacy · LTSS
In an industry commentary, the author argues that health insurance companies do not need another standalone AI point solution but rather "connective tissue" that enables existing technology investments to work together through agentic AI. The piece contends that insurers, including Medicaid plans, have accumulated disparate systems and tools over years without achieving coordinated automation or intelligence across them. The author frames agentic AI's real value as orchestration and integration across an organization's existing stack rather than the introduction of new isolated capabilities. No specific product, vendor, or regulatory action is cited in the piece.
Why it mattersFor health plans, including Medicaid MCOs, the argument bears on how IT and operations leaders prioritize technology spending decisions around AI integration versus new tool acquisition.
Managed Care
