Louisiana Healthcare Connections, a Centene-managed Medicaid plan, has told Ochsner Health System it may terminate coverage of Ochsner hospitals and clinics after Dec. 1, potentially affecting 70,000 enrollees. The two sides have negotiated a new contract since Louisiana Healthcare Connections first raised the possibility in June but have not reached agreement; Ochsner asked the Louisiana Department of Health to help extend the deadline and ensure payment for services already rendered. State Medicaid director Seth Gold said affected enrollees could switch plans and warned Louisiana Healthcare Connections could face penalties if it cannot show adequate provider access without Ochsner. The plan's $5.8 billion contract extension with the state is scheduled for legislative budget committee review this week.
Why it mattersA network termination would force tens of thousands of Medicaid enrollees to switch plans or providers and could expose Louisiana Healthcare Connections to state penalties for failing network adequacy requirements.
Managed Care
In a commentary piece, the author argues that Indiana's reforms to its Medicaid applied behavioral analysis (ABA) program offer a model for other states combating fraud and improper billing. The piece cites state data showing ABA spending grew from $17 million to $611 million by 2023, and a federal inspector general audit finding improper or potentially improper claims in all 100 sampled enrollee-months, with at least $56 million in improper fee-for-service payments in 2019-2020. Under Gov. Mike Braun, Indiana is requiring ABA provider accreditation by October 2027, imposed a temporary moratorium on new agency enrollments, mandated clinical supervision ratios for behavior technicians, barred telehealth billing for services requiring in-person observation, and restructured fee schedules. The author points to a new CMS ABA toolkit and 421% national growth in ABA spending from 2021 to 2025 as evidence other states should adopt similar safeguards.
Why it mattersState Medicaid agencies and ABA providers face growing federal and state scrutiny of billing practices, supervision ratios, and telehealth use that could reshape enrollment, reimbursement, and audit exposure nationwide.
Behavioral Health · Finance · Managed Care
Fitzgibbon Hospital in Marshall, Missouri, ended labor and delivery services just nine days after new owners Strawberry Fields REIT and operator American Medical Administrators completed their purchase of the bankrupt hospital in early September. The hospital, renamed Missouri Valley Regional Medical Center, delivered 252 babies in 2025 and was one of few options for pregnant patients north of Interstate 70 in central Missouri. Patients will now travel 30 minutes to over an hour to Bothwell Regional Health Center or Western Missouri Medical Center to deliver, while prenatal and postpartum care continues locally through Marshall Women's Care. Fitzgibbon had sued the buyers to force the sale through after it missed its deadline, alleging the new owners planned to cut services despite earlier commitments to preserve care; the new operator says the hospital's finances made maintaining obstetric staffing unsustainable at under one birth per day.
Why it mattersThe closure strips obstetric access from another rural Missouri county where nearly half of births are covered by Medicaid, deepening maternity care deserts that state Medicaid agencies and managed care plans must account for in network adequacy and care coordination.
Maternal · Managed Care
In a commentary, economist Julianne Malveaux argues that North Carolina's rural health efforts should extend beyond hospital funding to permanently support programs addressing social determinants of health like food, housing, and transportation. She cites the state's Healthy Opportunities pilot programs, which connect healthcare providers with community organizations and recently resumed operations with new state budget funding, as evidence of what's possible: one western North Carolina pilot tied to food insecurity produced a 67% drop in hospital readmission risk and $164 in monthly Medicaid savings per participant. Malveaux contends state leaders should treat these pilots as permanent infrastructure rather than temporary experiments, particularly given disparities facing rural and Black communities, and should view the Rural Health Transformation Program as a broader opportunity rather than a hospital-only investment.
Why it mattersFor state Medicaid agencies and MCOs, sustained funding of social-needs-screening and referral infrastructure directly affects per-member cost trends and readmission-linked quality metrics tied to value-based contracts.
LTSS · Managed Care · Finance
Bridge Michigan reports that state legislators are advancing bipartisan legislation to limit hospital "facility fees," additional charges added to bills for care delivered at off-site locations, telemedicine visits, and some outpatient hospital services. The bill follows complaints from patients and lawmakers, including Rep. Curt VanderWall, who was charged separately for each vial of blood drawn during a routine test. Hospitals say the fees, often undisclosed and untracked by the state, are needed to stay financially viable, with 33 Michigan hospitals operating at a loss or break-even in 2024 and three subsequently closing. The legislation's prospects and effective date are not specified in the reporting, but it places Michigan among several states, including Ohio and Indiana, considering caps, transparency mandates, or site-neutral payment requirements.
Why it mattersState Medicaid agencies and hospitals face growing pressure to disclose and potentially cap facility fees that a federal report estimates cost the Medicaid program tens of billions of dollars, directly affecting provider reimbursement and state oversight of outpatient billing practices.
Finance · Managed Care
New Hampshire's GO-NORTH office, which oversees roughly $205 million in annual federal rural health funding, says it is "cautiously optimistic" ahead of CMS's annual rescoring of state performance this September and October. Continued funding depends on CMS's assessment of program authority, satisfactory performance, and compliance with award terms and reporting requirements. Director Donnalee Lozeau points to the state's early "fully obligated" status in June and a supportive May CMS site visit as positive signs, crediting a five-"hub" distribution model covering primary care, behavioral health, capital infrastructure, and workforce development. The program, created by Congress to offset Medicaid and other public health cuts, runs through 2030, and New Hampshire hopes to secure the same funding level each year.
Why it mattersState Medicaid and rural health agencies nationwide face the same annual rescoring risk, making New Hampshire's experience a bellwether for how CMS will evaluate performance and compliance to determine continued funding under the program.
Behavioral Health · LTSS · Finance
The Colorado-based Bethesda Foundation closed its Cambridge Court assisted living facility in Kearney, Nebraska, giving its 40 residents, many with Alzheimer's or dementia, just 30 days to find new housing before selling the property to a real estate developer. The foundation is now withdrawing from Nebraska entirely, planning to close its Omaha facility, Hickory Villa, by October 16 and displace roughly 50 more residents. The company cited rising operating costs and economic pressures, including losses it said accrued over five years. Former staff and residents say Nebraska's stagnant Medicaid reimbursement rates, combined with limited Medicaid-certified assisted living capacity in areas like Buffalo County, left few alternative placements for low-income seniors who depend on the program for long-term care.
Why it mattersThe closures highlight how inadequate Medicaid reimbursement rates for assisted living can drive provider exits and strand low-income seniors without access to Medicaid-certified long-term care beds.
LTSS
In a Q&A published by the National Association of Medicaid Directors, Alabama Medicaid CIO Mason Tanaka discusses the state's approach to system modernization. Tanaka emphasizes that modernization efforts should be driven by business needs rather than technology for its own sake, and that strong governance structures are essential to building systems that last. The interview covers how Alabama's governance foundation is positioning the agency to adopt new technologies going forward. No new rule, contract, or procurement action is announced in the piece.
Why it mattersState Medicaid IT leaders can draw on Alabama's governance-first approach as a model for sequencing modernization investments and avoiding costly system failures.
Finance
Trinity College researchers, partnering with the REACH Fund of Connecticut, surveyed 969 people and found more than 80% delayed abortion care due to cost, including 83% of Medicaid patients and 76% of people with private insurance. Uninsured respondents almost universally reported delays for financial reasons, with some waits stretching a month or longer, raising procedure costs as delays push patients past the window for medication abortion. Though Connecticut Medicaid covers abortion services at in-state clinics, advocates note patients still face out-of-pocket costs for telehealth, travel, childcare and lost wages. The study calls for expanded funding for abortion access and related logistical costs, and advocates warn that more than 100,000 Connecticut residents could lose Medicaid coverage under new federal work requirements, compounding financial barriers to care.
Why it mattersState Medicaid officials and abortion-fund advocates face mounting evidence that coverage alone does not eliminate cost barriers, a problem advocates say will worsen as federal work requirements threaten coverage for over 100,000 Connecticut enrollees.
Maternal · Finance
Rep. Lauren Boebert and Democratic challenger Eileen Laubacher held their only debate before the November midterm for Colorado's 4th Congressional District, trading sharp attacks moderated by 9News' Kyle Clark. On health care, Boebert defended her vote for the federal tax and spending bill known as the Working Families Tax Cut, arguing rural hospitals are hurting from state Medicaid cuts rather than federal ones, and pointed to a $50 billion rural hospital fund included in the bill. Laubacher countered that rural hospital CEOs have told her the region's hospitals could disappear within five years without dramatic change. The debate also covered veterans' legislation, foreign policy and personal accusations between the two candidates.
Why it mattersState Medicaid agencies and rural hospital operators in Colorado face a live political dispute over whether federal or state funding decisions are driving Medicaid-related financial strain on rural providers.
Finance
In a WyoFile opinion column, Kerry Drake argues that Wyoming's Health Insurance Affordability Task Force should be extended another year after dropping its BearCare catastrophic coverage proposal and a state medical device purchasing plan. Legislative Service Office analysis found BearCare premiums would need to be fairly high to cover the risk pool, undercutting expected cost savings; the task force reached the same negative conclusion on the device purchasing idea. Drake notes the backdrop: over 9,000 Wyoming residents saw record premium spikes after Congress let enhanced ACA tax credits lapse, and some face increases over 400%. The task force is now exploring a health department proposal to designate "core" high-cost services for price regulation via a block grant and a utility-like commission, while leaving other services to market competition; Drake says the idea remains unfinished and raises funding concerns.
Why it mattersWyoming's abandonment of BearCare and pivot toward price regulation and block-grant funding for "core" services signals the state will keep relying on unregulated marketplace and provider-cost interventions rather than coverage expansion, directly affecting insurers' network negotiations and hospitals' uncompensated care exposure.
Finance
Georgia Democratic gubernatorial nominee Keisha Lance Bottoms debated an empty podium Monday after GOP nominee Rick Jackson skipped the Atlanta Press Club's Loudermilk-Young debate, the first general-election gubernatorial candidate to do so since 1994. Jackson instead campaigned with Gov. Brian Kemp across the state, citing affordability and property taxes as voter priorities over debate appearances. Bottoms used the forum to promote her platform, including expanding Medicaid, fully funding pre-K, and creating an affordable housing fund, while also criticizing Georgia's six-week abortion ban. Early voting for the Nov. 3 general election begins Tuesday.
Why it mattersA Bottoms victory would put Medicaid expansion back on the table in one of the largest remaining non-expansion states, directly affecting coverage for hundreds of thousands of low-income Georgians and the state's managed care landscape.
Managed Care
In a NASHP blog post, the organization shares lessons from AIR's MAAPPS Project, a multi-year effort that worked with Maryland and Oregon to help states incorporate community input into substance use disorder policy and funding decisions. The post outlines five strategies: inventorying existing data sources like Medicaid claims and SAMHSA's TEDS, meaningfully engaging people with lived experience, embedding community feedback into policy development, disseminating findings transparently, and building accountability mechanisms. It cites Maryland's Office of Overdose Response as an example, which used the MAAPPS framework to shape priorities for its 2027 Opioid Restitution Fund Grant Program. The piece targets state Medicaid and behavioral health agencies seeking to better align opioid settlement and SUD investments with community needs.
Why it mattersState Medicaid and behavioral health agencies overseeing opioid settlement funds and SUD grant programs can use these frameworks to improve accountability and reduce the risk of misaligned spending.
Behavioral Health · Finance
Bridge Michigan asked the state's 10 largest health systems and three rural hospitals how much they collect annually in facility fees and what the money funds; none disclosed dollar amounts, though some described general uses like cybersecurity and emergency staffing. Only one rural hospital, Scheurer Health, shared a figure, expecting roughly $125,000 this year against a $125 million budget. State Rep. Curt VanderWall, who chairs the House Health Policy Committee, has introduced legislation to ban facility fees for routine outpatient care, certain outpatient services, and telemedicine visits, and says the industry's refusal to disclose figures undermines its claim that the fees are essential. Neither the hospital association nor the state currently tracks total facility fee collections statewide.
Why it mattersState lawmakers and Medicaid officials lack the data needed to assess how facility fees affect provider payment adequacy and patient cost-sharing just as the legislature considers restricting the charges and Medicaid faces anticipated federal cuts.
Finance · Managed Care
Michigan's SNAP enrollment fell by more than 167,000 people, including over 53,000 children, between June 2025 and August 2026, a nearly 12% decline, according to the Detroit Free Press. State officials and policy experts attribute much of the drop to new federal work requirements and added paperwork enacted under the 2025 federal tax law, which expanded work-and-reporting mandates to adults aged 18-64 without dependents under 14 and eliminated exemptions for homeless individuals, veterans, and former foster youth. Michigan's Department of Health and Human Services says confusion over new reporting duties, rather than reduced need, is driving people off the program, and the state must now also cover a larger share of program costs. Food pantries across the state report rising demand as former SNAP recipients lose benefits.
Why it mattersState Medicaid and human services agencies face parallel administrative strain as similar federal work-requirement and eligibility-verification mandates extend to Medicaid, raising the risk of comparable coverage losses driven by paperwork rather than ineligibility.
Finance
Thirty-four South Dakota organizations, led by Bread for the World South Dakota, sent Gov. Larry Rhoden a letter asking him to opt into the federally funded Summer Electronic Benefits Transfer program for 2027. The program provides $120 per eligible child in grocery benefits over summer months to families enrolled in SNAP, TANF, Medicaid, free or reduced-price lunch, or similar programs; South Dakota would qualify for $6.8 million covering 57,000 kids. The governor's deputy secretary of education says the administration is reconsidering after years of declining to participate, citing an estimated $500,000 to $700,000 setup cost plus IT and staffing needs, though the federal government covers half of ongoing administrative costs. South Dakota must decide by January 1 to participate in summer 2027; it is one of 11 states, all with Republican governors, not currently offering the program.
Why it mattersState Medicaid and human services agencies weighing Summer EBT participation face a January 1 deadline and must budget for setup and administrative costs even though eligibility screening will draw heavily on Medicaid and SNAP enrollment data.
Maternal · Finance
California has allocated $3.6 million to launch PRIME Rx at UC San Diego's Skaggs School of Pharmacy, the first PRIME program housed at a pharmacy school. The program will fund scholarships for roughly 10 PharmD students per year over the four-year degree, with clinical training in community-based settings aimed at underserved areas including the U.S.-Mexico border region. The one-time funding is expected to sustain the program for three years while the school seeks permanent state support. UC San Diego is also partnering with Southwestern College on a separately funded pharmacy technician associate degree program to address broader workforce shortages.
Why it mattersExpanding the pharmacist pipeline to federally qualified health centers and tribal clinics could ease access bottlenecks for Medicaid beneficiaries in pharmacy deserts, but the funding's temporary nature leaves long-term workforce capacity uncertain.
Pharmacy
In a VTDigger commentary, Hartford School District superintendent Caty Sutton, the Hartford School Board and district and union leadership argue that state legislative actions are devastating their school system. They cite a legislative reduction of the excess spending threshold from 118% to 115.5% as forcing an almost $5 million budget cut, potentially requiring a 25% staff reduction, alongside unfunded PCB testing mandates, a rushed transition to a new Medicaid reimbursement model, and a mandatory regional service-area realignment. The authors say they received no transition time for the Medicaid billing change and no evidence that these mandates will improve outcomes or save taxpayers money. They call on their legislative delegation to revisit the spending threshold cut, fund PCB remediation, and slow the regional restructuring process.
Why it mattersSchool-based Medicaid providers in Vermont face a compressed, unfunded transition to a new reimbursement model that district leaders say threatens billing continuity and staffing capacity.
Finance
