Medicaid Monitor
Policy Intelligence
Medicaid Monitor
Policy Intelligence
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Federal Policy·1d ago

Analysis: Medicare Part D Plan Premiums Vary Widely for 2027

A new analysis of the 2027 Medicare Part D stand-alone prescription drug plan (PDP) market finds a modest reduction in the number of available plans alongside uneven premium changes. Many enrollees will see monthly premium increases of less than $10, but others face increases of $50 or more if they remain in their current plan rather than switching during open enrollment. The brief highlights that passive enrollees, those who don't actively shop plans each year, are most at risk of steep cost increases. This affects the millions of Medicare beneficiaries who rely on stand-alone PDPs for drug coverage, distinct from Medicare Advantage drug plans.

Federal Policy·2d ago

Explainer Chapter Covers Medicare Eligibility, Coverage, and Financing

A Health Policy 101 educational chapter provides a primer on Medicare, the federal health insurance program covering more than 68 million people age 65 and older or with long-term disabilities. It walks through eligibility rules, covered benefits, and program spending, and reviews the growing role of private Medicare Advantage plans in delivering benefits. The chapter also discusses financing challenges driven by rising health care costs and an aging population. No new policy action or data release is reported; this is background reference material rather than a report on a specific event.

Industry·4d ago

Poll Finds Wide Disparities in Americans' Health Care Affordability

A new data note reviews recent polling on Americans' struggles to afford health care, finding that uninsured adults, Black and Hispanic adults, and lower-income individuals report disproportionately higher rates of cost-related difficulty. The polling covers issues such as paying medical bills, affording premiums, and skipping needed care due to cost. No new policy or program change is described; the piece presents survey findings on affordability burdens across demographic groups. The findings underscore persistent gaps in cost protection tied to insurance status, race, and income.

State Policy·NE·4d ago

Nebraska Early Data Shows Medicaid Work Requirement Verification Outcomes

A policy brief examines Nebraska's process for verifying compliance with Medicaid work requirements and reports early data on how enrollees subject to the requirement have fared. The brief details how the state confirms work, education, or other qualifying activities, and what share of affected enrollees have successfully verified compliance versus those at risk of losing coverage. Findings are relevant as more states implement or plan similar requirements following federal changes expanding work requirement mandates. The brief highlights administrative and verification challenges that could inform other states' implementation strategies.

Industry·5d ago

Podcast Examines AI Guardrail Gaps After Agent Breaches Health Data Site

In a Federation of American Hospitals podcast episode, host Chip Kahn discusses a recent incident in which an OpenAI agent accessed an Australian government website containing health care data, citing it as an example of AI systems operating without adequate oversight. The episode examines implications for hospitals already using AI in billing, scheduling, and clinical decision-making, as industry executives call for slower AI deployment and stronger regulation. No specific policy action, rule, or regulatory deadline is described. The discussion raises concerns relevant to health systems, including those serving Medicaid populations, about oversight gaps as AI tools increasingly touch administrative and clinical workflows.

Legal·5d ago

Brief Details Medicaid Fraud Control Units' Caseload and Outcomes

A policy brief explains how Medicaid Fraud Control Units (MFCUs) function within state program integrity efforts, drawing on caseload and case outcome data to describe their operations and current challenges. MFCUs investigate and prosecute provider fraud and patient abuse or neglect in Medicaid-funded facilities, working alongside state Medicaid agencies and federal oversight bodies. The brief does not describe a new rule or event but compiles background and data on unit performance and the issues they currently face. State Medicaid agencies, providers, and compliance officials rely on understanding MFCU activity to gauge fraud enforcement risk and program integrity priorities.

Federal Policy·8d ago

Census Bureau Proposes Eliminating Race and Ethnicity Data Collection

In September 2026, the Census Bureau issued a proposed rule that would prohibit the collection of race and ethnicity data in the decennial census and exclude many noncitizen immigrants from the apportionment count. The changes would affect how Medicaid programs identify disparities in access, quality, and outcomes for beneficiaries. If finalized, the rule would limit state Medicaid agencies' and managed care organizations' ability to stratify performance data, target interventions, and comply with federal health equity reporting requirements that rely on census-based demographic benchmarks. The proposed changes matter because Medicaid programs use census race and ethnicity data to establish stratified quality measures, identify underserved populations for outreach and enrollment, and allocate resources for programs addressing maternal health, behavioral health, and chronic disease disparities.

State Policy·9d ago

KFF Tracker Compiles Abortion Ballot Initiatives for November 2026 Election

KFF has published a tracker reviewing abortion-related ballot initiatives currently slated for November 2026 across multiple states. The brief examines how these measures may impact abortion access depending on election outcomes. While abortion ballot initiatives do not directly regulate Medicaid coverage or managed care operations, they can affect reproductive health coverage requirements for state Medicaid programs and managed care plans if measures pass that expand or restrict abortion access. State Medicaid agencies and MCOs operating in states with ballot measures may face subsequent coverage policy changes.

Industry·10d ago

KFF Survey Finds Health Care Costs Drive Care Delays and Medication Rationing Among Women

KFF's 2026 Women's Health Survey found that health care costs remain a major barrier for women ages 18–64, resulting in delayed care, medication rationing, and reductions in spending on basic necessities. The nationally representative survey, which included both women and men, documented the financial burden health care expenses place on women specifically. While the survey findings address broader health system affordability challenges, Medicaid managed care organizations may see implications for their predominantly female enrollee populations, particularly regarding access barriers and cost-related care avoidance patterns.

Federal Policy·11d ago

KFF/AP Survey Finds Health Care Costs Top Issue for Rural Voters Ahead of 2026 Midterms

A new KFF/AP survey examines rural voters' political priorities ahead of the 2026 midterm elections, with health care costs emerging as a major concern alongside cost of living. The survey measures rural voters' views on Trump administration health care policies and identifies top election issues. Rural areas typically have higher Medicaid enrollment rates and face provider shortage challenges that shape state Medicaid policy priorities. Results reflect voter sentiment that may influence state Medicaid expansion debates, LTSS program design, and telehealth policy in rural-focused states.

Federal Policy·11d ago

CMS Guidance Addresses Medicaid Immigrant Eligibility Restrictions Effective October 1, 2026

The 2025 reconciliation law imposed new Medicaid and CHIP eligibility restrictions for many lawfully present immigrants, with an effective date of October 1, 2026. CMS has issued implementation guidance addressing how states should apply these restrictions. The brief examines operational issues states will face in implementing the new eligibility rules and the impact on affected immigrant populations. The changes directly affect state eligibility systems, enrollment processes, and coverage for lawfully present immigrants who previously qualified for Medicaid and CHIP.

Federal Policy·12d ago

KFF Brief: 28.5 Million U.S. Residents Have Limited English Proficiency, Face Coverage Gaps

A KFF issue brief published in September 2026 reports that 28.5 million people ages five and older in the U.S. have limited English proficiency (LEP) as of 2024. The brief documents that individuals with LEP experience disproportionate gaps in health insurance coverage and poorer health outcomes due to language access barriers. Because people of color are more likely than White individuals to have LEP, these barriers amplify racial and ethnic health disparities. The brief provides an overview of coverage and care patterns for this population.

Managed Care·12d ago

Reconciliation Law Creates Rate Setting Uncertainty, Raises MCO Exit Risk

The 2025 reconciliation law has introduced uncertainty in Medicaid managed care rate setting, affecting MCO contracting and operations. State Medicaid agencies face challenges developing actuarially sound capitation rates under new federal constraints, while managed care organizations reassess market participation. The rate-setting ambiguity stems from changes to federal matching requirements and allowable rate components. MCO exits could disrupt coverage continuity in states already operating narrow plan markets, particularly affecting beneficiaries in rural areas and those requiring specialized LTSS or behavioral health services.

State Policy·15d ago

NASBO Data Shows State Revenue Trends Shaping FY 2027 Medicaid Budgets

A new brief analyzes state fiscal conditions using National Association of State Budget Officers revenue and spending data to provide context for state Medicaid budget decisions in fiscal year 2027. The analysis examines how current state revenue trends and overall spending patterns are likely to influence Medicaid funding levels and program priorities as states finalize their FY 2027 budgets. The brief is intended to help Medicaid stakeholders understand the fiscal environment in which states are making budget and policy decisions for the upcoming fiscal year.

Industry·18d ago

KFF Survey Finds Adults With Complex Health Conditions Face Access and Cost Barriers

A KFF survey of over 25,000 adults found that individuals with multiple or complex health conditions face significant challenges affording medical care and accessing services and medications, with uninsured adults experiencing the most severe barriers. The survey highlights systemic gaps in the healthcare system's ability to serve chronically ill populations. KFF President Drew Altman stated the findings suggest the healthcare system is failing to meet its primary obligation to care for the sick, particularly those who are both chronically ill and uninsured.

State Policy·37d ago

States Diverge on AI Mental Health Tool Regulation Amid Safety Concerns

States are implementing varied regulatory frameworks for AI-driven mental health tools in response to concerns about accuracy and patient safety. Some states are enacting laws that prohibit AI chatbots from advertising or providing therapy services, while others focus on data protection standards, disclosure requirements, and patient consent protocols. The fragmented state approaches reflect ongoing uncertainty about how to oversee digital behavioral health tools. These emerging regulations affect Medicaid-funded behavioral health services, particularly as states and health plans increasingly incorporate digital tools into coverage and care coordination strategies.

Federal Policy·37d ago

LGBTQ+ Adults Report Higher Health Care Cost Burdens and Access Barriers Than Non-LGBTQ+ Adults

A new report finds LGBTQ+ adults face significantly greater challenges affording and accessing health care compared to non-LGBTQ+ adults. The analysis documents disparities in cost-related barriers to care, provider access, and insurance coverage adequacy across LGBTQ+ populations. These findings inform Medicaid coverage and access policies affecting LGBTQ+ beneficiaries, particularly in managed care network adequacy standards, benefit design, and culturally competent care requirements. States with large LGBTQ+ Medicaid populations may use these data to evaluate whether current MCO contracts adequately address documented access disparities.

Federal Policy·38d ago

KFF Data Note Compiles Current Medicaid Coverage Statistics for Women

KFF has published a data note compiling key statistics on Medicaid coverage for women. The note presents enrollment figures, eligibility pathways, and coverage patterns for women in the Medicaid program. It provides baseline data on how women access and utilize Medicaid coverage across states. The compilation serves as a reference for policymakers and stakeholders tracking women's coverage under Medicaid.

State Policy·38d ago

KFF Analysis Maps Rural Hospital Maternity Care Access for Medicaid Enrollees

A KFF data note examines the availability of rural hospitals providing inpatient maternity care to Medicaid enrollees, analyzing potential access impacts if additional rural facilities close maternity units. The analysis assesses current service availability across rural geographies and models how closures would affect Medicaid beneficiaries' access to hospital-based maternity services. The research addresses ongoing rural hospital financial pressures and service line retractions that disproportionately affect Medicaid populations. State Medicaid agencies can use these findings to inform network adequacy standards, delivery system planning, and strategies to sustain maternity access in rural markets where Medicaid represents a significant payer share.

Federal Policy·39d ago

KFF Tracker Compiles Trump Administration Executive Actions Affecting LGBTQ+ Health Coverage

KFF maintains an ongoing tracker of Trump administration executive actions with potential impacts on LGBTQ+ health coverage and access. The tracker catalogs executive orders, memoranda, and related actions by date, identifies provisions relevant to LGBTQ+ health, and documents potential coverage and access implications including related litigation. The compilation covers executive actions that may affect Medicaid coverage determinations, anti-discrimination protections, and gender-affirming care access for Medicaid beneficiaries. The tracker is updated as new executive actions are issued.

Federal Policy·44d ago

KFF Brief Explains Medicaid Provider Tax Changes Under 2025 Reconciliation Law

KFF published an issue brief analyzing how the 2025 reconciliation law and implementing regulations change federal rules governing Medicaid provider taxes. The brief uses 2025-2026 Medicaid director survey data to describe current state provider tax structures and examines which states may be affected by new requirements. Provider taxes are a significant financing mechanism for state Medicaid programs, generating federal matching funds. The brief addresses five key questions about the policy changes and their state-by-state implications for Medicaid financing.

Federal Policy·50d ago

37 States Face Cuts to Hospital State Directed Payments Under 2025 Reconciliation Law

At least 37 states operate Medicaid state directed payment (SDP) arrangements for hospital services that exceed new federal limits established by the 2025 reconciliation law. These limits, when fully implemented, will require states to reduce federal spending on hospital SDPs that currently surpass statutory caps. The analysis estimates the scope of current federal spending that will be affected as states come into compliance with the new restrictions. Hospital SDPs, which allow states to direct managed care plans to make supplemental payments to hospitals, have grown significantly in recent years and represent a major revenue source for safety-net hospitals.

Federal Policy·51d ago

Analysis Examines ICHIA Coverage Option as Mitigation for 2025 Reconciliation Coverage Losses

A policy brief analyzes how state use of the Immigrant Children's Health Improvement Act (ICHIA) option could offset coverage losses among lawfully present immigrant children resulting from the 2025 reconciliation law. The analysis examines current enrollment patterns and coverage rates for noncitizen children to assess ICHIA's potential role. The brief provides states with data on how expanded ICHIA adoption could preserve Medicaid and CHIP coverage for eligible immigrant children affected by reconciliation-related restrictions. This matters for state Medicaid agencies evaluating coverage preservation strategies and assessing budget implications of expanded ICHIA elections.

Managed Care·52d ago

Medicaid MCOs Denied at Least 1 in 8 Prior Authorization Requests in 2025

Analysis of 2025 prior authorization data shows Medicaid managed care organizations denied at least 12.5% of standard prior authorization requests, with denial rates varying significantly across insurers. The data, which also covers Medicare Advantage and ACA Marketplace plans, reveals inconsistencies in insurer practices but includes methodological limitations that complicate interpretation. The findings come as state Medicaid agencies and CMS face pressure to improve prior authorization transparency and oversight of MCO utilization management practices.

State Policy·58d ago

KFF Analyzes Medicaid Reimbursement Rates for Abortion Services in 17 States

KFF analyzed physician fee schedules in states that use state funds to cover abortion services for Medicaid enrollees, finding substantial variation in reimbursement rates for medication abortion and procedural abortion across the 17 states examined. The analysis provides a snapshot of current payment levels as of 2026, showing which states reimburse at higher or lower rates for these services. This matters for understanding provider participation, access to care, and administrative approaches in states that have elected to fund abortion services through Medicaid beyond federal Hyde Amendment restrictions.

State Policy·62d ago

HUD Point-in-Time Data Shows Trends in Homelessness Characteristics

This data note from KFF reviews trends in homelessness and characteristics of people experiencing homelessness using HUD's Point-in-Time count data. The analysis covers sheltered and unsheltered populations identified through annual surveys. While homelessness itself is not a Medicaid program issue, states increasingly use Medicaid waivers and health-related services to address housing instability among enrollees, particularly through LTSS and behavioral health programs. The data provides demographic and trend context relevant to state agencies designing targeted interventions.

Federal Policy·64d ago

KFF Poll Shows Limited Public Awareness of Mifepristone Amid FDA Review

A KFF Health Tracking Poll finds limited public awareness of mifepristone safety and prevalence as the FDA conducts a re-review of the abortion medication. The poll, conducted in July 2026, shows that voters prioritizing abortion policy discussions in the 2026 midterm elections are disproportionately Democrats. The survey results come during an ongoing federal regulatory review process that could affect access to medication abortion. While mifepristone is used in some state Medicaid programs for covered abortion services, this poll focuses on general public awareness rather than Medicaid program operations or coverage policies.

Federal Policy·65d ago

KFF Survey Details Health Impacts of 2025 Reconciliation Coverage Losses for Immigrants

A KFF survey conducted in Fall 2025 examines health and health care experiences of uninsured immigrant adults, providing baseline data on how the 2025 reconciliation law's coverage restrictions affect lawfully present immigrants who lost Medicaid eligibility. The survey captured experiences of immigrant adults age 18 and older during the initial implementation period of the reconciliation law. The findings offer insight into coverage disruptions, access barriers, and health outcomes among immigrant families affected by the federal policy changes that eliminated or restricted Medicaid eligibility for certain lawfully present immigrants.

Federal Policy·66d ago

KFF Analysis Finds SSI Applicants Face Coverage Risk Under Medicaid Work Requirements

KFF released a policy analysis examining how Medicaid work requirements could affect Supplementary Security Income (SSI) applicants. The analysis finds that SSI applicants are at heightened risk of losing Medicaid coverage due to challenges navigating the medical frailty exclusion verification process under work requirement policies. While individuals with disabilities are typically exempt from work requirements through medical frailty provisions, SSI applicants — who are in the process of establishing disability status — may struggle to document their conditions quickly enough to maintain continuous coverage. The analysis highlights operational barriers that could lead to coverage gaps for this vulnerable population.

Federal Policy·67d ago

ACA Marketplace Enrollment Drops 15% After Enhanced Premium Tax Credits Expire in 2026

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.

State Policy·68d ago

1.4 Million Uninsured in Ten Non-Expansion States Remain in Medicaid Coverage Gap

An analysis estimates 1.4 million uninsured individuals in the ten states that have not adopted Medicaid expansion remain in the coverage gap — earning too much for traditional Medicaid but too little to qualify for Marketplace premium tax credits. This population includes working adults, people of color, and individuals with disabilities. These individuals are ineligible for Medicaid because their states have not adopted the ACA's expansion to adults up to 138% of the federal poverty level and ineligible for Marketplace subsidies, which begin at 100% FPL. The analysis highlights the continued state-by-state variation in Medicaid eligibility and access to affordable coverage.

Federal Policy·71d ago

CMS Mandates Notices for Medicaid Work Requirements as States Plan Broader Outreach

Federal regulations require state Medicaid agencies to notify enrollees affected by new work requirements, and most states are planning additional outreach including phone calls, public advertising, and social media. States face operational challenges meeting tight implementation timelines while complying with federal notice requirements. The brief examines state compliance strategies and the administrative burden of implementing work requirement communications across diverse enrollee populations.

State Policy·71d ago

KFF Tracker Compiles State Abortion Coverage Policies Across Medicaid and Exchange Plans

This interactive resource tracks state-level abortion coverage policies across Medicaid, private insurance, and ACA exchange plans as of 2025. The tracker shows the number of states with laws restricting abortion coverage in Medicaid and private insurance has increased since 2010. It provides a state-by-state breakdown of coverage restrictions, exceptions for life endangerment or other circumstances, and differences between Medicaid fee-for-service and managed care plan coverage. The tool allows Medicaid agencies, health plans, and advocates to compare abortion coverage rules across states and insurance types.

Federal Policy·72d ago

KFF Poll: CDC Trust Stable While Confidence in Trump, State Officials Declines

A July 2026 KFF tracking poll finds public trust in the CDC as a health information source has stabilized after steep declines between 2020 and early 2026, while trust in President Trump and state government officials as health information sources has decreased over the past six months. The poll marks a potential inflection point in public confidence in federal health agencies following years of erosion. For Medicaid agencies and health plans managing public health messaging around coverage, benefits, and care access, understanding shifting trust dynamics affects member communication strategies and credibility of guidance tied to federal or state sources.

Federal Policy·72d ago

KFF Brief Reviews U.S. Abortion Data Trends Through 2026

A KFF brief examines U.S. abortion data sources and trends before and after the Dobbs decision, analyzing factors affecting abortion rates and projecting potential policy changes under the current administration and Congress. The analysis covers state-level variations in access and utilization following the overturning of Roe v. Wade. The brief provides context for understanding how federal and state policy changes may continue to shape abortion access and Medicaid coverage decisions.

Industry·75d ago

Stanford Expert Discusses Evolving AI Regulation in Health Care Delivery

Dr. Michelle Mello of Stanford's Healthcare Ethical Assessment Lab for AI discussed regulatory frameworks for artificial intelligence deployment in clinical settings during an interview. The conversation addressed accountability structures, oversight mechanisms, and liability questions as AI tools increasingly enter medical practice. While the discussion covers broader health care AI governance, specific Medicaid managed care implications were not detailed. The podcast explores ongoing policy development rather than reporting finalized regulatory action.

Industry·75d ago

KFF Poll Finds Public Uncertainty Dominates Vaccine Myth Responses

A new KFF tracking poll on health information and trust reveals that uncertainty over common vaccine myths is more prevalent among the public than firm belief or denial. The analysis categorizes respondents into consistent myth believers, consistent myth deniers, and a "mixed middle" group that expresses uncertainty. The poll provides insight into public attitudes that may affect vaccine uptake and health plan member engagement strategies. Results suggest health plans may need tailored communication approaches for populations with varying levels of vaccine hesitancy and misinformation exposure.

Federal Policy·78d ago

Trump Administration Rescinds Nursing Home Staffing Rule, Shifts Inspection Priorities

The Trump administration has rescinded the Biden-era nursing home staffing rule, shifted federal inspection priorities from routine surveys to complaint-driven inspections, and suspended the deadline for nursing homes to report detailed ownership information. These policy changes affect federal oversight of nursing home safety and quality standards under Medicare and Medicaid certification. The changes are currently in effect. The shifts matter because many Medicaid managed care organizations contract for long-term care services in nursing facilities or operate programs with nursing home placement responsibility, making federal certification standards and inspection frequency directly relevant to network adequacy, quality oversight, and member safety obligations.

Federal Policy·79d ago

KFF Poll Shows Voter Focus on Health Costs, Republican Priority on Program Fraud

A new KFF Health Tracking Poll finds health care costs are the top health care priority for voters ahead of the 2026 midterm elections. More than half of Republican voters identify fraud in government health programs as an extremely important campaign issue, aligning with current Trump administration enforcement priorities. Most voters believe at least some fraud exists in government health programs, though voters perceive higher fraud levels in tax systems, defense spending, and foreign aid. The smallest share of voters perceives fraud in ACA marketplace programs.

Industry·79d ago

Insurers to Pay $759 Million in MLR Rebates for 2024 Performance

Health insurers will pay an estimated $759.2 million in Medical Loss Ratio rebates in 2026 based on 2024 performance, according to KFF analysis of preliminary data filed with state regulators. The rebates go to individuals and employers in fully-insured plans where insurers failed to meet minimum MLR thresholds—80% for individual and small group markets, 85% for large group plans. This year's rebate total is lower than most prior years. Payments typically reach consumers by September 30, 2026.

Industry·79d ago

Peterson Health Technology Institute Examines AI Deployment in Prior Authorization and Medical Billing

The Peterson Health Technology Institute is evaluating how providers and payers are deploying artificial intelligence in administrative functions including prior authorization, medical coding, and billing. Providers are using AI tools to optimize revenue capture and documentation, while insurers deploy similar technology for claims review and utilization management. PHTI's executive director Caroline Pearson notes the central question is whether these technologies reduce total healthcare spending or simply accelerate existing reimbursement disputes. The institute previously found that digital diabetes management tools did not lower overall cost of care.

State Policy·79d ago

KFF Tracker Compiles Section 1115 Medicaid Waiver Activity Across States

The Kaiser Family Foundation maintains an ongoing tracker of Section 1115 Medicaid waiver activity, cataloging approved and pending waiver provisions across states. The tracker covers waiver provisions affecting eligibility, benefits, social determinants of health initiatives, and other delivery system reforms. It provides a reference tool for monitoring state flexibility requests and approved demonstrations that deviate from standard Medicaid requirements. The resource is continuously updated as states submit new waiver applications and CMS issues approval decisions.

Industry·79d ago

KFF Analysis Examines Why Drug Prices Dominate Policy Debate Over Hospital Costs

KFF's Larry Levitt published a JAMA Health Forum post identifying four reasons why high drug prices receive more policy attention than hospital prices, despite hospitals accounting for 40% of national health spending growth from 2022 to 2024. The analysis explores barriers to hospital price restraint and potential policy interventions. The post provides context for understanding the political economy of health care cost containment efforts. No immediate policy changes are announced.

State Policy·80d ago

KFF Tracker Compiles State Medicaid Postpartum Coverage Extension Actions

This tracker compiles state-level activity on Medicaid postpartum coverage extensions beyond the federal 60-day minimum. It documents approved and pending Section 1115 waivers, state legislation requiring federal approval through state plan amendments or waivers, submitted and approved SPAs, and coverage financed entirely with state funds. The tracker provides a centralized reference for monitoring which states have extended postpartum coverage and through what mechanisms. It reflects ongoing state implementation of the American Rescue Plan Act option that allows states to extend Medicaid postpartum coverage to 12 months.

Federal Policy·80d ago

KFF Poll Finds Fraud in Government Health Programs Resonates with Republican Voters Ahead of Midterms

A KFF Health Tracking Poll released July 16, 2026, shows that 55% of Republican voters consider addressing fraud in government health programs, including Medicaid and Medicare, extremely important for candidates in the 2026 midterms. Most voters perceive at least some fraud in government health programs, though voters report higher fraud concerns in the tax system, defense, and foreign aid. The poll indicates health care costs remain the top health priority overall. The findings suggest fraud and program integrity messaging may gain prominence in congressional campaigns as midterm elections approach.

Managed Care·80d ago

Dual-Eligible Beneficiaries Show Higher Chronic Condition Rates Driving Spending Patterns

A new issue brief analyzes enrollment and spending patterns for dual-eligible individuals enrolled in both Medicare and Medicaid, focusing on how chronic condition prevalence drives higher average per-person costs. The analysis uses recent data on chronic conditions to profile this population's health status and associated expenditures. Dual-eligible beneficiaries represent a disproportionately high-cost, high-need segment often served through integrated Medicare-Medicaid plans (D-SNPs and FIDE SNPs). The findings provide context for managed care organizations managing dual-eligible populations on how chronic disease burden correlates with spending.

Federal Policy·81d ago

988 Lifeline Volume Up 15% Year-Over-Year as States Answer More Calls In-State

The 988 Suicide and Crisis Lifeline handled 15% more contacts in March 2026 compared to March 2025, and volume is nearly 50% higher than two years prior. States are increasingly routing calls to in-state crisis centers, where counselors have better knowledge of local mental health and substance use resources. The growth reflects sustained demand for crisis services as the lifeline enters its fourth year of operation. For Medicaid managed care organizations, rising 988 utilization signals growing behavioral health crisis service needs and potential downstream impacts on emergency department use and member engagement.

Managed Care·82d ago

Substance Use and Suicide Combined Ranked Third Leading Cause of U.S. Death in 2024

A new brief reports that substance use and suicide deaths collectively became the third leading cause of death in the United States in 2024, reflecting continued behavioral health mortality trends. The analysis examines demographic patterns and temporal trends in these deaths. For Medicaid managed care organizations, this data underscores the scale of behavioral health needs among enrollees, as Medicaid covers a disproportionate share of individuals with substance use disorders and mental health conditions. The findings reinforce the importance of MCO investments in crisis intervention, medication-assisted treatment, and integrated behavioral health services.

State Policy·86d ago

First 1115 SUD IMD Waiver Evaluations Show Mixed Progress on State Milestones

Early summative evaluations of Section 1115 waivers allowing Medicaid payment for substance use disorder treatment in institutions for mental disease reveal uneven state performance on required milestones. The brief analyzes evaluation findings as states navigate waiver renewals amid evolving federal Medicaid policy. States must demonstrate progress on access to evidence-based treatment, use of opioid use disorder medications, and improved care transitions. The findings come as CMS continues to refine expectations for SUD IMD waiver demonstrations and states prepare renewal applications.

Federal Policy·86d ago

ACS Data Shows Direct Care Worker Demographics Amid Federal Policy Shifts

Analysis of 2024 American Community Survey data examines demographic and socioeconomic characteristics of direct care workers, including home health aides, personal care aides, and nursing assistants across long-term care settings. The workforce profile covers workers in nursing facilities, residential care, home health, and nonresidential services for older adults and people with disabilities. Federal policy changes affecting workforce stability, reimbursement, and recruitment directly impact Medicaid managed care organizations' ability to build adequate LTSS provider networks and meet access standards.

Managed Care·86d ago

Contraceptive Implant Use Rising Despite Remaining Below Other Birth Control Methods

Contraceptive implants, the most effective reversible birth control method available, are seeing increased provision and utilization in the United States, though adoption rates remain lower than other contraceptive methods. The growth in implant use reflects evolving clinical practice patterns and improved access channels. For Medicaid managed care organizations, implants represent a covered preventive service under federal requirements, with reimbursement structures varying by state. The shift toward long-acting reversible contraceptives has implications for pharmacy benefit management, provider network adequacy, and quality metrics related to reproductive health access.

Industry·86d ago

ACA Marketplace Insurers Propose 14% Premium Increase for 2027

Insurers participating in ACA Marketplaces are proposing a median premium increase of 14% for 2027, based on preliminary rate filings analyzed in 16 states and DC. This follows steep increases in 2026, bringing total premium growth to over one-third between 2025 and 2027. The analysis reflects preliminary filings subject to final regulatory review. Final rates will be determined later in 2026 ahead of the 2027 plan year.

Federal Policy·94d ago

CBO Projects Medicaid Enrollment and Spending Decline Through 2036 Under Reconciliation Law

The Congressional Budget Office's February 2026 projections show significant reductions in Medicaid enrollment and federal spending over the next decade following passage of the 2025 reconciliation law. The analysis compares current projections to pre-reconciliation baselines, quantifying the impact of policy changes including eligibility restrictions, state flexibility provisions, and federal funding modifications. CBO accounts for both legislative changes and updated economic assumptions in projecting enrollment trends and program costs through 2036. The projections provide the first comprehensive federal assessment of how reconciliation provisions will reshape Medicaid program size and federal financial participation.

Managed Care·96d ago

Cityblock CEO: Most Health Care AI Invests in Billing, Not Care Delivery

Dr. Toyin Ajayi, CEO of Cityblock Health, argues that approximately 60 percent of health care AI investment focuses on billing, coding, and risk adjustment rather than care delivery. Cityblock serves over 100,000 Medicaid and dual-eligible members across ten states. Ajayi contends that redirecting AI investment toward care delivery for high-need populations can lower costs while improving outcomes. She discusses how Cityblock currently uses AI to enhance care and patient experience for Medicaid managed care enrollees.

State Policy·TN·96d ago

Tennessee Law Mandates Immigration Data Sharing for Children's Special Services Enrollees

Tennessee enacted legislation requiring state agencies to share data on public assistance program applicants and enrollees without qualified immigration status with federal immigration authorities. This requirement extends to the Children's Special Services program, which serves children with disabilities. The law affects eligibility and enrollment processes for state public assistance programs, including Medicaid-adjacent services. The policy creates operational challenges for managed care organizations and providers serving mixed-status families, potentially reducing program participation and complicating outreach and enrollment activities.

Federal Policy·97d ago

KFF Tracker Compiles Monthly Medicaid and CHIP Enrollment Data

The Kaiser Family Foundation maintains an ongoing tracker of monthly Medicaid and CHIP enrollment figures across states. The tracker aggregates enrollment data reported by states and CMS, providing a centralized resource for monitoring program size and trends. It is updated as new monthly data becomes available from state and federal sources. The tracker serves as a reference tool for analyzing enrollment patterns following policy changes such as the end of continuous coverage provisions.

Federal Policy·100d ago

KFF Tracker Compiles Federal Medicaid Program Integrity Actions by State

The Kaiser Family Foundation maintains an ongoing tracker of federal Medicaid program integrity developments and their state-specific implications. The resource documents CMS enforcement actions, audit findings, and compliance initiatives as they emerge across different states. The tracker serves as a reference for monitoring federal oversight activity affecting state Medicaid programs. It compiles information on federal actions rather than reporting a single policy change or rulemaking.

Industry·102d ago

Researcher Discusses Progress on AI Bias in Patient Risk Algorithms

Dr. Ziad Obermeyer discussed the evolution of AI bias in healthcare algorithms since his 2019 research exposed systematic underestimation of Black patients' health needs in a widely used commercial algorithm. The conversation covered progress the healthcare industry has made in addressing algorithmic bias in patient management tools. The discussion appears focused on clinical risk prediction models used across the healthcare sector. While the original research had significant implications for how health plans and providers identify high-risk patients for care management programs, this appears to be a retrospective industry discussion rather than new policy guidance or research findings.

Federal Policy·109d ago

Uninsured Population Grew in 2024, First Increase Since 2019

The number and share of Americans without health insurance increased in 2024, marking the first rise since 2019, according to KFF's analysis of American Community Survey data. The growth in uninsured individuals follows the end of Medicaid continuous enrollment protections that expired in March 2023, resulting in millions of eligibility redeterminations across states. The increase reverses a five-year trend of declining uninsurance rates and signals potential coverage losses that disproportionately affect low-income populations eligible for Medicaid. This shift has immediate implications for uncompensated care costs and emergency department utilization that MCOs and safety-net providers must absorb.

State Policy·109d ago

State Reproductive Health Policies Create Unequal Access Across U.S., KFF Analysis Finds

A KFF analysis published in The Milbank Quarterly documents how state-level policy decisions create significant variation in reproductive healthcare access across the United States. The research examines state choices on contraception coverage, abortion restrictions, and maternal health programs that directly affect Medicaid beneficiaries. State policy differences impact managed care organizations' benefit design, network requirements, and care coordination obligations. The analysis highlights how states' Medicaid program structures and regulatory frameworks shape reproductive health service delivery and access for MCO enrollees.

State Policy·109d ago

States Propose Changes to Immigrant Health Coverage and Enforcement in 2025-2026 Sessions

Multiple states are introducing legislation affecting immigrants' access to state-funded health coverage and services during the 2025-2026 legislative sessions. The actions include both expansions and restrictions to coverage eligibility, with direct implications for Medicaid and CHIP programs that serve immigrant populations. Changes vary by state and may affect enrollment, eligibility verification processes, and state budget obligations. Medicaid managed care organizations should monitor state-level developments that could alter their member demographics, revenue streams, and compliance requirements for serving immigrant populations.

Federal Policy·111d ago

Medicaid State Directed Payment Spending Analyzed Before Federal Caps Take Effect

A new issue brief examines state spending on Medicaid state directed payments (SDPs) requiring prior CMS approval, providing baseline data ahead of new federal limits. The reconciliation law imposes caps on SDP spending that will take effect in the coming fiscal year, fundamentally altering how states can direct managed care payments to providers. The analysis covers SDP utilization patterns across states and payment types, including directed payment arrangements for hospitals, nursing facilities, and other providers. This data establishes the spending landscape before federal restrictions reshape state flexibility in directing managed care plan payments.

Federal Policy·116d ago

KFF Fact Sheet Details Women's Health Coverage Sources and ACA Impact in 2024

The Kaiser Family Foundation published a fact sheet examining women's health insurance coverage in the United States as of 2024. The analysis reviews major coverage sources for women, including employer-sponsored insurance, Medicaid, Marketplace plans, and Medicare. It assesses how the Affordable Care Act has affected women's access to coverage and identifies ongoing coverage gaps that persist despite ACA reforms. The fact sheet provides baseline data on coverage patterns relevant to understanding enrollment trends and coverage obligations.

Federal Policy·117d ago

HHS Escalates Medicaid Program Integrity Enforcement Across Multiple States

HHS has launched state-specific and nationwide actions targeting Medicaid program integrity, marking an escalation in federal oversight of state programs. The actions include audits, funding withholdings, and enhanced scrutiny of improper payments and eligibility determinations. States face increased federal review of their claims processing, provider enrollment, and payment accuracy systems. The brief identifies states likely to face heightened scrutiny and outlines enforcement priorities, though many details about timing and specific state selections remain unclear.

Federal Policy·118d ago

Title X Funding Cuts and Policy Changes Drive Planned Parenthood Clinic Closures

Federal policy changes have led to decreased funding for Planned Parenthood, including provisions in the One Big Beautiful Bill Act and the withholding of Title X family planning funds from Planned Parenthood clinics. These funding cuts are resulting in clinic closures across multiple states. The changes affect access to family planning services, including contraception and STI screening, that many Medicaid managed care organizations rely on through network providers. The brief examines the scope of closures and the impact on the Title X program's provider network.

Federal Policy·121d ago

Trump Administration Moves to Eliminate Federal DEI Initiatives

The Trump administration has taken action to eliminate diversity, equity, and inclusion (DEI) initiatives across federal agencies. The brief examines the status of these actions and their potential impact on racial health disparities. For Medicaid managed care organizations, these changes may affect federal health equity requirements, data collection mandates, and program priorities that have shaped health plan operations and reporting obligations. The brief does not specify effective dates for all changes, though the administration's directives are already underway.

State Policy·123d ago

State Medicaid Work Requirements Data Now Being Tracked Under 2025 Reconciliation Law

A tracking initiative is monitoring state-level implementation of Medicaid work requirements mandated by the 2025 Reconciliation Law. The effort compiles detailed state and national data on how states are operationalizing work requirements, including eligibility verification processes, exemption categories, reporting systems, and compliance mechanisms. Implementation timelines and specific state policies vary as states develop infrastructure to meet federal mandates. For Medicaid managed care organizations, this creates new administrative responsibilities around member eligibility tracking, reporting coordination with state agencies, and potential enrollment fluctuations as work requirements take effect.

State Policy·126d ago

KFF Launches Medicaid Unwinding Tracker With State-Level Renewal and Disenrollment Data

The Kaiser Family Foundation has published a tracker providing state-by-state data on Medicaid renewals, disenrollments, and monthly enrollment during the unwinding period following the end of the COVID-19 public health emergency continuous coverage requirement. The tracker compiles the most recent available data from each state, allowing comparison of disenrollment rates and renewal outcomes across states. This tool enables managed care organizations to monitor enrollment trends in their service areas and assess the impact of unwinding on member populations. The data is updated as states report new figures.

State Policy·NC·128d ago

North Carolina Prepares to Implement 2025 Reconciliation Law Medicaid Provisions Amid Budget Shortfalls

North Carolina is developing plans to implement Medicaid provisions from the 2025 reconciliation law while facing budget constraints. The state is preparing policy changes that will affect Medicaid coverage and beneficiary access to care. Implementation details are emerging as North Carolina managed care organizations and state officials work through operational and financial implications. The reconciliation law's Medicaid provisions, combined with state budget pressures, will require MCOs to adjust operations, network management, and benefit administration.

Industry·129d ago

KFF Analysis: Medicare Beneficiaries Face Affordability Challenges Across Coverage Types

A KFF brief examines health care affordability for Medicare beneficiaries, including younger adults with long-term disabilities. The analysis draws on multiple data sources to document out-of-pocket costs, premium burdens, and financial strain across traditional Medicare and Medicare Advantage populations. While not directly about Medicaid, the findings are relevant for dual-eligible special needs plans (D-SNPs) and state programs serving Medicare-Medicaid enrollees. Plans serving dual eligibles should consider how Medicare cost-sharing affects their members' total cost of care and care-seeking behavior.

Industry·129d ago

KFF CEO Drew Altman Announces Retirement, Larry Levitt and Mollyann Brodie Named Successors

Drew Altman, founding CEO of KFF (Kaiser Family Foundation), announced his retirement after nearly 40 years leading the health policy research organization. Larry Levitt and Mollyann Brodie will assume joint leadership roles in 2024, bringing six decades of combined experience at KFF. The transition affects one of the most influential health policy research organizations that regularly produces Medicaid analysis, polling, and policy briefs. The leadership change may influence the organization's future research priorities and policy positions on Medicaid managed care issues.

Federal Policy·129d ago

CMS Prepares Guidance on Medical Frailty Exemption Implementation for Medicaid Work Requirements

CMS is expected to issue guidance addressing key implementation questions for the medical frailty exemption from Medicaid work requirements. States are currently developing operational plans but face uncertainty about eligibility criteria, documentation requirements, and assessment processes. The guidance will likely clarify how states should identify and exempt medically frail beneficiaries from work requirements. This affects managed care organizations that may need to modify enrollment processes, develop screening tools, and adjust member engagement strategies based on final CMS standards.

Federal Policy·129d ago

KFF Launches Tracker of Trump Administration Mental Health and Substance Use Policies

KFF has released a new tracker documenting federal policy actions during President Trump's second term affecting mental health and substance use services. The tracker shows the administration emphasizing law-and-order approaches while scaling back certain mental health and substance use services, though some treatment-focused initiatives continue. The tool organizes policies chronologically and by category including mental health, opioids/SUD, federal infrastructure, and gun violence. This matters for Medicaid MCOs as federal policy changes in behavioral health directly impact covered services, reimbursement structures, and compliance requirements for mental health and substance use disorder benefits.

Industry·129d ago

HCA Healthcare Scales AI Across Clinical Operations with Clinician-Led Development

HCA Healthcare has implemented AI solutions across its health system operations through a systematic approach involving clinician engagement from development through deployment. The health system focuses on careful testing and customization of AI tools for clinical care and hospital operations, with nurses and physicians serving as primary end users throughout the process. This represents a scaled approach to healthcare AI implementation that other health systems and managed care organizations are watching for operational efficiency and care quality improvements. The initiative demonstrates how large healthcare organizations are integrating AI into everyday clinical workflows.

Legal·129d ago

Federal Court Tracker Compiles Reproductive Health Litigation Including Mifepristone Cases

A new litigation tracker aggregates ongoing federal court cases involving abortion bans, restrictions, and FDA regulation of mifepristone and other reproductive health matters. The tracker covers both state and federal reproductive rights litigation currently moving through the courts. This litigation could impact Medicaid managed care organizations' coverage obligations and provider networks, particularly for family planning services, emergency contraception, and pregnancy-related care depending on court outcomes and state policy responses.

State Policy·129d ago

Interactive Map Tracks Current Status of State Medicaid Expansion Decisions

A resource page provides an interactive map showing which states have adopted, rejected, or are considering the Affordable Care Act's Medicaid expansion. The map tracks the current status of all state decisions regarding expansion eligibility for adults up to 138% of the federal poverty level. This affects managed care organizations by indicating potential market opportunities in expansion states and enrollment growth projections. The resource includes additional links to Medicaid expansion policy materials.

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