Medicaid Monitor
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Pennsylvania Capital-Star

16 stories

State Policy·PA·3d ago

Pennsylvania House Advances Menopause Treatment Coverage Bill Package

Pennsylvania House committees have advanced seven bills addressing perimenopause and menopause care, including measures from Reps. Liz Hanbidge and Morgan Cephas that would expand Medicaid and private insurance coverage for hormonal and non-hormonal menopause therapy and pelvic floor therapy. Other bills in the package address provider education partnerships with the Department of Health and workplace accommodations for menopausal symptoms. Some Republicans opposed the measures over concerns about increased Medicaid costs. The bills are still moving through House committees, with no final floor votes or effective dates yet reported.

State Policy·PA·5d ago

Allegheny County Kindergarten MMR Rate Falls Below Herd Immunity Threshold

Pennsylvania has confirmed 835 measles cases across 39 counties in 2026, including 164 hospitalizations and four deaths among unvaccinated residents, compared to just 16 cases statewide in 2025. Allegheny County's kindergarten MMR vaccination rate stood at 91.8% for the 2025-26 school year, below the 95% threshold needed to prevent community spread, continuing a decade-long decline. The MMR vaccine is available at no cost to Medicaid-enrolled, uninsured, and underinsured children at Pennsylvania's 59 state health centers. The outbreak underscores how declining childhood vaccination coverage is driving disease resurgence in a state where Medicaid covers a large share of pediatric immunizations.

State Policy·11d ago

Nine States to Vote on Tax Measures Affecting Medicaid and Public Program Funding

Voters in at least nine states will decide tax ballot measures this fall that could significantly alter revenue available for Medicaid and other public services. California's Proposition 40 would impose a one-time 5% wealth tax on billionaires to close budget gaps in Medicaid, food assistance, and education programs — a response to federal funding losses from the 2025 One Big Beautiful Bill Act. Colorado and Washington state also face income tax measures. California's measure would raise tens of billions for Medicaid and other services, though competing ballot measures could undo it if they receive more votes. The outcomes will determine state capacity to fund Medicaid programs amid tightening federal support.

State Policy·18d ago

Pediatricians Report Immigrant Families Avoiding Medicaid, CHIP Amid Immigration Enforcement Fears

Forty percent of pediatricians surveyed by the American Academy of Pediatrics report children in immigrant families are avoiding healthcare due to immigration status concerns, with 31% reporting families avoided applying for Medicaid, CHIP, or food assistance. The survey of over 1,600 pediatricians conducted April-June 2026 found urban pediatricians reported higher rates of families retreating from care (48%) compared to rural providers (32%). A new federal public charge policy effective September 20, 2026 allows immigration officers reviewing green card and visa applications to consider enrollment in Medicaid, CHIP, housing assistance, and food programs as grounds for inadmissibility, which pediatricians say will further deter eligible families from enrolling.

Federal Policy·18d ago

Census Reports 2025 Poverty Rate at Historic Low Amid Warnings of Medicaid, SNAP Cuts

The U.S. Census Bureau reported the 2025 official poverty rate fell to 10.2%, a historic low, while the supplemental poverty rate held steady at 13.1%. Median household income rose 2.6% to $87,460. Experts cautioned the data does not reflect 2026 federal policy changes, including major Medicaid and SNAP cuts enacted through last year's tax and spending legislation. The Congressional Budget Office estimates 15 million people will lose health coverage by 2034, and SNAP enrollment for children already dropped 1.2 million between July 2025 and July 2026.

State Policy·PA·31d ago

Pennsylvania Labor Agency Launches Proactive Wage Compliance Reviews of Home Care Providers

Pennsylvania's Department of Labor and Industry announced September 2, 2026, that it will proactively investigate Minimum Wage Act violations across home care agencies statewide, rather than waiting for worker complaints. The initiative targets an industry where nearly 40% of the state's wage complaints originate, affecting an estimated 100,000 home care workers. Agencies received legal demands for wage and hour records starting Wednesday. The state will focus on unpaid overtime, travel time between clients, and improper sleep-time deductions — common violations in a sector heavily reliant on Medicaid reimbursement for personal care services.

Federal Policy·33d ago

SNAP Eligibility Changes Threaten Free School Meal Access for Low-Income Students

Over 1 million children lost SNAP benefits following implementation of the One Big Beautiful Bill Act, which imposed new work requirements and state cost-sharing provisions. Because many students qualify automatically for free school meals through household SNAP or Medicaid participation, reductions in those programs directly threaten school meal eligibility. Schools offering universal free meals under USDA's Community Eligibility Provision face potential loss of federal reimbursement, as funding formulas tie reimbursement rates to SNAP enrollment percentages. The 30-day grace period for previously qualified students is ending as the 2026-27 school year begins, with advocates warning of increased childhood hunger and academic impacts.

Managed Care·34d ago

Drug-Resistant Fungal Infections Reported in 3,500 Patients Across 28 States

Twenty-eight states reported over 3,500 clinical cases of candida auris, a drug-resistant fungus, as of August 1, 2026, according to CDC surveillance data. The infection primarily affects severely ill patients in healthcare and long-term care facilities, particularly those with breathing tubes, feeding tubes, or catheters. California reported the highest number of clinical cases at 887, followed by Texas (437) and Tennessee (293). The fungus is resistant to multiple antifungal drugs and spreads easily in healthcare settings, with an additional 3,325 screening detections of patients who are colonized but not yet ill.

Federal Policy·34d ago

DHS Inspector General: Fentanyl Seizures Fell 39% as ICE Shifted to Immigration Enforcement

Fentanyl seizures dropped 39% in the first year of the second Trump administration after Homeland Security Investigations shifted agents from drug enforcement to immigration cases, according to a DHS Office of Inspector General report published August 21, 2026. HSI dedicated 250,000 fewer hours to fentanyl investigations in fiscal 2025 compared to fiscal 2024, while immigration enforcement hours increased over 800%. One HSI field office devoted 99% of its resources to immigration, reducing a seven-agent drug team to three. ICE agreed with the inspector general's recommendation to review staffing levels and expects to complete that review by June 2027.

State Policy·34d ago

States Increase Home Caregiver Pay as Labor Shortage Intensifies Ahead of Boomer Wave

Several states have raised Medicaid reimbursement for home care aides as the nation faces a projected need for 5 million home caregivers by 2034, up from 4.3 million today. The national median wage for home care aides remains $16.78 per hour ($34,900 annually), contributing to persistent workforce shortages. Ohio and other states have implemented marginal pay increases through Medicaid, but those gains face jeopardy from billions in federal Medicaid cuts scheduled to take effect in 2027 under tax and spending legislation signed by President Trump. The demographic pressure intensifies as 10,000 baby boomers turn 80 daily through the next decade, straining state budgets and home- and community-based services programs.

Legal·PA·34d ago

Pennsylvania, 23 States Sue Over Trump Administration Title X Grant Conditions

Pennsylvania Governor Josh Shapiro and nearly two dozen states filed suit Thursday in U.S. District Court in Maryland challenging new federal conditions on Title X family planning grants for the 2027-2032 funding cycle. The Trump administration's Office of Population Affairs requirements include ending diversity, equity and inclusion policies and what HHS terms "support for gender ideology." Title X provides Medicaid-funded family planning services including cervical cancer screening, STI testing, and contraceptive care primarily for low-income and uninsured populations. The lawsuit seeks to vacate these new grant requirements.

Federal Policy·34d ago

ACA Enhanced Subsidies Expiration Cuts Marketplace Enrollment by Nearly 3 Million Nationwide

Congressional inaction allowed enhanced ACA subsidies enacted in 2021 to expire at the end of 2025, causing marketplace enrollment to drop from 21.8 million to 19.2 million people nationwide as of August 2026 — a decline of nearly 3 million. Mississippi saw enrollment fall by nearly two-thirds in eight months. The subsidies, created as a pandemic-era measure under the American Rescue Plan Act and extended by the Inflation Reduction Act, made ACA coverage more affordable. Their expiration has left low-income adults without employer coverage, particularly in non-expansion states, facing higher premiums and loss of coverage.

State Policy·PA·51d ago

Pennsylvania Budget Excludes Home Health Nurse Rate Increase Despite Workforce Shortages

Pennsylvania's enacted budget does not include funding increases for home health nursing services, despite workforce shortages in the sector. Industry representatives report that current Medicaid reimbursement rates make it difficult to recruit and retain home health nurses. The budget outcome means existing rate structures will continue, affecting access to home-based nursing care for Medicaid beneficiaries. Home health agencies serving Medicaid populations face ongoing challenges competing for nursing staff without enhanced reimbursement.

Federal Policy·93d ago

Medicaid Coverage Reinstated for Non-Abortion Services at Planned Parenthood Clinics

Federal restrictions preventing Medicaid reimbursement for non-abortion services at Planned Parenthood have ended, restoring coverage for routine healthcare provided at these clinics. States now have discretion to determine whether Medicaid enrollees can access covered services at Planned Parenthood locations that remain operational. The change takes effect immediately, reversing a previous ban that prohibited Medicaid payment for any services delivered by Planned Parenthood providers, including primary care, family planning, STI testing, and cancer screenings. Medicaid managed care organizations must now determine network participation and reimbursement policies for these providers according to state guidance.

Legal·PA·96d ago

Pennsylvania Joins Multi-State Lawsuit Challenging Federal Medicaid Work Requirement Rules

Pennsylvania has joined a multi-state lawsuit against the Trump administration over new Medicaid work requirement rules. The litigation challenges federal restrictions on how states can handle applicants deemed medically frail, a term that lacks a standardized definition in Medicaid policy. The lawsuit represents a coordinated state effort to block implementation of the work requirement framework. This legal action creates compliance uncertainty for managed care organizations operating in participating states as they await court resolution on exemption criteria and enrollment procedures.

State Policy·PA·115d ago

Pennsylvania Lawmakers Push PBM Oversight After 1,000+ Pharmacy Closures Since 2020

Pennsylvania has lost over 1,000 pharmacies since 2020, prompting state lawmakers to pursue legislative action targeting pharmacy benefit managers. A Pennsylvania Department of Human Services official expressed skepticism about a legislative proposal to hire a PBM to oversee other PBMs. The legislative effort aims to address pharmacy closures attributed to PBM practices, though specific proposals and timelines are not detailed in the available information.

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