Medicaid Monitor
Policy Intelligence
Medicaid Monitor
Policy Intelligence
Updated 12:32 PM MT
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Industry·7h ago

Trump Nominates White House Health Adviser Heidi Overton as FDA Commissioner

President Trump announced Wednesday he will nominate Dr. Heidi Overton, currently a White House domestic policy adviser on health issues, to serve as FDA Commissioner. The nomination comes amid significant staff turnover at the agency. If confirmed by the Senate, Overton would lead the FDA's oversight of prescription drugs, including Medicaid drug coverage policy and pharmaceutical manufacturer rebates. The nomination's impact on Medicaid will depend on Senate confirmation timing and Overton's policy priorities once in office.

Legal·1d ago

Democratic Senators Accuse HHS of Violating Court Order on Medicaid Data Sharing with ICE

Four Democratic senators accused the Trump administration of violating a court order by continuing to share Medicaid enrollment data with DHS and ICE for deportation proceedings. Sens. Wyden, Booker, Merkley, and Van Hollen demanded HHS immediately halt the data sharing practice. The complaint alleges ongoing transfers of beneficiary information despite judicial restrictions. The disclosure raises compliance and enrollment concerns for state Medicaid agencies managing beneficiary data and MCOs responsible for protecting member information under privacy regulations.

Industry·7d ago

Research Suggests GLP-1 Drugs May Reduce Birth Control Effectiveness and Boost Fertility

Emerging research indicates that GLP-1 receptor agonist medications may interfere with oral contraceptive effectiveness and potentially increase fertility in users. The mechanism appears related to GLP-1s' effects on gastric emptying and hormone metabolism, which could reduce contraceptive absorption and alter reproductive hormone levels. The timing and clinical significance remain under investigation, but the findings have immediate implications for prescribing guidance and patient counseling. For Medicaid programs covering GLP-1s for diabetes and obesity, this raises questions about contraceptive coverage coordination, prior authorization criteria, and member education protocols.

Federal Policy·7d ago

March of Dimes: 5.8 Million Women Live in Maternity Care Deserts

A March of Dimes report finds that 5.8 million women live in counties without full access to maternity care, with one-third of U.S. counties classified as maternity care deserts — areas lacking hospitals or birth centers offering obstetric services. The report highlights geographic disparities in prenatal and delivery care access nationwide. These gaps affect Medicaid-covered pregnancies, as Medicaid finances approximately 42% of births nationally and faces network adequacy and provider participation challenges in underserved areas.

Industry·MI·16d ago

Two Deaths Reported in Michigan Cyclosporiasis Outbreak with Over 11,000 Cases

Two Michigan residents with cyclosporiasis have died amid an outbreak that has reached 11,234 reported cases, according to the state's Department of Health and Human Services. Both individuals had significant underlying health conditions that may have been affected by the parasitic infection and resulting dehydration, state officials said Monday. Cyclosporiasis causes watery diarrhea and can lead to serious complications in vulnerable populations. The outbreak's scale and severity raise infection control and care coordination concerns for health plans and providers serving high-risk Medicaid enrollees.

Legal·16d ago

HRC Sues Trump Administration Over Gender-Affirming Care Coverage Ban in Federal Employee Health Plans

The Human Rights Campaign filed a class-action lawsuit Monday challenging the Trump administration's ban on gender transition treatment coverage in federal employee health plans. The suit alleges the coverage ban violates federal sex discrimination protections in employment. The lawsuit does not directly target Medicaid or CHIP programs, though similar coverage restrictions could inform future Medicaid policy debates. The case centers on Federal Employees Health Benefits Program coverage, not state Medicaid programs.

Federal Policy·16d ago

HHS Secretary Kennedy Endorses Measles Vaccine Amid Outbreak Discussions

Health and Human Services Secretary Robert F. Kennedy Jr. endorsed the measles vaccine during a CNN interview on August 3, 2026, while making additional claims about other vaccines and RSV during ongoing measles outbreaks. The statement represents the Secretary's public position on measles immunization policy as the nation's top health official. The endorsement comes as federal and state health agencies manage measles outbreak response and vaccination campaigns. HHS guidance on childhood vaccinations influences state Medicaid EPSDT requirements, managed care quality metrics, and VFC program administration.

Federal Policy·16d ago

HHS Secretary Kennedy Says Trump Directed Investigation of Autism-Vaccine Link

HHS Secretary Robert F. Kennedy Jr. stated in a CNN interview that President Trump has directed him to investigate perceived links between autism and vaccines. Kennedy confirmed the Wall Street Journal's reporting on the matter. The statement signals potential federal review of vaccine policy and safety monitoring under the current administration. No timeline or specific investigative framework has been announced.

Federal Policy·20d ago

Bipartisan Bill Directs CMS to Add Stuttering Screening to EPSDT

Sens. Jim Banks (R-Ind.) and Andy Kim (D-N.J.) introduced the Kidd's Stuttering Act on Wednesday, directing CMS to add stuttering and fluency screening to Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services. The legislation would require Medicaid to cover screening and treatment for stuttering in children enrolled in the program. If enacted, state Medicaid agencies and managed care organizations would need to ensure network adequacy for speech-language pathology services and update coverage policies to include fluency disorder screening as part of well-child visits.

Industry·20d ago

Silver Diamine Fluoride Stops Decay in Over Half of Baby Teeth, Study Finds

A University of Michigan study found that silver diamine fluoride, a topical liquid treatment, stopped decay in more than half of treated baby teeth without drilling. The research adds evidence for non-invasive caries arrest in pediatric populations. The treatment is already FDA-cleared and used in some dental practices, including Medicaid programs that cover it as a preventive service. For Medicaid dental programs, wider adoption could reduce costs associated with general anesthesia and operating room visits for young children requiring restorative care.

Industry·23d ago

Danish Study Finds GLP-1 Drugs Reduce Long-Term Sick Leave by 17%

A study based on Danish data found that patients taking GLP-1 drugs experienced 17% fewer long-term work absences compared to those not on the medications. The research examined workplace absenteeism patterns among GLP-1 users. The findings suggest potential broader economic benefits beyond direct health outcomes. For Medicaid programs covering GLP-1s for weight management or diabetes, this data may inform cost-benefit analyses around coverage decisions, though workforce participation effects in Medicaid populations may differ from the Danish workforce studied.

Federal Policy·23d ago

FDA Raises Safety Concerns About Compounded GLP-1 Drugs as Alternative to Ozempic

The FDA and physicians are expressing concern about compounded versions of GLP-1 drugs like Ozempic, which patients are increasingly using as cheaper, more accessible alternatives. These compounded formulations, while easier to obtain, carry serious safety risks according to medical experts. The issue affects Medicaid beneficiaries who may turn to compounded versions due to cost or access barriers with brand-name GLP-1s. This raises questions for state Medicaid programs about coverage policies, prior authorization criteria, and quality oversight for diabetes and weight management drugs.

Industry·26d ago

Study Finds GLP-1 Drugs Reduce Long-Term Sick Leave by 17 Percent

A study using Danish data found that patients taking GLP-1 medications had 17 percent fewer long-term sick leave absences compared to those not on the drugs. The research suggests potential workforce participation and productivity benefits beyond clinical outcomes for obesity and diabetes treatment. The findings may inform Medicaid coverage decisions and utilization management policies for GLP-1s, which have been subject to state budget scrutiny due to high costs. The study did not specify implementation timelines but reflects ongoing evaluation of these drugs' broader economic impacts.

Federal Policy·28d ago

Trump Announces 100% Tariff on Imported Generics Effective August 2028

President Trump announced Tuesday via social media that imported generic drugs will face a 100 percent tariff beginning in August 2028 unless manufacturers relocate production to the United States. The tariff is described as a penalty designed to reshore generic pharmaceutical manufacturing. Generic drugs constitute the majority of Medicaid pharmacy spending, and most generics dispensed in the U.S. are manufactured overseas or contain active pharmaceutical ingredients from foreign suppliers. The two-year implementation timeline provides MCOs and state programs time to assess potential pharmacy cost impacts and supply chain disruptions.

Federal Policy·29d ago

Senate Democrat Proposes Medicare Enrollment for All Children Under Age 26

Sen. Andy Kim (D-N.J.) introduced legislation to automatically enroll all American children in Medicare from birth through age 25, calling the proposal MediKids. The bill would create universal federal coverage for children regardless of family income. No timeline for committee consideration or floor action has been announced. The proposal would fundamentally restructure pediatric coverage currently delivered through Medicaid, CHIP, and commercial insurance, though passage prospects remain uncertain given divided government.

Federal Policy·30d ago

Medicare Part D Now Covers GLP-1s for Weight Loss Under New CMS Policy

Insurance coverage for GLP-1 medications used for weight loss has changed for approximately 56 million Americans. The policy shift affects Medicare Part D beneficiaries and potentially other federal health programs. The coverage expansion comes as GLP-1 drugs like Ozempic and Wegovy gain widespread use for obesity treatment. Medicare previously covered these medications only for diabetes, not weight management alone, making this a significant benefit expansion with major cost implications for plans and enrollees.

Federal Policy·30d ago

Planned Parenthood Medicaid Funding Prohibition Excluded from GOP Reconciliation Framework

Republicans' reconciliation 3.0 framework omits language that would prohibit Medicaid funding from flowing to abortion providers like Planned Parenthood, prompting intensified activism from anti-abortion groups. The exclusion marks a potential shift in Republican legislative strategy on reproductive health provider funding within Medicaid. No timeline for final reconciliation language has been announced. The omission affects managed care organizations that currently contract with or reimburse Planned Parenthood affiliates for covered Medicaid services in states that have not already enacted provider exclusions.

Federal Policy·34d ago

Acting AG Pledges Federal Action to Restrict Mail Order Mifepristone

Acting Attorney General Todd Blanche told Republican senators he will prioritize stopping abortion medication from being mailed to patients if confirmed. Blanche specifically opposes the Biden-era policy that permitted mail distribution of mifepristone but did not detail enforcement mechanisms or timeline. The commitment signals potential federal action against telehealth abortion services and mail-order pharmacy dispensing of medication abortion. Any DOJ enforcement action could affect Medicaid managed care plans that cover telehealth reproductive services and pharmacy benefits including mifepristone.

Federal Policy·35d ago

Senate Questions CDC and HHS Nominees on Vaccine Policy Alignment

Two Trump administration health nominees—Erica Schwartz for CDC Director and Sean Kaufman for an HHS position—faced Senate scrutiny on July 15, 2026, over their willingness to challenge administration positions on vaccines. Both Democrats and some Republicans expressed concern about the nominees' reluctance to break with administration policy. The hearing centered on whether the nominees would maintain agency independence on vaccine policy and public health guidance. Confirmation votes have not been scheduled.

Federal Policy·37d ago

HHS Secretary Kennedy Blocks Preventive Services Task Force Meetings, Fires Leadership

HHS Secretary Robert F. Kennedy Jr. has prevented the U.S. Preventive Services Task Force from meeting, declined to replace members whose terms have expired, and fired the panel's leaders in May 2026. The task force determines which preventive medical services insurers must cover without cost-sharing under the Affordable Care Act. The disruption affects coverage recommendations for screenings, counseling, and preventive medications that Medicaid managed care plans must cover as essential health benefits. The timeline for new coverage recommendations and the panel's future composition remain uncertain.

Federal Policy·42d ago

FDA Approves Gene Therapy for Children with Sickle Cell Disease

The FDA has approved a new gene therapy treatment for children aged 2 and older with sickle cell disease. The approval expands treatment options for pediatric patients with this serious inherited blood disorder, which disproportionately affects Medicaid beneficiaries. Sickle cell disease affects approximately 100,000 Americans, with the majority covered by Medicaid. Managed care organizations will need to evaluate coverage policies, establish prior authorization criteria, and assess the financial impact of this high-cost specialty therapy on capitation rates and medical loss ratios.

Managed Care·42d ago

GLP-1 Weight Loss Use Jumps to 11% of Americans in Two Years

A Gallup survey released Tuesday shows 11 percent of Americans now take GLP-1 medications for weight loss, up from 3 percent in 2024. An additional 15 percent report considering use. The sharp uptick in utilization represents significant pharmacy cost pressure for Medicaid managed care plans, which face coverage mandates in some states and growing member demand. Plans must manage prior authorization protocols, medical necessity criteria, and budget forecasts as obesity prevalence grows among Medicaid populations.

Federal Policy·48d ago

DEA Proposes Schedule I Classification for Synthetic Kratom Compound 7-OH

The Drug Enforcement Administration announced plans to temporarily classify 7-hydroxymitragynine (7-OH) and three related synthetic kratom compounds as Schedule I controlled substances, placing them in the same regulatory category as heroin and LSD. The classification applies to synthetic versions of the psychoactive compound found in kratom products. If finalized, the scheduling action would prohibit manufacture, distribution, and possession of these substances, with enforcement implications for entities handling these compounds. The timing of implementation and comment period was not specified in the available content.

Industry·50d ago

PBM Trade Group Escalates Advocacy Against Drugmakers Following Congressional Overhaul

The leading pharmacy benefit manager lobbying organization is intensifying its advocacy campaign against pharmaceutical manufacturers after Congress enacted comprehensive PBM reform legislation earlier this year. The pharmaceutical industry has long blamed PBMs for high drug costs, culminating in legislative action this past winter. The lobbying escalation suggests ongoing tension between PBMs and drugmakers over responsibility for drug pricing and the implementation of new federal oversight provisions that affect both sectors.

Federal Policy·51d ago

Sanders Releases HHS Emails Showing Kennedy Pressured CDC on Vaccine Messaging

Senator Bernie Sanders released internal HHS emails indicating that HHS Secretary Robert F. Kennedy Jr. pressured the CDC to alter vaccine messaging and directed the CDC's vaccine advisory panel to restrict vaccine access. The emails document direct intervention in CDC communications and advisory processes. The release comes amid ongoing scrutiny of the administration's vaccine policy direction and its potential impact on public health programs.

Legal·NY·55d ago

Federal Judge Blocks DOJ Subpoenas for Transgender Patient Records at NYC Hospitals

A federal district court issued a temporary restraining order blocking the Justice Department from obtaining medical records of transgender patients treated at New York City hospitals. The ruling halts an ongoing DOJ investigation into gender-affirming care provided at these facilities. The order provides immediate protection for patient records while the case proceeds. The decision affects hospitals treating Medicaid beneficiaries receiving gender-affirming services and raises questions about federal enforcement priorities and patient privacy protections.

Federal Policy·56d ago

Senate Democrats Challenge Trump Administration's Moms.gov Site Over Crisis Pregnancy Center Listings

Eleven Democratic senators raised concerns about the Trump administration's Moms.gov website, launched on Mother's Day, which features resources from 2,750 pregnancy centers. The lawmakers argue the site directs families to crisis pregnancy centers rather than licensed medical providers. The site provides information for new and expecting mothers, but critics including Planned Parenthood contend these centers do not provide comprehensive medical care. The senators' letter signals potential congressional oversight of federal maternal health resource guidance.

Industry·58d ago

Meta-Analysis Compares Weight Loss Efficacy Across Tirzepatide, Semaglutide, and Liraglutide

A new meta-analysis compared weight loss outcomes for three GLP-1 receptor agonists: tirzepatide (Zepbound, Mounjaro), semaglutide (Wegovy, Ozempic), and liraglutide (Saxenda, Victoza). The study evaluated clinical efficacy data across the three drug classes to determine comparative effectiveness for weight management. The findings provide evidence that could inform prior authorization criteria, formulary placement, and medical policy for obesity treatment in Medicaid managed care plans. Many state Medicaid programs have restricted or excluded coverage of anti-obesity medications due to cost, making comparative effectiveness data particularly relevant for coverage and utilization management decisions.

Federal Policy·62d ago

Senate Democrats Investigate HHS Changes to Federal Vaccine Advisory Panel

Senate Democrats Ron Wyden and Maggie Hassan have launched an investigation into Health Secretary Robert F. Kennedy Jr.'s restructuring of the Advisory Committee on Immunization Practices (ACIP), the federal panel that issues vaccine recommendations. The senators are demanding communications and records showing who determined the legal and public health consequences of remaking the advisory committee. ACIP recommendations typically inform Medicaid and CHIP coverage decisions for vaccines under the Vaccines for Children program and mandatory coverage requirements for pediatric vaccines. The investigation seeks transparency around the decision-making process that led to changes in the federal vaccine policy infrastructure.

Federal Policy·63d ago

FDA Approves Third Over-the-Counter Naloxone Nasal Spray

The FDA approved Rextovy, a 4mg naloxone nasal spray, for over-the-counter sale in pharmacies, convenience stores, and online for emergency treatment of opioid overdose. This is the third OTC naloxone product approved by FDA. The approval expands consumer access to overdose reversal medication without a prescription. For Medicaid managed care organizations, this may affect pharmacy benefit management, member education strategies, and harm reduction program design, particularly for plans serving populations with substance use disorders.

Federal Policy·64d ago

Senate Democrats Release Prescription Drug Pricing Policy Blueprint

Senate Democrats released a policy blueprint proposing measures to lower prescription drug costs ahead of the midterm elections. The proposals aim to address voter concerns about drug affordability and provide a counter-message to White House voluntary pricing initiatives. The blueprint reflects ongoing bipartisan interest in drug pricing reform but does not specify legislative text, implementation timelines, or comment periods. For Medicaid managed care organizations, potential reforms could affect pharmacy benefit management, capitation rate calculations, and prescription drug rebate programs.

Federal Policy·64d ago

HHS Secretary Kennedy Demands Explanation for Retracted Vaccine-SIDS Study

HHS Secretary Robert F. Kennedy Jr. sent a June 11 letter to the editor-in-chief of Toxicology Reports demanding justification for the removal of a 2021 study linking vaccines to sudden infant death syndrome. Kennedy has cited this research in support of proposed changes to childhood immunization schedules. The retraction raises questions about the scientific basis for potential federal policy shifts affecting Medicaid-covered pediatric vaccine programs. No timeline has been announced for HHS policy changes to childhood vaccination requirements.

Legal·AK·68d ago

Planned Parenthood Sues Alaska Over Medication Abortion Telehealth Ban

Planned Parenthood Great Northwest filed a lawsuit Thursday in Alaska state court challenging the state's requirement that medication abortion be provided only in person, arguing it violates Alaska's constitutional right to abortion. The lawsuit seeks a preliminary injunction against the telehealth ban. Alaska is among states restricting medication abortion access through telehealth despite broader telemedicine expansion. The case affects how Medicaid managed care plans handle abortion coverage and telehealth protocols in Alaska, particularly for reproductive health services where telehealth has become standard in other states.

Federal Policy·69d ago

Six States Report Higher-Than-Expected ACA Marketplace Attrition After Enhanced Subsidies Expired

State-level enrollment data through April 2026 from Arkansas, Colorado, Maryland, Massachusetts, New Mexico, and New York show significant coverage losses as enrollees canceled plans or stopped paying premiums following the expiration of enhanced ACA subsidies. Georgetown University analysis indicates attrition rates exceed initial federal projections. Congress did not renew the enhanced subsidies that had been in place, resulting in higher premium costs for marketplace enrollees. The coverage losses could affect Medicaid managed care organizations in states with integrated or coordinated care models between marketplace and Medicaid coverage.

Federal Policy·70d ago

ACOG Issues Maternal Vaccine Schedule Diverging from CDC Guidance

The American College of Obstetricians & Gynecologists released a recommended maternal vaccine schedule that differs from CDC guidance for the first time. ACOG recommends four vaccines during pregnancy: influenza, COVID-19, Tdap, and RSV. The new schedule affects prenatal care protocols and provider counseling for pregnant Medicaid beneficiaries. This divergence creates potential confusion for managed care organizations that must decide whether to align coverage policies and quality metrics with CDC or ACOG recommendations for their maternal health programs.

Industry·72d ago

Trump Administration Adds 160 Drugs to TrumpRx Direct-to-Consumer Platform

President Trump announced Friday that TrumpRx.gov will add 160 prescription medications to its direct-to-consumer platform, bringing the total to over 800 drugs available at discounted prices. This marks the second expansion of the initiative in two months. The platform sells drugs directly to consumers, bypassing traditional pharmacy channels. The announcement did not specify which drugs were added or provide details about pricing structures or manufacturer participation.

Industry·72d ago

Trump Announces 160 Additional Drugs Added to TrumpRx Direct-to-Consumer Platform

President Trump announced Friday that TrumpRx.gov will add 160 prescription medications to its direct-to-consumer platform, bringing the total to over 800 drugs. This marks the second expansion in two months of the federal government's discounted drug initiative. The platform sells medications directly to consumers at reduced prices. No timeline for implementation or specific drug categories were detailed in the announcement.

Federal Policy·75d ago

CDC Reports Over 2,000 Measles Cases in 2026, 93% Outbreak-Related

The CDC confirmed 2,030 measles cases in the U.S. as of June 4, 2026, with 1,890 cases (93%) linked to outbreaks. This total is rapidly approaching the full-year 2025 count. Measles is a highly contagious vaccine-preventable disease that poses particular risks to immunocompromised populations and young children. For Medicaid managed care plans, rising case counts may trigger increased EPSDT screening requirements, higher utilization of pediatric acute care and emergency services, and potential quality measure impacts related to childhood immunization rates.

Federal Policy·75d ago

FDA Launches Safety Review of Abortion Drug Mifepristone

The Food and Drug Administration has initiated a safety review of mifepristone, the abortion medication, according to an administration official. The retrospective analysis could lead to restrictions on the drug's use and distribution channels. Anti-abortion groups view this as a significant development that may result in tighter federal controls over medication abortion access. The timing and scope of the review have not been disclosed.

Federal Policy·75d ago

FDA Launches Safety Review of Mifepristone Abortion Pill

The Food and Drug Administration has initiated a safety review of mifepristone, the abortion medication used in medication abortions. The retrospective data analysis follows pressure from anti-abortion groups and could lead to new restrictions on the drug's use and distribution. The review's timing and scope remain unclear, but any resulting restrictions would affect Medicaid managed care organizations that cover reproductive health services. Medicaid is the largest payer for births in the United States and covers family planning services for millions of beneficiaries.

Managed Care·75d ago

U.S. Measles Cases Surpass 2,000 in 2026, 93% Outbreak-Linked

The CDC reports 2,030 confirmed measles cases in the U.S. as of June 4, 2026, with 1,890 cases (93%) linked to outbreaks. This figure is rapidly approaching last year's full annual total. The surge in measles transmission reflects declining vaccination rates and increased outbreak activity across multiple jurisdictions. Medicaid managed care plans covering children are responsible for ensuring EPSDT compliance, including MMR vaccination coverage and outbreak response coordination with state and local health departments.

Federal Policy·76d ago

Senator Cassidy Blames HHS Secretary Kennedy for Rise in Vaccine-Preventable Diseases

Sen. Bill Cassidy (R-La.) publicly blamed HHS Secretary Robert F. Kennedy Jr. for a resurgence in vaccine-preventable diseases, citing a New York Times report that hospitals are seeing illnesses previously controlled by childhood immunizations. The statement comes as doctors report increased cases of diseases they rarely encountered in recent years. The criticism targets Kennedy's well-documented skepticism of vaccines and his influence over federal health policy. No immediate policy change or enforcement action has been announced.

Federal Policy·76d ago

Senator Cassidy Blames HHS Secretary for Resurgence in Vaccine-Preventable Diseases

Sen. Bill Cassidy (R-La.) publicly criticized HHS Secretary Robert F. Kennedy Jr. for contributing to a resurgence in vaccine-preventable illnesses, citing a New York Times report that hospitals are seeing increased cases of diseases previously rare due to vaccination. The senator's statement on social media directly linked Kennedy's leadership to the public health trend reported by doctors. This marks a notable Republican critique of the HHS secretary on vaccination policy. The timing follows broader debates about vaccine policy and public health messaging under the current administration.

Legal·HI·76d ago

HHS OIG Defunds Hawaii Medicaid Fraud Control Unit After Four Years Without Indictments

The HHS Office of Inspector General will not recertify Hawaii's Medicaid Fraud Control Unit, cutting off $3 million in federal funding after the unit failed to produce any indictments or convictions over four years. Inspector General March Bell notified Hawaii Attorney General Anne Lopez of the decision in a letter. The decertification means Hawaii loses federal matching funds for its MFCU operations. This is the first known instance of OIG defunding a state MFCU for performance failure.

Federal Policy·77d ago

CMS Administrator Oz to Lead White House Press Briefing

Dr. Mehmet Oz, Administrator of the Centers for Medicare and Medicaid Services, will conduct the White House press briefing on Tuesday. He is filling in for press secretary Karoline Leavitt during her maternity leave, joining other Cabinet officials who have taken on briefing duties. The briefing may provide insight into CMS priorities and policy direction under the current administration. Managed care organizations should monitor for any announcements regarding Medicaid policy, regulatory changes, or administrative guidance that could affect program operations.

Federal Policy·77d ago

CMS Administrator Oz to Brief White House Press Corps Tuesday

CMS Administrator Dr. Mehmet Oz will conduct the White House press briefing on Tuesday, filling in for press secretary Karoline Leavitt during her maternity leave. Oz joins other Cabinet officials who have led briefings in recent weeks, including the Secretary of State, Vice President, and Treasury Secretary. The briefing presents an opportunity for Oz to address CMS priorities and respond to questions on Medicare and Medicaid policy. This marks a high-profile public appearance for the new CMS administrator since his confirmation.

Federal Policy·81d ago

Trump Executive Order Endorses HHS Reduction in Required Childhood Vaccinations

President Trump signed an executive order Friday endorsing HHS's decision to reduce required childhood vaccinations. The order cites religious liberty and parental rights as justification for adjusted immunization requirements. The policy change affects federally recommended vaccine schedules that states and health plans use for EPSDT and well-child care compliance. Medicaid managed care organizations must monitor whether state Medicaid agencies adjust their EPSDT screening requirements in response, which could impact quality metrics, HEDIS measures, and contractual performance standards tied to childhood immunization rates.

Federal Policy·81d ago

Trump Executive Order Endorses HHS Reduction in Required Childhood Vaccinations

President Trump signed an executive order Friday endorsing HHS's decision to reduce the number of required childhood vaccinations. The order cites religious liberty and parental rights as justifications for the policy change. The new requirements will affect state immunization mandates that govern school enrollment and could impact Medicaid's Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, which requires medically necessary immunizations for children. The order's implementation timeline and specific vaccines affected were not detailed in the announcement.

Managed Care·82d ago

UnitedHealthcare Eliminates Two-Thirds of Pediatric Prior Authorization Requirements by Year-End

UnitedHealthcare announced it will remove prior authorization requirements for the majority of pediatric services for members under age 18 by the end of the year, eliminating two-thirds of current authorization requirements. The change affects commercial and Medicare Advantage plans with pediatric enrollment. The policy takes effect by December 31, 2024. This reflects growing pressure on health plans to reduce administrative burden and aligns with broader industry and regulatory momentum toward prior authorization reform, potentially setting a benchmark other Medicaid MCOs may need to match.

Federal Policy·82d ago

CDC Reports 8% Uninsured Rate, 800,000 More Uninsured in 2025

The CDC's National Health Interview Survey found that approximately 8% of the U.S. population was uninsured in 2025, a rate largely unchanged from 2024 but representing 800,000 additional uninsured individuals, including 300,000 children. The uninsured rate remains below 2019 levels. The increase in uninsured individuals suggests potential shifts in Medicaid eligibility or enrollment following the end of pandemic-era continuous coverage protections. These coverage losses may affect Medicaid managed care plan enrollment and revenue projections.

Managed Care·82d ago

UnitedHealthcare Eliminates Two-Thirds of Prior Authorization Requirements for Pediatric Members

UnitedHealthcare announced it will remove prior authorization requirements for two-thirds of pediatric services for members under age 18 by the end of 2025. The change affects commercial, Medicare Advantage, and Medicaid lines of business. UnitedHealthcare is reducing prior authorization across multiple service categories as part of a broader initiative to decrease administrative burden on providers. This follows similar moves by other national health plans to streamline utilization management processes.

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