Medicaid news from every state
Medicaid reporting from more than 400 local newsrooms, public radio stations, advocates, attorneys general and state agencies, sorted into one feed per state and updated every four hours.
Medicaid stories from local newsrooms in every state, updated every four hours.
Latest from every state, page 17
- Published Oct 23
- Published Oct 23
- Published Oct 23
- Published Oct 23
- Published Oct 23ND
North Dakota HHS Names Stephanie Bates Medicaid Division Director
North Dakota Health and Human Services has appointed Stephanie Bates as executive director of its Medical Services Division. Bates brings more than 25 years of experience to the role, which oversees Medicaid, the Children's Health Insurance Program, autism services, and other state health programs. The appointment places her in charge of policy and operational decisions affecting the state's Medicaid beneficiaries, providers, and managed care arrangements.
Why it mattersProviders, health plans, and advocates working with North Dakota Medicaid now have a new senior decision-maker to engage on program policy, provider payment, and CHIP administration.
- Published Oct 22
- Published Oct 22
- Published Oct 22
- Published Oct 22TX
Texas Hospital Association Roundup Covers Medicaid Provider Updates
In its Oct. 22, 2026 Healthcare Advocate newsletter, the Texas Hospital Association compiles several items including TMHP provider updates relevant to Texas Medicaid. Highlights include a requirement that Healthy Texas Women providers recertify in PEMS starting Nov. 1, 2026, a phishing scam alert targeting STEPS providers using an HHSC logo, and registration system issues affecting MDS forms in the Long-Term Care Online Portal. The newsletter also covers non-Medicaid items such as early voting information, a THA membership survey due Dec. 1, a new workforce taskforce, and a palliative care CE event. These updates require action from Texas Medicaid providers and plans working with TMHP systems.
Why it mattersTexas Medicaid providers, particularly Healthy Texas Women and STEPS program participants, must act on enrollment recertification deadlines and security alerts to avoid payment or compliance disruptions.
- Published Oct 22CA
HPSJ Trains Providers on California's Updated Encounter Data Standards
Health Plan of San Joaquin/Mountain Valley Health Plan held a provider training on October 1, 2026 covering Quality Measures for Encounter Data (QMED) 2.0, based on California DHCS All Plan Letter 26.003, which supersedes APL 14-020. The update outlines five encounter data standards DHCS uses to evaluate claims quality: uniqueness, completeness, accuracy, reasonability, and timeliness, including a requirement to include the rendering clinician's individual NPI and to submit complete claims within 30 days of service. Medi-Cal providers contracted with HPSJ/MVHP are affected and can access the training slide deck and APL documents through the plan's website. The notice is informational, directing providers to plan resources and customer service for questions.
Why it mattersProviders who fail to meet the updated encounter data standards risk claim denials, rework, and encounter data rejections that can affect the plan's compliance reporting to DHCS.
- Published Oct 22NY
Opinion Backs Trump Administration's Federal Fraud Crackdown Efforts
In this opinion piece, the author argues that the Trump administration's ongoing campaign against government fraud is already yielding billions in savings for taxpayers and will continue paying off for years. The commentary praises the anti-fraud push as overdue and credits it with identifying and stopping improper payments across federal programs. No specific Medicaid enforcement action, rule, or dollar figure tied to Medicaid is detailed in the piece. The argument is general and programmatic rather than citing a discrete new policy or legal development.
Why it mattersStates and health plans should watch for whether this broader anti-fraud push translates into specific Medicaid program integrity directives or enforcement actions.
- Published Oct 22
- Published Oct 22CA
Judge Lets Rady Children's Limit Gender-Affirming Care for New Patients
San Diego Superior Court Judge Matthew Braner this week ruled that Rady Children's Hospital may limit gender-affirming medical care for some new patients, modifying an earlier February order that had required the hospital to continue such care except for surgeries. Rady had announced it would stop offering gender-affirming medical care over fears of losing federal funding; California Attorney General Rob Bonta sued, arguing the hospital is obligated to continue the services under conditions tied to its merger with Children's Hospital of Orange County. Advocates say the ruling will force families, including many covered by Medi-Cal, to travel to Los Angeles for care and navigate out-of-network insurance barriers. The litigation continues, with the next court date set for January 2027.
Why it mattersMedi-Cal-covered families seeking gender-affirming care for minors now face reduced access and potential out-of-network costs as the underlying hospital obligation remains in active litigation.
- Published Oct 22
- Published Oct 22
- Published Oct 22
- Published Oct 22
- Published Oct 22CA
HPSJ Opens SNF Encounter File Reconciliation for WQIP Payments
Health Plan of San Joaquin/Mountain Valley Health Plan notified skilled nursing facilities that DHCS's Calendar Year 2025 encounter files for the Skilled Nursing Facilities Workforce & Quality Improvement Program are now available via File Exchange on the DRE Provider Portal. Facilities must review qualifying bed day data, verify claims were submitted and paid, and submit corrected claims through their clearinghouse if discrepancies or missing bed days are found. Corrected claims are due by November 20, 2026, to allow processing time before final WQIP scoring and payment calculations. Facilities with access issues should contact HPSJ Provider Services.
Why it mattersSkilled nursing facilities that fail to reconcile encounter data by the deadline risk inaccurate WQIP scoring and reduced directed payments tied to their CY25 performance.
- Published Oct 22CA
HPSJ Sets Dec. 31 Deadline for Provider Equity Training Attestation
Health Plan of San Joaquin/Mountain Valley Health Plan notified all network providers that staff who have not completed the plan's Excellent Health Outcomes for All (EHOA) training, formerly called Diversity, Equity, and Inclusion training, must attest to compliance by December 31, 2026. The requirement stems from a California DHCS all-plan letter and was previously extended from a 2025 deadline. Providers may attest by completing HPSJ's own training, an equivalent training from another health plan, or an internally supplemented curriculum that at minimum covers HPSJ's Module 4 on understanding member demographics. Training materials and the attestation form are available on HPSJ's website, with Provider Services available for questions.
Why it mattersMedi-Cal managed care and D-SNP providers in HPSJ's network who miss the attestation deadline risk noncompliance with a state-mandated training requirement tied to their health plan contract.
- Published Oct 22
- Published Oct 22
- Published Oct 22
- Published Oct 22
- Published Oct 22
- Published Oct 22
- Published Oct 22
- Published Oct 22IN
Indianapolis Nonprofit Hosts Sessions on HIP Work Requirements
Shepherd Community Center will hold information sessions on Oct. 28 and Nov. 7 to help Healthy Indiana Plan enrollees understand the state's new Medicaid work requirements. Starting in January 2027, HIP enrollees ages 19-64 must document at least 80 hours per month of work, volunteering or schooling, or qualify for an exemption, to keep coverage. The free, no-registration sessions in Indianapolis will offer drop-in help with reporting hours and using the state's screening tool, with limited on-site laptops available. Indiana's Family and Social Services Administration estimates roughly 58,000 Hoosiers could lose Medicaid coverage next year for not meeting the requirements.
Why it mattersHIP enrollees who fail to document compliance risk losing Medicaid coverage starting in 2027, making community outreach and reporting assistance critical to limiting disenrollment.
- Published Oct 22
- Published Oct 22
- Published Oct 22