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 2
- Published Nov 5
- Published Nov 5CA
DHCS Launches California 988 Network Website
The California Department of Health Care Services (DHCS) has launched the California 988 Network website, a centralized resource on the 988 Suicide and Crisis Lifeline, which offers free, confidential crisis support around the clock. The site explains how to contact 988, what to expect from a trained counselor, and offers resources for schools, Tribal communities, and multilingual users, along with downloadable posters and flyers. Health Plan of San Joaquin/Mountain Valley Health Plan notified its providers and behavioral health providers of the launch and encouraged them to share 988 materials with members, include 988 and local county behavioral health access lines in treatment plans, and post materials in offices.
Why it mattersMedi-Cal managed care providers and behavioral health providers serving Health Plan of San Joaquin/Mountain Valley Health Plan members could use the new DHCS website and materials to expand member awareness of crisis support resources.
- Published Nov 5CA
Health Plan of San Joaquin Flags Medi-Cal Rx Prior Auth Policy Retirement
Health Plan of San Joaquin/Mountain Valley Health Plan notifies practitioners, facilities, and hospitals that Medi-Cal Rx will retire its extended duration prior authorization policy for certain maintenance medications effective November 30, 2026. The policy had supported California Code of Regulations, Title 22, Section 51003(e); once retired, all historically approved prior authorizations with expired dates, including those approved by previous managed care plans, will be deactivated. Medication claims under this policy submitted on or after November 30, 2026 will need a new prior authorization reviewed for medical necessity or they will reject with Reject Code 75. Medi-Cal Rx's stated preference is to switch patients to a covered alternative drug, and providers can consult the Contract Drugs & Covered Products Lists or submit a new PA.
Why it mattersProviders and pharmacies serving Medi-Cal managed care members may need to resubmit prior authorizations or switch patients to covered alternative medications before November 30, 2026 to avoid claim rejections.
- Published Nov 5
- Published Nov 5
- Published Nov 5MN
Minnesota Fraud Trial Over $15M Neurofeedback Billing Scheme Paused
Center of the American Experiment reports, citing KARE-11's Lou Raguse, that a federal jury trial in St. Paul for Gabriel Luther and Elizabeth Brown was delayed after Luther checked himself into a hospital on the eve of trial. The couple are accused of using their company, Golden Victory Medical LLC, to overbill Medicare and Medicaid roughly $15 million for neurofeedback therapy services not rendered. They face six counts of wire fraud and one count of money laundering under a March 2025 indictment, which alleges the operation began in Nevada in 2018 before relocating to Minnesota in 2019; Golden Victory ceased operations in late 2022. Jury selection occurred Tuesday and the trial continued into Wednesday before the delay, with proceedings originally scheduled to run until Thanksgiving.
Why it mattersState Medicaid program integrity units and Medicare contractors may watch the outcome as a signal of how aggressively overbilling schemes involving dual Medicare-Medicaid billing are prosecuted.
- Published Nov 5
- Published Nov 5
- Published Nov 5
- Published Nov 5
- Published Nov 5
- Published Nov 5
- Published Nov 5
- Published Nov 5OR
Springfield Council Approves Land Annexation for Behavioral Health Campus
The City of Springfield, Oregon voted 5-0 to annex land off International Way for a new behavioral health campus, reversing an earlier signal from September that councilors might deny the request. Lane County plans a stabilization center at the site, located next to a planned PeaceHealth hospital focused on behavioral health, with supporters saying the facilities would reduce jail stays and wait times at RiverBend hospital. Some residents raised neighborhood safety concerns, and the annexation agreement requires the site's owner to work with Springfield Police and neighbors on safety and security plans. Lane County hopes to break ground next spring, with openings by 2029.
Why it mattersBehavioral health providers and Lane County officials may need to coordinate closely with local police and residents on safety planning as the stabilization center and hospital move toward a 2029 opening.
- Published Nov 5CA
Bonta Announces Firearms Seizure, Arrest at Concord Care Home
California Attorney General Rob Bonta announced that DOJ special agents executed a search warrant on October 29, 2026, at a residential care home in Concord housing elderly residents and infant children, seizing 11 firearms including eight assault weapons. An employee of the facility was arrested and faces felony charges including importation and illegal possession of assault weapons, importation of a large-capacity magazine, and a misdemeanor improper storage charge. DOJ will prosecute the case; charges are allegations and the defendant is presumed innocent. The announcement notes that the Division of Medi-Cal Fraud and Elder Abuse, which also investigates abuse and neglect of elderly and dependent adults in care facilities, receives 75 percent federal and 25 percent state funding totaling over $114 million for federal fiscal year 2027.
Why it mattersResidential care providers and Medi-Cal-serving elder care facilities may face heightened scrutiny of staff screening and firearm storage practices following this enforcement action by the state's Medi-Cal Fraud and Elder Abuse division.
- Published Nov 5CA
California Hospital Association Argues OHCA Penalties Threaten Hospital Access
In a commentary, California Hospital Association (CHA) argues that the Office of Health Care Affordability's (OHCA) proposed penalties for exceeding its health care spending growth cap would wipe out three years of combined operating earnings for more than 100 California hospitals, about one in four statewide. CHA contends the proposal fails an "affordable, accessible, accountable" test, saying it relies on unvalidated data likely to find over 80% of hospitals noncompliant, does not reduce patient costs, and penalizes hospitals for state-driven cost mandates including wage rules, seismic requirements, and Medi-Cal underpayments. CHA says it submitted a letter to Department of Health Care Access and Information Director Elizabeth Landsberg and will raise these concerns when OHCA's board meets November 18, also noting OHCA loses its emergency rulemaking authority in January.
Why it mattersCalifornia hospitals, including Medi-Cal managed care providers, could face significant financial penalties and potential service cuts if OHCA finalizes the spending growth cap enforcement methodology as proposed.
- Published Nov 5CA
California Hospital Association Flags HCAI Survey on CalRHT Grants
California Hospital Association reports that the California Department of Health Care Access and Information (HCAI) is asking hospitals and other stakeholders to complete a survey on the 2026 California Rural Health Transformation (CalRHT) Program grant funding opportunities. The survey, open through Nov. 13 and taking about 10 minutes, asks about hospitals' awareness of the funding opportunities, factors affecting decisions to apply, and resources that could help during the program's next budget period. California Hospital Association notes the survey follows CMS's recent announcement of $233 million in funding made available to California. Questions can be directed to info@calruralhealth.org or (855) 225-7487.
Why it mattersCalifornia hospitals, particularly rural facilities, may want to weigh in on the survey to help shape how the state structures CalRHT grant funding and support in its next budget period.
- Published Nov 5CA
California Hospital Association Shares DataSuite FFY27 PACT, CAH VBP Analyses
California Hospital Association reports that DataSuite has issued two hospital-specific analyses for federal fiscal year 2027. The first estimates Medicare inpatient fee-for-service payments and MS-DRG volumes affected by the IPPS post-acute care transfer adjustment policy for discharges from FFY 2022 through 2027, covering transfers to skilled-nursing facilities, rehab facilities, long-term care hospitals, psychiatric facilities, and hospice, among other settings. The second estimates Critical Access Hospital performance scores and impacts under a scenario resembling the IPPS Value-Based Purchasing program, using CMS's second quarter 2026 Care Compare update, but it is not CMS's actual CAH VBP demonstration program, which CMS has not yet proposed. Both analyses note that detailed data and source information are available in the analysis descriptions, and the CAH VBP figures should not be used for budgeting.
Why it mattersCalifornia hospitals, including Critical Access Hospitals, may use these analyses to gauge potential Medicare payment and performance impacts ahead of CMS's eventual FFY 2027 IPPS and CAH VBP rulemaking.
- Published Nov 5
- Published Nov 5
- Published Nov 5SD
CHAD Publishes Medicaid Recipient's Story of Coverage After Job Loss
The Community HealthCare Association of the Dakotas (CHAD) published a personal account as part of its Medicaid stories project. In it, an individual describes losing a job and employer-sponsored insurance, and credits Medicaid with allowing him to treat high blood pressure, cholesterol, and mental health conditions he could not otherwise afford to address. CHAD states the project collects stories from recipients, providers, small business owners, and community leaders to show why Medicaid matters, and invites the public to submit their own stories.
Why it mattersAdvocates and state Medicaid agencies in the Dakotas may see this storytelling effort cited in public messaging about the value of Medicaid coverage for people experiencing job loss.
- Published Nov 5SD
CHAD Publishes Patient Story on Medicaid-Supported Opioid Recovery
The Community HealthCare Association of the Dakotas (CHAD) published a first-person account from a man named Johnny as part of its Medicaid stories project. Johnny describes developing an opioid addiction after being prescribed pain medication following surgery, then being cut off without support. He says that after enrolling in Medicaid he was able to access treatment and medication, and has been sober for about a year. CHAD describes the Medicaid stories project as an effort to reduce stigma through storytelling and invites recipients, providers, and community members to submit their own accounts.
Why it mattersBehavioral health providers and state Medicaid agencies in the Dakotas may draw on these patient narratives as they weigh coverage of substance use disorder treatment and medication-assisted therapy.
- Published Nov 5SD
CHAD Shares Staffer's Personal Story to Promote Medicaid Storytelling Project
In a personal essay published by Community HealthCare Association of the Dakotas (CHAD), Medicaid storyteller Liz Schenkel describes growing up in a South Dakota family that earned just above the threshold to qualify for Medicaid or CHIP, leaving her without coverage for chronic health conditions until adulthood. She argues that Medicaid expansion could have changed her family's circumstances and says collecting personal stories helps reduce stigma and build support for preserving and improving Medicaid. CHAD invites Medicaid recipients, providers, small business owners, and community leaders to submit their own stories through its online collection form.
Why it mattersMedicaid advocates and community health centers in South Dakota may find CHAD's storytelling project useful for building public and legislative support for Medicaid access and expansion.
- Published Nov 5OR
OHA Medicaid Advisory Committee Schedules Ombuds Report Subcommittee Meeting
The OHA Medicaid Advisory Committee announces a public meeting of its Ombuds 2025 Report subcommittee on November 9 from 9:35 to 10:30 a.m., held via Zoom with a registration link provided. The notice describes the Medicaid Advisory Committee (MAC) as a federally mandated body that advises the Oregon Health Authority's State Medicaid Director and the Oregon Department of Human Services on policies, procedures and operation of Oregon's Medicaid program from a consumer and community lens. The notice includes accommodation contact information and is published in both English and Spanish.
Why it mattersOregon Medicaid stakeholders, advocates and consumers who want input into the Ombuds 2025 Report process may want to register for the November 9 subcommittee meeting.
- Published Nov 5SD
CHAD Publishes Medicaid Recipient's Story of Pregnancy, NICU Care
The Community HealthCare Association of the Dakotas (CHAD) published a first-person account from a woman named Ellen as part of its Medicaid stories project. Ellen describes becoming pregnant at 19 as a college sophomore, applying for Medicaid with help from her clinic's financial team, and relying on it to cover a difficult pregnancy, an emergency C-section, and a week-long NICU stay for her son, who has ongoing health conditions requiring specialists. She credits Medicaid with allowing her to avoid significant medical debt and to later graduate college early and enter a career that no longer requires Medicaid coverage. CHAD's Medicaid stories project collects experiences from people affected by Medicaid to reduce stigma, and it invites others to submit their own stories.
Why it mattersAdvocates and state Medicaid agencies in the Dakotas may draw on firsthand accounts like this one to illustrate how Medicaid coverage for pregnancy, delivery, and NICU care affects young, low-income beneficiaries.
- Published Nov 5VA
VNPP Reports Virginia Behavioral Health Commission's 2027 Session Picks
In a post on its site, Virginia Network of Private Providers (VNPP) reports that Virginia's Behavioral Health Commission has approved a set of staff recommendations and options to carry into the 2027 legislative session. According to VNPP, the approved items relate to the BRAVO project and a broader behavioral health system redesign, including recommendations on transition preparation, building provider capacity, and monitoring implementation, each tied to specific page numbers and recommendation or option numbers in the Commission's legislative plan. VNPP notes these priorities were set by Commission members themselves, which it says carries more weight than priorities proposed by a trade association, and that the items have already been vetted and approved by key players. VNPP states the approved items include different start dates for monitoring-related recommendations.
Why it mattersVirginia behavioral health providers and associations may want to review the Commission's approved BRAVO and redesign recommendations to align their own 2027 legislative advocacy with priorities already vetted by the Commission.
- Published Nov 5SD
CHAD Publishes Medicaid Recipient's Personal Story of Recovery
The Community HealthCare Association of the Dakotas (CHAD) published a first-person account from a Medicaid recipient named Chelsea as part of its Medicaid stories project. In the piece, Chelsea describes a personal crisis in early 2025 and credits Medicaid coverage with giving her a chance to heal, arguing that health care should be treated as a basic right rather than something earned. CHAD says the project collects stories from recipients, providers, small business owners, and community leaders to show why Medicaid matters and invites others to submit their own experiences.
Why it mattersAdvocacy groups and state Medicaid agencies in the Dakotas may draw on these personal narratives when communicating the human impact of Medicaid coverage to policymakers and the public.
- Added Nov 5SD
CHAD Publishes Medicaid Recipient's Personal Coverage Story
The Community HealthCare Association of the Dakotas (CHAD) published a first-person story as part of its Medicaid stories project, in which a single parent named Queen describes how Medicaid coverage for her children relieves the financial stress of choosing between food and medical costs. She credits a Navigator with helping her understand her insurance options and encourages others who may be eligible to apply. CHAD invites additional submissions from Medicaid recipients, providers, small business owners, and community leaders to share how Medicaid affects them.
Why it mattersState Medicaid agencies and community health centers may find such first-person accounts useful for illustrating enrollment outreach and Navigator assistance to eligible families.
- Published Nov 5
- Published Nov 5SD
CHAD Publishes Patient Story on Medicaid Managing Diabetes
The Community HealthCare Association of the Dakotas (CHAD) published a first-person account from Tsion, a 19-year-old Medicaid recipient, as part of its Medicaid stories project. Tsion describes using Medicaid coverage to obtain diabetes management supplies, including monitors, insulin, syringes, and lab work, and says it has reduced emergency room visits and helped prevent diabetic ketoacidosis. She credits Medicaid with allowing her to stay in school and pursue automotive work. CHAD's Medicaid stories project solicits similar accounts from recipients, providers, and community members to highlight the program's impact.
Why it mattersAdvocates and state Medicaid agencies in the Dakotas may use patient narratives like this to illustrate the program's role in chronic disease management amid ongoing policy debates over Medicaid eligibility and funding.