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Wednesday, May 27 · 61 stories
- Federal Policy
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
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
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
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.
- Federal Policy
GAO: VA Improved Cybersecurity for Million Veteran Program After 2025 Recommendations
The Government Accountability Office found that VA has implemented 9 of 13 cybersecurity recommendations made in September 2025 to protect veterans' health information in the Million Veteran Program system. While VA's business associate agreements with external entities fully comply with HIPAA Privacy Rule requirements, GAO identified deficiencies in asset management, configuration management, and access controls that reduced assurance of data confidentiality. The improvements are significant given that MVP contains sensitive health data for approximately 1 million veterans in the nation's largest veteran biorepository. GAO continues monitoring VA's progress on the remaining four recommendations.
- State Policy
States Align Community Supervision and Health Services for Justice-Involved Reentry
NASHP published guidance on how states can coordinate community supervision and health services to support individuals reentering communities from correctional facilities. The collaboration aims to reduce recidivism and improve public safety through aligned health and supervision services. States can use these strategies to better serve justice-involved populations who often qualify for Medicaid upon release. This matters for Medicaid managed care organizations because justice-involved individuals represent a high-need, high-cost population requiring coordinated behavioral health, substance abuse, and primary care services.
- State Policy · MA
Massachusetts Expands Behavioral Health Integration Through Sub-Capitation Program
MassHealth has implemented a sub-capitation program that uses tiered primary care payments to increase integrated behavioral health access. The program creates financial incentives for primary care providers to build advanced behavioral health capacity within their practices. This approach represents a significant shift in how states can structure payment mechanisms to promote behavioral health integration. The model could serve as a template for other state Medicaid programs seeking to improve behavioral health access through innovative payment arrangements.
- State Policy
States Expand Perinatal Care Systems Through Coverage and Partnership Strategies
States are implementing comprehensive strategies to improve maternal health outcomes by expanding perinatal care services, extending postpartum coverage periods, and developing cross-sector partnerships. These initiatives affect Medicaid managed care organizations through enhanced coverage requirements for maternal health services and coordination with community-based organizations. Implementation varies by state based on existing policy frameworks and waiver authorities. These changes require MCOs to adapt network adequacy standards, care coordination protocols, and quality metrics to support comprehensive perinatal and postpartum care delivery.
- Managed Care
NASHP Hosts State-Only Webinar on PBM Oversight Approaches
The National Academy for State Health Policy will host a state-only webinar on May 20 covering state approaches to pharmacy benefit manager oversight and federal policy developments. The session targets state officials working on PBM regulation and oversight strategies. The webinar will likely address emerging state legislative and regulatory approaches to PBM transparency, contracting practices, and oversight mechanisms. This matters for Medicaid managed care organizations as states increasingly scrutinize PBM practices that affect prescription drug costs and access in Medicaid programs.
- State Policy
Five States Join NASHP Collaborative on Medicaid Sustainability Strategies
Five states have joined the National Academy for State Health Policy's new Medicaid Policy and Strategy Learning Collaborative to address sustainability challenges. The initiative focuses on helping states navigate ongoing fiscal pressures and upcoming changes from the Older Americans and Better Benefits for All Act (OBBBA). The collaborative will provide states with policy guidance and peer learning opportunities to strengthen their Medicaid programs. This matters for managed care organizations as state sustainability strategies directly impact MCO contracts, rate setting methodologies, and program requirements.
- Industry
NASHP Hosts Webinar on Private Equity Hospital Ownership Analysis
The National Academy for State Health Policy will host a state-only webinar examining private equity ownership patterns in hospitals and provider groups across four states on May 19. The analysis focuses on ownership structures that could affect provider networks and care delivery. State officials will review findings relevant to network adequacy monitoring and provider stability oversight. The research provides insights for states managing Medicaid managed care networks where private equity-backed providers participate.
- State Policy
States Implement National Family Caregiver Support Strategy Through Service Integration
States are implementing a national strategy to support family caregivers through enhanced services, protections, and care integration initiatives. The strategy focuses on better coordination between formal care systems and family caregivers who provide unpaid support to Medicaid beneficiaries. Implementation varies by state but includes caregiver assessments, respite services, and training programs. This matters for Medicaid MCOs because family caregivers are critical partners in long-term services and supports delivery, and better caregiver support can improve member outcomes while potentially reducing institutional care costs.
- Federal Policy
NASHP Hosts Rural Payment Reform Learning Session for States
The National Academy for State Health Policy (NASHP) is hosting a collaborative learning session on rural payment and delivery reform for state officials on Thursday, May 21 from 2-3 p.m. ET. The session will focus on innovative payment models and delivery strategies for rural healthcare providers. State Medicaid directors and managed care organizations operating in rural markets may gain insights into emerging payment reform approaches and delivery innovations that could inform future contract negotiations and provider network strategies.
- State Policy
State Medicaid Coverage of Certified Nurse Midwives Expands Maternal Care Access
States are increasingly using Medicaid reimbursement for certified nurse midwives (CNMs) to expand access to maternal care services and improve perinatal outcomes. This coverage strategy allows states to address provider shortages in maternal health while potentially reducing costs compared to physician-delivered care. The approach is particularly relevant for rural and underserved areas where obstetricians may be limited. For Medicaid managed care organizations, CNM coverage presents opportunities to expand provider networks and develop innovative maternal health programs while managing costs.
- Industry
FDA Extends Decision Deadline for AstraZeneca Breast Cancer Drug After Advisory Panel Opposition
The FDA has extended the decision deadline for AstraZeneca's experimental breast cancer pill following an advisory panel's negative vote on the drug's approval. The delay affects potential formulary decisions for Medicaid managed care organizations that cover cancer treatments. Medicaid MCOs should monitor the FDA's final decision timeline as it will impact prior authorization protocols and specialty pharmacy networks for oncology services. The extension creates uncertainty for health plans developing 2024 drug coverage policies.