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Wednesday, October 7 · 30 stories
- State Policy · ME
Maine Budget Gap Projection Fuels Election Fight Over MaineCare
Maine's Bureau of the Budget projected a $1.085 billion structural general fund gap for the 2028-2029 biennium, the budget the next governor and Legislature will have to craft, plus a separate $256.7 million highway fund gap. State officials note such gaps are routinely projected and this one tracks historical averages, though the dollar figure is larger because the overall budget has grown under Gov. Janet Mills. Republicans, campaigning ahead of the Nov. 3 election, are citing the gap to call for structural changes to MaineCare, the state's Medicaid program, citing its rising costs; Democrats counter that growth reflects the state meeting statutory funding obligations and reducing the uninsured rate. The next governor and Legislature will decide whether to cut program spending or raise revenue, with updated state revenue estimates due in December.
- State Policy · SC
SC Governor Candidates Clash Over Medicaid Expansion in Debate
In the only scheduled South Carolina gubernatorial debate before the election, Democrat Jermaine Johnson and Republican Alan Wilson split on Medicaid expansion, gambling, and data centers while agreeing abortion restrictions should not go further. Johnson called expanding Medicaid eligibility to all adults up to 138% of the federal poverty level a necessity, citing his mother's diabetes-related leg amputation and high amputation rates in a north Columbia ZIP code. South Carolina is one of 10 states that has not expanded Medicaid under the Affordable Care Act. Wilson did not join Johnson's call for expansion, continuing the state's divide over coverage for low-income adults ahead of the election.
- Industry
Team Select Reports 15% Hospitalization Drop From AI Platform
Home Health Care News reports that Team Select Home Care has expanded its proprietary predictive AI platform, CareSight AI, to cover its entire patient census after investing $6 million in development. The pediatric and senior home care provider, which serves medically complex patients in 16 states, says hospitalization rates fell 14.9% year-over-year between April and August 2026 compared to the same period in 2025. CareSight uses over a decade of patient data and monitors vital signs, nurse notes, and condition changes to flag clinical decline before it requires hospitalization. CEO Fred Johnson says the outcomes data is now being used to negotiate additional value-based contracts with payers, including Medicaid managed care plans, as an alternative to fee-for-service rate increases.
- Industry · AZ
Ascension, CommonSpirit to Transfer Arizona Medicaid Plan Mercy Care to Aetna
Becker's reports that Ascension and CommonSpirit Health's Dignity Health have agreed to transfer ownership of Mercy Care, an Arizona managed care plan, to Aetna, which has run the plan's daily operations for more than 20 years, pending regulatory approval. The deal is part of Ascension's broader financial turnaround, which cut operating losses from $3 billion in 2023 to $120 million in fiscal 2026 through hospital divestitures, cost discipline, and a $3.9 billion acquisition of ambulatory surgery operator AmSurg. Ascension's CFO said the health system's core strength is as a provider, not an insurer, and that Mercy Care "didn't fit really well" with either system's strategy. Timing of regulatory approval and transition was not specified.
- Industry
Latham & Watkins Issues October Drug Pricing Digest
In its October 2026 Drug Pricing Digest, Latham & Watkins' Drug Pricing and Market Access team compiles recent developments across healthcare reform, the Medicaid Drug Rebate Program, the 340B Program, Medicare, and state drug pricing law. The digest serves as a recurring tracker rather than a report on a single event, aggregating regulatory and legal activity relevant to pharmaceutical manufacturers, covered entities, and payers. No specific new rule, ruling, or action is detailed in the summary provided. Readers rely on the digest to monitor the evolving drug pricing landscape across federal and state levels.
- State Policy · ID
Idaho Commentary Urges Lawmakers to Honor Pledge on Work Requirements
In an Idaho Capital Sun commentary, the author argues state lawmakers must follow through on promises that no eligible Idahoan will lose Medicaid coverage when work requirements take effect January 1, 2026 under House Bill 913. The piece contends that coverage losses typically stem from administrative red tape, missed notices, paperwork errors, and reporting burdens, rather than actual ineligibility, and warns that cancer patients and others who should qualify for medical frailty exemptions could be wrongly disenrolled. The author cites Idaho's 2018 voter-approved Medicaid expansion, which covers more than 80,000 residents, and notes advocates had sought a one-year delay in implementation that lawmakers rejected. The commentary calls on the Idaho Department of Health and Welfare and legislators to minimize enrollment barriers and improve communication ahead of the rollout.
- Legal · WV
Commentary: WV Hospitals Overstate Charity Care, Undercount Bad Debt
In a commentary piece, the author argues that West Virginia's non-profit hospitals are failing to deliver on the charity care obligations tied to their tax-exempt status as federal Medicaid changes under H.R. 1 threaten to cut enrollment by up to 75,000 people. The author cites West Virginia Hospital Association data showing charity care averages just 0.9% of net patient revenue, with hospitals writing off more in bad debt ($103 million) than they forgave in charity care ($79 million), while inflating "community benefit" totals by including provider tax payments and Medicare shortfalls excluded under Catholic Health Association standards. The piece points to Texas and Oregon as models that condition tax exemption on meeting charity care standards or require financial screening before collections. The author urges West Virginia's upcoming legislative session to mandate true charity care and pre-collection financial screening.
- Legal
DOJ Retreats From Enforcing Olmstead Disability Integration Rights
The Trump administration's Department of Justice has moved to stop enforcing Olmstead v. L.C., the 1999 Supreme Court ruling requiring states to serve people with disabilities in the most integrated setting rather than institutions. A June DOJ memo stated the federal government has no obligation to enforce Olmstead, and in August the department began withdrawing from cases defending disabled people seeking home- and community-based care. Last month DOJ settled Texas v. Kennedy, invalidating federal regulations that defined what it means to live in a community. Disability advocates warn the shift threatens decades of progress moving people out of institutions and into home and community-based Medicaid-funded care.
- Industry
KFF Survey: States Exceed Federal Rules on Home Care Fraud Detection
In a new report, KFF finds that states administering Medicaid home care programs are going beyond federal requirements to detect fraud, including cross-checking billed claims against electronic visit verification (EVV) data and using AI-based monitoring tools. KFF surveyed Medicaid home care officials in all 50 states and D.C. between April and August 2026; Florida and South Carolina did not respond, and Minnesota skipped a program integrity question. All 48 responding states reported some program integrity protocols beyond EVV, and 21 states said they are using, piloting, or planning AI for fraud detection. The report's authors caution that added scrutiny, while reducing fraudulent spending, can create administrative burdens that limit provider participation and access to care.
- State Policy · AR
Arkansas Budget Hearings Begin Amid Medicaid Expansion Uncertainty
Arkansas lawmakers opened a monthlong series of state budget hearings this week, starting with the military and labor departments, as part of the process leading to the 2027 budget the governor will unveil in late November. The Department of Human Services will present its budget October 29 amid unresolved uncertainty over the state's Medicaid expansion program: CMS verbally declined to renew it in July, and DHS requested a two-year grace period in August to maintain coverage while the state selects a new Medicaid model, but has received no formal notification or response from CMS. DHS's budget was not increased for fiscal year 2026, raising advocate concerns about the agency's capacity to handle rising administrative costs, including an expected $24 million increase in SNAP administrative costs. The full Legislature will consider agency budget recommendations when its regular session begins in January.
Tuesday, October 6 · 52 stories
- State Policy · NY
Hochul Declares Disaster Emergency Over New York Measles Outbreak
New York Gov. Kathy Hochul declared a statewide disaster emergency Monday in response to a measles outbreak that has sickened 108 people as of Oct. 3, with most cases occurring outside New York City. The declaration marks the state's first disaster emergency of the year and is intended to mobilize additional public health resources to contain the outbreak. Seven cases have occurred in New York City itself, according to state officials. The move signals an escalating public health response that will likely involve vaccination campaigns and coordination with local health departments and providers.
- Federal Policy
Georgetown CCF Submits Comments on Head Start Standards Proposal
Georgetown University McCourt School's Center for Children and Families (CCF) submitted formal comments to HHS on proposed changes to Head Start Program Performance Standards. The comments respond to a proposed rule affecting Head Start, a federal early childhood program serving low-income children and families, many of whom are also enrolled in Medicaid or CHIP. The source does not detail the specific content or recommendations in CCF's comments. No effective date or final rule status is indicated.
- Legal
Oracle Health Discloses 2025 Breach Affected Nearly 20 Million
Bloomberg reports, citing a Texas attorney general disclosure, that Oracle Health's 2025 data breach compromised personal information of nearly 20 million people nationwide, including almost 3 million Texans. The breach involved older Cerner servers accessed by attackers sometime after January 22, 2025, before that data had been migrated to Oracle's cloud. Exposed information varied by patient but could include names, addresses, Social Security numbers, physicians, diagnoses, medications and test results. Oracle's healthcare customers include hospitals, clinics, the Defense Department and VA, though the VA said it was not affected; at least 29 hospitals and health systems have reported impact, and Oracle Health faces litigation over the incident.
- Industry
TFAH Report Finds 21 States at or Above 35% Obesity Rate
Trust for America's Health's annual State of Obesity report, released Sept. 24, finds adult obesity rates largely unchanged in 2025, with 21 states at or above 35%, up from 19 in 2024. For the first time since 2020, no state reached 40%, and Alabama led at 39.7% while the District of Columbia had the lowest rate at 24.2%. Louisiana and West Virginia posted the only statistically significant declines from 2024. TFAH warns the stabilization is fragile, citing more than 200 staff reductions at the CDC's chronic disease center, a proposed fiscal 2027 budget eliminating its obesity prevention division, and an estimated 5 million people losing SNAP access, alongside growing GLP-1 use including roughly 700,000 new Medicare patients since the Medicare GLP-1 Bridge launched in July.
- Industry
NASHP Recaps Largest-Ever Annual State Health Policy Conference
In a NASHP blog recap, the organization's leadership reflects on its 2026 Annual Conference, held for the first time in New York City, which drew its largest attendance to date with officials from all 50 states and DC. Speakers and state leaders discussed health care affordability, Medicaid's relationship with the commercial market, rural health, and aging policy, amid candid conversation about budget pressures and policy challenges. The post is a reflective recap rather than a report of new policy action, and NASHP notes it will share detailed takeaways in future newsletters. NASHP also announced its 40th anniversary conference will be held in Louisville, Kentucky, August 30–September 1, 2027.
- Industry
ACAP Elects New Health Plan Leaders to Board of Directors
The Association for Community Affiliated Plans (ACAP) announced the election of several health plan executives to its Board of Directors. The election occurred ahead of ACAP's annual CEO Summit. ACAP represents nonprofit Safety Net Health Plans that serve Medicaid and other publicly sponsored populations, making its board composition relevant to the trade group's policy priorities and advocacy direction.
- Federal Policy
Federal Vaccine Policy Shift Coincides With Measles Resurgence
Federal vaccine policy has moved toward recommending fewer routine childhood vaccinations, emphasizing individual choice over uniform recommendations, and expressing greater skepticism about the safety and efficacy of some vaccines. These changes coincide with falling childhood vaccination rates, increasing exemptions from school vaccine requirements, and a major measles resurgence nationally. Children and families relying on Medicaid and CHIP for immunization access are affected, as federal recommendations shape state vaccine schedules, school requirements, and coverage policy. The piece is framed as a midterm election update tracking how vaccine policy may factor into state and federal elections.
- Federal Policy
Bipartisan House Group Urges CMS to Drop RPM Staffing Limits
A bipartisan group of 32 House members sent an Oct. 2 letter to CMS Administrator Mehmet Oz urging the agency to reconsider proposed restrictions on remote patient monitoring in the 2027 Medicare Physician Fee Schedule. The proposal would limit Medicare payment to remote monitoring services furnished only by clinical staff employed directly by the billing practice, excluding contracted third-party partners. Lawmakers cited data showing nearly 1 million Medicare enrollees used remote monitoring in 2024 and that nearly 70% of rural health clinics offering the service rely on outside partners. They argued CMS's own OIG review found concerning billing patterns at under 1% of practices, calling for targeted rather than sweeping restrictions; most provisions would take effect Jan. 1, 2027.
- State Policy · CO
Denver Council Mandates Oversight, Records Access for Behavioral Health Nonprofit
The Denver City Council voted 11-0 to require greater oversight of Caring for Denver and two other tax-funded nonprofits, following a CPR News investigation and an auditor's report that found weak due diligence and transparency gaps. The ordinance subjects Caring for Denver to public records laws, sets aside up to 1% of designated tax revenue for oversight, bans use of administrative funds for alcohol purchases, and raises the administrative spending cap from 5% to 7% of tax revenues. Caring for Denver, which distributes more than $40 million annually in city tax money for mental health and substance use treatment, must also develop a strategic plan with measurable goals and performance metrics. The changes take effect following Monday's council vote and apply similarly to the Denver Preschool Program and Prosperity Denver Fund.
- Legal
FTC Warns 24 Hospital Systems Over Price Transparency Failures
The FTC sent warning letters to two dozen hospital systems, alleging that incomplete or misleading price disclosures may violate federal consumer protection laws. The letters target hospitals' compliance with price transparency rules requiring public posting of standard charges and shoppable service prices. No specific compliance deadline or enforcement action was announced, but the letters signal heightened federal scrutiny of hospital pricing practices. The action matters for hospitals and health systems serving Medicaid and dual-eligible populations, where pricing transparency intersects with billing practices and consumer protection obligations.
