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Friday, September 25 · 27 stories
- State Policy · NC
North Carolina Restores Perinatal Quality Collaborative After Medicaid Funding Dispute
North Carolina has restored funding for the Perinatal Quality Collaborative of North Carolina, enabling dozens of hospitals statewide to participate in maternal and newborn care research beginning next year. The collaborative lost funding in October 2025 due to a Medicaid funding dispute, delaying planned research projects that were originally scheduled to launch in 2025. The restoration allows the state's hospitals to resume quality improvement work targeting maternal and perinatal outcomes. This matters for North Carolina providers and state Medicaid officials managing maternal health initiatives under heightened federal scrutiny of maternal outcomes.
- Federal Policy
CMS Seeks Comment on Generic Clearance for State Plan Amendments and Waiver Information Collections
CMS has published a Federal Register notice requesting public comment on one or more information collection requests under its existing Paperwork Reduction Act generic clearance umbrella (control number 0938-1148). The umbrella, approved in April 2021, covers Medicaid and CHIP state plan amendments, waivers, demonstrations, and reporting requirements. Comments are due 60 days from publication. The generic clearance process allows CMS to expedite approval of voluntary, low-burden information collections that do not raise substantive policy issues, streamlining the agency's ability to request information from states without full PRA review for each individual collection.
- Federal Policy
CMS Re-Establishes Data Match With Treasury Do Not Pay System
CMS has re-established a computer matching program with the U.S. Department of the Treasury's Do Not Pay Working System, administered by the Bureau of Fiscal Service. The match enables CMS to verify payment eligibility and prevent improper payments across Medicare and Medicaid by cross-referencing beneficiary and provider data against federal databases tracking death records, excluded parties, and debarred entities. The re-establishment continues an existing fraud prevention tool used by CMS to support program integrity efforts. The match affects CMS payment operations and supports state Medicaid agencies' ability to identify ineligible providers or payments flagged through federal screening.
- Federal Policy
Senate Finance Committee Advances Chris Klomp Nomination for HHS Deputy Secretary
The Senate Finance Committee on September 24, 2026, advanced Chris Klomp's nomination for deputy secretary of the Department of Health and Human Services by a 15-12 vote, sending it to the full Senate. Klomp currently serves as director of Medicare and deputy administrator at CMS. The nomination now awaits a floor vote. If confirmed, Klomp would hold the second-highest position at HHS, with oversight authority spanning CMS, including Medicaid and CHIP operations, along with other departmental programs.
- State Policy · ID
Idaho Lawmakers Seek Payment, Prior Authorization Protections in Medicaid Transition
Idaho's Medicaid Review Panel heard updates on the state's transition to a new service delivery model, with legislators emphasizing the need for timely provider payments and prior authorization decisions. The article does not specify what new model Idaho is adopting, when the transition takes effect, or what triggered the legislative focus. Medicaid recipients testified on service coordination concerns. The development suggests Idaho is restructuring its delivery system with legislative oversight of operational safeguards for providers and beneficiaries.
- State Policy · NY
190,000 New York CDPAP Caregivers File for Union Election with 1199SEIU
Caregivers in New York's Consumer-Directed Personal Assistance Program (CDPAP) have filed for a union election with 1199SEIU United Healthcare Workers East. If successful, 190,000 self-directed Medicaid home care workers would join the union. The filing sets the stage for a vote that could reshape labor relations in New York's largest self-directed personal care program. For Medicaid managed care plans administering CDPAP benefits, unionization could affect caregiver wage rates, contracting terms, and administrative costs tied to CDPAP services.
- State Policy · DE
Delaware Awards $23M to Local Health Centers Ahead of Federal Medicaid Cuts
Delaware has awarded $23 million to three local medical centers as the state prepares for federal Medicaid funding reductions set to take effect later this year. The awards are part of Delaware's strategy to stabilize its healthcare infrastructure as both Medicaid cuts and rising commercial insurance rates threaten access. The investments target health centers serving Medicaid and uninsured populations, positioning safety-net providers to absorb increased demand as federal support declines. The timing reflects state anticipation of coverage losses and shifts in payer mix once federal cuts are implemented.
Thursday, September 24 · 28 stories
- Industry
LHC Group Reports Patient Data Breach After Employee Phishing Attack
LHC Group, a home health and hospice provider owned by UnitedHealth Group's Optum, disclosed a data breach stemming from a voice phishing (vishing) attack on an employee. The company became aware of the incident on April 7, 2026, and issued a public notice in September 2026. Patient information was exposed in the breach. The notice does not specify the number of affected individuals or what types of patient data were compromised.
- Industry
Hospital CEOs Prioritize Budget Increases for 2027 Amid Medicaid Cuts
Hospital and health system CEOs are finalizing 2027 budget priorities as the industry faces deepened Medicaid cuts and revised 340B rebate policies from the Health Resources and Services Administration. The article identifies which budget lines executives are increasing and decreasing in response to these pressures. For Medicaid-dependent providers, these strategic budget shifts signal how hospitals are absorbing state and federal reimbursement reductions and addressing operational sustainability under constrained Medicaid revenue.
- Federal Policy
CMS Halts ACA Broker Registrations for 2027, Terminates 760,000 Enrollments
CMS announced Tuesday it is freezing new broker registrations for the 2027 marketplace open enrollment period and terminating coverage for more than 760,000 individuals the agency has identified as unauthorized enrollees. The broker registration pause aims to reduce fraud in the exchanges; the agency did not specify which populations or enrollment circumstances triggered the coverage terminations. The registration freeze affects brokers seeking new marketplace access for plan year 2027. The actions reflect heightened federal scrutiny of marketplace enrollment integrity following reports of unauthorized sign-ups and agent misconduct in certain states.
- Federal Policy
KFF Analysis Finds TrumpRx Prices Below OECD Average for 17 of 32 Brand-Name Drugs
A Peterson-KFF Health System Tracker analysis compared prices for 32 brand-name drugs on TrumpRx.gov—a federal portal launched in February 2026 offering medications from manufacturers that signed voluntary pricing agreements with the White House—to publicly listed prices in 11 wealthy OECD countries. TrumpRx prices were lower than the OECD peer average for 17 drugs and higher for 15; TrumpRx had the lowest price for 5 drugs and the highest for 13. The analysis does not assess whether these negotiated prices affect Medicaid or Medicare reimbursement, whether domestic prices outside TrumpRx have changed, or how the retail prices compare to net costs after rebates in Medicaid or other public programs.
- Federal Policy · DE
CMS Awards $23 Million to Delaware for Rural Health Center Modernization and Mobile Care
CMS announced nearly $23 million in federal funding to Delaware for rural health center modernization, mobile care expansion, and chronic disease management infrastructure. The award supports facility upgrades, mobile health units, and technology improvements in underserved rural areas. The funding is available immediately for eligible health centers and state agencies to draw down for approved projects. For Medicaid, this matters because rural health centers serve significant Medicaid populations, and improved infrastructure and mobile capacity can expand access for beneficiaries in areas where provider shortages limit care availability.
- State Policy
KFF Tracker Compiles Abortion Ballot Initiatives for November 2026 Election
KFF has published a tracker reviewing abortion-related ballot initiatives currently slated for November 2026 across multiple states. The brief examines how these measures may impact abortion access depending on election outcomes. While abortion ballot initiatives do not directly regulate Medicaid coverage or managed care operations, they can affect reproductive health coverage requirements for state Medicaid programs and managed care plans if measures pass that expand or restrict abortion access. State Medicaid agencies and MCOs operating in states with ballot measures may face subsequent coverage policy changes.
- State Policy
NASHP Convenes States on Children's Behavioral Health Service Delivery Models
The National Academy for State Health Policy (NASHP) reports it convened states through a policy academy focused on strengthening behavioral health services for children and youth. Participating states worked on expanding service capacity, supporting the behavioral health workforce, and improving care coordination across systems. The initiative addresses persistent challenges in children's behavioral health access and integration, particularly relevant for states expanding Medicaid-covered behavioral health benefits and managed care network adequacy requirements. Details on specific state participants, policy commitments, or timelines were not provided in the source material.
- Federal Policy
CMS Administrator Oz Predicts AI Will Drive Up Healthcare Costs Before Reducing Them
CMS Administrator Dr. Mehmet Oz stated Wednesday that artificial intelligence will initially increase healthcare costs by accelerating medical billing before delivering long-term savings. He described AI as likely to "turbocharge" billing processes in the near term. The comments suggest CMS anticipates cost pressure from AI adoption across the healthcare sector, including Medicaid programs and managed care plans investing in AI-driven administrative tools. No timeline or policy response was specified.
- State Policy · AR
Arkansas Launches Outreach Campaign for Medicaid Work Requirements Starting January
Arkansas Department of Human Services released an outreach toolkit Thursday including flyers, posters, text messages, and videos to inform Medicaid expansion enrollees about work requirements taking effect in January. The requirements will apply to certain expansion population members. Affected enrollees will need to meet work, education, or qualifying activity thresholds to maintain coverage. The campaign reflects Arkansas's move to implement community engagement requirements following federal approval.
- Federal Policy · AR
CMS Awards Arkansas $54.6 Million for Chronic Disease, Maternal Health, and Rural Workforce
CMS awarded Arkansas $54.6 million in federal funding to support chronic disease management, maternal healthcare services, and rural health workforce development. The funding will flow to Arkansas Medicaid and other state programs to expand access to care in underserved areas and improve health outcomes for vulnerable populations. The award takes effect in federal fiscal year 2027. This matters for Arkansas Medicaid stakeholders because it will fund network expansion, provider recruitment, and care coordination for high-need populations, potentially affecting managed care plan responsibilities and provider contracting requirements.
- Federal Policy
Trump Administration Claims All States Accepted GENEROUS Drug Pricing Model, Several States Deny Enrollment Decision
Trump administration officials announced that all states have agreed to participate in the GENEROUS model, a federal initiative designed to provide lower drug prices to state Medicaid programs. However, officials in multiple states say they have not committed to participation and are still evaluating whether GENEROUS offers better value than existing manufacturer rebate arrangements. Pricing details for the GENEROUS model remain unavailable to the public. The discrepancy raises questions about enrollment claims and creates uncertainty for state Medicaid agencies making coverage and financial planning decisions.
- Federal Policy
GAO: Five State MMRCs Drove 12-Month Postpartum Medicaid Extensions Through Mortality Reviews
In a report released September 24, 2026, the Government Accountability Office found that Maternal Mortality Review Committees in five states successfully recommended extending Medicaid postpartum coverage to 12 months, which those states subsequently adopted. GAO reviewed 10 MMRCs and found all consider federal and state laws as factors affecting maternal mortality, with committees commonly making recommendations on care coordination, mental health and substance use, health equity, reproductive health, and health care workers. CDC provides approximately $134 million over 2024-2029 to support 52 state and territorial MMRCs and monitors performance through regular meetings, required reports, and site visits. The findings demonstrate how state-level mortality review processes directly influence Medicaid coverage policy decisions aimed at reducing preventable maternal deaths, particularly those linked to chronic conditions like severe hypertension in the postpartum period.
- State Policy · FL
Florida ABA Task Force to Hear Managed Care Plans on Autism Therapy Delivery
A Florida task force examining applied behavior analysis service delivery for children with autism and special needs will convene Monday to hear from managed care organization representatives, including Simply Healthcare, Sunshine Health, and Humana Healthy Horizons. The task force is considering potential changes to how the state structures and delivers ABA therapy through its Medicaid program. The meeting follows earlier sessions exploring current delivery models and stakeholder concerns about access and reimbursement.
