All stories
Jump to date
Wednesday, September 23 · 26 stories
- Managed Care
Commonwealth Fund Reviews State Options for Addressing Medicaid MCO Performance Issues
The Commonwealth Fund published guidance on how state Medicaid agencies can address underperforming managed care plans through contractual tools and staff oversight strategies. The analysis covers corrective action plans, financial penalties, contract suspension, and systematic performance monitoring approaches states can deploy when plans fail to meet quality, access, or administrative standards. The guidance emphasizes strategic prioritization of enforcement resources and graduated remedies. State Medicaid agencies managing MCO contracts gain a framework for structuring performance oversight and escalating interventions when plans fall short of contractual obligations.
- Legal · FL
Florida Sues Insulin Manufacturers and PBMs Over Alleged Price Inflation Scheme
Florida Attorney General James Uthmeier filed suit in Miami-Dade County Circuit Court against Eli Lilly, Novo Nordisk, Sanofi, and three pharmacy benefit managers, alleging they inflated insulin list prices and paid rebates that increased costs for consumers. The lawsuit accuses the companies of a coordinated pricing scheme involving diabetes medications. The action reflects growing state enforcement efforts targeting pharmaceutical pricing practices that affect state Medicaid pharmacy expenditures and beneficiary access to essential medications. The complaint follows similar insulin pricing litigation in other states.
- State Policy · NM
New Mexico Approves 11 of 13 Regional Behavioral Health Plans
The committee tasked with rebuilding New Mexico's behavioral healthcare infrastructure has approved 11 of 13 regional plans, with two regional plans remaining for approval. The chair provided the update to the interim Legislative Finance Committee on Tuesday. The approvals represent progress toward statewide implementation of a restructured behavioral health delivery system. This development directly affects how behavioral health services will be organized and delivered across New Mexico's Medicaid program.
- State Policy · AR
Arkansas Child Uninsured Rate Reaches Decade High at 7.7 Percent
Arkansas Advocates for Children and Families reports that 57,000 Arkansas children — 7.7% of the state's child population — were uninsured in 2024, an increase of 7,000 from the previous year and the highest level in a decade. Hispanic children face the highest uninsured rate at nearly 14%, and foreign-born children are more than seven times more likely to be uninsured than U.S.-born children. The report attributes rising uninsurance to Medicaid disenrollment following pandemic-era continuous enrollment protections and warns that federal Medicaid spending cuts under H.R. 1 will create additional instability. Arkansas' Medicaid expansion program, covering more than 200,000 low-income adults, faces an uncertain future after the Trump administration denied the state's renewal request.
- Federal Policy
NAMD Submits Comments on Proposed Health Care-Related Tax Hold Harmless Rule
The National Association of Medicaid Directors submitted comments on September 21 responding to a CMS notice of proposed rulemaking that would amend the indirect hold harmless threshold for health care-related taxes. Health care-related taxes are a key financing mechanism states use to draw down federal Medicaid matching funds, and the hold harmless provisions limit the extent to which states can return tax revenue to providers. The proposed rule would modify the threshold that triggers federal hold harmless scrutiny, directly affecting state Medicaid financing flexibility and the permissible structure of provider tax arrangements.
- Federal Policy
Becker's Compiles 20 CMS Policy Actions Under Trump Administration in 2026
In its compilation titled 'CMS under Trump: 20 key actions,' Becker's Hospital Review reports CMS has advanced coverage, payment, and program integrity changes throughout 2026. The actions span Medicare and Medicaid payment reforms, ACA marketplace oversight, prior authorization requirements, fraud enforcement, and new value-based care models. The compilation provides an overview of major federal healthcare policy developments across both Medicare and Medicaid programs during the current administration. For Medicaid stakeholders, the relevant subset of these 20 actions may include Medicaid-specific payment policy changes, program integrity enforcement affecting Medicaid managed care, and ACA marketplace changes affecting dual-eligible populations.
- Legal · NY
OIG Finds New York Made Unallowable Capitation Payments for Incarcerated Enrollees
The HHS Office of Inspector General determined that New York made unallowable managed care capitation payments on behalf of incarcerated Medicaid enrollees. Federal law prohibits federal Medicaid funding for services provided to incarcerated individuals, with limited exceptions for inpatient hospital care. The audit findings indicate the state made capitation payments to managed care organizations for enrollees who were incarcerated during the coverage period. OIG recommendations typically require states to refund the federal share of identified overpayments and implement corrective actions to prevent future unallowable payments.
- Industry
Becker's Tracks 14 Healthcare Bankruptcies in 2026 to Date
Becker's Hospital Review is tracking healthcare organization bankruptcies in 2026, reporting 14 filings year-to-date. The publication notes an upward trend from 15 bankruptcies in 2024 to 20 in 2025, attributing financial pressures to workforce shortages, rising operational costs, and declining reimbursement rates. The article appears to be an ongoing tracker compiling bankruptcy filings as they occur rather than reporting a specific bankruptcy event.
- Industry · FL
Empath Health Launches Dementia Training Program Across Nine Florida Counties
Empath Health, a Florida home-based care provider, launched an immersive dementia education program in early September covering nine counties. The program trains professional care teams and first responders while providing support for family caregivers. It aims to reduce avoidable hospitalizations and improve crisis management for patients with dementia-related cognitive decline. The initiative addresses both workforce training and caregiver support gaps in community-based dementia care.
- Industry
McDermott Outlines Physician Alignment Strategies Amid Payment Pressures
McDermott Will & Emery published guidance for hospitals and health systems on physician alignment models under current financial constraints, including Medicaid funding reductions, 340B uncertainty, and site-neutral payment expansion. The analysis covers alternative structures to traditional employment models that may preserve margin while maintaining physician relationships. The guidance is aimed at hospital CFOs and strategic planning teams navigating payment model transitions.
- Industry
Pelago Launches Integrated Behavioral Health Platform with AI Triage
Pelago launched a behavioral health platform integrating substance use disorder, mental health, and behavioral addiction treatment with AI-powered triage to match patients with appropriate care levels. The platform is designed for health plan and employer deployment. No information is provided about specific Medicaid health plan contracts or state agency adoption. The launch reflects ongoing vendor activity in integrated behavioral health technology targeting payers.
- Managed Care
Nursing Home Bed Supply Declining as Baby Boomers Age Into Peak Need Years
Nursing home bed capacity is shrinking as the oldest baby boomers reach age 80, raising concerns about availability for long-term care services. Researchers warn that facility supply may not meet demand from an aging population entering the years when institutional care is most likely. The article does not specify implementation timelines or immediate policy changes. The capacity gap threatens access for Medicaid beneficiaries who rely on nursing facility services, potentially forcing states and managed care plans to accelerate community-based alternatives or face waitlists.
- Federal Policy
KFF/AP Survey Finds Health Care Costs Top Issue for Rural Voters Ahead of 2026 Midterms
A new KFF/AP survey examines rural voters' political priorities ahead of the 2026 midterm elections, with health care costs emerging as a major concern alongside cost of living. The survey measures rural voters' views on Trump administration health care policies and identifies top election issues. Rural areas typically have higher Medicaid enrollment rates and face provider shortage challenges that shape state Medicaid policy priorities. Results reflect voter sentiment that may influence state Medicaid expansion debates, LTSS program design, and telehealth policy in rural-focused states.
- State Policy · OR
Oregon to Notify 600,000 Medicaid Members of Coming Program Changes
Approximately 600,000 Oregon Health Plan members will receive notices about upcoming changes to the state's Medicaid program following new federal requirements. The notices will inform members of modifications to their coverage. The timing of the changes and specific effective dates were not detailed in the available information. The notifications represent a significant communication effort affecting roughly half of Oregon's Medicaid enrollment, requiring coordination between the state and health plans to ensure members understand how their benefits or program participation may shift.
- State Policy · CT
Connecticut GOP Candidate Proposes $336M Medicaid Cut, Managed Care Transition
Connecticut Republican gubernatorial candidate Ryan Fazio announced a tax cut plan that would reduce Medicaid spending by $336 million annually by 2031 through eliminating coverage for undocumented residents, fraud reduction efforts, and transitioning to a managed care model for the state's Medicaid program. The proposal would also cut $1.2 billion in annual state spending and $500 million in borrowing. The managed care transition faces strong opposition from the Democratic-controlled state legislature. The plan's fiscal projections rely on outdated revenue forecasts and do not account for recent investments in municipal aid, childcare, and social services.
- State Policy · MT
Montana DPHHS Director Charlie Brereton to Leave Oct. 30, Harrington Named Successor
Charlie Brereton will step down as director of Montana's Department of Public Health and Human Services on October 30 after four years, moving to the private sector. Dr. Doug Harrington, the department's state medical officer, will replace him. The transition occurs as DPHHS oversees a $233 million federal Rural Health Transformation Program grant, implements new Medicaid and SNAP work requirements set to begin this fall, and manages a $7 billion biennial budget covering Medicaid, behavioral health, and other health and human services programs. Brereton led the agency through Medicaid unwinding, behavioral health investments, and rural hospital stabilization efforts.
- State Policy · MD
Maryland Health IG Reports $42M in Improper Payments from Audits Now Public
Maryland's Office of Inspector General for Health conducted 1,369 investigations and 53 audits over fiscal years 2023-2025 identifying $42 million in improper or unrecovered payments from healthcare providers and local health departments. The agency has now posted 20 audit reports publicly for the first time after operating largely without public disclosure since becoming independent in 2022. The reports detail $4.3 million owed by 13 healthcare providers for inadequate documentation and duplicate payments, plus $1.7 million owed by local health departments for documentation errors and missing equipment. The Maryland Department of Health, not the IG, handles recoveries and has historically forgiven portions of identified overpayments.
- Federal Policy
Federal Medicaid Work Requirements Take Effect January 1, 2027
New federal work and reporting requirements for Medicaid take effect January 1, 2027, affecting millions of beneficiaries nationwide. States are preparing to implement the requirements, which represent a significant programmatic change. Beneficiaries who do not meet work or reporting requirements risk coverage loss. The requirements mark the first nationwide mandatory work requirements in Medicaid's history.
- State Policy · MO
Over Half of Missouri Counties Lack Labor and Delivery Services, March of Dimes Reports
A new March of Dimes report finds that more than 50% of Missouri counties are maternity care deserts with no labor and delivery units or obstetric physicians, affecting nearly 140,000 women of childbearing age. Between 2010 and 2024, nine Missouri counties lost hospital-based obstetric services, driven by high fixed costs, low birth volumes, and higher Medicaid patient shares at rural hospitals. Research shows that after rural counties lose obstetric services, risks of preterm birth, out-of-hospital birth, and delivery at facilities without dedicated obstetric units increase. The closures add an average of 25 minutes to travel times for families near affected facilities.
- State Policy
Nine States to Vote on Tax Measures Affecting Medicaid and Public Program Funding
Voters in at least nine states will decide tax ballot measures this fall that could significantly alter revenue available for Medicaid and other public services. California's Proposition 40 would impose a one-time 5% wealth tax on billionaires to close budget gaps in Medicaid, food assistance, and education programs — a response to federal funding losses from the 2025 One Big Beautiful Bill Act. Colorado and Washington state also face income tax measures. California's measure would raise tens of billions for Medicaid and other services, though competing ballot measures could undo it if they receive more votes. The outcomes will determine state capacity to fund Medicaid programs amid tightening federal support.
