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Tuesday, September 22 · 36 stories
- State Policy · VA
Virginia Survey Finds 51% of Families with Children Face Food Insecurity
A statewide survey commissioned by the Federation of Virginia Food Banks, Virginia Department of Social Services, and No Kid Hungry Virginia found 51% of families with children are food insecure, up from 42% in the final federal USDA survey that ended in 2025. The University of Chicago survey of 5,600 Virginians shows rising food insecurity amid inflation and SNAP eligibility changes under H.R. 1, which resulted in more than 100,000 Virginians losing benefits over the past year. The survey also found three out of four food-insecure adults have chronic conditions and three in five visited an emergency room or urgent care at least once in the past year. Governor Spanberger signed an executive order to streamline inter-agency coordination as H.R. 1 threatens 300,000 with Medicaid loss in 2027.
- State Policy
Rural Maternal Health Access Deteriorates Following H.R. 1 Passage
Rural maternal health care access has worsened following passage of H.R. 1, compounding pre-existing challenges including 109 rural hospital closures since 2005, workforce shortages, and low reimbursement rates. The legislation's impact on rural maternity services adds to infrastructure vulnerabilities affecting pregnant Medicaid beneficiaries in rural areas. State Medicaid agencies face mounting pressure to address maternal health deserts through alternative delivery models, enhanced reimbursement, or emergency transport solutions as traditional brick-and-mortar access points continue closing.
- Managed Care
Safety Net Health Plans Achieve Record Performance in NCQA Quality Ratings
Safety Net Health Plans, members of the Association for Community Affiliated Plans (ACAP), achieved record performance in the National Committee for Quality Assurance's (NCQA) 2026 health plan ratings. The announcement, released September 21, 2026, indicates improved quality measures among plans serving predominantly Medicaid and dual-eligible populations. These ratings affect star ratings, quality bonus payments, and auto-enrollment assignments for Medicaid managed care plans. The results suggest safety net plans—which disproportionately serve low-income and complex populations—are closing quality gaps with commercial-focused plans.
- Federal Policy
CMS Proposes RAPID Pathway to Accelerate Medicare Coverage for FDA-Approved Devices
CMS proposed the Regulatory Alignment for Predictable and Immediate Device (RAPID) pathway to coordinate FDA device approval with Medicare coverage decisions, compressing a typical five-year lag to 60-90 days. The pathway synchronizes regulatory approval and coverage determination processes from the outset. Manufacturers of breakthrough devices would participate in joint FDA-CMS reviews. This matters for Medicaid managed care organizations and state agencies because accelerated Medicare coverage pathways often influence state Medicaid coverage decisions and MCO formulary policies for medical devices and durable medical equipment.
- State Policy · OK
Oklahoma Transitions Four State Mental Health Clinics to Private Operation
Oklahoma's Department of Mental Health is privatizing four state-run certified community behavioral health clinics, with over 90% of affected state employees receiving job offers as part of the transition. The privatization effort shifts clinic operations from direct state management to private providers. The timing and effective date of the transition were not specified in the report. This matters for states considering similar CCBHC delivery model changes and for understanding workforce continuity during Medicaid behavioral health delivery system transitions.
- State Policy · MA
Massachusetts Proposes $2M to Expand Postpartum Mental Health Services Under Medicaid
Massachusetts Governor Maura Healey is requesting $2 million from the state legislature to expand the Welcome Family program, which provides free home nurse visits for postpartum mental health screening to new mothers. The expansion would increase coverage from 3,000 to 68,000 households annually. Several other states enacted similar legislation this year: Illinois mandated at-home mental health screenings for all new mothers, while Maryland and Virginia required Medicaid and other insurers to cover postpartum depression screenings. The Policy Center for Maternal Mental Health expects a 200% increase in state legislative activity on maternal mental health in the coming year.
- State Policy · RI
Rhode Island Redesigns Medicaid and Public Benefits Decision Notices for Clarity
Rhode Island has redesigned the decision notices sent to approximately 60,000 residents monthly regarding Medicaid coverage and other public benefits. The redesigned notices aim to make approval, denial, and change decisions easier to understand for beneficiaries. The changes took effect this month. The redesign matters for state agencies and health plans because clearer notices can reduce appeals, call center volume, and coverage gaps caused by beneficiary confusion about eligibility decisions.
- State Policy · UT
Utah Disability Watchdog Cites State Oversight Failures After Three LTSS Client Deaths
The Disability Law Center released a report Monday accusing Utah's Department of Health and Human Services of inadequate oversight of Safe and Sound Services, a licensed provider whose transport driver has been charged with murder after three clients with disabilities died in his vehicle in February 2026. The center says DHHS allowed a high-risk provider to serve individuals with complex needs despite prior complaints of physical assaults, failure to provide medical care, dangerously low staffing ratios, and facilities lacking heat or running water. Utah DHHS responded that it has hired a contractor to assess risk mitigation, added four oversight staff, and is exploring stricter provider qualification standards. The provider's license has been revoked.
- Legal
DOJ Revises Justice Manual to Strengthen False Claims Act Enforcement
On September 18, 2026, the Department of Justice announced revisions to the Justice Manual strengthening False Claims Act enforcement. The changes affect how DOJ pursues FCA cases, including potential modifications to dismissal policies and limitations on relying on sub-regulatory guidance as the basis for FCA liability. Healthcare providers, including those serving Medicaid beneficiaries, face increased enforcement scrutiny. The revisions took effect immediately upon announcement.
- Legal
FinCEN Flags $17.5B in Suspected Health Care Fraud Across Medicare and Medicaid
On September 9, 2026, the Financial Crimes Enforcement Network (FinCEN) issued a Financial Trend Analysis identifying approximately $17.5 billion in suspicious activity potentially linked to health care fraud. The analysis is based on more than 5,700 Bank Secrecy Act reports filed between March 2025 and February 2026, with roughly 89 percent originating from depository institutions. The suspected fraud schemes targeted Medicare, Medicaid, and private insurance programs. This alert signals heightened financial institution monitoring of health care transactions and potential increased enforcement scrutiny across all payers, including Medicaid.
- Legal · NC
Abbott Pays $384M to Settle Medicaid Fraud Claims Over 2022 Formula Contamination
Abbott Laboratories agreed to pay $384 million to resolve federal and state allegations that it caused Medicaid to pay for contaminated infant formula prior to the 2022 recall and shortage. North Carolina will receive over $216,000 as part of the multistate settlement. The settlement addresses claims that Abbott violated the False Claims Act by distributing adulterated formula that was reimbursed by Medicaid. The case stems from the February 2022 recall of formula manufactured at Abbott's Sturgis, Michigan facility after bacterial contamination led to infant illnesses and deaths.
- State Policy · IN
Indiana Medical Frailty Definition Unfinished Three Months Before Work Requirements Start
Indiana's Family and Social Services Administration has not finalized its medical frailty exemption criteria for Healthy Indiana Plan (HIP) work requirements set to begin in three months. The exemption will determine which HIP enrollees — able-bodied adults ages 19-64 — are excused from work requirements due to medical conditions that prevent compliance. The delay creates uncertainty for thousands of low-income enrollees and health plans administering HIP. Medical frailty definitions are critical because they determine who faces coverage loss if work requirements are not met versus who receives an automatic exemption.
- Federal Policy
GOP Health Policy Expert Defends $1 Trillion Medicaid Cut Proposal
An influential Republican health policy expert is defending proposed $1 trillion cuts to Medicaid spending and identifying additional policy targets for future action. The article does not specify which Republican expert or what legislative vehicle would implement these cuts. The timing and likelihood of enactment are unclear given the need for congressional approval. For state Medicaid agencies and managed care organizations, these proposals signal continued federal-level debate over Medicaid financing that could affect coverage levels, eligibility, and capitation payments if enacted.
- Federal Policy
AHA Urges CMS to Limit Retrospective Reconciliation in Medicaid Provider Tax Rule
The American Hospital Association submitted comments September 21 on CMS's proposed rule implementing Medicaid provider tax changes from the July 2025 reconciliation law. Beginning in fiscal year 2027, states cannot raise the provider tax indirect hold harmless threshold above the rate in place at enactment; for expansion states, the hospital threshold decreases 0.5 percentage points annually starting FY 2028. AHA opposes CMS's proposed retrospective reconciliation requirement, arguing it creates unpredictability for state Medicaid programs and adds administrative burden. AHA recommends CMS use prospective estimates for ongoing compliance monitoring and limit retrospective calculations to the one-time statutory threshold determination.
- Federal Policy
MACPAC Comments on CMS Proposed Rule to Revise Health Care Tax Safe Harbor Threshold
The Medicaid and CHIP Payment and Access Commission (MACPAC) submitted comments to CMS on a proposed rule that would revise the indirect hold harmless threshold — the safe harbor — used to determine whether health care-related taxes impermissibly shift Medicaid costs to the federal government. The proposed rule changes how CMS evaluates whether provider tax arrangements violate federal Medicaid financing requirements. This affects state Medicaid financing strategies that rely on provider taxes to fund non-federal share of payments, a common mechanism used by states to draw down federal matching funds.
- Legal
Medical Groups and Enrollees Sue Over Federal Medicaid Work Requirements
Medicaid enrollees from five states and medical organizations filed suit Friday challenging work requirements established under the One Big Beautiful Bill Act signed by President Trump in summer 2026. The lawsuit targets new federal mandates requiring low-income adults in Medicaid expansion populations to meet work, school, or community service requirements. The legal challenge directly affects expansion enrollees in participating states and could determine whether millions of beneficiaries face coverage loss for non-compliance. The outcome will shape state implementation timelines and whether states must enforce work requirements pending judicial review.
Monday, September 21 · 26 stories
- Industry
Judge Approves CVS Unit Omnicare Bankruptcy Plan
A federal bankruptcy judge approved the restructuring plan for Omnicare, a long-term care pharmacy subsidiary of CVS Health. The plan is designed to fully repay all creditors, including the Department of Justice, which held claims against the company. The approval allows Omnicare to emerge from bankruptcy proceedings and continue operations serving nursing homes and other institutional settings. The resolution affects Medicaid programs indirectly, as Omnicare serves facilities where many residents rely on Medicaid coverage for pharmacy services.
- Federal Policy
Senators Reintroduce Bill Setting Federal Cybersecurity Standards for Hospitals
Sens. Mark Warner (D-Va.) and Ron Wyden (D-Ore.) reintroduced the Health Infrastructure Security and Accountability Act on September 17, 2026. The legislation would establish minimum federal cybersecurity standards for healthcare organizations and allocate $1.3 billion to help hospitals strengthen their defenses. The bill sets mandatory cybersecurity requirements for healthcare providers, addressing vulnerabilities exposed by recent ransomware attacks on hospital systems. If enacted, it would affect all hospitals and potentially apply to Medicaid providers serving beneficiaries through fee-for-service or managed care arrangements.
- Industry
Epic AI Tool Rollout Overwhelms Health Systems With Implementation Decisions
Epic Systems is releasing hundreds of AI tools simultaneously, forcing health systems to develop their own prioritization frameworks without clear vendor guidance. Seattle Children's CMIO reports that Epic is deploying 100-300 AI applications at once, leaving providers to independently assess clinical value, workflow integration, and implementation sequencing. Health systems must now triage which AI tools warrant investment and staff training resources. This reflects a broader industry challenge as EHR vendors accelerate AI deployment faster than healthcare organizations can evaluate and integrate new technologies.
- Federal Policy
KFF Brief: 28.5 Million U.S. Residents Have Limited English Proficiency, Face Coverage Gaps
A KFF issue brief published in September 2026 reports that 28.5 million people ages five and older in the U.S. have limited English proficiency (LEP) as of 2024. The brief documents that individuals with LEP experience disproportionate gaps in health insurance coverage and poorer health outcomes due to language access barriers. Because people of color are more likely than White individuals to have LEP, these barriers amplify racial and ethnic health disparities. The brief provides an overview of coverage and care patterns for this population.