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Monday, September 21 · 26 stories
- Federal Policy
All States Apply for CMS Medicaid Drug Pricing Program
All 50 states, Washington, D.C., and Puerto Rico have applied to participate in a CMS arrangement designed to reduce Medicaid drug costs, with 40 states and Puerto Rico already signing agreements. President Trump announced the milestone Friday, characterizing the program as delivering significant savings to state Medicaid programs. The timing and specific mechanics of the drug pricing arrangement were not detailed in the announcement. The development signals broad state interest in federal cost-containment tools for Medicaid pharmacy spending.
- Federal Policy
CMS Launches Medicaid Drug Payment Model with Participating States
CMS announced participating states in a new Medicaid drug payment model aimed at reducing prescription drug costs for Medicaid beneficiaries. The model will test alternative reimbursement methodologies for prescription drugs in Medicaid programs. Participating states will implement the model beginning in 2027, with CMS providing technical assistance and evaluating outcomes over a multi-year period. The initiative targets cost reduction while maintaining access to necessary medications for Medicaid enrollees.
Friday, September 18 · 33 stories
- Industry
12 Million Americans Lack Broadband Access for Telehealth, Study Finds
New research indicates approximately 12 million Americans cannot access telehealth services due to unavailable or inadequate broadband infrastructure, with the majority residing in rural areas. The study highlights ongoing digital divide challenges that limit virtual care delivery in communities that could benefit most from remote access to healthcare providers. While telehealth utilization has grown across Medicaid programs since the pandemic, this infrastructure gap affects beneficiaries' ability to access covered services in underserved areas. The findings underscore persistent barriers to care delivery models that states and managed care plans have increasingly incorporated into benefit design.
- Industry
60 Hospitals Close Departments or End Services Citing Financial Pressures, Staffing Shortages
Becker's Hospital Review compiled 60 hospital department closures and service discontinuations reported since January 1, 2026. Healthcare organizations cite financial challenges, efforts to focus on higher-demand services, and staffing shortages as primary drivers. The closures affect various service lines across facilities nationwide. The trend reflects ongoing operational pressures facing hospitals that may affect Medicaid beneficiaries' access to care depending on the services eliminated and markets affected.
- Managed Care
Health Systems Report Claims Automation Gap with Payers Creating Revenue Cycle Pressure
Revenue cycle executives at 17 health systems report that payers are now reviewing and denying claims at volumes and speeds that providers cannot match, creating what they describe as an unsustainable financial asymmetry. The automation gap affects providers' ability to respond to denials and prior authorization requests in real time. The imbalance is intensifying as payers deploy AI and automation tools faster than health systems can adopt corresponding technology. For Medicaid managed care organizations and their provider networks, this dynamic accelerates existing tensions over claims processing, prior authorization burden, and network adequacy tied to provider financial stability.
- Industry
One-Third of Privately Insured Adults Carry Medical Debt, Commonwealth Fund Reports
A Commonwealth Fund study found that one-third of privately insured adults have unpaid medical debt to healthcare providers, demonstrating that medical debt affects insured populations beyond emergency care scenarios. The findings highlight ongoing affordability challenges even among those with commercial coverage. The research underscores systemic issues with cost-sharing structures and provider billing practices affecting access to care. For Medicaid managed care organizations, the data provides context for understanding financial barriers facing dual-eligible populations and individuals cycling between coverage types.
- Federal Policy
Law Firm Comments on CMS Proposed Rule for Remote Monitoring Payment Under 2027 Physician Fee Schedule
Epstein Becker Green submitted comments to CMS on September 14, 2026, regarding the 2027 Physician Fee Schedule Proposed Rule, focusing on payment and coverage policies for device-enabled remote monitoring services furnished to Medicare beneficiaries. The comments were submitted on behalf of health care practices providing these services. The Proposed Rule affects Medicare Part B payment rates and policies that will take effect in calendar year 2027, with the comment period having closed in mid-September 2026.
- Federal Policy · KS
Kansas Receives $16.8M Federal Grant for Rural Health Tech and Transport
Kansas will receive $16.8 million in federal funding to expand telehealth, AI diagnostic tools, and patient transportation in rural areas. The funds are part of CMS's $50 billion Rural Health Transformation Program enacted in 2025, distributed across 14 organizations with $16.2 million for technology modernization and $780,000 for transportation coordination. The program was authorized through the One, Big Beautiful Bill Act, which also included $930 billion in Medicaid cuts over ten years.
- Industry
CVS Aetna Bundles Cancer Prior Authorizations Into Single Upfront Request
CVS Aetna announced it will consolidate prior authorization requirements for cancer care into one upfront approval covering all treatment types, replacing the current piecemeal approach that requires separate authorizations for different services. The change aims to reduce administrative burden on oncology providers who currently submit multiple prior authorization requests throughout a patient's cancer treatment episode. The new bundled authorization process will apply across CVS Aetna's commercial and Medicare Advantage plans. This affects how oncologists interact with CVS Aetna's utilization management systems and may influence treatment access and care coordination for cancer patients.
- State Policy · WI
Wisconsin Extends Civil Rights Compliance Period for Medicaid Providers Through 2028
The Wisconsin Department of Health Services extended the civil rights compliance period for recipients of federal financial assistance through December 31, 2028. The compliance period, which began January 1, 2022, was originally set to expire on December 31, 2026. This extension affects Medicaid providers and health plans that receive federal financial assistance through DHS and must maintain compliance with civil rights requirements. The extension provides an additional two years under the current compliance framework before any potential updates to civil rights compliance requirements take effect.
- Federal Policy
Georgetown CCF Submits Comments on HHS Vaccination Policy RFI
The Georgetown University Center for Children and Families submitted comments to HHS responding to a Request for Information on federal vaccine recommendation categories and the role of shared clinical decision-making. The comments address how federal vaccination guidance affects clinical practice and policy implementation. The RFI reflects HHS consideration of potential changes to how vaccine recommendations are categorized and communicated to providers and patients. For Medicaid programs, this matters because federal vaccine recommendations drive EPSDT coverage requirements and Early and Periodic Screening, Diagnostic and Treatment mandates for children.
- Industry
Rural Hospitals Deploy Seven Workforce Strategies to Address Provider Shortages
Forty-three million Americans live in rural areas facing primary care shortages, and workforce instability ranks among the top strategic challenges for rural hospitals and health systems. Physician and clinician shortfalls, burnout, and thin talent pipelines limit access and strain already-lean operations, particularly in markets affected by closures and consolidations. The article outlines seven workforce transformation strategies rural providers are using to address these pressures. For Medicaid stakeholders, rural workforce challenges directly affect network adequacy, access to care for beneficiaries, and health plan compliance in rural service areas.
- State Policy
States Prepare for Medicaid Work Requirements, Expand Rural Health Programs in August 2026
State Health and Value Strategies compiled state Medicaid and health policy activity from August 2026. States prepared enrollees for upcoming Medicaid work reporting requirements under H.R. 1, awarded additional Rural Health Transformation Program grants, and established rural health advisory councils. Massachusetts returned $14.5 million in dental insurance rebates under state law, becoming the first state to enforce dental rebate requirements. Two states received CMS 1115 waiver approvals, and Oregon secured approval to transition to a State-Based Marketplace. States also acted on vaccine access, reproductive healthcare, healthcare affordability, primary care investment, and medical debt.
- State Policy
NASBO Data Shows State Revenue Trends Shaping FY 2027 Medicaid Budgets
A new brief analyzes state fiscal conditions using National Association of State Budget Officers revenue and spending data to provide context for state Medicaid budget decisions in fiscal year 2027. The analysis examines how current state revenue trends and overall spending patterns are likely to influence Medicaid funding levels and program priorities as states finalize their FY 2027 budgets. The brief is intended to help Medicaid stakeholders understand the fiscal environment in which states are making budget and policy decisions for the upcoming fiscal year.
- Federal Policy
Census Bureau Releases 2025 Child Uninsured Data; ACS Release Delayed
The U.S. Census Bureau released Current Population Survey data for calendar year 2025 examining child uninsured rates, poverty, income, and health insurance trends. The American Community Survey, which typically releases simultaneously and provides larger sample sizes for state-level analysis, has not yet been published. The delay in ACS data limits the ability to conduct granular state and sub-state analysis of coverage trends. For state Medicaid agencies and advocates tracking coverage following recent policy changes, the absence of robust state-level data complicates assessment of enrollment shifts and children's coverage losses.
- State Policy · SD
South Dakota AG Says Ballot Measure Would Auto-Repeal Medicaid Expansion
South Dakota Attorney General Marty Jackley has stated that a constitutional amendment on the November 3 ballot would automatically end Medicaid expansion if federal funding falls below 90%, contradicting Republican lawmakers who placed the measure and claim it would only grant them authority to consider ending expansion. The legal interpretation dispute centers on whether the amendment is self-executing or requires legislative action. The disagreement creates uncertainty for approximately 50,000 South Dakotans who gained coverage under the state's voter-approved expansion.
- Federal Policy
White House Announces 50-State Medicaid Drug Pricing Initiative
President Trump will announce that all 50 states will implement "most favored nation" pricing for certain Medicaid-covered drugs, according to an administration official. The announcement, scheduled for Friday with several governors present, would tie Medicaid drug prices to lower international reference prices. Implementation details including which drugs are covered, effective dates, and how this aligns with existing Medicaid best price and rebate requirements remain unclear. The initiative reflects ongoing White House focus on drug affordability as a voter priority.
- Industry · NY
NYC Health + Hospitals-Maimonides Merger Clears State Public Health Council
New York's Public Health and Health Planning Council unanimously approved NYC Health + Hospitals' proposed acquisition of Maimonides Health on September 17, 2026. The transaction still requires additional state regulatory approvals before closing. NYC Health + Hospitals is the nation's largest public health system and a major Medicaid provider in New York City. The merger would consolidate provider capacity in Brooklyn, where both systems operate and serve substantial Medicaid and uninsured populations.
- Industry
Agentic AI Deployment in Healthcare Outpacing Governance Frameworks, Imprivata Warns
Healthcare organizations are deploying agentic AI tools faster than governance frameworks are being established, according to Imprivata's chief medical and growth officer. The report warns that patient safety risks could emerge if these autonomous AI systems are implemented without adequate guardrails and oversight mechanisms. The concern centers on AI tools that can take actions independently rather than simply providing recommendations. For Medicaid stakeholders, this raises questions about managed care organizations' use of AI in utilization management, care coordination, and clinical decision support without clear regulatory standards.
- Industry
HCA Reports Elective Surgery Volume Decline Tied to Exchange Coverage Loss
HCA Healthcare reported softer elective surgery volumes linked to patients losing health insurance exchange coverage, CFO Mike Marks told investors September 15. The 189-hospital for-profit system cited broader affordability pressures as a potential contributing factor to the slowdown. HCA continues to see strong overall demand for healthcare services despite the elective procedure decline. The trend signals potential financial pressure on hospital systems as coverage instability affects commercially insured patient volumes.