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Friday, September 18 · 33 stories
- Managed Care
ECRI Finds 73% of Medication Reconciliation Errors Occur During Care Transitions
ECRI reported September 16 that 73% of medication reconciliation errors occur when patients move between care settings, based on analysis of 10,000 safety events. The findings highlight care transitions as a high-risk period for medication safety failures. The report emphasizes the need for improved handoff protocols and communication systems between settings. For Medicaid managed care plans, this underscores operational risk in care coordination programs, particularly for high-utilizing populations moving between hospital, SNF, home health, and outpatient settings.
- Industry
HCA CFO Says Hospitals Lag Payers on AI-Driven Claims Processing
HCA Healthcare CFO Mike Marks stated September 15 that health insurers have outpaced hospitals in deploying artificial intelligence for claims processing, exacerbating existing friction over denials, underpayments, and prior authorization. Marks' comments highlight a technology gap that puts hospitals at a disadvantage in revenue cycle management as payers increasingly automate claims review and adjudication. The remarks suggest growing competitive pressure on hospital systems to accelerate AI adoption to match payer capabilities in claims operations.
- State Policy · CT
Connecticut Poll Shows Voter Support for Increasing State Medicaid Spending Amid Federal Cuts
A poll of 602 Connecticut voters found 86% support using state surplus funds to offset federal cuts to social services, including Medicaid, and 54% favor adjusting budget caps to increase funding. An estimated 110,000 low-income adults in the HUSKY D Medicaid program face coverage loss in January 2027 due to new federal work requirements, and hundreds of lawfully present immigrants will lose Medicaid eligibility regardless of work status. Connecticut has run surpluses averaging $1.8 billion annually since 2017, and Governor Lamont created a $550 million fund for one-time assistance but has not committed to ongoing state-funded replacements for federal programs. The state increased nonprofit provider funding by $60 million in fiscal year 2027, but advocates say payments still lag inflation by over $300 million annually.
- State Policy · WV
West Virginia Allocates $855K in Federal Funds to Expand Health Information Exchange
West Virginia will allocate $855,400 in federal Rural Health Transformation Program funds to the West Virginia Health Information Network to expand statewide health information exchange capacity. The funding will support the Connected Care Grid initiative, increasing participation in secure data sharing among healthcare providers and organizations. The allocation is part of West Virginia's $199 million Rural Health Transformation award from CMS in 2026, aimed at strengthening rural healthcare infrastructure. The investment expands provider connectivity for care coordination across the state's rural healthcare delivery system.
- State Policy · MI
Michigan Lawmakers Push Coverage Expansion for Group Prenatal Care Programs
Michigan legislators are advancing bills to require Medicaid and private insurance coverage for group prenatal care services, defined as up to 12 visits in an evidence-based group setting. SB 415, requiring Medicaid coverage, has already been signed into law. Three companion bills extending similar mandates to private insurers remain in committee. Michigan currently operates 39 licensed Centering Pregnancy sites — second-most nationally — through a state health department partnership launched in 2024. The legislation aims to expand access to group care models that combine prenatal visits, education, and peer support for expectant mothers at similar pregnancy stages.
- Federal Policy
HHS Secretary Kennedy Tells Anti-Vaccine Group Administration Supports Its Cause
HHS Secretary Robert F. Kennedy Jr. told Children's Health Defense, an anti-vaccine organization he previously led, that the Trump administration is a "strong and steadfast friend" to the group's cause. The remarks were delivered Thursday at a one-day conference. The statement signals potential alignment between federal health policy leadership and vaccine skepticism advocacy. This raises questions about future federal vaccine policy direction, including recommendations affecting Medicaid pediatric EPSDT requirements and childhood immunization standards.
- State Policy · VT
Vermont Regulator Cuts Hospital Commercial Rates 1.2%, Expects $1.94B Revenue Cap
Vermont's Green Mountain Care Board issued budget orders Monday reducing commercial insurance rates charged by hospitals by approximately 1% statewide, with collective commercial revenue capped at $1.94 billion for fiscal year 2027 beginning October 1, 2026. The University of Vermont Medical Center faces the steepest reduction at 4.4%, while only Northwestern Medical Center and Springfield Hospital received 2% rate increases. The orders aim to slow health insurance premium growth in a state where residents pay among the nation's highest premiums, but hospital leaders warn the cuts will destabilize facilities already projecting collective deficits this fiscal year and next. Vermont hospitals have cut $57 million from projected fiscal 2026 expenses as part of a broader plan to reduce spending by $330 million by 2028.
- State Policy · GA
Georgia Remains Among 10 States Without Medicaid Expansion Despite Public Support
Georgia has not expanded Medicaid eligibility under the Affordable Care Act, remaining one of 10 non-expansion states. Public polling shows strong support for expansion among Georgia residents. The article discusses whether recent state proposals represent genuine expansion efforts or delay tactics. The continued non-expansion affects coverage for low-income adults in the coverage gap who earn too much for traditional Medicaid but cannot afford marketplace plans.
- State Policy
Colorado Medicaid Projects Service and Funding Cuts Amid Budget Overruns
Colorado’s Medicaid program is forecasting service reductions and funding cuts as the program significantly overspends its budget. State lawmakers attribute rising costs to multiple converging factors creating financial pressure on the program. The forecast signals potential cuts affecting the state's Medicaid beneficiary population. Specific timing, affected services, and dollar amounts were not detailed in available information.
- Industry · AZ
Ascension Transfers Mercy Care Ownership Stake to Aetna
Ascension has agreed to transfer its ownership stake in Mercy Care, an Arizona managed care health plan, to Aetna (CVS Health). Ascension co-owns the plan with CommonSpirit's Dignity Health. The transaction is subject to regulatory approval. The deal represents consolidation in the Arizona managed care market, with a national commercial insurer acquiring equity from health system owners.
- State Policy · CA
California Medicaid Rate Increase Expected to Shift Pediatric Care to Home Settings
California implemented a Medicaid rate increase for home-based pediatric care, prompting Aveanna Healthcare to raise caregiver wages and plan January recruiting expansion. The company anticipates hundreds of families will transition medically complex children from institutional settings to home care as a result of improved reimbursement. The rate adjustment addresses longstanding workforce shortages in California's home health sector by enabling providers to offer competitive wages. This shift affects California's Medicaid program, pediatric providers, managed care organizations with LTSS responsibilities, and families of children with complex medical needs.
- Legal · VT
Vermont Provider Settles Medicaid Fraud Allegations for $390,000
Health Care & Rehabilitation Services of Southeastern Vermont will pay $390,000 to resolve allegations it mishandled Medicaid funds. The settlement also requires the provider to adopt new compliance policies. The case involved claims that the organization improperly managed federal Medicaid dollars. The settlement demonstrates continued state and federal enforcement activity targeting Medicaid billing and fund management practices at community-based providers.
- State Policy · MA
Massachusetts Reduces Estimate of Members Subject to Work Requirements by 50,000
MassHealth has lowered its projection of members who will be affected by upcoming Medicaid work and education requirements by approximately 50,000 individuals. The revised estimate reflects a recalculation of the member population subject to community engagement rules. The requirements will impose work, education, or volunteer obligations on non-exempt adult Medicaid beneficiaries. The reduction in projected impact suggests either narrower implementation scope or expanded exemption categories compared to initial projections, which will affect state administrative planning and managed care organizations' member engagement strategies.
- State Policy · PA
Pennsylvania Families Sue Shapiro Administration Over Medicaid Caregiver, Travel Restrictions
Four Pennsylvanians with intellectual and developmental disabilities filed a class action lawsuit challenging new Medicaid waiver rules that limit paid hours for family caregivers to 40–60 per week and restrict out-of-state travel support. The Shapiro administration imposed the limits through participation agreements after Commonwealth Court struck down nearly identical policies in February 2026 for failing to follow required rulemaking procedures. The administration gave participants an Aug. 6 deadline to sign new agreements or face involuntary service terminations; over 8,300 beneficiaries had signed by early September. Plaintiffs argue the state is bypassing the regulation process and forcing families to choose between uncompensated caregiving or institutional care.
- Managed Care · LA
Louisiana Proposes Higher Capitation Rates as Two MCOs Exit Medicaid Program
The Louisiana Department of Health has proposed new contract extensions with increased capitation rates for the four Medicaid managed care organizations remaining in the program after two plans exit by year-end. The departures will affect up to 580,000 enrollees who must be reassigned to the remaining plans. The proposed contracts were presented to state legislators on September 17, 2026. The rate increases reflect the state's need to retain existing plans and ensure adequate network capacity as the program consolidates from six to four MCOs.
Thursday, September 17 · 29 stories
- State Policy · CA
California Prop 36 Treatment Mandates Vary Widely by County, Leaving Gaps in Drug Treatment Access
Two years after California voters passed Proposition 36 requiring drug treatment for certain theft and drug offenses, counties are implementing treatment-mandated felony provisions inconsistently — with treatment durations ranging from three months in Ventura County to two years in San Luis Obispo County. Officials who supported the measure acknowledge gaps in the state's treatment infrastructure, with people waiting for services while charges remain pending. Defendants entering plea deals face challenges securing employment with felony convictions on record during court-mandated treatment periods that can extend well beyond residential program completion. The lack of state-funded treatment capacity and standardized implementation protocols has left some individuals the law intended to help falling through the cracks, according to state and local officials.
- Legal
OIG Finds Humana and UnitedHealth MA Plans Generated $180M in Upcoding Overpayments
HHS OIG audits released September 17, 2026 found that HumanaChoice and UnitedHealthcare of Wisconsin overstated member health conditions in Medicare Advantage risk adjustment submissions, resulting in nearly $180 million in overpayments over a two-year period. The audits concluded both plans frequently exaggerated health needs to inflate capitation payments. OIG has referred the findings to CMS for recovery action. While these audits focus on Medicare Advantage, they signal heightened federal scrutiny of risk adjustment practices that could extend to Medicaid managed care plans using similar diagnosis-driven payment models.
- Industry
Health Systems Lease SNF Beds to Address Patient Boarding and Discharge Delays
Hospitals are leasing skilled nursing facility beds to reduce emergency department boarding and expedite patient discharges as SNF capacity tightens. Four health systems report success using bed leasing arrangements that include value alignment with SNF partners, transparent patient selection criteria, and regular operational check-ins. The approach addresses growing pressure from an aging population and declining overall SNF bed supply. Systems largely exited the SNF business years ago but are now contracting for guaranteed bed access.
- Industry
FTC Tightens Failing Firm Defense Standards for Hospital Acquisitions
The Federal Trade Commission is applying stricter standards to the failing firm defense in hospital merger reviews, even as rural and critical access hospitals face documented financial pressures from low reimbursements, high Medicaid and Medicare volumes, uninsured patient populations, and expired pandemic relief funding. Hospitals seeking acquisition approval must now meet heightened thresholds to demonstrate they cannot remain independent or find alternative purchasers. The guidance affects health systems pursuing distressed hospital acquisitions, including those serving significant Medicaid populations.
- Legal
CMS Affiliation Rule Enables 10-Year Medicare Enrollment Bars for Physicians Without Direct Violations
Under current Medicare enrollment regulations, physicians can face up to 10-year exclusions from treating Medicare patients based solely on affiliation with another provider or supplier that has compliance issues, even when the physician has no personal history of fraud, improper billing, or disciplinary actions. The affiliation rule allows CMS to deny or revoke enrollment based on an individual's relationship with an entity that has been sanctioned or excluded. This administrative action does not require proof that the physician submitted improper claims or engaged in wrongdoing. The rule particularly affects hospice medical directors and other physicians in administrative or leadership roles where formal affiliations are documented.