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Wednesday, September 16 · 25 stories
- State Policy · LA
Louisiana Awards Rural Health Grants to Tech Startups
Louisiana received over 200 applications from technology companies seeking $250,000 to $3 million in state funding to address rural health care gaps. The state is directing rural health dollars to unproven startups as traditional providers exit underserved markets. The initiative reflects a broader state-level trend of funding technology solutions where brick-and-mortar providers have closed or left. States are assuming financial and operational risk by investing public dollars in early-stage companies without demonstrated outcomes in Medicaid populations.
- Federal Policy
Census Reports 2025 Poverty Rate at Historic Low Amid Warnings of Medicaid, SNAP Cuts
The U.S. Census Bureau reported the 2025 official poverty rate fell to 10.2%, a historic low, while the supplemental poverty rate held steady at 13.1%. Median household income rose 2.6% to $87,460. Experts cautioned the data does not reflect 2026 federal policy changes, including major Medicaid and SNAP cuts enacted through last year's tax and spending legislation. The Congressional Budget Office estimates 15 million people will lose health coverage by 2034, and SNAP enrollment for children already dropped 1.2 million between July 2025 and July 2026.
- Managed Care
Network Health Launches Epic Prior Authorization API Ahead of 2027 CMS Deadline
Network Health has implemented Epic's prior authorization application programming interface (API) in advance of CMS's January 1, 2027 interoperability rule deadline. The rule requires insurers to deploy APIs for patient access, provider access, provider directory, payer-to-payer data exchange, and prior authorization. Network Health is among the early adopters working with Epic to meet these requirements before the mandate takes effect. The implementation aims to streamline prior authorization processes between the health plan and providers using Epic's electronic health record system.
- Federal Policy · ME
Maine Analysis Links $4,300 Household Cost Increase to Expired ACA Premium Tax Credits
A Maine Center for Economic Policy analysis attributes rising household costs to federal policy changes, including the January 2026 expiration of enhanced Affordable Care Act premium tax credits for marketplace plans. Healthcare costs represent the largest driver, with families enrolled in marketplace plans seeing significant premium increases while those with employer coverage were less affected. Maine's individual market premiums rose 14.8% for 2027, reflecting declining enrollment by healthier members after subsidies expired. The analysis also cited rising gas, heating oil, and tariff-related costs, but healthcare policy changes had the most direct impact on affected households.
- State Policy
State Health and Value Strategies Issues Messaging Guidance on Medicaid Work Requirements
State Health and Value Strategies published Part 2 of messaging guidance for state Medicaid agencies implementing work reporting requirements under H.R. 1. The guidance reflects the June 2026 interim final rule and provides communication templates for explaining requirements, compliance procedures, and exemptions to enrollees, applicants, and community partners. This resource is designed to help state agencies develop clear, standardized communications as they operationalize the federal work reporting mandate. States face enrollee outreach and education obligations as work requirements take effect.
- State Policy · SC
South Carolina Awards $200M in Federal Rural Health Grants as State Cuts Medicaid
South Carolina Governor Henry McMaster announced federal grant awards to rural hospitals and physician practices through the Rural Health Transformation Program, totaling $200 million. The funding comes as the state implements Medicaid budget cuts. Rural healthcare providers will receive grants to support operations and infrastructure amid declining Medicaid reimbursement. The timing of these awards reflects the tension between federal rural health support and state-level Medicaid contraction.
- State Policy · MS
CMS Awards Mississippi $104 Million for Rural Healthcare Technology and Access Expansion
CMS has approved $104 million in federal funding to Mississippi to expand rural healthcare access through technology infrastructure and care delivery improvements. The funding will support telehealth expansion, care coordination technology, and increased provider capacity in underserved areas across the state. Implementation begins in fiscal year 2027. This represents a significant federal investment in Mississippi's rural health infrastructure, particularly relevant for managed care plans and providers serving Medicaid beneficiaries in rural counties where access to specialists and technology-enabled care has been limited.
- Federal Policy
CMS Adds Four Condition Tracks to ACCESS Model in Spring 2027
CMS announced September 15 that it will expand the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model to include four new condition tracks: heart failure, chronic obstructive pulmonary disease, substance use disorders, and tobacco cessation. The expansion takes effect in spring 2027. The addition broadens the model's scope beyond its current conditions, creating new opportunities for providers to participate in value-based care arrangements for these chronic conditions under Medicaid and Medicare.
- State Policy · IL
Illinois and Chicago Sue to Block Trump Green Card Restriction for Medicaid Users
Illinois and the City of Chicago filed suit to block a Trump administration plan that would allow immigration officers to deny green cards to legal immigrants who use Medicaid, SNAP, and other public benefits. The policy would expand the "public charge" rule, giving immigration authorities broader discretion to reject permanent residency applications based on lawful use of safety net programs. The lawsuit challenges the rule as exceeding federal authority and harming state interests. If implemented, the policy could reduce Medicaid enrollment among legal immigrants and their families due to chilling effects, impacting state budgets and coverage levels.
Tuesday, September 15 · 19 stories
- Federal Policy
CMS Expands Medicare Coverage for Chronic Disease Management Including Substance Use Disorder
CMS announced new Medicare coverage options for chronic condition management, including substance use disorder, heart failure, and other common conditions. The changes expand covered services and payment mechanisms under Medicare fee-for-service and Medicare Advantage to support ongoing care coordination and monitoring. Implementation details and effective dates were not specified in the announcement. While this is a Medicare-focused policy, Medicaid agencies and dual-eligible special needs plans (D-SNPs) should monitor how these coverage expansions affect care coordination for dually-eligible beneficiaries, particularly for behavioral health and chronic disease management.
- Industry
Hospital Margins Fall to 1.4% in July Amid Rising Bad Debt and Charity Care
Hospital operating margins declined to 1.4% in July 2026, with bad debt and charity care rising significantly, according to Kaufman Hall's National Hospital Flash Report analyzing data from over 1,300 hospitals. The increases in uncompensated care suggest deteriorating payer mix, meaning fewer patients with commercial insurance and more with Medicaid or no coverage. The trend pressures hospital financial sustainability and may affect provider participation in Medicaid managed care networks as hospitals reassess contracting strategies. Kaufman Hall warns hospitals may need to redesign financial and operational strategies to remain viable.
- Industry
Hospital Physician Advisor Overturns 78% of Payer Denials Across 11-Hospital System
Dr. Maliha Iqbal, physician advisor at Beacon Health System, completed 5,118 utilization reviews in 2025 as the sole physician advisor across 11 hospitals, overturning 78% of peer-to-peer denials. The workload doubled following a health system merger. The article profiles operational practices for managing high-volume utilization review and payer denial appeals at scale. This reflects ongoing provider strategies to combat managed care prior authorization and medical necessity denials.
- Industry
KFF Survey Finds Adults With Complex Health Conditions Face Access and Cost Barriers
A KFF survey of over 25,000 adults found that individuals with multiple or complex health conditions face significant challenges affording medical care and accessing services and medications, with uninsured adults experiencing the most severe barriers. The survey highlights systemic gaps in the healthcare system's ability to serve chronically ill populations. KFF President Drew Altman stated the findings suggest the healthcare system is failing to meet its primary obligation to care for the sick, particularly those who are both chronically ill and uninsured.
- Industry
Hospitals Lease SNF Beds to Reduce ED Boarding Amid Post-Acute Capacity Crunch
Hospital systems are leasing skilled nursing facility beds to address emergency department boarding driven by post-acute discharge bottlenecks. The strategy responds to reduced overall SNF capacity, an aging population, and persistent throughput challenges despite testing other post-acute alternatives. Systems previously exited the SNF business but are now returning to secure discharge capacity. Implementation timelines and specific health system participation were not detailed in the available excerpt.
- Federal Policy
HHS Certifies 17th IDR Entity as No Surprises Act Disputes Increase
HHS has certified Physio Solutions (doing business as medlitix) as the 17th independent dispute resolution entity authorized to settle out-of-network payment disputes under the No Surprises Act. The certification comes amid growing volume of surprise billing arbitration cases and increased scrutiny of IDR entities by researchers and lawmakers. The No Surprises Act requires federal certification of dispute resolution entities to adjudicate payment disputes between providers and health plans when patients receive out-of-network emergency or certain facility-based care. The expansion of certified IDR entities affects Medicaid managed care plans that contract with out-of-network providers and face similar surprise billing scenarios under state law or federal Medicaid managed care regulations.
- State Policy · AR
Arkansas Sen. Jonathan Dismang Resigns After Two Decades, Medicaid Expansion Architect
Republican Sen. Jonathan Dismang resigned from the Arkansas Senate on Tuesday, September 15, 2026, to join Arkansas Electric Cooperatives. Dismang served nearly 20 years in the legislature, including two terms as Senate president pro tempore, and was a co-architect of Arkansas' private option Medicaid expansion model. His departure removes a key Republican voice who helped design and defend the state's Medicaid expansion approach. The resignation creates a vacancy in legislative leadership with potential implications for Medicaid policy continuity in Arkansas.
- State Policy · VT
Vermont Regulator Orders UVM Medical Center to Cut Commercial Rates 4.4% Amid $75M Deficit
The Green Mountain Care Board voted 3-2 to require the University of Vermont Medical Center to reduce commercial insurance rates by 4.4% ($32.4 million) for fiscal year 2027, setting total patient revenue at $1.916 billion. The decision comes as UVM Health Network projects $75 million in losses this fiscal year and expects another $75 million deficit next year, driven by lower BlueCross BlueShield reimbursement rates and new state drug pricing caps. The network has already cut 140 jobs and plans $140 million in expense reductions. The rate cut primarily affects commercial payers, who account for $1.054 billion of UVM's allowed revenue, while Medicaid reimbursement levels are not addressed in this budget order.
- State Policy · AR
Arkansas Expands Medicaid Waiver Services to Children on Disability Waitlist
Arkansas will provide supportive living services to over 2,400 children with disabilities currently on the waitlist for the Community and Employment Services Medicaid waiver, Gov. Sarah Huckabee Sanders announced September 15, 2026. The state's four PASSE managed care plans must begin offering in-home care services to waitlist families by January 2027 at the latest, at an estimated cost of $17 million. The change responds to sustained public advocacy from families whose children receive coverage through Arkansas's PASSE managed care program but lack access to supportive living services available to waiver enrollees. Arkansas will incorporate the expansion into its federal waiver renewal request next year.
- Legal
CMS Defers $1 Billion in Medicaid Payments and Expands Provider Exclusion Authority
CMS has deferred $1 billion in Medicaid payments as part of a federal crackdown on fraud, waste, and abuse in healthcare. The agency has also gained new authority to exclude providers from Medicaid participation. These actions represent a significant expansion of CMS enforcement powers affecting both providers and state Medicaid programs. The changes follow earlier federal commitments to intensify program integrity efforts across healthcare programs.
- Industry
Latent Adds Seven Health Systems for AI-Driven Specialty Pharmacy Platform
Latent, an enterprise pharmacy intelligence platform, announced partnerships with seven health systems including Cleveland Clinic and AdventHealth, bringing its total partner count to 60. The company is deploying autonomous AI agents designed to address specialty drug access bottlenecks by automating pharmacy operations rather than simply flagging issues for human review. The expansion reflects growing health system interest in automation tools to manage complex specialty pharmacy workflows as the specialty drug pipeline continues to expand faster than traditional operational infrastructure can support.