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Tuesday, September 8 · 16 stories
- Managed Care
GLP-1 Prescriptions for Children Rose 30,000 Percent Since 2019
Prescriptions of GLP-1 medications for children increased more than 30,000 percent between 2019 and present, according to new data. Children with obesity-related conditions such as high cholesterol or sleep apnea were substantially more likely to receive GLP-1 prescriptions than those without these comorbidities. The dramatic rise in pediatric GLP-1 use reflects growing clinical acceptance of these medications for weight management in children with obesity-related health complications. This trend has significant implications for Medicaid managed care pharmacy budgets and prior authorization protocols, as GLP-1s are high-cost specialty medications and children represent a growing share of Medicaid enrollment.
- State Policy · CA
California Expands Assisted Living Coverage in Rural Counties After Advocacy Push
California launched a pilot program expanding Medi-Cal coverage for assisted living facilities in select rural counties, following advocacy by a family member whose sister faced limited long-term care options. The program addresses gaps in California's current Medi-Cal structure, which typically excludes assisted living from covered services except in limited circumstances. The pilot applies to designated rural counties where nursing home access is constrained. The expansion reflects growing pressure on California to diversify institutional long-term care options beyond nursing facilities, particularly in underserved areas where beneficiaries have few alternatives.
- State Policy · CA
California Gubernatorial Candidate Becerra Confronts Rising Uninsured as Medicaid Coverage Erodes
California faces a significant increase in its uninsured population as former HHS Secretary Xavier Becerra campaigns to become the state's next governor. The article reports a projected surge in uninsured individuals following recent Medicaid coverage losses, reversing historical coverage gains achieved during Becerra's tenure as federal health secretary. The timing creates a policy challenge for California's next administration, which will need to address coverage gaps through state programs and Medicaid eligibility policies. This matters for California's Medicaid program, which covers over 15 million residents and will face pressure to expand coverage or mitigate enrollment losses through policy changes.
- Industry
Rural Hospitals Accelerate M&A Activity Amid Anticipated Federal Medicaid Cuts
Rural hospital systems are pursuing mergers and partnerships in response to anticipated Medicaid funding reductions under the Trump administration. The consolidation wave is driven by financial survival concerns as rural facilities face revenue pressures from potential federal cuts. This activity is intensifying debate over healthcare market competition and care costs in rural communities. The timing and scope of any federal Medicaid reductions remain uncertain, but rural providers are acting preemptively to strengthen their financial positions through scale and integration.
- State Policy · NC
North Carolina Resumes Healthy Opportunities Pilot with $25M, Down from $80M Request
North Carolina is restarting its Healthy Opportunities Pilot after a one-year suspension, but with $25 million in funding — less than one-third of the $80 million the state requested. Food-related services will likely resume first, while transportation services like car repairs will not return in their previous form under the new Medicaid waiver structure. The state is still finalizing implementation details. The reduced funding marks a significant scaling back of the pilot, which provided social determinants of health services to Medicaid enrollees in selected regions.
- Industry · IN
Indiana Launches $68 Billion Medicaid Managed Care Procurement for 1.5 Million Enrollees
Indiana has issued a procurement for its Medicaid managed care program covering approximately 1.5 million enrollees, representing $68 billion in total contract value. The RFP will determine which health plans deliver Medicaid services to Hoosiers under managed care arrangements. Contract awards will shape the state's Medicaid delivery system for the coming contract period. The procurement represents one of the largest Medicaid managed care procurements nationally and will directly affect existing MCO contracts, provider networks, and care delivery infrastructure across Indiana.
Monday, September 7 · 15 stories
- Industry
Rural Hospital Leader Argues Home-Based Care Reduces System Costs
A rural health care executive argues that providing care locally in rural communities generates system savings compared to patient transfers, but rate-setting bodies do not adequately account for these cost benefits. The author contends that policymakers making rural health care decisions need to hear directly from practitioners who deliver local care. The commentary emphasizes that rural care delivery models keeping patients near home are cost-effective but undervalued in current payment structures. No specific policy change or data is presented.
- Industry · IA
Rural Iowa Pharmacy Owner Cites PBM Reimbursement Pressures in Senate Candidate Stop
A rural Iowa pharmacy owner told Senate candidate Josh Turek his business lost over $100,000 in its first year because pharmacy benefit managers reimburse below drug acquisition costs, particularly for Medicare prescriptions. The owner said a 2025 Iowa PBM reform law, currently tied up in litigation, would not cover Medicare patients who represent the majority of his pharmacy's business. Turek called for federal PBM reform, noting that state-level action exempts federally administered programs like Medicare and creates a patchwork of standards.
- State Policy · WV
West Virginia Awards $2.4M in Federal Rural Health Funds for Employer-Based Care Expansion
West Virginia will allocate $2.4 million from its $199 million federal Rural Health Transformation Program to three organizations — Spotted Owl Health Care ($1.17M), Charleston Area Medical Center ($612K), and Cabell Huntington Foundation ($612K) — to expand worksite clinics and employer-based health services. The funding, part of Gov. Morrisey's Health to Prosperity initiative, aims to improve access to preventive and chronic disease care for rural workers. The state must obligate the full $199 million by October 30, 2026, to meet federal requirements. Additional grant announcements are forthcoming.
- State Policy · NC
UNC Health Pardee Expands Behavioral Health and Trauma Services in Western North Carolina
UNC Health Pardee opened a 23-bed adolescent mental health unit in August and received Level III Trauma Center designation, expanding specialty services in western North Carolina. The Henderson County hospital has increased its Buncombe County patient volume by 60% since 2019, from 12,973 to 20,981 residents, while adding cancer infusion services and new medical offices in Brevard and Mills River. Pardee operates under a 2011 management agreement with UNC Health that maintains 100% local ownership while providing access to the academic health system's resources. The expansion comes as Mission Health's market position weakens following its 2019 acquisition by HCA, creating opportunities for Pardee to grow in traditionally Mission-dominated service areas.
- State Policy
NASHP Tracker Compiles State AI Policy Activity in Health Care
The National Academy for State Health Policy has published a resource tracking state-level activity on artificial intelligence in health care. The tracker compiles emerging policy questions and practical considerations states are addressing as they evaluate AI adoption in their health programs. It covers state legislation, regulatory approaches, and implementation frameworks across multiple health care sectors. The resource is designed for state policymakers navigating AI governance, including Medicaid agencies evaluating AI tools for care management, utilization review, and administrative functions.
- Federal Policy
Alliance Official Cites Bipartisan Congressional Support for Home-Based Care Expansion
Denis Fleming Jr., the National Alliance for Care at Home's new chief government affairs officer, reports growing bipartisan congressional support for home-based care policy. Fleming describes the current legislative environment as unprecedented for home and community-based services providers. The Alliance is monitoring both opportunities for policy expansion and emerging access barriers. This development signals potential federal legislative action on HCBS, which could affect Medicaid LTSS delivery models and managed care network adequacy requirements.
- Industry · CA
24 Hour Home Care to Lay Off 738 Employees Following Health Net Contract Loss
24 Hour Home Care will lay off 738 employees effective September 15, 2026, according to a California WARN notice. The layoffs result from Health Net's planned discontinuation of personal care and homemaker services. The workforce reduction affects a home care provider serving Medicaid beneficiaries who rely on personal care services, typically covered under LTSS benefits in managed care contracts. The layoffs signal potential network adequacy concerns for Health Net's Medicaid line of business if personal care services are not transitioned to alternative providers.
- State Policy · AZ
Arizona Audit Proposal Would Cut Disability Services by Up to $493M, Not Parent Caregiver Fraud
An Arizona Auditor General report issued in July 2026 estimated the state could reduce spending by $133 million to $493 million by implementing age-based standardized assessments that decrease authorized services for children with disabilities. The audit did not find widespread fraud in Arizona's Parents as Paid Caregivers model, which allows qualified parents to provide already-authorized Medicaid home and community-based services. Arizona Health Care Cost Containment System paused a similar standardized assessment tool in October 2025 after 16 days due to legal and operational concerns. Advocates argue the projected savings would come from unfilled care needs, not program efficiencies, and could shift costs to emergency and institutional settings.
- State Policy · MI
Michigan Free Clinics See Surge as Medicaid Work Requirements, Coverage Losses Loom
Michigan's free health clinics reported a 54% patient increase through August 2026 as health insurance costs rise and Medicaid enrollment shrinks to its smallest since 2019. Starting January 1, 2027, federal rules will require 650,000 Michigan Medicaid enrollees to document 80 hours monthly of work or volunteer activity twice yearly, with full benefits ending October 1, 2026 for many non-citizens. Clinics operating on volunteer staff and donated supplies expect demand to spike as enrollees lose coverage, while 130,000 fewer Michiganders enrolled in ACA marketplace plans mid-year amid 20% premium increases.
- Legal
CMS Blocks $1.6 Billion in Lab Payments Using AI-Powered Fraud Detection
On August 28, 2026, CMS announced it has blocked over $1.6 billion in potentially improper Medicare payments to diagnostic laboratories since the start of the current administration, using expanded AI-powered enforcement tools for payment suspensions and revocations. The enforcement actions target laboratories billing Medicare and represent a significant escalation in CMS program integrity efforts using predictive analytics. While these actions focus on Medicare fee-for-service, the AI-powered detection methods and aggressive enforcement posture signal heightened scrutiny that will likely extend to Medicaid managed care laboratory networks and state Medicaid program integrity operations.
- State Policy · KS
Kansas Republicans Challenge KDADS Reallocation of $24M Away From I/DD Waiting List
Kansas Republican lawmakers criticized the state Department for Aging and Disability Services for reallocating approximately $24 million in unspent funds originally intended to reduce the intellectual and developmental disability waiting list, which has grown to 5,357 people. KDADS instead transferred the funds to programs serving frail elderly Kansans ($19 million), individuals with severe brain injuries, and those requiring assistive technology. KDADS Secretary Laura Howard defended the action, stating the reallocation was endorsed through legislative oversight and that all legislatively authorized I/DD slots were filled, but lawmakers argued the move violated the intent of HB 2513.
- State Policy · ME
Maine Gubernatorial Candidates Diverge on Medicaid, Medical Debt, and Federal Policy Responses
Maine's gubernatorial candidates presented competing healthcare proposals at a September 3, 2026 conference, with Democrat Hannah Pingree, independent Rick Bennett, and Republican Bobby Charles offering different approaches to Medicaid cuts, access barriers, and rising costs. Approximately 31,000 Mainers are expected to lose Medicaid coverage due to federal changes. Bennett proposed a prevention-first model and a $2 million program to eliminate medical debt by negotiating bulk settlements with providers; Charles endorsed Trump administration Medicaid changes. The contest occurs as Maine faces closing hospitals, expiring federal subsidies, and coverage losses.
- Legal
Fifth Circuit to Hear Mifepristone Access Case Amid Medicaid Coverage Implications
A three-judge panel on the Fifth Circuit Court of Appeals will hear oral arguments in a case challenging nationwide distribution of mifepristone, the medication abortion drug. The case could result in restrictions on mifepristone access that would affect Medicaid beneficiaries and state Medicaid pharmacy programs. Oral arguments are scheduled for next week, with a decision timeline uncertain. The outcome could require state Medicaid agencies and managed care plans to adjust pharmacy benefits, provider networks, and utilization management protocols for medication abortion services covered under Medicaid.
- Legal
HRSA Issues FQHC Scope of Project Manual Governing Provider Arrangements and 340B Operations
On August 11, 2026, HRSA released its Health Center Program Scope of Project Policy Manual, providing comprehensive guidance on what constitutes an FQHC's approved scope of project under Section 330 of the Public Health Service Act. The manual took effect immediately upon release. It addresses provider-patient relationships, arrangements with other providers, and 340B drug pricing program operations for federally qualified health centers. The guidance affects how FQHCs structure their service delivery, contractual relationships, and participation in federal programs, with implications for Medicaid managed care plans contracting with FQHCs and state agencies overseeing network adequacy.