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Monday, August 31 · 111 stories
- Legal · VA
Chesapeake Regional Reaches Tentative Deferred Prosecution Deal in Perwaiz Fraud Case
Federal prosecutors have reached a tentative deferred prosecution agreement with Chesapeake Regional Medical Center related to criminal charges stemming from former OB-GYN Javaid Perwaiz's unnecessary surgeries and sterilizations between 2010 and 2019. The deal requires the hospital to admit certain facts, accept an independent monitor, repay health care programs, and create a $12.8 million patient fund. The hospital received $18.5 million from public and private payers — including Medicaid — for procedures Perwaiz performed, some of which prosecutors allege were misclassified. If finalized, the agreement would allow Chesapeake Regional to avoid a criminal trial and potential exclusion from Medicare and Medicaid, while a separate civil lawsuit with more than 1,000 plaintiffs remains ongoing.
- State Policy · KS
Kansas Diverts $24 Million From I/DD Waitlist Reduction as Backlog Hits 5,348
Kansas lawmakers confronted state officials after the Department for Aging and Disability Services shifted $24 million intended to reduce the intellectual and developmental disability waitlist to services for the frail elderly and brain injury populations. The I/DD waitlist grew to 5,348 in August 2026, exceeding statutory caps of 4,800 for FY2025 and 4,000 for FY2026. KDADS Secretary Laura Howard said the transfer, made with legislative consent, prevented waitlists from forming in other populations, and urged lawmakers to appropriate additional funding in the January 2027 session. The Legislature's Medicaid oversight committee expressed frustration over the failure to meet statutory requirements and provide a strategic waitlist reduction plan.
- Federal Policy
ACA Enhanced Subsidies Expiration Cuts Marketplace Enrollment by Nearly 3 Million Nationwide
Congressional inaction allowed enhanced ACA subsidies enacted in 2021 to expire at the end of 2025, causing marketplace enrollment to drop from 21.8 million to 19.2 million people nationwide as of August 2026 — a decline of nearly 3 million. Mississippi saw enrollment fall by nearly two-thirds in eight months. The subsidies, created as a pandemic-era measure under the American Rescue Plan Act and extended by the Inflation Reduction Act, made ACA coverage more affordable. Their expiration has left low-income adults without employer coverage, particularly in non-expansion states, facing higher premiums and loss of coverage.
- State Policy · MN
Minnesota Medicaid Spending Projected to Reach $29B by 2029
Minnesota's Medicaid spending is projected to reach $29 billion by 2029, outpacing state tax revenue growth. The acceleration is driven by rising healthcare costs, a growing elderly population, and federal funding cuts. State budget officials face increasing pressure to address the gap between Medicaid expenditure growth and available revenue. The projection signals potential state budget constraints that could affect provider rates, managed care capitation, and program eligibility in coming years.
- State Policy · PA
Pennsylvania Governor Race Centers on Medicaid Work Rules, Fraud Enforcement, and Expansion Coverage
Pennsylvania's 2026 gubernatorial race between Democratic Gov. Josh Shapiro and Republican Treasurer Stacy Garrity focuses heavily on Medicaid policy, particularly implementation of 2025 federal budget law changes affecting 2.9 million enrollees. The federal law imposes work requirements and semi-annual eligibility reviews for Medicaid expansion adults, with Pennsylvania estimating over 310,000 will lose coverage due to administrative barriers. Shapiro joined a multi-state lawsuit challenging CMS work requirement exceptions and opposes the federal cuts, while Garrity supports implementing the law's fraud provisions and requiring independent performance audits of state Medicaid programs. The candidates also differ on abortion coverage under Medicaid and false claims whistleblower legislation.
- State Policy · PA
Pennsylvania Health System Launches Volunteer Program to Help Medicaid Patients Meet Work Requirements
Guthrie health system in Pennsylvania is expanding its volunteer program to help Medicaid patients meet new 80-hour monthly community engagement requirements taking effect in January 2027. The requirements, enacted in July 2025 federal legislation, apply to certain adults without young children and could result in 310,000 Pennsylvania residents losing Medicaid coverage. Pennsylvania expects a $20 billion federal funding reduction over 10 years starting in 2028. Guthrie, which derives 16% of revenue from Medicaid, projects $38 million in net revenue loss and is offering volunteer roles including greeting visitors, working in gift shops, and delivering flowers to help patients maintain eligibility and preserve the system's reimbursement stream.
- State Policy · LA
Louisiana Proposes Medicaid Work Requirements for January 2027 Implementation
Louisiana has released proposed regulations implementing Medicaid work requirements for able-bodied adults, following federal guidelines enacted by Congress and signed by President Trump in 2025. The state regulations are expected to take effect in January 2027, requiring certain Medicaid enrollees to meet work, training, or community engagement requirements to maintain coverage. The proposal adheres to the federal framework established last year. Louisiana would join other states implementing work requirements under the new federal statutory authority, affecting coverage for non-exempt adult Medicaid beneficiaries.
- Federal Policy · GA
Justice Department Memo Signals End to Federal Enforcement of Olmstead Community Integration Requirements
A June 2026 Department of Justice memo states that federal disability laws do not require states to provide community-based services to people with disabilities and that DOJ lacks authority to monitor state compliance, reversing nearly two decades of federal oversight. The memo affects Georgia's disability care system, which has operated under a 2010 settlement agreement requiring community-based service expansion. Georgia's disability services agency director says he plans to continue following settlement requirements despite the federal policy shift. The timing coincides with anticipated Medicaid funding cuts and leaves states without federal pressure to maintain or expand home and community-based services for people with disabilities.
- State Policy · CA
California Seeks Emergency $10M to Replace Federal Funds for Transgender Youth Services
California lawmakers are requesting $10 million in emergency funding after CMS finalized a rule prohibiting federal reimbursement for gender-affirming care for minors, effective October 13, 2026. Approximately 1,500 transgender and gender-nonconforming children on Medi-Cal could lose access to puberty blockers, hormones, and related care without state action. The emergency funds would allow California's Department of Health Care Services up to one year to establish a separate state-funded pathway that keeps federal and state dollars separate while maintaining care access. Parents and LGBTQ advocates say they warned state officials for eight months about the federal funding cut and believed money was set aside during June budget negotiations, but now question whether California can implement a solution before the October deadline.
Saturday, August 29 · 64 stories
- Federal Policy
KFF Issue Brief Outlines Mandatory and Optional Medicaid Eligibility and Benefits
KFF published an issue brief describing federal mandatory and optional eligibility pathways and covered services in Medicaid. The brief explains how federal statute and regulations establish baseline coverage requirements while allowing states flexibility to expand eligibility and benefits beyond federal minimums. It serves as a reference guide for understanding the framework within which states design their Medicaid programs. The document provides foundational information on program structure rather than reporting new policy changes.
- Managed Care
CMS Guidance Addresses Medicaid Provider Enrollment and MCO Credentialing Standards
Chapter 7 of a CMS guidance document covers Medicaid provider enrollment and managed care organization credentialing requirements. The guidance addresses processes designed to ensure enrollees receive care from qualified providers while preventing enrollment of providers with criminal records related to federal health programs or histories of fraud, waste, or abuse. The content applies to state Medicaid agencies administering provider enrollment and managed care plans conducting credentialing. It clarifies federal expectations for screening and enrollment standards that affect provider network composition and compliance obligations.
- State Policy
NAMD Podcast Covers Medicaid Technology Strategy and Vendor Management
The National Association of Medicaid Directors released a podcast episode examining how state Medicaid directors approach technology system strategy and vendor management. The episode addresses operational challenges state agencies face in implementing and maximizing value from IT systems. The discussion is relevant for state Medicaid agencies responsible for technology procurement, system implementation, and vendor oversight.
- Federal Policy
CMS Expands Joint Replacement Model Nationwide Through Medicare Program
CMS announced a nationwide expansion of its joint replacement bundled payment model through the Medicare program. The expansion builds on results from a previous demonstration that tested episode-based payments for hip and knee replacements. Medicare Advantage plans and traditional Medicare will implement the model across all states. The expansion does not directly affect Medicaid fee-for-service or managed care payment methodologies, though some dual-eligible beneficiaries may be affected if enrolled in Medicare Advantage.
- State Policy
NAMD Podcast Examines Leadership Team Development for State Medicaid Agencies
The National Association of Medicaid Directors released a podcast episode focused on strengthening senior leadership teams within state Medicaid agencies. The episode addresses how leadership teams can build collective capacity to manage complex program challenges. The content is aimed at state Medicaid directors and senior agency staff responsible for organizational development and strategic decision-making. This reflects ongoing efforts by state agencies to enhance internal capacity amid increasing program complexity and operational demands.
- Federal Policy · OH
CMS Awards $3.15 Million to Expand Pharmacy Connectivity in Rural Ohio
CMS announced $3.15 million in funding to expand pharmacy connectivity infrastructure in rural Ohio communities. The grant supports enhanced electronic prescribing and health information exchange capabilities for pharmacies serving Medicaid and Medicare beneficiaries in underserved areas. The funding is part of broader federal efforts to improve prescription drug access and coordination in rural settings. Rural Medicaid managed care plans and provider networks may see improved medication management and reduced gaps in care coordination as pharmacy data integration improves.
- State Policy · MA
Massachusetts Proposes Behavioral Health Workforce Expansion in Response to Access Crisis
Massachusetts Governor Healey is advancing initiatives to expand the behavioral health workforce following a May 2026 Health Policy Commission report documenting an access crisis in the state. The proposals aim to address provider shortages affecting Medicaid beneficiaries' ability to access mental health and substance use disorder services. The initiatives would affect MassHealth managed care organizations, which must maintain adequate behavioral health networks under federal and state requirements. Implementation timelines and specific workforce development measures have not been detailed in available reporting.
- Legal · IN
Indiana AG Discusses Medicaid Fraud Enforcement in Wide-Ranging Interview
Indiana Attorney General Ford addressed Medicaid fraud enforcement as part of a broader interview covering multiple policy topics, including the state's opioid litigation efforts and data center regulation. The attorney general defended the administration's record on these issues. No specific new Medicaid fraud actions or enforcement changes were announced. The interview provides insight into the state's current enforcement priorities and approach to Medicaid program integrity.
- Federal Policy
MACPAC Comments on Proposed Medicare Advantage Rule for Contract Year 2027
The Medicaid and CHIP Payment and Access Commission submitted comments to CMS on proposed Medicare Advantage policy and technical changes for contract year 2027. The letter focuses on dual eligible special needs plans (D-SNPs), which serve beneficiaries enrolled in both Medicare and Medicaid. MACPAC has prioritized D-SNPs given their widespread use and the coordination challenges between Medicare Advantage plans and state Medicaid programs. The comment letter addresses proposed changes affecting how these plans operate and coordinate care for dual eligibles.
- Federal Policy
Medicaid Transitions for Youth with Special Health Care Needs Face Coverage and Benefit Gaps
Medicaid covers nearly half of all children and youth with special health care needs (CYSHCN), but when they age out of children's Medicaid and transition to adult coverage, they face significant changes to benefits, provider networks, and care coordination. These transitions can result in coverage gaps and disruptions in medically necessary services. The challenges are particularly acute for youth who rely on pediatric specialists, EPSDT benefits, and care coordination programs that do not continue into adult Medicaid. State Medicaid agencies and managed care organizations must address transition planning, benefit continuity, and provider capacity to support this population.
- Managed Care
MACPAC Report Recommends Strengthening State Oversight Tools for Medicaid MCOs
The Medicaid and CHIP Payment and Access Commission released recommendations to improve accountability mechanisms for Medicaid managed care plans. The report identifies gaps in current state oversight practices and proposes enhanced tools for state Medicaid agencies to ensure MCO performance and compliance. MACPAC notes that despite managed care being the predominant delivery system, little is known about the accountability tools states actually deploy. The recommendations aim to strengthen both CMS and state-level oversight of managed care programs.