All stories
Jump to date
Thursday, August 13 · 24 stories
- State Policy · IA
Iowa Advocates Push to Remove Medicaid Earnings and Asset Limits for Working Disabled Beneficiaries
Advocates in Iowa are urging state lawmakers to eliminate income and asset limits in Medicaid programs that allow people with disabilities to work while receiving benefits. Currently, most states impose earnings caps and asset restrictions on these programs, which advocates argue discourage career advancement and higher-paying employment. The advocacy effort targets state-level policy changes to expand economic opportunity for disabled Medicaid enrollees without risking benefit loss. If enacted, such changes would affect eligibility and enrollment administration for Iowa's Medicaid program serving working individuals with disabilities.
- Managed Care
Medicaid MCOs Denied at Least 1 in 8 Prior Authorization Requests in 2025
Analysis of 2025 prior authorization data shows Medicaid managed care organizations denied at least 12.5% of standard prior authorization requests, with denial rates varying significantly across insurers. The data, which also covers Medicare Advantage and ACA Marketplace plans, reveals inconsistencies in insurer practices but includes methodological limitations that complicate interpretation. The findings come as state Medicaid agencies and CMS face pressure to improve prior authorization transparency and oversight of MCO utilization management practices.
- Legal · FL
Federal Appeals Court Questions Florida Medicaid Redetermination Process in Oral Arguments
A three-judge federal appeals panel questioned Florida officials during oral arguments over the state's Medicaid termination procedures following the end of the COVID-19 public health emergency. The lawsuit, filed three years ago, challenges how Florida conducted eligibility redeterminations and disenrolled beneficiaries after continuous enrollment protections expired. The court's scrutiny focused on the state's procedural compliance with federal notice and due process requirements. The case could affect how states manage Medicaid disenrollment processes and beneficiary protections during eligibility reviews.
- State Policy · IN
Indiana Lawmakers Seek Audit After Medicaid Disability Waiver Denials Jump to 6%
Democratic lawmakers in Indiana are demanding an independent audit of interRAI, an assessment tool the state's Family and Social Services Administration began using in January 2026. Disability waiver denials spiked to 6% this year from under 1% previously. The timing and scale of the increase has raised questions about the tool's calibration and impact on beneficiaries who need long-term services and supports. This matters for states using or considering similar standardized assessment tools for LTSS eligibility determination.
Wednesday, August 12 · 11 stories
- State Policy · KS
Kansas Faces $20.6M Federal Penalty Despite Lower SNAP Error Rate
Kansas reduced its Supplemental Nutrition Assistance Program (SNAP) error rate below 12% following passage of the One Big Beautiful Bill Act in 2025, but the state still faces a potential $20.6 million federal penalty. The penalty relates to error rate thresholds established under federal law. State officials have not indicated when the penalty determination will be finalized or whether Kansas plans to contest it. The development affects state budget planning and SNAP administrative operations.
- State Policy · WV
West Virginia Medicaid Work Requirements Launch January 1, 33,000 Beneficiaries Not Meeting Criteria
West Virginia's Medicaid work and volunteer requirements will take effect January 1, 2027, according to a briefing to state lawmakers by the Department of Human Services. An initial analysis found approximately 33,000 current Medicaid beneficiaries are neither meeting the federal work or volunteer requirements nor automatically exempt from them. The requirements were authorized under federal law and will require affected beneficiaries to demonstrate compliance to maintain coverage. This implementation affects a substantial segment of West Virginia's Medicaid population and follows years of legal challenges to work requirements nationwide.
- Federal Policy
Brookings Researchers Challenge CMS Data Underlying Medicaid Work Requirements Rule
Brookings Institution researchers have publicly criticized the data and assumptions CMS used to support its Medicaid work requirements rule, which imposed stricter documentation standards for enrollees claiming medical exemptions from work mandates. The rule, already facing litigation, required beneficiaries to provide more extensive proof of illness or disability to qualify for exemptions than stakeholders anticipated. The Brookings critique alleges CMS misrepresented or manipulated data to justify the policy. This matters because if the agency's analytical foundation is undermined, courts may be more likely to vacate the rule, and CMS may face pressure to withdraw or revise the policy.
- Federal Policy
March of Dimes: 5.8 Million Women Live in Maternity Care Deserts
A March of Dimes report finds that 5.8 million women live in counties without full access to maternity care, with one-third of U.S. counties classified as maternity care deserts — areas lacking hospitals or birth centers offering obstetric services. The report highlights geographic disparities in prenatal and delivery care access nationwide. These gaps affect Medicaid-covered pregnancies, as Medicaid finances approximately 42% of births nationally and faces network adequacy and provider participation challenges in underserved areas.
- Industry
Research Suggests GLP-1 Drugs May Reduce Birth Control Effectiveness and Boost Fertility
Emerging research indicates that GLP-1 receptor agonist medications may interfere with oral contraceptive effectiveness and potentially increase fertility in users. The mechanism appears related to GLP-1s' effects on gastric emptying and hormone metabolism, which could reduce contraceptive absorption and alter reproductive hormone levels. The timing and clinical significance remain under investigation, but the findings have immediate implications for prescribing guidance and patient counseling. For Medicaid programs covering GLP-1s for diabetes and obesity, this raises questions about contraceptive coverage coordination, prior authorization criteria, and member education protocols.
- State Policy · NC
North Carolina Hospitals Deploy Postpartum Wristbands as Medicaid Coverage Cuts Loom
North Carolina hospitals are implementing "I Gave Birth" wristbands to identify recent mothers and encourage emergency care-seeking when postpartum complications arise. The initiative is expanding across multiple states as the Trump administration pursues Medicaid cuts that threaten to reduce postpartum coverage. The wristbands aim to address maternal mortality by prompting clinical staff to recognize and treat postpartum complications. The timing coincides with growing concerns about access to postpartum care under proposed federal Medicaid reductions.
- Federal Policy · MA
Massachusetts Launches Member Notice Campaign on Federal Medicaid Eligibility Requirements
Massachusetts is mailing notices to MassHealth members this week informing them of federal eligibility requirement changes and actions needed to maintain coverage. Governor Healey characterized the federal requirements as burdensome. The notices aim to help members understand how the changes affect them and what steps they must take to avoid coverage loss. The campaign reflects state efforts to minimize enrollment disruption from new federal compliance mandates.
- State Policy · NV
Nevada Lawmakers Consider Maternal Health Protections, Medicaid Fraud Enforcement for 2027 Session
Nevada legislators discussed health policy priorities for the 2027 legislative session at an interim Health and Human Services committee meeting on August 12, 2026. The agenda includes a maternal health "momnibus" bill with multiple pregnancy and postpartum protections, enhanced Medicaid fraud investigation capacity, and streamlined state health agency reporting requirements. Child welfare funding reforms were deferred despite prior discussion. These proposals would affect Nevada Medicaid operations, managed care oversight, and provider compliance once the 2027 session convenes.
- State Policy · NY
New York Gets CMS Approval to Overhaul Medicaid Provider Enrollment and Revalidation
New York's Department of Health received CMS approval to implement a plan revamping the state's Medicaid provider enrollment and revalidation processes. The changes aim to improve oversight of New York's Medicaid program. The announcement follows a McDermott Will & Emery client alert from August 4, 2026, addressing Medicaid moratorium and ownership change issues in the state. The timing and scope of implementation will affect providers seeking enrollment or ownership changes in New York's Medicaid program.
- State Policy · IN
Indiana Medicaid Work Requirement Affects 300,000 Enrollees Starting January 2027
Indiana's Medicaid work requirement takes effect January 1, 2027, affecting an estimated 300,000 low-income enrollees. State officials confirmed the mandate applies to new applicants and existing members renewing coverage in January, but compliance systems and exemption procedures remain incomplete with the first deadline less than two months away. The requirement will impact non-exempt adults enrolled in Indiana's Medicaid expansion population. State agencies and managed care plans must finalize tracking, verification, and disenrollment protocols before implementation.
- Federal Policy
CMS Final Rule Bars Federal Medicaid, CHIP Funds for Pediatric Gender-Affirming Care
CMS issued a final rule prohibiting federal Medicaid and CHIP matching funds for gender-affirming care for minors, including puberty blockers, hormone therapy, and related surgeries such as mastectomies. The rule takes effect October 13, 2026. States will no longer receive federal financial participation for these services furnished to children enrolled in Medicaid or CHIP. The policy represents a federal prohibition on a category of care previously covered under state Medicaid programs' Early and Periodic Screening, Diagnostic and Treatment benefit and other authorities.
Tuesday, August 11 · 14 stories
- Legal
Drug Manufacturers Challenge State 340B Contract Pharmacy Laws in Illinois, South Dakota
AbbVie and Novartis filed suit against Illinois on August 7, 2026, seeking to block the state's new 340B contract pharmacy law. Three days later, a federal judge in South Dakota dismissed three separate lawsuits from AbbVie, AstraZeneca, and PhRMA challenging South Dakota's similar law. The legal battles center on state efforts to require drug manufacturers to honor 340B pricing at contract pharmacies. The outcome will determine whether states can enforce 340B contract pharmacy requirements against manufacturer restrictions.
- Federal Policy
Sequoia Project Names 19 Members to TEFCA Governing Council
The Sequoia Project updated its TEFCA Governing Council roster on August 10, 2026, naming 19 representatives from health systems, health information networks, technology vendors, and federal agencies. TEFCA is the ONC-overseen national framework for exchanging health data across qualified health information networks. The Governing Council advises on implementation and policy for the framework. The update reflects ongoing governance structure for the national interoperability initiative.
- Industry
DentaQuest Data Breach Affects 15 Million Individuals
DentaQuest, a dental and vision benefits administrator serving Medicaid managed care plans, reported a data breach affecting 15 million individuals — the largest breach reported this year. The company has notified affected individuals and implemented additional security controls following the incident. The breach affects Medicaid enrollees whose dental benefits are administered through DentaQuest's platform across multiple states.
- Industry
Humana Names J.P. Holland to Lead Medicaid Business
Humana appointed James "J.P." Holland as head of its Medicaid division, effective August 18, 2026. Holland previously served as an executive at Johns Hopkins. The move is part of a broader leadership restructuring announced by Humana in late 2025. The appointment comes as Humana continues to position Medicaid as a growth segment within its business portfolio.
- Industry
Healthcare Cybersecurity Risks Escalate Amid Regulatory Gaps and Consolidation
Healthcare industry experts warn that regulatory failures, inadequate funding, and consolidation are creating significant cybersecurity vulnerabilities that threaten patient safety. The vulnerabilities affect healthcare providers and payers, including Medicaid managed care organizations that hold sensitive beneficiary data and operate critical care delivery infrastructure. Security gaps expose health plans and providers to data breaches, ransomware attacks, and operational disruptions that can interrupt care access and compromise protected health information. Industry stakeholders characterize these cybersecurity weaknesses as patient safety issues requiring urgent attention.
