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Tuesday, August 4 · 15 stories
- State Policy · CA
California Medi-Cal Program Changes Prompt Beneficiary Outreach on Coverage Continuity
California's Medi-Cal program is undergoing changes that may affect some beneficiaries' coverage, though most enrollees will not be impacted. Beneficiaries are advised to update contact information with their county benefits office and monitor correspondence from county and state agencies to avoid unintended coverage loss. The guidance emphasizes the importance of maintaining current contact details to receive notices about eligibility determinations. State and county agencies are conducting outreach to prevent coverage disruptions during the transition.
- State Policy · CA
California Advises Medi-Cal Enrollees to Update Contact Information Amid Program Changes
California is advising Medi-Cal enrollees to update their contact information with county benefits offices as the program undergoes changes. Most enrollees will not see changes to their benefits, but the state is emphasizing the importance of monitoring mail from county and state agencies to ensure uninterrupted coverage. The guidance comes as the state works to manage transitions that could affect eligibility determination or benefit administration. Enrollees who fail to update contact information or respond to renewal notices risk coverage disruptions.
- Federal Policy
CMS Seeks Public Comment on Potential CPT Coding System Reforms in 2027 Fee Schedule Rule
CMS published a Request for Information on July 16, 2026, soliciting stakeholder feedback on potential reforms to the American Medical Association's Current Procedural Terminology (CPT) coding system. The RFI appears in the Calendar Year 2027 Physician Fee Schedule Proposed Rule (CMS-1848-P). Comments are due 60 days after Federal Register publication, typically in mid-September 2026. The inquiry signals CMS consideration of structural changes to how physician and outpatient services are coded and reimbursed across Medicare and Medicaid programs.
- Industry
Hospitals Report Rising Uninsured Rates Six Months After ACA Exchange Cuts
For-profit hospitals report financial strain from increased uninsured patients following cuts to Affordable Care Act exchanges that took effect six months ago. Hospital executives cite declining insurance coverage among patients as a drag on revenues. The trend reflects broader coverage losses stemming from federal policy changes to ACA subsidies and eligibility. While the article focuses on ACA exchange changes rather than Medicaid-specific policy, Medicaid programs may see increased enrollment pressure as individuals lose marketplace coverage.
- Managed Care · CA
California Health Plan Deploys AI to Prevent Medicaid Disenrollment Ahead of Work Requirements
A California Medicaid health plan is using artificial intelligence to automate appointment scheduling and paperwork reminders for enrollees facing new work requirements, aiming to reduce coverage losses during the compliance transition. The plan reports the AI system performs work equivalent to 40 staff members at significantly lower cost. The deployment comes as states prepare to implement work requirements that historically trigger coverage loss for eligible members who fail to complete verification processes. The approach raises questions about AI reliability, member experience, and whether automation adequately supports vulnerable populations navigating new administrative hurdles.
- Legal
HRC Sues Trump Administration Over Gender-Affirming Care Coverage Ban in Federal Employee Health Plans
The Human Rights Campaign filed a class-action lawsuit Monday challenging the Trump administration's ban on gender transition treatment coverage in federal employee health plans. The suit alleges the coverage ban violates federal sex discrimination protections in employment. The lawsuit does not directly target Medicaid or CHIP programs, though similar coverage restrictions could inform future Medicaid policy debates. The case centers on Federal Employees Health Benefits Program coverage, not state Medicaid programs.
- Federal Policy
CMS Issues FY 2027 IPPS Final Rule With GME, LTCH, and Quality Reporting Changes
CMS published its final rule updating Medicare inpatient prospective payment systems for acute care hospitals and long-term care hospitals for fiscal year 2027, effective October 1, 2026. The rule revises operating and capital payment rates, modifies graduate medical education policies for teaching hospitals, updates LTCH PPS rates, and changes requirements for hospital quality reporting programs. HHS also adopts updated health IT standards. While this is a Medicare rule, Medicaid managed care organizations and state agencies should monitor GME policy changes and quality measure updates that often influence Medicaid hospital payment methodologies and managed care contract requirements.
- Federal Policy
CMS Announces Healthcare Advisory Committee Virtual Meetings for FY 2026-2027
CMS has announced virtual public meetings of the Healthcare Advisory Committee (HAC) for fiscal year 2026-2027. The Committee advises the HHS Secretary and CMS Administrator on healthcare system improvements consistent with the Executive Order establishing the President's Make American Healthy Again Commission. The meetings are open to public participation. The announcement provides stakeholders advance notice of opportunities to observe federal healthcare policy deliberations.
- State Policy · IN
Indiana Families Report Coverage Losses During Medicaid Redetermination Process
Indiana families are losing Medicaid coverage despite submitting required documentation during the state's ongoing eligibility redetermination process. Parents report receiving termination notices after complying with verification requests, with some experiencing gaps in coverage for children despite resubmitting paperwork. The coverage losses appear tied to administrative processing issues during Indiana's unwinding of pandemic-era continuous enrollment protections. Affected families face immediate barriers to accessing care and prescription medications while attempting to restore coverage through state appeals processes.
- State Policy · FL
Florida Lawmaker Questions Continuing KidCare Continuous Eligibility Legal Fight
A Florida lawmaker is calling for the next governor to reconsider the state's ongoing litigation challenging federal continuous eligibility requirements for children in KidCare, Florida's CHIP program. Governor DeSantis has spent two years in court opposing the federal mandate that children remain enrolled for 12 months. The challenge has prevented implementation of a 2023 state law the governor signed. The legal dispute centers on whether Florida must comply with the federal continuous eligibility policy as a condition of receiving federal Medicaid and CHIP funding.
- State Policy · CA
California Reverses Medi-Cal Expansion Amid Budget Shortfalls and Federal Restrictions
California is reversing decades of health coverage expansion, rolling back Medi-Cal eligibility and benefits in response to state budget shortfalls and new federal restrictions. The changes affect millions of California Medi-Cal beneficiaries who gained coverage through previous expansions. The timing and specific scope of cuts are detailed in a CalMatters documentary examining impacts at a Los Angeles clinic. This represents a significant shift in the nation's largest state Medicaid program, affecting managed care plans, providers, and beneficiaries who previously gained coverage.
- Federal Policy
HHS Officials Dispute State Concerns Over Medicaid Coverage Loss Projections
HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz are characterizing concerns about Medicaid coverage losses as "myths," while state Medicaid directors report that recent federal policy changes are expected to result in significant disenrollment. The dispute centers on whether new eligibility verification requirements, work requirements, or other administrative changes constitute "cuts" when they reduce enrollment. State agencies are preparing for increased disenrollment based on federal guidance issued in recent weeks. The disagreement highlights tension between federal policymakers and state administrators responsible for implementing Medicaid changes.
- Federal Policy
Federal Medicaid Work Requirements Exclude Homeless Individuals from Exemptions
Federal Medicaid work requirements do not include homelessness as an exemption category, despite assurances that vulnerable populations would receive waivers. Homeless individuals must meet work or community engagement requirements to maintain coverage, even though securing employment typically requires stable housing. The rule affects Medicaid beneficiaries experiencing homelessness in states that adopt work requirements. This gap exposes a population already facing barriers to healthcare access to potential coverage loss.
Monday, August 3 · 20 stories
- Federal Policy
Advocates Warn Trump Administration Budget Proposals Could Cut Medicaid Funding
On Medicaid's 61st anniversary, advocacy groups are raising concerns about potential funding cuts in budget proposals from the Trump administration. The warnings come as beneficiaries like 55-year-old Ivon Meneses rely on Medicaid for coverage of chronic conditions including asthma and diabetes. Advocates are highlighting the program's role as a safety net and the potential impact of federal budget actions on coverage and access. The timing of these warnings coincides with the program's July 30th anniversary, drawing attention to proposed changes that could affect state Medicaid budgets and beneficiary eligibility.
- Federal Policy
CMS Finalizes 2.3% Medicare Hospital Payment Increase for FY 2027
CMS issued a final rule increasing Medicare inpatient payment rates by a net 2.3% for FY 2027, reflecting a 3.2% market basket increase offset by a 0.9% productivity adjustment. The rule adds $2.9 billion in total hospital payments, including $228 million in DSH and uncompensated care payments and $779 million in new technology payments. The rule expands the Comprehensive Care for Joint Replacement bundled payment model nationwide starting January 1, 2028, making it mandatory for most acute care hospitals with accountability for spending and quality during inpatient stays and 90 days post-discharge. Changes to quality reporting programs include eight new measures for the Inpatient Quality Reporting Program and electronic prior authorization requirements extending to medical benefit drugs beginning in 2028.
- State Policy
NASHP Tracker Compiles State Hospital Reference-Based Pricing Initiatives
The National Academy for State Health Policy has published an ongoing overview tracking state efforts to implement hospital reference-based pricing tied to Medicare rates. The tracker compiles state purchaser initiatives aimed at controlling hospital price growth through payment rate caps or benchmarks. These state policies primarily affect state employee health plans, not Medicaid programs. The tracker serves as a reference resource for state policymakers monitoring hospital pricing approaches across states.
- Industry
Rural Health Systems Prioritize Strategic Tech Investment Over Volume Spending
Rural healthcare leaders are focusing on targeted technology investments rather than high-volume spending as they receive federal funding from the $50 billion Rural Health Transformation Program. The article examines how resource constraints are driving more intentional technology adoption decisions in rural health systems. Organizations achieving the strongest results are evaluating innovation based on practical impact rather than novelty. The piece outlines seven operational approaches rural providers are using to maximize technology investment returns.
- Federal Policy · ME
Medicaid Cuts in HR 1 Expected to Drop 31,000 Maine Enrollees, Strain Rural Hospitals
The "One Big Beautiful Bill Act" (HR 1), enacted in July 2025, imposed substantial Medicaid funding reductions and new administrative requirements. In Maine, approximately 31,000 enrollees are projected to lose coverage due to these administrative burdens. Those losing coverage are expected to shift to charity care at hospitals. The changes threaten financial stability for rural hospitals and local economies dependent on Medicaid reimbursement.
- State Policy · CA
California Cuts Medi-Cal Asset Limits 84% Effective July 2027
California will reduce Medi-Cal asset limits by 84% starting July 1, 2027. Current limits of $130,000 for an individual (plus $65,000 per additional household member, up to 10 people) will drop to $21,000 for one person. The change affects eligibility determination for Medi-Cal applicants and enrollees subject to asset tests. This represents a significant tightening of financial eligibility criteria that will reduce the asset threshold available to certain Medi-Cal populations.
- Federal Policy
Rural Emergency Hospital Model Faces Uncertain Future Under One Big Beautiful Bill Act
The Rural Emergency Hospital (REH) designation, created by Congress to stabilize small rural hospitals through Medicare payments for emergency and outpatient services without inpatient beds, is now threatened by provisions in the One Big Beautiful Bill Act. While some hospitals have successfully converted to the REH model to remain operational, others closed before or after conversion. The law's impact on REH payment rates and eligibility remains unclear as CMS develops implementation guidance. State Medicaid agencies and managed care plans in rural service areas face potential network adequacy challenges if REH facilities close or lose viability.
