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Monday, August 3 · 20 stories
- Federal Policy
HHS Secretary Kennedy Says Trump Directed Investigation of Autism-Vaccine Link
HHS Secretary Robert F. Kennedy Jr. stated in a CNN interview that President Trump has directed him to investigate perceived links between autism and vaccines. Kennedy confirmed the Wall Street Journal's reporting on the matter. The statement signals potential federal review of vaccine policy and safety monitoring under the current administration. No timeline or specific investigative framework has been announced.
- Federal Policy
CMS Finalizes 2.3% IPPS Rate Increase, Mandatory Joint Replacement Bundled Payment Model for FY 2027
CMS finalized its fiscal year 2027 Inpatient Prospective Payment System (IPPS) rule on July 31, establishing a 2.3% payment rate increase for acute care and long-term care hospitals. The rule introduces the first mandatory, nationwide episode-based payment model for joint replacement procedures covering knee, hip, and ankle replacements. The rule takes effect October 1, 2026 (FY 2027 start). This matters for Medicaid because many state programs base their hospital payment rates on Medicare methodologies, and the bundled payment model could influence state approaches to managing orthopedic services under managed care and fee-for-service arrangements.
- Federal Policy
CMS Proposes Ban on Outsourced Remote Patient Monitoring for Medicare
CMS released the CY 2027 Physician Fee Schedule proposed rule restricting remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) under Medicare. The proposal would prohibit outsourcing of RPM/RTM services and revise reimbursement methodology, reversing 2026 expansions that lowered data-transmission thresholds and added new billing codes. The proposed changes would take effect January 1, 2027 if finalized. State Medicaid agencies that follow Medicare payment policies or allow RPM under managed care contracts may face operational and reimbursement changes if states align telehealth coverage with Medicare rules.
- State Policy · IN
Indiana Families Navigate Ongoing I/DD Waiver System Changes Since Late 2023
Indiana's Medicaid waiver system for individuals with intellectual and developmental disabilities has undergone continuous changes since late 2023, including new service rules, case management restructuring, and modified eligibility requirements. Families and providers are managing multiple policy shifts simultaneously while maintaining care continuity. The accumulated changes affect how services are authorized, delivered, and documented across Indiana's I/DD waiver programs. These reforms create operational uncertainty for MCE plans administering waiver services and providers contracted to deliver them.
- Legal · IA
Former Iowa Agency Directors Criticize Attorney General's New Medicaid Fraud Task Force
Two former directors of Iowa's Department of Inspections and Appeals publicly criticized Attorney General Brenna Bird's newly created Medicaid fraud task force, calling it political theater. Dean Lerner and Kevin Techau, who led the agency under previous Democratic governors, questioned the legitimacy and operational purpose of the task force announced Friday. The criticism comes as Bird, a Republican, establishes what she characterizes as enhanced fraud enforcement efforts. The statement represents rare public pushback from former state officials with direct program integrity experience.
- Federal Policy
HRSA Proposes Second Attempt at 340B Rebate Model After Initial Failure
The Health Resources and Services Administration announced a new proposal to allow rebate models in the 340B drug pricing program, marking its second attempt in 2026 after an earlier effort failed. The proposal would change how covered entities receive 340B discounts, moving from upfront discounts to post-purchase rebates. Hospital associations immediately opposed the plan, arguing it would create cash flow problems and administrative burdens for safety-net providers. If finalized, the rebate model could affect how Medicaid providers, particularly disproportionate share hospitals and federally qualified health centers, manage pharmaceutical costs.
- Managed Care · VA
Sentara Health to Drop Anthem Networks Dec. 31 Without New Rates
Sentara Health has notified Anthem that it will terminate commercial, Medicare, and Medicaid contracts effective December 31, 2026, unless the parties reach a new rate agreement. The contract dispute affects an estimated 380,000 Virginians enrolled in Anthem plans. Sentara has indicated it will not renew under current rate terms. The termination would force Anthem Medicaid managed care enrollees in Virginia to find new in-network providers or face out-of-network costs if the impasse continues through year-end.
- State Policy · IN
Indiana Medicaid Enrollment Drops 18.5% in One Year, Raising Uninsurance Concerns
Indiana's Medicaid enrollment declined by 343,000 people (18.5%) between June 2025 and June 2026, falling from 1.86 million to 1.51 million enrollees — one of the steepest drops nationally. The decline follows the end of Medicaid continuous coverage protections and completion of post-PHE redeterminations. Hospitals, providers, and advocates are concerned about rising uninsurance rates as former enrollees lose coverage. The enrollment reduction affects provider revenue, hospital uncompensated care levels, and managed care plan membership and capitation.
- State Policy · AR
CMS Denies Arkansas Medicaid Expansion Waiver Renewal Covering 200,000 Enrollees
The Centers for Medicare and Medicaid Services rejected Arkansas' request to renew its hybrid Medicaid expansion waiver, which currently covers more than 200,000 low-income adults. Governor Sarah Huckabee Sanders' office confirmed the verbal denial from CMS on Friday. The decision creates immediate uncertainty about whether Arkansas will continue expansion coverage, with potential coverage termination if no alternative arrangement is reached. Arkansas' expansion operates under a Section 1115 waiver with unique program features that required federal approval to continue.
- State Policy
HUD Point-in-Time Data Shows Trends in Homelessness Characteristics
This data note from KFF reviews trends in homelessness and characteristics of people experiencing homelessness using HUD's Point-in-Time count data. The analysis covers sheltered and unsheltered populations identified through annual surveys. While homelessness itself is not a Medicaid program issue, states increasingly use Medicaid waivers and health-related services to address housing instability among enrollees, particularly through LTSS and behavioral health programs. The data provides demographic and trend context relevant to state agencies designing targeted interventions.
- Federal Policy
Trump Administration Attributes ACA Enrollment Drop to Fraud Crackdown Amid Premium Increases
The Trump administration, through HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz, is attributing a significant decline in Affordable Care Act marketplace enrollment primarily to fraud prevention efforts rather than rising premiums. The administration's position contrasts with evidence that premium increases have driven many enrollees to drop coverage. This framing has implications for how federal officials justify enrollment declines and potential future policy decisions around marketplace subsidies and eligibility verification. The dispute centers on whether coverage losses stem from legitimate fraud detection or affordability barriers created by higher premiums.
- Federal Policy
HHS Announces Revised 340B Rebate Model Pilot for Medicare Negotiated Drugs Starting January 2027
HHS issued a notice announcing a revised 340B Rebate Model Pilot Program that allows qualifying drug manufacturers to use rebates rather than upfront discounts for certain 340B-eligible drugs. The pilot is limited to drugs included on the CMS Medicare Drug Price Negotiation Selected Drug Lists for 2026 and 2027. Manufacturers must submit participation plans to HRSA by August 24, 2026, with approval decisions by September 24, 2026, and approved models taking effect January 1, 2027. The AHA opposes the pilot, citing concerns about administrative burdens, cash-flow disruptions, and compliance costs for hospitals serving vulnerable populations, and is considering legal options to block implementation.
- State Policy · NY
New York Imposes Six-Month Moratorium on Medicaid Provider Enrollment for Certain Categories
New York's Medicaid Director announced an immediate six-month moratorium on new provider enrollments and change of ownership applications for certain provider categories, effective July 30, 2026. The moratorium affects specific provider types yet to be fully detailed but includes enrollment and ownership transfer processing freezes. The policy takes effect immediately and runs through January 2027. This represents a significant network access and administrative barrier for health plans managing provider networks, providers seeking Medicaid participation or ownership changes, and state agencies coordinating with managed care organizations on network adequacy requirements during the moratorium period.
Friday, July 31 · 22 stories
- Federal Policy
Updated Brief Examines Medicaid Coverage Among Early Childhood Educators Using 2024 Data
A coalition including the Center for Law and Social Policy and the National Association for the Education of Young Children has republished a brief examining Medicaid coverage among early childhood educators, incorporating 2024 data and recent federal policy developments. The brief analyzes how Medicaid serves this workforce population and discusses implications of federal actions over the past year. Early childhood educators represent a low-wage workforce with high rates of Medicaid enrollment. The updated analysis provides current context for policymakers and stakeholders assessing coverage needs in this sector.
- Industry
438 Urban Hospitals Closed Since 2000, Yale Data Shows
Between 2000 and June 2026, 438 urban hospitals closed across the United States, according to Yale University's Health Care Affordability Lab data. For the 2001-2023 period when both openings and closures are tracked, urban hospitals showed a net gain of only 11 facilities nationally. The data provides state-by-state breakdowns of hospital closures and net changes in urban markets.
- Industry
Teladoc Lowers Revenue Outlook as BetterHelp Insurance Growth Outpaces Cash Pay
Teladoc Health revised its revenue outlook downward due to demand shifts at BetterHelp, its mental health subsidiary. The company reported that BetterHelp's insurance-based offerings grew faster than anticipated, reducing its higher-margin cash pay business. The shift occurred in Q2 2026 and affects Teladoc's overall financial projections for the year. For Medicaid managed care organizations contracting with Teladoc or similar telehealth vendors for behavioral health services, this signals potential pricing pressure as commercial telehealth providers compete more aggressively for insured members, including Medicaid populations.
- Industry
Health Plans Deploy AI to Assist Customer Service Representatives During Member Calls
Health insurers, including UnitedHealth Group, are using AI tools to support customer service representatives in real time during member calls. UnitedHealth reports deploying AI in over 1,000 use cases, including chatbots that initially handle customer inquiries and AI assistants that provide guidance to representatives as they speak with members. The technology is operational now. This matters for Medicaid managed care organizations considering similar tools to reduce call handling time, improve response accuracy, and manage administrative costs in member services operations.
- Federal Policy
KFF Poll Shows Limited Public Awareness of Mifepristone Amid FDA Review
A KFF Health Tracking Poll finds limited public awareness of mifepristone safety and prevalence as the FDA conducts a re-review of the abortion medication. The poll, conducted in July 2026, shows that voters prioritizing abortion policy discussions in the 2026 midterm elections are disproportionately Democrats. The survey results come during an ongoing federal regulatory review process that could affect access to medication abortion. While mifepristone is used in some state Medicaid programs for covered abortion services, this poll focuses on general public awareness rather than Medicaid program operations or coverage policies.
- State Policy · NE
Nebraska Launches Dashboard Tracking Rural Health Transformation Program Funding
Nebraska's Department of Health and Human Services launched a public dashboard on July 30, 2026, to track the distribution of Rural Health Transformation Program funds across the state. The tool provides transparency on how transformation program dollars are allocated to rural providers and communities. The dashboard is live and accessible to stakeholders and the public. This matters for Nebraska Medicaid providers and state agencies because it increases visibility into state-administered funding flows that may support rural provider participation in Medicaid programs and value-based care initiatives.
- Industry
Centene Projects $315M-$365M in Severance Costs from Voluntary Buyouts
Centene announced projected severance costs of $315 million to $365 million for the second half of 2026, primarily from voluntary employee buyouts offered in June. The company already incurred $61 million in related expenses during the second quarter. The buyouts were extended to most employees across the organization. These workforce reduction costs will affect Centene's financial performance through year-end 2026.