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Thursday, July 30 · 22 stories
- Federal Policy
Commerce Order Bans Census Bureau Privacy Methods, Threatens Medicaid Enrollment and Utilization Data
On June 4, 2026, the Commerce Department issued Administrative Order 216-26 banning "noise infusion" privacy techniques in Census Bureau and Bureau of Economic Analysis data products, effective immediately. The order affects data systems that state Medicaid agencies and researchers rely on for enrollment projections, eligibility determination, and program evaluation, including American Community Survey data used to estimate uninsured rates and demographic trends. Census Bureau officials have warned the ban may compromise their ability to release small-area statistics while protecting respondent privacy, potentially limiting availability of county-level data critical for Medicaid managed care network adequacy assessments and CHIP outreach.
- State Policy · IN
Indiana Medicaid to Cover GLP-1 Medications for Obesity Under Federal Initiative
Indiana Governor Mike Braun directed the state's Family and Social Services Administration to cover GLP-1 medications for obesity through a federal Centers for Medicare & Medicaid Innovation Center initiative. The policy will affect 1.9 million Medicaid enrollees in Indiana. The directive was issued July 30, 2026, though specific implementation timelines were not provided in the announcement. This marks a significant expansion of pharmacy benefits for Indiana's Medicaid population, as most state Medicaid programs have historically excluded coverage of anti-obesity medications.
- Legal
Federal Judge Denies States' Motion to Postpone Medicaid Work Requirements
A federal judge denied a motion from 26 states seeking to delay implementation of Medicaid work requirements announced by CMS in June. The ruling means the work requirements will proceed as scheduled, absent further legal action. The decision affects states that had challenged the timeline for implementing the requirements, which would condition Medicaid eligibility on meeting work or community engagement standards. The ruling has immediate implications for state Medicaid agencies preparing operational and system changes to comply with the federal policy.
- Industry
Home Infusion Demand Grows Amid Reimbursement and Site-of-Care Restrictions
Demand for home infusion services is accelerating as payers and health systems move patients to lower-cost settings and expedite hospital discharges. Providers face operational obstacles including site-of-care restrictions that limit where services can be rendered and delivered, inconsistent contracting standards across payers, and reimbursement constraints that complicate scaling these programs. The trend affects Medicaid managed care plans seeking cost savings through alternate site strategies and providers adjusting care delivery models to accommodate payer preferences for home-based treatment.
- Industry
Provider-Sponsored Health Plans Face Closures as Providence Exits Insurance Business
Providence Health Plan, owned by Renton, Wash.-based Providence health system, will close most of its insurance operations starting in 2027. Similar closures have occurred at provider-sponsored plans operated by Carle Health in Illinois and Michigan Medicine. These closures reflect ongoing financial and operational challenges for health system-owned insurance companies. The trend affects provider-sponsored plans that serve Medicaid managed care markets alongside commercial lines of business.
- Industry
Five Health Systems Announce Major Layoffs in 2026
Multiple health systems have announced significant workforce reductions in 2026, driven by diverse operational pressures. A Texas psychiatric hospital eliminated 648 positions following CMS certification loss. Baylor Scott & White Health Plan also conducted layoffs amid broader industry trends including regulatory penalties, exits from unprofitable insurance markets, and outsourcing arrangements. The reductions reflect ongoing financial and operational challenges facing health systems and their affiliated health plans. Specific effective dates and total numbers across all five systems were not detailed in the summary.
- Industry · VT
UVM Health Cuts Costs After Vermont Policy Reduces Revenue by $220M
UVM Health is reducing expenses, restructuring leadership, and cutting positions after Vermont state policy changes reduced annual revenue at its flagship academic medical center by approximately $220 million starting January 1, 2026. The system is implementing affordability-focused operational changes under new leadership. These actions reflect broader financial pressures facing health systems, with implications for provider networks and service capacity in Vermont's Medicaid program.
- Federal Policy
CMS Finalizes 2.4% SNF Payment Increase for FY 2027, Expands Quality Reporting
CMS issued a final rule July 29 updating the skilled nursing facility prospective payment system for fiscal year 2027, increasing aggregate payments by 2.4% (3.3% market basket minus 0.9% productivity adjustment). The rule also revises the SNF Quality Reporting Program by removing two COVID-19 vaccination measures, shortening data reporting timelines, and requiring facilities to submit assessment data for all patients regardless of payer source. Changes take effect October 1, 2026. The all-payer reporting requirement expands data submission obligations beyond Medicare to include Medicaid and other payers.
- Industry · WV
West Virginia Lawmakers Question Majestic Care's Long-Term Care Hospital Expansion Plans
Majestic Care, a New York-based developer operating four long-term care hospitals in West Virginia, reports progress on new facility construction. State lawmakers have expressed concerns that the new builds could relocate elderly patients and jobs away from existing communities, though specific facility locations have not been disclosed. The expansion comes as the company consolidates its footprint in West Virginia's long-term care hospital market. The development raises questions about access to post-acute care services for Medicaid beneficiaries who comprise a significant portion of long-term care hospital patients.
- Industry
UHS Reports Rising Uninsured Volumes, Projects $10M Loss From ACA Coverage Churn
Universal Health Services reported increased uninsured patient volumes in the second quarter of 2026, with executives attributing the trend to individuals losing Affordable Care Act marketplace coverage. The hospital operator now projects an additional $10 million loss for the year beyond initial expectations due to the coverage losses. The trend affects UHS's hospital operations as patients transition from insured to uninsured status, impacting revenue cycle performance and bad debt provisions.
- State Policy · LA
Louisiana Controlled Substance Law Restricts Hospital Access to Hemorrhage Medications
Louisiana's 2024 law reclassifying misoprostol and mifepristone as controlled substances has limited hospital access to these medications for emergency hemorrhage treatment in pregnant patients. The restrictions affect how quickly providers can obtain these drugs in non-abortion medical emergencies, creating delays in time-sensitive obstetric care. Other states are reportedly considering similar legislation. The law has operational implications for Medicaid-covered maternity care, where hemorrhage is a leading cause of maternal mortality and misoprostol is a standard emergency treatment.
- Federal Policy
Bipartisan Bill Directs CMS to Add Stuttering Screening to EPSDT
Sens. Jim Banks (R-Ind.) and Andy Kim (D-N.J.) introduced the Kidd's Stuttering Act on Wednesday, directing CMS to add stuttering and fluency screening to Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services. The legislation would require Medicaid to cover screening and treatment for stuttering in children enrolled in the program. If enacted, state Medicaid agencies and managed care organizations would need to ensure network adequacy for speech-language pathology services and update coverage policies to include fluency disorder screening as part of well-child visits.
- Federal Policy
HHS Launches National Behavioral Health Quality Pledge with Insurers and Providers
HHS Secretary announced July 29 that dozens of insurers, medical societies, providers, and behavioral health experts have pledged to strengthen behavioral health systems through improved access, quality measurement, patient-centered recovery services, and whole-person care integrating behavioral and physical health. The voluntary initiative commits participants to advancing best practices in mental health and addiction treatment. HHS positioned the effort as part of the administration's broader strategy to address addiction and mental illness and improve long-term patient outcomes.
- State Policy · CO
Colorado Enacts ABA Provider Licensure Law With Medicaid Implications
Colorado Governor signed HB 26-1425 on June 2, 2026, establishing the Applied Behavior Analysis Practice Act. The law creates comprehensive licensing requirements for ABA practitioners and provider entities operating in Colorado, including facility licensing, professional liability insurance mandates, and provisions affecting Medicaid reimbursement. The legislation includes phased implementation timelines. ABA providers serving Colorado Medicaid beneficiaries must prepare for new credentialing, facility standards, and compliance requirements that will affect network participation and claims processing.
- Federal Policy
CMS Finalizes 2.3% IPF Payment Increase for FY 2027, Delays Outlier Cap
CMS issued a final rule July 29 increasing inpatient psychiatric facility payments by 2.3% ($60 million) for fiscal year 2027, reflecting a 3.2% market basket update minus a 0.9-point productivity adjustment. The rule finalizes an outlier payment cap but defers implementation until FY 2028 and excludes facilities with fewer than 50 stays annually. CMS also removes two quality reporting measures on alcohol and tobacco screening effective CY 2026/FY 2028 and modifies implementation of the standardized IPF Patient Assessment Instrument with a lower compliance threshold and extended timeline. Changes take effect October 1, 2026.
- State Policy · IA
Iowa Democratic Gubernatorial Candidate Pledges to End Medicaid Managed Care
A Democratic candidate for Iowa governor has announced plans to eliminate the state's private Medicaid managed care program if elected, which would make Iowa the second state to exit managed care after implementing it. The candidate characterized the current managed care system as "a disaster." Iowa transitioned to managed care several years ago, contracting with private health plans to administer Medicaid benefits. The outcome of the gubernatorial race will determine whether Iowa's Medicaid MCOs retain their contracts or face termination, affecting coverage for hundreds of thousands of enrollees.
- Legal
Texas District Court Vacates CMS Rule Excluding 1115 Waiver Days from DSH Calculations
On July 27, 2026, the U.S. District Court for the Northern District of Texas vacated a 2023 CMS regulation that excluded inpatient days covered by Section 1115 waiver uncompensated care funding pools from Medicaid disproportionate share hospital (DSH) day counts. This is the second time the court has struck down this rule in Covenant Medical Center v. Kennedy. The ruling affects how hospitals calculate their Medicaid patient volume for DSH payment eligibility. The decision takes effect immediately, allowing hospitals to include these waiver days in their DSH calculations until CMS takes further action.
Wednesday, July 29 · 20 stories
- Industry
Law Firm Publishes Explainer on Special Needs Trusts and Medicaid Eligibility
Lippes Mathias LLP published an educational article explaining how special needs trusts can preserve Medicaid and SSI eligibility for individuals with disabilities who receive inheritances, gifts, or legal settlements. The piece outlines how direct financial transfers can disqualify beneficiaries from needs-based programs, and describes trust structures designed to maintain eligibility while providing supplemental support. The article is a general educational resource for families and estate planners, not a policy development or regulatory action. It does not announce new guidance, legal precedent, or program changes affecting Medicaid administration.
- State Policy
Pennsylvania, Nevada, Wisconsin Medicaid Directors Detail Member Engagement Strategies
Three state Medicaid directors describe operational approaches for gathering and acting on member feedback, including advisory councils, community listening sessions, and embedding member voices in agency decision-making. The leaders discuss how they structure engagement to reach diverse populations, particularly members with complex needs, and translate input into policy and operational changes. These practices aim to improve program responsiveness and member experience across eligibility, benefits, and service delivery.
- State Policy · LA
Louisiana Enacts Commercial PBM Reimbursement Floor Using NADAC
Louisiana enacted Act 913 on June 12, establishing a commercial market reimbursement floor for pharmacy benefit managers that requires use of National Average Drug Acquisition Cost (NADAC) as the reimbursement benchmark. The law applies to commercial PBM arrangements and includes provisions intended to prevent cost-shifting to patients. The legislation took effect upon signing and affects how PBMs reimburse pharmacies in commercial insurance markets in Louisiana.