All stories
Jump to date
Monday, October 5 · 64 stories
- Industry
KFF Health News Reporters Discuss Rural Health, MAHA in Media Hits
KFF Health News compiled a roundup of recent media appearances by its journalists. Sarah Jane Tribble discussed KFF-AP polling on rural support for the Make America Healthy Again movement on NPR's Morning Edition, tied to a co-reported piece finding rural MAHA followers say Trump health policies haven't reached their communities. Céline Gounder appeared on CBS News programs to discuss a new GLP-1 weight loss drug, RFK Jr.'s MAHA summit remarks, and how AI tools from Anthropic might aid gene-editing research. Renuka Rayasam discussed the Rural Health Transformation Program on Georgia public radio.</summary> <parameter name="why_it_matters">Stakeholders tracking rural health policy and the Rural Health Transformation Program can find original reporting and expert commentary consolidated through these media appearances.
- State Policy · VT
Vermont Nursing Homes Issue Voter Assistance Guidance After CMS Memo
Vermont officials and advocates are addressing voting accessibility gaps ahead of the November election, including for nursing home residents, people with disabilities, and other underserved groups. The Vermont Health Care Association issued guidance in September clarifying residents' voting rights and the assistance process, following a July CMS memo reminding nursing facilities to avoid coercing or influencing residents while preserving their right to vote. The CMS memo followed election fraud allegations in Texas and Wisconsin involving residents with diminished cognitive capacity. Advocates, including the state long-term care ombudsman, worry the memo could create a "chilling effect" where facilities wrongly withhold voting assistance from residents with cognitive impairment, even though Vermont law only bars voting for those judged incompetent by a court.
- Industry · AL
Alabama Reflector Analysis Finds Grocery Tax Repeal, Minimum Wage Themes
In an opinion piece, an Alabama Reflector columnist argues that after reviewing over 200 campaign websites and Facebook pages from Alabama state candidates, several political patterns emerged ahead of 2026 elections. The author notes bipartisan support for repealing the state's 2% grocery tax, with a Republican legislator reportedly drafting repeal legislation for the next session, and highlights Democratic candidates increasingly calling for a state minimum wage. The piece also observes that Republican candidates are distancing themselves from Trump messaging in general election materials, and that Democrats are fielding more, though often inexperienced, legislative candidates than in 2022. No Medicaid-specific policy action is reported.
- Federal Policy
CMS Opens 60-Day Comment Period on Information Collection Request
CMS published a Federal Register notice seeking public comment on a proposed information collection activity, as required under the Paperwork Reduction Act of 1995. The notice does not specify the particular program or data collection at issue beyond the standard PRA procedural requirements. Commenters have 60 days to weigh in on the necessity, burden estimates, and clarity of the proposed collection, as well as suggestions for reducing reporting burden through automation or other means. This is a routine procedural step CMS must take before implementing or renewing any information collection requirement.
- Industry · TX
Tradeoffs: Texas Nonprofit Hospitals Often Bill Before Financial Aid Screening
In its Hidden Help investigative series, Tradeoffs and KFF Health News report that 44% of 166 Texas nonprofit general and children's hospitals reviewed will bill patients before screening them for financial aid eligibility, rather than using presumptive eligibility to proactively reduce or erase bills. The analysis found wide variation in screening timing, with some hospitals screening after one bill and others sending multiple bills and using collection agencies first; only 10 of 166 hospitals guarantee full refunds to patients later found eligible, and some large systems don't notify patients when debt is automatically forgiven. The findings arrive as Texas lawmakers consider legislation requiring nonprofit hospitals to use presumptive eligibility before billing. The Texas Hospital Association defended current practices, saying hospitals first seek other payment sources like Medicaid before offering charity care as a "relief of last resort."
- State Policy · NV
Nevada Approves 17% Rate Hike for ACA Marketplace Plans
The Nevada Division of Insurance approved an average 17% rate increase for Nevada Health Link marketplace plans for 2027, the second straight year of double-digit hikes after last year's 26% jump. Open enrollment runs Nov. 1 through Jan. 15, 2027, with 12 insurers offering 165 plans, including the state's public-option Battle Born State Plans. About 82% of the marketplace's 100,000-plus enrollees receive federal subsidies, a share that has declined after Congress did not extend enhanced premium tax credits. State officials report rising cancellations due to non-payment, growing numbers of enrollees downgrading to cheaper plans, and expect enrollment to fall further alongside new federal Medicaid work requirements, trends they warn will push up Nevada's uninsured rate.
- Federal Policy
CMS Launches Portal for 340B Part D Claims Data Submissions
CMS opened its Medicare Part D Claims Data 340B Repository on Oct. 1 for voluntary submissions, ahead of a proposed Jan. 1, 2027 deadline when submissions would become mandatory for 340B covered entities and their third-party administrators. The repository collects data elements from Part D 340B claims tied to the Medicare Prescription Drug Inflation Rebate Program. The launch coincides with other Jan. 1, 2027 changes, including 15 additional drugs moving to negotiated Medicare prices, the CY 2027 Part D benefit redesign, and a planned 340B rebate pilot shifting some covered entities to a post-sale rebate model. It also arrives amid disputes between drugmakers like Eli Lilly and Johnson & Johnson, which require direct claims-data submission from covered entities, and hospital groups and states that have challenged or restricted that practice; a CMS-run repository offers an alternative compliance path.
- State Policy · MN
Schutz Pledges Blind Trust, Cites Ellison's Medicaid Fraud Record
At an MPR News debate on Oct. 2, Republican attorney general candidate Ron Schutz committed to placing his stock portfolio in a blind trust and divesting from companies in litigation with Minnesota if elected, responding to reports about his 174 individual stock holdings. Democratic incumbent Keith Ellison, seeking a third term, defended his enforcement record, citing more than 350 Medicaid fraud convictions and his pursuit of pharmaceutical and employer fraud cases. Schutz criticized Ellison for not doing enough to stop fraud affecting Minnesota government, referencing the state's ongoing fraud scandals since 2022. The debate also covered lawsuits against the Trump administration, pardons, and prediction markets ahead of the competitive statewide race.
- State Policy · SD
South Dakota Factions Clash Over Ad Claims in Amendment L Fight
Backers and opponents of South Dakota's Amendment L traded accusations this week over campaign ads linking the measure to "out-of-state billionaires." Amendment L, on the Nov. 3 general election ballot, would require 60% voter approval for future constitutional amendments, though it would not change thresholds for citizen-initiated laws or referendums. Supporter Rep. John Hughes sent a cease-and-desist letter to media outlets airing opposition ads, calling them defamatory, while opponents say the ads illustrate how costly ballot campaigns would become under a higher threshold. The measure is the third such attempt in South Dakota since 2018, following past efforts that included constitutional ballot measures on Medicaid expansion and marijuana legalization.
- State Policy · MS
Mississippi Budget Committee Begins Hearings on $32B Spending Plan
Mississippi's Joint Legislative Budget Committee held two days of public hearings last week, starting the formal process of building a recommendation for the state's fiscal year 2027 budget, currently running at over $32 billion including $13.11 billion in federal funds. The committee will develop a budget recommendation before the legislative session begins January 5, 2027, which then serves as a starting point for lawmakers. Federal funds make up a significant share of spending for agencies including Medicaid, Human Services, Environmental Quality and Transportation, while the general fund and state-support funds ($9.22 billion) are the portion legislators have the most discretion over. The article describes the ongoing, largely behind-the-scenes annual budgeting cycle rather than a specific new policy decision.
- Industry
Commentary: Allergy Care Access Gaps Hit Medicaid, Rural Patients
In a MedCity News commentary, the author argues that access to allergy diagnosis and care is unequal, with rural patients, Medicaid enrollees, and patients from underrepresented racial and ethnic groups more likely to go undiagnosed, be misdiagnosed, or rely on emergency departments instead of allergist visits. The piece frames this diagnostic gap as a broader health equity issue tied to specialist shortages and access barriers facing underserved populations. No specific policy, funding, or regulatory action is described; the commentary instead highlights disparities as a call to attention for the health care field.
- Industry
Kusserow Pitches Caregiver-Centered Model as 'Next' Home Health
In remarks from HHCN's FUTURE conference, Careforth CEO and Elara Caring chairman Paul Kusserow argues the home health industry must shift from a visit-based clinical model to one blending skilled care, trained family caregivers, technology and value-based risk arrangements. Kusserow, former Amedisys CEO, says chronic disease and an aging population make recurring hospitalizations unsustainable for health plans and government payers, pushing providers to take on higher-acuity, disease-specific care in the home. He cites Careforth's approach of identifying and paying family caregivers of Medicaid waiver recipients ($50/day for 24/7 care) alongside training, technology and clinical backup as a model for sustainable caregiving. Kusserow frames data collection and community-based support as essential to scaling value-based, longer-term home care.
- State Policy · CO
Colorado Voters to Decide Medicaid Ban on Youth Gender Surgeries
Colorado's November ballot includes Proposition 135, which would prohibit health care professionals from performing gender-affirming surgeries on minors and bar state and federal funding, including Medicaid, from covering such procedures. The measure, backed by Protect Kids Colorado, is opposed by a coalition of LGBTQ+ advocacy groups, Democratic officials, and the Colorado Medical Society, whose board says the measure's vague language around a minor's "perception of sex or gender" could make care delivery too legally uncertain for providers to administer. Gender-affirming surgeries for minors are rare nationally and already unavailable at Colorado's two major pediatric hospital systems, which halted such care in 2025 amid federal pressure. The measure goes before voters in November 2026.
- Industry · CA
Sanders Rallies Bakersfield for Democrat Who Attacks Valadao on Medicaid Cuts
Sen. Bernie Sanders rallied in Bakersfield on Oct. 4 for Randy Villegas, the progressive Democratic challenger seeking to unseat Republican Rep. David Valadao in California's 22nd Congressional District, a toss-up race in the Central Valley. Villegas criticized Valadao for supporting Medicaid and nutrition assistance cuts in the federal budget bill and for accepting campaign contributions from corporations including UnitedHealthcare. The event drew hundreds of supporters and highlighted Democrats' bet that progressive messaging, including universal healthcare, can resonate in a historically conservative, low-turnout district ahead of the November midterms.
- Legal
Eleventh Circuit Upholds False Claims Act's Qui Tam Provisions
The Eleventh Circuit reversed a district court ruling and held that False Claims Act whistleblowers (relators) are not "Officers of the United States" subject to the Constitution's Appointments Clause, in United States ex rel. Zafirov v. Florida Medical Associates. The court reasoned relators do not occupy a continuing government position, they lack a permanent office, government salary, or ongoing duties, and their recovery is a contingent, case-specific bounty rather than compensation for institutional service. The case, which originated as a Medicare fraud action, was remanded to the district court to address separate Take Care Clause and Vesting Clause challenges. The ruling preserves qui tam enforcement authority within the Eleventh Circuit, though other constitutional challenges to the FCA framework remain pending on remand and in other circuits.
- State Policy · ID
NAMI Idaho to Honor Providers Who Reversed Medicaid Mental Health Cuts
The National Alliance on Mental Illness of Idaho plans to award clinic owners Laura Scuri and Ric Boyce its Kathie Garrett Impact Award for advocacy that led the Idaho Legislature to restore funding for Assertive Community Treatment and peer support services. The programs, administered through the state's Medicaid behavioral health contractor Magellan, had been cut following a gubernatorial executive order reducing the vendor's payment; four patients died after the mobile treatment service was eliminated. Gov. Brad Little signed legislation on the final day of the session temporarily restoring the funding after the two providers built relationships with lawmakers and engaged journalists. The award will be presented October 9 at a Boise gala, as Idaho continues moving toward privatized management of all Medicaid benefits.
- Federal Policy
HRSA Approves 10 Drugmakers for 340B Rebate Pilot
HRSA announced Oct. 1 that it has approved 10 manufacturers, including AbbVie, Amgen, AstraZeneca, Merck and Pfizer, to join a revised 340B Rebate Model Pilot Program covering drugs like Eliquis, Jardiance and Enbrel. Starting Jan. 1, 2027, covered entities will keep buying through existing 340B wholesaler accounts at wholesale acquisition cost but submit limited claims data within 45 days so manufacturers can pay or deny rebates within 10 days; denials cannot be based on eligibility, diversion or Medicaid duplicate-discount concerns, which must go through separate audit channels. This is a reworked version of a pilot a federal court in Maine previously vacated and remanded to HRSA. HRSA will publish periodic implementation findings with a final evaluation due by April 2028, while the AHA says it opposes the program and is weighing options to stop it.
- State Policy · WI
Wisconsin Governor Candidates Clash Over BadgerCare, Healthcare Cost Plans
Wisconsin's gubernatorial candidates, Democrat David Crowley and Republican Tom Tiffany, have released competing healthcare affordability plans ahead of the 2026 election. Crowley proposes opening BadgerCare (Wisconsin's Medicaid program) to any household, with income-based premiums, subsidies for small businesses and gig workers, and expanded coverage for dental, vision and mental health. Tiffany's plan focuses on price transparency requirements for hospitals and insurers, a direct-pay subscription model for primary care, and increased oversight of pharmacy benefit managers. The debate comes as a Forward Analytics report shows Wisconsin hospital prices among the highest in the nation, with hospital costs up 274 percent since 2000 versus 90 percent income growth, and as federal Medicaid work requirements for childless adult BadgerCare members are set to begin in 2027.
- Legal
DOJ Creates Fraud Division Targeting Medicare, Medicaid Fraud
In a client alert, Hall Render reports that the DOJ has issued a memorandum announcing priorities for its newly created National Fraud Enforcement Division, naming health care fraud as a top focus. The Division will prioritize telemedicine arrangements, Medicare and Medicaid fraud, controlled-substance diversion, home health and hospice programs, and marketing of unsafe or misrepresented health products. DOJ plans a more coordinated, data-driven enforcement approach, including use of large language models and AI tools to analyze unstructured records like EHR documentation, contracts, and compliance materials alongside claims and billing data. Hall Render advises providers to review compliance programs, coding/billing practices, and federal health care program submissions to reduce enforcement risk.
- State Policy · WY
Wyoming Committee Advances Bill to Raise Medicaid Nursing Home Limits
Wyoming's Joint Labor, Health and Social Services Committee directed staff to draft legislation raising the personal needs allowance for Medicaid nursing home residents from $50 to $100 monthly and the asset limit from $2,000 to $5,000. The current limits date to 2001 and 1989 respectively and have not kept pace with inflation, according to hospital association and ombudsman testimony. Supporters, including the Wyoming Hospital Association and the Long-Term Care Ombudsman, say the low thresholds cause residents to lose coverage over small asset fluctuations and create uncompensated care burdens for facilities. The change is estimated to cost the state $1.3 million annually; the committee will consider the draft bill at its November meeting.