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Wednesday, July 29 · 20 stories
- Federal Policy
HHS Secretary Kennedy Convenes Health Plans and Providers on Behavioral Health Quality Pledge
HHS Secretary Robert F. Kennedy, Jr. held a roundtable with healthcare leaders, insurers, medical societies, and behavioral health providers who pledged to advance best practices for mental health and addiction treatment. The meeting occurred on July 29, 2026, at HHS headquarters in Washington. The voluntary commitments focus on improving care quality and patient outcomes across the behavioral health system. The initiative signals federal priority attention to behavioral health standards but lacks binding requirements or timelines for implementation.
- Federal Policy
KFF Analysis Finds SSI Applicants Face Coverage Risk Under Medicaid Work Requirements
KFF released a policy analysis examining how Medicaid work requirements could affect Supplementary Security Income (SSI) applicants. The analysis finds that SSI applicants are at heightened risk of losing Medicaid coverage due to challenges navigating the medical frailty exclusion verification process under work requirement policies. While individuals with disabilities are typically exempt from work requirements through medical frailty provisions, SSI applicants — who are in the process of establishing disability status — may struggle to document their conditions quickly enough to maintain continuous coverage. The analysis highlights operational barriers that could lead to coverage gaps for this vulnerable population.
- State Policy · OR
Oregon Medicaid Enrollees Face New Requirements Under HR1 Starting January 2027
Oregon Health Plan enrollees will be subject to new eligibility requirements beginning January 2027 under the One Big Beautiful Bill Act (HR1). The federal legislation mandates a slate of new requirements for Medicaid beneficiaries that Oregon must implement. The changes take effect in approximately six months. Oregon Medicaid agencies and managed care plans will need to modify systems, processes, and beneficiary communications to comply with the federal mandate.
- Industry
CHCS Report Examines Women's Financial Security Challenges Including Health Care Costs
The Center for Health Care Strategies published a report examining how caregiving responsibilities, health care costs, longer lifespans, and workforce participation patterns affect women's financial stability as they age. The analysis explores structural factors that create financial vulnerability among women over their lifetimes. While the report addresses health care costs as one component of women's financial challenges, it does not announce or analyze specific Medicaid policy changes, program rules, or managed care operations.
- State Policy
CHCS Report Outlines State Strategies to Address Social Isolation Among Older Adults
The Center for Health Care Strategies published a report examining how states and communities can help older adults build social connections and reduce isolation. The report identifies strategies for state Medicaid agencies and community organizations to support older adults in connecting to social resources. It addresses a population health priority relevant to states implementing Medicaid LTSS programs and managed care plans serving dual-eligible beneficiaries. The guidance is particularly relevant for states operating HCBS waivers and integrated care models where social determinants of health are increasingly incorporated into care management.
- State Policy · NM
New Mexico Launches Healthy Aging App for Older Adults via UNM Health Sciences
The University of New Mexico Health Sciences Center launched Vive Bien/Live Well, a healthy aging program designed to help older adults maintain health, independence, and quality of life. The program is funded by the New Mexico Health Care Authority and aligns with the World Health Organization's Integrated Care for Older People framework. The initiative targets the state's aging population with tools to support independent living and reduce care needs.
- Industry
High Interest Rates Create Buying Opportunities in Home-Based Care M&A
Higher borrowing costs have slowed merger and acquisition activity in the home-based care sector, but investors willing to enter the market now may benefit from more favorable deal terms. The slower dealmaking environment has made compliance screening a more important factor in transactions. Buyers able to absorb higher interest rates are finding opportunities as sellers face pressure to consolidate. The shift affects Medicaid managed care organizations and state agencies contracting with home health and home- and community-based services providers.
- Industry
Hospital-at-Home Programs Show Equivalent Readmission Rates for Heart Failure Patients
A study published in JAMA Network Open found that heart failure patients receiving advanced medical care at home had comparable post-discharge outcomes to those treated in traditional hospital settings, with no significant differences in readmission rates. The research supports hospital-at-home as a viable alternative care delivery model for heart failure management. The findings may inform future Medicaid coverage policies and managed care contracting decisions around alternative site-of-service arrangements. The study provides evidence on quality and safety parity between home-based and facility-based acute care for this high-cost, high-utilization condition.
- Industry
ACA Subsidy Expiration Boosts Payer Margins, Shifts Hospital Payer Mix
The expiration of enhanced ACA premium tax credits is improving profit margins for several health insurers while increasing uninsured volume at major hospital systems. The enhanced credits, which reduced exchange premiums for millions of enrollees, lapsed and are no longer available. Insurers are seeing improved margins as healthier enrollees drop coverage while sicker members remain, and as medical loss ratios decline. Hospitals report increased uninsured and self-pay volumes as former exchange enrollees seek care without coverage.
- Federal Policy
CMS Re-Establishes Data Match With OPM for Marketplace and Medicaid Eligibility Verification
CMS has re-established a Privacy Act matching program with the Office of Personnel Management to verify minimum essential coverage through OPM health benefit plans. The data match enables CMS and State Administering Entities to determine eligibility for qualified health plans through exchanges and insurance affordability programs, including Medicaid and CHIP. The match supports initial eligibility determinations, renewals, redeterminations, and appeals. Effective July 29, 2026, this routine data exchange ensures states can verify coverage status when individuals apply for Medicaid or marketplace subsidies.
- Federal Policy
ACAP and CHCS Launch Technical Assistance Series on Medicaid Work Requirements
The Association for Community Affiliated Plans and the Center for Health Care Strategies announced a learning and action series to help safety net health plans implement newly established Medicaid work requirements. The initiative will provide technical assistance to plans as they develop operational processes for verifying beneficiary compliance, managing exemptions, and coordinating with state agencies. The timing suggests recent federal policy changes have authorized or expanded work requirement programs in multiple states. Safety net plans serving Medicaid populations will need new systems for tracking work activities, processing beneficiary documentation, and managing potential coverage terminations for noncompliance.
- Industry
Rural Hospitals Closed at Triple the Opening Rate Since 2001, Yale Data Shows
Rural hospitals accounted for all net hospital losses in the United States between 2001 and 2023, closing at more than three times the rate they opened, according to Yale University's Health Care Affordability Lab data. The data tracks both openings and closures during this 22-year period. Rural hospital closures disproportionately affect Medicaid beneficiaries who rely on these facilities for emergency care, obstetric services, and behavioral health treatment, often with limited alternative access points.
- State Policy · CA
California Business Group Opposes November Ballot Measure on Billionaire Tax for Medi-Cal
A California business association leader is opposing a November 2026 ballot measure that would impose a tax on billionaires to address Medi-Cal funding shortfalls and rising living costs. The op-ed argues the measure would harm long-term economic growth despite potential short-term revenue gains. The ballot measure has not yet been voted on. This matters for California Medi-Cal stakeholders because the measure, if passed, could alter the state's Medicaid funding landscape and sustainability.
- Federal Policy
AHRQ Grant Spending Down 95% Despite Congressional Appropriation
The Agency for Healthcare Research and Quality has spent less than $15 million of its $345 million fiscal year 2026 appropriation on grants and has not issued new grants in over a year. The agency typically funds health services research including quality measurement, patient safety, and care delivery studies that inform Medicaid program design and quality initiatives. The spending freeze affects research that state Medicaid agencies and managed care plans rely on for evidence-based policy development, quality improvement, and payment reform.
- Industry
HHS Launches Behavioral Health Pledge as Optum Signs On First
HHS is introducing a behavioral health pledge on July 29, 2026, to advance mental health and addiction care nationwide, bringing together payers and medical associations in Washington, D.C. Optum will be the first private-sector company to sign the pledge, according to CEO Patrick Conway, and is simultaneously rolling out new behavioral health products. The pledge aims to expand access to mental health and substance use disorder services across the healthcare system. This represents a coordinated public-private effort to address behavioral health access gaps that affect Medicaid programs, which cover a disproportionate share of Americans with serious mental illness and substance use disorders.
- Legal
Hospice Fraud Scrutiny Raises Concerns About Patient Access and Regulatory Overreach
Health policy researchers and hospice providers warn that heightened fraud enforcement and negative attention on the hospice industry could lead to overly restrictive regulations that limit patient access to end-of-life care. The concerns emerge as federal enforcement actions against fraudulent hospice operators have intensified. While stakeholders acknowledge fraud exists and requires intervention, they caution that broad-brush regulatory responses could penalize compliant providers and restrict legitimate hospice utilization. The tension reflects ongoing challenges in Medicaid and Medicare hospice program integrity.
- Federal Policy
Senator Kim Introduces MediKids Act for Universal Child Health Coverage
Sen. Andy Kim (D-NJ) introduced S. 5037, the MediKids Act, to establish guaranteed healthcare coverage for all children in America. The bill was cosponsored by four Democratic senators and referred to the Senate Finance Committee. No timeline for committee consideration has been announced. If enacted, the legislation would significantly expand federal health coverage for children beyond current Medicaid and CHIP eligibility thresholds, affecting state program design and federal-state financing arrangements.
Tuesday, July 28 · 19 stories
- Industry
Flourish Health Raises $26M Series A for In-Home Youth Mental Health Services
Flourish Health, a youth mental health provider offering in-home visits for young people with serious, complex behavioral health needs, raised $26 million in Series A funding led by B Capital, F-Prime, and Cherryrock Capital. The round brings total funding to $46 million. The company provides home-based care through specialized workers for youth with high-acuity mental health conditions. This expansion comes as states increasingly contract with specialized behavioral health providers to serve high-need Medicaid populations, particularly children with serious emotional disturbance.
- Federal Policy
ACA Marketplace Enrollment Drops 15% After Enhanced Premium Tax Credits Expire in 2026
ACA Marketplace enrollment declined nationwide in 2026 for the first time in seven years following the expiration of temporary enhanced premium tax credits, with all states except New Mexico experiencing enrollment losses. Enrollment fell 15% on the federal marketplace (HealthCare.gov), while state-based marketplaces saw smaller declines averaging 6%, particularly in states that partially offset the federal subsidy loss with state funds. The enhanced subsidies, which had driven enrollment growth since their introduction, expired at the end of 2025.
- Industry
UHS Says Talkspace Acquisition Will Expand Outpatient Behavioral Health Capacity
Universal Health Services executives stated the pending Talkspace acquisition will address two key obstacles to outpatient behavioral health growth: access to virtual care and therapist capacity for post-discharge patients. UHS CFO Steve Filton described Talkspace as providing both a virtual delivery platform and a larger therapist network to serve patients transitioning from inpatient settings. The acquisition, announced earlier in 2026, is positioned as an accelerant for UHS's outpatient behavioral health expansion strategy. This reflects ongoing consolidation in behavioral health delivery and growing emphasis on virtual care integration.