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Monday, July 27 · 19 stories
- Federal Policy
HRSA Rural Maternal Health Program Reaches 8,600 Women Across Three States
The Health Resources and Services Administration's Rural Maternity and Obstetrics Management Strategies Program (RMOMS) improved prenatal and postpartum care access for more than 8,600 women through networks in Minnesota, Missouri, and West Virginia, according to a 2026 program report covering the second cohort. The program addresses maternal care gaps in rural areas where provider shortages and hospital closures limit access to obstetric services. RMOMS networks coordinate care across providers, implement telehealth, and expand midwifery services to maintain maternal health infrastructure in underserved communities. For Medicaid agencies and managed care organizations covering rural populations, the program demonstrates models for sustaining maternal care capacity where traditional hospital-based delivery is no longer viable.
- Legal
HHS-OIG Spring 2026 Report Details Oversight of $2.4 Trillion in Federal Health Spending
The HHS Office of Inspector General published its Semiannual Report to Congress covering October 1, 2025, through March 31, 2026. The report documents OIG's oversight activities across Medicare, Medicaid, and related public health programs, representing more than $2.4 trillion in annual federal health care spending. The report details enforcement actions, audit findings, and program integrity recommendations relevant to Medicaid programs and managed care plans. State Medicaid agencies and health plans should review the report for emerging enforcement priorities and compliance risks.
- State Policy
1.4 Million Uninsured in Ten Non-Expansion States Remain in Medicaid Coverage Gap
An analysis estimates 1.4 million uninsured individuals in the ten states that have not adopted Medicaid expansion remain in the coverage gap — earning too much for traditional Medicaid but too little to qualify for Marketplace premium tax credits. This population includes working adults, people of color, and individuals with disabilities. These individuals are ineligible for Medicaid because their states have not adopted the ACA's expansion to adults up to 138% of the federal poverty level and ineligible for Marketplace subsidies, which begin at 100% FPL. The analysis highlights the continued state-by-state variation in Medicaid eligibility and access to affordable coverage.
- Federal Policy
CMS Proposes Rule Implementing H.R. 1 Provider Tax Restrictions
CMS issued a proposed rule on July 21, 2026, implementing two of three provider tax restrictions from H.R. 1, which limits states' ability to use provider taxes to finance their Medicaid share. The rule prohibits new provider taxes and increases in existing taxes. This affects state Medicaid financing strategies and budget planning, with implications for how states fund their programs and potential pressure on state general funds. The proposal will proceed through standard notice-and-comment rulemaking.
- Legal
HHS Appeals Ruling Vacating Portions of 2025 Marketplace Integrity Rule
HHS and CMS filed an appeal in July 2026 challenging a Maryland federal district court's June 2026 decision that vacated portions of CMS's 2025 Marketplace Integrity and Affordability Rule. The underlying case was brought by the city governments of Columbus, Baltimore, and Chicago, along with other plaintiffs. The district court ruled on summary judgment to strike down specific provisions of the rule. The appeal will determine whether those provisions remain enforceable or are permanently set aside.
- Federal Policy
FDA Raises Safety Concerns About Compounded GLP-1 Drugs as Alternative to Ozempic
The FDA and physicians are expressing concern about compounded versions of GLP-1 drugs like Ozempic, which patients are increasingly using as cheaper, more accessible alternatives. These compounded formulations, while easier to obtain, carry serious safety risks according to medical experts. The issue affects Medicaid beneficiaries who may turn to compounded versions due to cost or access barriers with brand-name GLP-1s. This raises questions for state Medicaid programs about coverage policies, prior authorization criteria, and quality oversight for diabetes and weight management drugs.
- Industry
Danish Study Finds GLP-1 Drugs Reduce Long-Term Sick Leave by 17%
A study based on Danish data found that patients taking GLP-1 drugs experienced 17% fewer long-term work absences compared to those not on the medications. The research examined workplace absenteeism patterns among GLP-1 users. The findings suggest potential broader economic benefits beyond direct health outcomes. For Medicaid programs covering GLP-1s for weight management or diabetes, this data may inform cost-benefit analyses around coverage decisions, though workforce participation effects in Medicaid populations may differ from the Danish workforce studied.
- State Policy
National Association of Medicaid Directors Elects New Board Leadership
State Medicaid directors have elected a new board of directors for the National Association of Medicaid Directors (NAMD). The organization represents state Medicaid agencies in policy discussions with CMS and serves as the primary vehicle for state-to-state coordination on Medicaid program operations. The new board will guide NAMD's advocacy priorities and engagement with federal policymakers during a period of ongoing program changes. State agencies should monitor NAMD communications for shifts in organizational priorities or focus areas under the new leadership.
- Managed Care · CA
California Managed Care Plans Deploy Chief Health Equity Officers Under Medi-Cal Mandate
Medi-Cal managed care plans are required to employ chief health equity officers as part of California's strategy to address health disparities. These officers are implementing initiatives to reduce inequities in care delivery and outcomes across plan populations. The requirement affects all Medi-Cal MCOs operating in California. This represents a structural shift in how managed care plans address social determinants of health and health equity, requiring dedicated executive leadership and resources for disparities reduction.
- Industry
Bayada Deploys AI Clinical Decision Support to Reduce Home Health Hospitalizations
Home-based care provider Bayada is using AI-enabled clinical decision-support tools to identify patients at elevated risk of hospitalization earlier than traditional manual chart review. The tools synthesize electronic medical record data and clinical documentation to flag risk signals for care teams, enabling preventive interventions before conditions deteriorate. The approach aims to reduce avoidable acute care use among home health patients. This development matters for Medicaid managed care organizations that contract with home health agencies and bear financial risk for preventable hospitalizations, particularly in states with LTSS carved into managed care.
- Federal Policy
HHS Appeals Court Ruling Invalidating 2025 ACA Marketplace Rule Provisions
The Department of Health and Human Services filed an appeal to reinstate portions of a 2025 Affordable Care Act rule that a federal judge invalidated in June 2026. The invalidated provisions include shortened enrollment periods and stricter eligibility verification requirements for marketplace coverage. The appeal seeks to restore these requirements, which originally applied to ACA marketplace plans beginning with the 2026 plan year. The outcome affects marketplace operations and enrollment procedures, with potential implications for Medicaid-marketplace coordination on eligibility determinations and transitions between coverage types.
- State Policy
KFF Tracker Compiles State Rural Health Transformation Plans
KFF Health News is maintaining an ongoing database of state rural health transformation plans as they become available through state responses and public records requests. The tracker aims to compile approved plans across states. This is a standing resource updated as new state plans are obtained, not a report of a specific policy development or deadline.
- Federal Policy
CMS Proposes Mandatory Attestation Process for Off-Campus Hospital Outpatient Departments
The Centers for Medicare & Medicaid Services has proposed a new process requiring hospitals to submit provider-based attestations for off-campus hospital outpatient departments, converting what was previously a voluntary submission into a mandatory requirement. The proposed rule establishes a compliance framework for hospitals operating off-campus HOPDs under provider-based status. CMS has not specified an effective date or comment deadline in the available information. This change affects hospitals billing Medicare and Medicaid for services delivered at off-campus locations under provider-based arrangements, requiring new administrative processes to maintain compliance and avoid potential payment denials.
- State Policy · ID
Idaho to Implement Medicaid Expansion Work Requirements in 2027
Idaho will begin enforcing work requirements for Medicaid expansion enrollees in 2027, following state adoption of provisions from the federal One Big Beautiful Bill Act in April 2026. The Idaho Department of Health and Welfare will administer the requirements. State officials indicate most current expansion enrollees already meet the work requirement criteria, though specific exemption categories and compliance verification procedures have not been detailed.
- State Policy · NC
North Carolina AG Says Federal Medicaid Work Requirement Rule Shifts Millions to Counties
North Carolina's attorney general says a last-minute federal rule change regarding Medicaid work requirements will impose significant costs on counties. Congress included a medically frail exemption in last year's federal Medicaid work requirement law for individuals with serious or complex conditions like cancer, Parkinson's disease, and cystic fibrosis. The state AG contends recent federal regulatory changes will shift financial responsibility for administering or monitoring these exemptions to county governments, resulting in millions of dollars in unexpected local costs. The timing and specific implementation details of the rule change are causing concern about counties' ability to absorb these new expenses.
Friday, July 24 · 26 stories
- Legal · NY
New York Couple Spent Down Assets Before Accessing Medicaid Long-Term Care Coverage
A New York couple exhausted their retirement savings paying for healthcare before qualifying for Medicaid coverage, reflecting broader challenges with Medicaid eligibility rules for long-term care. The story illustrates how asset spend-down requirements can delay access to Medicaid-funded long-term services and supports for aging Americans who need care but have resources above eligibility thresholds. The couple's experience highlights ongoing policy tensions around Medicaid estate recovery, asset limits, and the financial burden on families navigating the transition from private pay to Medicaid coverage.
- Industry · IA
Democratic Lt. Governor Candidate Visits Youth Behavioral Health Facility in Iowa
Dave Muhlbauer, Democratic candidate for lieutenant governor in Iowa, visited Ember Recovery, a YSS-operated youth behavioral health facility in Cambridge, to discuss cannabis legalization policy and children's behavioral health treatment access. The visit focused on treatment accessibility for children with substance use and behavioral health needs. No specific policy proposals or program changes affecting Medicaid were announced during the visit.
- Industry
Study Finds GLP-1 Drugs Reduce Long-Term Sick Leave by 17 Percent
A study using Danish data found that patients taking GLP-1 medications had 17 percent fewer long-term sick leave absences compared to those not on the drugs. The research suggests potential workforce participation and productivity benefits beyond clinical outcomes for obesity and diabetes treatment. The findings may inform Medicaid coverage decisions and utilization management policies for GLP-1s, which have been subject to state budget scrutiny due to high costs. The study did not specify implementation timelines but reflects ongoing evaluation of these drugs' broader economic impacts.
- State Policy · WI
Wisconsin Medicaid Functional Screen Determines Long-Term Care Program Eligibility
Wisconsin Medicaid requires applicants for long-term care programs to pass a functional screen test in addition to meeting financial eligibility criteria. The functional screen assessment evaluates an individual's ability to perform activities of daily living and need for assistance to determine whether they meet the level of care required for program enrollment. The screen applies to programs including Family Care, IRIS, and institutional care. For applicants and providers, understanding functional screening requirements is critical to navigating Wisconsin's long-term care access and ensuring appropriate program placement.
- Federal Policy
No Surprises Act Disputes Rose 16% in Second Half of 2025
Providers and payers initiated 16% more disputes under the No Surprises Act in the second half of 2025 compared to the first half, according to new CMS data released July 23, 2026. Arbiters are closing cases more quickly and working through the backlog of disputes. The No Surprises Act primarily governs commercial insurance out-of-network billing disputes and does not apply to Medicaid managed care or fee-for-service.
