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Friday, July 24 · 26 stories
- Federal Policy
CMS Mandates Notices for Medicaid Work Requirements as States Plan Broader Outreach
Federal regulations require state Medicaid agencies to notify enrollees affected by new work requirements, and most states are planning additional outreach including phone calls, public advertising, and social media. States face operational challenges meeting tight implementation timelines while complying with federal notice requirements. The brief examines state compliance strategies and the administrative burden of implementing work requirement communications across diverse enrollee populations.
- Industry
For-Profit Hospital Systems Report Higher-Than-Expected Uninsured Volume After ACA Subsidy Expiration
Major for-profit hospital operators including HCA Healthcare, Community Health Systems, and Tenet Healthcare reported in second-quarter 2026 earnings calls that ACA premium tax credit expiration produced larger-than-anticipated increases in uninsured patient volume. Patients who lost subsidized marketplace coverage are not transitioning to other insurance but instead remaining uninsured and continuing to seek care. The development affects hospital bad debt and charity care volumes effective second quarter 2026. This matters because increased uninsured volume at major hospital chains signals broader coverage losses that affect Medicaid-eligible populations through coverage transitions and emergency department utilization patterns.
- Industry
Rural Hospitals in Three States Form Regional Networks to Compete with Larger Systems
Independent rural hospitals in Minnesota, North Dakota, and Ohio are forming regional networks to gain scale and compete with consolidating health systems and payers, according to a Commonwealth Fund report published July 22, 2026. North Dakota's Rough Rider High-Value Network includes 23 critical access hospitals and launched with $3.5 million in funding. These networks aim to preserve local control while building collective bargaining power with payers and operational efficiencies. The consolidation trend affects Medicaid managed care plans contracting with rural providers and state agencies monitoring network adequacy in rural areas.
- Industry
Community Health Systems Reports Higher Uninsured Volume Pressures Q2 Financials
Community Health Systems reported second-quarter financial results reflecting higher-than-expected uninsured patient volumes, primarily attributed to patients dropping Affordable Care Act coverage. The for-profit hospital operator indicated these uninsured volumes are affecting revenue and margins more significantly than projected. The trend reflects broader ACA enrollment shifts impacting hospital payer mix. CHS joins other hospital systems reporting increased uncompensated care costs as commercial and subsidized coverage levels fluctuate.
- State Policy
KFF Tracker Compiles State Abortion Coverage Policies Across Medicaid and Exchange Plans
This interactive resource tracks state-level abortion coverage policies across Medicaid, private insurance, and ACA exchange plans as of 2025. The tracker shows the number of states with laws restricting abortion coverage in Medicaid and private insurance has increased since 2010. It provides a state-by-state breakdown of coverage restrictions, exceptions for life endangerment or other circumstances, and differences between Medicaid fee-for-service and managed care plan coverage. The tool allows Medicaid agencies, health plans, and advocates to compare abortion coverage rules across states and insurance types.
- State Policy · CA
California Medi-Cal Enrollment Drops 5% as 730,000 Disenroll Between June 2025 and March 2026
California's Medi-Cal program lost 730,000 enrollees—a 5% decline—between June 2025 and March 2026, according to California Health Care Foundation data analysis. Undocumented children and young adults experienced disproportionate coverage losses during this period. The enrollment decline follows the end of Medicaid continuous coverage requirements that had kept enrollment elevated during the public health emergency. State agencies and managed care plans should anticipate continued membership volatility and assess impacts on network capacity, risk adjustment, and community-based provider networks serving populations with higher disenrollment rates.
- Legal
HHS Delegates Exclusion Authority to CMS as Q1 2026 Revocations Surge 40%
On July 21, 2026, HHS Secretary Kennedy announced that CMS now has direct exclusion authority, previously held only by the HHS Office of Inspector General. CMS revoked 1,413 Medicare and Medicaid providers and suppliers in Q1 2026, a 40% increase over prior years and the largest quarterly surge on record. The delegation gives CMS "force multiplier" capacity to exclude providers from federal health programs based on fraud, abuse, or program integrity concerns. Medicaid managed care organizations must screen networks for excluded providers and may face increased mid-year terminations and provider adequacy challenges as revocation volumes accelerate.
- Industry
Major Health Insurers Shift Focus to Services Units in Q2 Earnings
UnitedHealth Group and Elevance Health reported second-quarter 2026 earnings showing increased reliance on their services divisions rather than traditional insurance operations. The companies continue to invest heavily in these non-insurance business units, accelerating a long-term diversification trend. This shift affects how major payers — many of which operate Medicaid managed care plans — allocate capital and structure their operations. The earnings reports reflect a broader industry pivot away from pure risk-bearing insurance models toward integrated care delivery and services.
- Legal · WA
Seattle Hospital, UNOS Sued Over Race-Adjusted Kidney Function Formula Delaying Transplant Eligibility
A lawsuit filed July 21, 2026 in U.S. District Court for the Western District of Washington alleges Swedish Medical Center and the United Network for Organ Sharing used a race-based kidney function formula that delayed the plaintiff's transplant waitlist eligibility by six years. The complaint challenges the use of race-adjusted eGFR calculations in determining transplant eligibility. The case follows broader clinical and policy shifts away from race-based algorithms in kidney function assessment. The outcome could affect transplant referral protocols and eligibility determinations for Medicaid beneficiaries with end-stage renal disease.
- Managed Care
Survey Finds 62% of Family Caregivers View Home Care as Long-Term Solution
A 2026 report from A Place for Mom found that 62% of family caregivers view home care as a long-term or permanent solution for aging in place, suggesting families are more likely to adjust home care hours than transition to institutional settings. The finding indicates sustained demand for home and community-based services. While the brief article does not provide detailed methodology or timing, the trend reflects ongoing caregiver preferences that influence LTSS utilization patterns and Medicaid HCBS program design.
- Industry
Home Health Care News Profiles Six Home Health Companies for 2026
Home Health Care News highlights six home health companies amid a 2026 landscape shaped by a Medicare enrollment moratorium aimed at combating fraud and increased federal program integrity enforcement. The article examines how these companies are positioned to navigate regulatory constraints that industry observers say may limit provider growth. The coverage appears focused on business strategy and market positioning rather than Medicaid-specific policy developments.
- Industry
Hospital Behavioral Health Programs Shift Performance Metrics to Long-Term Patient Outcomes
Hospitals are increasingly measuring behavioral health program success through long-term patient outcomes rather than traditional short-term metrics. The shift emphasizes performance measures aligned with care pathways and sustained patient improvement. This approach reflects growing recognition that acute-care metrics may not accurately capture behavioral health treatment effectiveness. The change affects how hospitals evaluate programs and allocate resources for behavioral health services.
- Federal Policy
KFF Poll: CDC Trust Stable While Confidence in Trump, State Officials Declines
A July 2026 KFF tracking poll finds public trust in the CDC as a health information source has stabilized after steep declines between 2020 and early 2026, while trust in President Trump and state government officials as health information sources has decreased over the past six months. The poll marks a potential inflection point in public confidence in federal health agencies following years of erosion. For Medicaid agencies and health plans managing public health messaging around coverage, benefits, and care access, understanding shifting trust dynamics affects member communication strategies and credibility of guidance tied to federal or state sources.
- Federal Policy
CMS Proposes Medicare Payment Category for Clinical Decision Support Software
CMS released proposed rules on July 2 and July 14, 2026 establishing a new Medicare payment category called Software as a Medical Service (SaMS) for software that supports clinical decision-making through algorithmic analysis. The proposals appear in the CY 2027 Hospital Outpatient Prospective Payment System and Physician Fee Schedule proposed rules. This represents CMS's first structured approach to paying separately for clinical decision support software under Medicare. Comments on the proposed rules are typically due 60 days after publication in the Federal Register.
- Legal
CMS Proposes Sweeping Medicare Home Health Enrollment Enforcement Tools in 2027 Rule
CMS released the calendar year 2027 Home Health Prospective Payment System proposed rule, combining payment updates with expanded program integrity enforcement authority. The rule introduces new enrollment enforcement mechanisms targeting home health agencies participating in Medicare. While the rule focuses on Medicare home health, the enforcement framework may signal CMS's broader compliance and enrollment oversight direction. Comments on the proposed rule are due 60 days after Federal Register publication.
- State Policy
NASHP Examines State Use of Community Health Workers for Oral Health Access
The National Academy for State Health Policy published an analysis of how states are deploying community health workers to expand oral health access in rural areas. The publication explores state-level strategies for integrating these workers into care delivery models where dental provider shortages limit access. The approach is particularly relevant for states addressing dental health disparities through Medicaid program design, as community health workers can connect beneficiaries to preventive services and coordinate care in underserved regions.
- Federal Policy
House Bill Proposes EHR Implementation Grants for Home Health and Post-Acute Providers
The Connecting Health and Records Technology for Seniors (CHARTS) Act has been introduced in the U.S. House of Representatives to provide up to $500,000 grants for home health, long-term care, and post-acute care providers to implement electronic health records and improve health information sharing. The legislation aims to reduce implementation costs and administrative burden for providers serving Medicare and Medicaid beneficiaries. If passed, the grants would support interoperability efforts critical to care coordination for dual-eligible and Medicaid long-term services and supports populations. The bill is in the early legislative stage with no timeline for passage.
- State Policy
Political Dispute Over Medicaid Payment Deferrals Threatens Home Care Provider Stability
Political tensions are escalating around states' use of Medicaid payment deferrals, with home care providers caught in the crossfire. The dispute centers on whether states can delay payments to manage budget cycles, a practice that disproportionately affects home- and community-based services providers operating on thin margins. Home care advocates warn that payment timing conflicts threaten provider solvency and beneficiary access to HCBS. The controversy reflects broader partisan divisions over Medicaid financing and state flexibility in program administration.
- Federal Policy
CMS Halts Premium Tax Credit Reconciliation Enforcement After Court Injunction
CMS issued implementation guidance July 22 following a federal district court injunction that blocked eight provisions of its 2027 notice of benefit and payment parameters final rule. The injunction, issued July 16, prevents enforcement of provisions set to take effect July 20. CMS directed exchanges to immediately stop removing or denying advance premium tax credits for applicants who failed to file and reconcile prior years' credits, effective for plan years 2026 and 2027. The agency also reinstated the automatic 60-day extension for resolving household income data inconsistencies.
- Legal
OIG Advisory Opinion Finds Hospital Discharge Referral Software Creates Anti-Kickback Risk
The HHS Office of Inspector General issued Advisory Opinion 26-15 concluding that a subscription-based referral management software platform used in hospital discharge planning could generate prohibited remuneration under the Federal Anti-Kickback Statute. OIG determined that providers paying subscription fees to use the platform may receive improper referrals in exchange for those payments. The opinion affects hospitals, post-acute care providers, and technology vendors involved in discharge planning and care coordination arrangements. The advisory opinion provides immediate compliance guidance for similar arrangements nationwide.