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Friday, July 24 · 26 stories
- Federal Policy
Poll Shows Most Americans Reject Claims of Widespread Medicaid Beneficiary Fraud
A new poll finds that most Americans do not believe Medicaid beneficiaries are the primary source of program fraud, contradicting recent allegations from some Republican leaders. Respondents view current fraud enforcement rhetoric as politically motivated rather than substantive. The poll results come amid ongoing congressional and administrative debates over program integrity measures, oversight authority, and enforcement resource allocation. Public perception could influence state Medicaid agency priorities and federal oversight emphasis as policymakers weigh beneficiary-focused versus provider-focused fraud detection strategies.
Thursday, July 23 · 14 stories
- State Policy
Rhode Island and Hawaii Enact Healthcare AI Laws; Arizona Governor Vetoes Chatbot Bill
Rhode Island and Hawaii enacted healthcare AI legislation in June and July 2026, while Arizona's governor vetoed a similar chatbot disclosure bill. Rhode Island Governor Dan McKee signed two AI-related healthcare bills into law. The measures reflect divergent state approaches to regulating artificial intelligence in healthcare settings. These laws may affect how Medicaid managed care organizations deploy AI tools for utilization management, care coordination, or member services in these states.
- Federal Policy
KFF Brief Reviews U.S. Abortion Data Trends Through 2026
A KFF brief examines U.S. abortion data sources and trends before and after the Dobbs decision, analyzing factors affecting abortion rates and projecting potential policy changes under the current administration and Congress. The analysis covers state-level variations in access and utilization following the overturning of Roe v. Wade. The brief provides context for understanding how federal and state policy changes may continue to shape abortion access and Medicaid coverage decisions.
- Industry
Elder Law Firm Highlights Long-Term Care Cost Burden on Middle-Class Families
A law firm analysis describes how long-term care expenses deplete family savings, noting Medicare's limited coverage and Medicaid's spend-down requirements. The piece emphasizes that middle-class households face significant financial exposure before qualifying for Medicaid long-term services and supports. No new policy change is reported. The content reflects ongoing challenges in the LTSS financing landscape that affect Medicaid eligibility and enrollment dynamics.
- Industry
Molina Healthcare Plans Additional ACA Exchange Cuts in 2027
Molina Healthcare announced plans to further reduce its participation in ACA marketplace exchanges in 2027 following second-quarter financial challenges in that segment. While the company reported stable Medicaid performance and stronger-than-expected Medicare Advantage results, ACA exchange operations underperformed expectations. CEO leadership characterized the ACA exchange trend as "unfortunate." The insurer did not specify which states or exchanges would face reductions. Molina's Medicaid operations, which represent a significant portion of its business, showed stability during the quarter.
- Legal
DOJ Secures Six Healthcare Fraud Convictions in Three Weeks, $1.1B in Alleged Losses
The Department of Justice's National Fraud Enforcement Division obtained six jury trial convictions between May 13 and June 1, 2026, across five federal districts. The defendants include a software platform executive and a rural nurse practitioner, among others spanning multiple healthcare settings. Total alleged losses exceed $1.1 billion to Medicare, Medicaid, and other health benefit programs. The convictions demonstrate DOJ's sustained enforcement activity across the healthcare sector, with direct implications for Medicaid managed care organizations' fraud, waste, and abuse compliance programs.
- Federal Policy
CMS Proposes Provider Enrollment Changes Across All Provider Types in 2027 Home Health Rule
CMS published a proposed rule on July 6, 2026, that includes provider enrollment changes applicable to all provider and supplier types, not just home health agencies. The changes are designed to strengthen program integrity across Medicare and Medicaid. The rule appears in the Calendar Year 2027 Home Health Prospective Payment System Proposed Rule. Comments are due 60 days after publication in the Federal Register.
- Federal Policy
Urban Institute Finds Postpartum Coverage Gains Stalling Among New Mothers
The Urban Institute reports that health insurance coverage for new mothers in the first year postpartum has improved in recent years but progress has stalled, according to Census Bureau American Community Survey data. The analysis examines uninsured rates among women ages 19 and older who gave birth within the past year. The findings come as states navigate the end of Medicaid continuous enrollment and implementation of the American Rescue Plan's optional 12-month postpartum coverage extension. The report signals potential erosion of maternal coverage gains that have reduced coverage gaps during the critical postpartum period.
- State Policy · KY
Kentucky Governor Reverses 4% Medicaid Provider Rate Cuts
Kentucky Governor Andy Beshear announced a reversal of the state's previously enacted 4% Medicaid provider rate cuts. The move follows criticism of the original cuts' impact on disability services and other providers. Beshear cautioned that the reversal would not immediately resolve all provider concerns, saying the change is not "a magic wand" or "a magic bullet." Managed care organizations operating in Kentucky should expect updated rate schedules reflecting the restored funding levels.
- Federal Policy · VA
Virginia Hospitals Project $31B Medicaid Loss Under Proposed CMS Rule
A proposed CMS rule implementing last summer's reconciliation bill includes Medicaid payment cuts to healthcare facilities that Virginia hospitals say go beyond what Congress authorized. Hospital systems contend the rule would reduce state Medicaid funding by $31 billion. The public comment period closed this week. The rule affects facility reimbursement under Medicaid and represents CMS's interpretation of reconciliation bill directives that hospital chains argue exceeds legislative intent.
- Federal Policy
CMS Proposes CY 2027 Hospital Outpatient Payment and ASC Policy Changes
CMS issued the Calendar Year 2027 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center proposed rule affecting hospitals participating in Medicare. The proposed rule includes significant payment and policy changes for hospital outpatient services and ASCs. The rule establishes payment rates and updates operational policies for calendar year 2027. While focused on Medicare payment systems, managed care organizations contracting with hospitals for Medicaid services should monitor for potential cost-shifting effects and policy precedents that states may adopt.
- Federal Policy
Partnership for Medicaid Issues Statement Opposing Coverage Reduction Policies
The Partnership for Medicaid released a statement on May 9, 2025, expressing concerns about unspecified policy changes that could reduce Medicaid coverage and access to care. The statement does not identify specific rules, proposals, or effective dates. No federal guidance or rulemaking is referenced in the brief announcement. The Partnership for Medicaid is a coalition that includes Medicaid Health Plans of America among its members.
- Industry
Choice Health at Home Plans National Expansion Amid Regulatory Uncertainty
Choice Health at Home, which serves 15,000 patients, is pursuing national expansion despite regulatory challenges including a federal enrollment moratorium and Medicaid policy changes under the One Big Beautiful Bill Act (OBBBA). CEO David Jackson outlined the company's westward growth strategy for 2026. The expansion comes as home-based care providers navigate heightened federal scrutiny, enrollment restrictions, and uncertain Medicaid reimbursement. The company's plans signal continued private investment in home health despite regulatory headwinds affecting the sector.
- Federal Policy
CMS Clarifies Home Health Acceptance-to-Service Requirements in Survey Guidance
CMS issued updated survey guidance on July 16, 2026, clarifying home health agencies' obligations under the acceptance-to-service standard in the Home Health Agency Conditions of Participation. The standard, which took effect in January 2025, requires agencies to develop, implement, and maintain policies governing patient acceptance. The guidance provides surveyors and agencies with clearer expectations for compliance. For Medicaid managed care organizations contracting with home health providers, this guidance affects network adequacy assessments and provider compliance monitoring.
- Federal Policy
CMS Announces Public Data Release Under OPEN Government Data Act
CMS will release new public data assets in machine-readable formats under the OPEN Government Data Act, part of the Foundations for Evidence-Based Policymaking Act of 2018. The data release aims to support fraud, waste, and abuse identification while promoting transparency and accountability. CMS states it has balanced transparency objectives with protection of sensitive information. The notice does not specify which datasets will be released or when they will become available.
Wednesday, July 22 · 13 stories
- Industry
988 Lifeline In-State Call Answer Rate Data Unavailable Due to Access Restrictions
This content is password-protected and cannot be accessed for analysis. The title suggests it may contain data on in-state answer rates for the 988 Suicide and Crisis Lifeline. Without access to the underlying content, it is not possible to determine what information is presented, when any reported data applies, or whether it contains actionable intelligence for Medicaid managed care organizations. The 988 Lifeline, launched nationally in July 2022, is relevant to Medicaid MCOs that cover behavioral health crisis services, but the specifics of this protected content remain unknown.
- Industry
Commentary Argues Behavioral Health Needs Better Prescribing Infrastructure Over Deprescribing Focus
A MedCity News commentary argues that the behavioral health policy conversation should shift from deprescribing initiatives to building clinical infrastructure for consistent, high-quality care. The piece challenges the current policy emphasis on reducing prescriptions and instead advocates for systematic improvements in prescribing practices. The commentary does not announce specific policy changes or requirements but contributes to ongoing discussions about behavioral health quality in managed care settings.
- Federal Policy
Trump Announces 100% Tariff on Imported Generics Effective August 2028
President Trump announced Tuesday via social media that imported generic drugs will face a 100 percent tariff beginning in August 2028 unless manufacturers relocate production to the United States. The tariff is described as a penalty designed to reshore generic pharmaceutical manufacturing. Generic drugs constitute the majority of Medicaid pharmacy spending, and most generics dispensed in the U.S. are manufactured overseas or contain active pharmaceutical ingredients from foreign suppliers. The two-year implementation timeline provides MCOs and state programs time to assess potential pharmacy cost impacts and supply chain disruptions.
- Legal · TX
AstraZeneca Pays Texas $34M to Settle Medicaid Kickback Claims
AstraZeneca Pharmaceuticals LP agreed to pay $33,998,000 to Texas to resolve allegations that it provided illegal remuneration to healthcare providers in connection with prescriptions for drugs covered by the state's Medicaid program. The settlement addresses potential violations of anti-kickback statutes related to inducements tied to Medicaid prescribing. Texas Medicaid managed care organizations that reimbursed claims for the implicated drugs during the alleged period may have paid inflated costs tied to these arrangements. The settlement follows state enforcement action under Texas Medicaid fraud statutes.
- Federal Policy
CMS Proposes Tighter Remote Patient Monitoring Requirements in 2027 Physician Fee Schedule
CMS published a proposed rule on July 16, 2026, that would tighten requirements for remote patient monitoring (RPM) services in the Calendar Year 2027 Medicare Physician Fee Schedule. The changes respond to Office of Inspector General reports flagging program integrity concerns about RPM billing. The proposed rule affects how providers document and bill for remote monitoring services under Medicare. Comments on the proposed rule are typically due 60 days after publication in the Federal Register.