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Tuesday, July 21 · 15 stories
- Federal Policy · OR
Eastern Oregon Healthcare Sees Federal Funding Boost Amid Anxieties About Medicaid Cuts
Congress has allocated $50 billion over five years for rural healthcare programs, including facilities in Eastern Oregon. The funding represents less than one-tenth of projected Medicaid funding losses anticipated over the next decade. The allocation comes amid broader concerns about federal Medicaid cuts that could disproportionately affect rural safety-net providers. The timing and distribution mechanisms for the rural health funding have not been specified.
- Federal Policy
HHS Corrects Technical Errors in 2027 ACA Payment Parameters Final Rule
The Department of Health and Human Services published a correction to the 2027 Notice of Benefit and Payment Parameters final rule, originally issued May 20, 2026. The correction addresses typographical errors in the rule governing qualified health plan standards, risk adjustment, and the Basic Health Program. These are technical corrections only and do not change the substantive policy or operational requirements established in the May rule. The corrections are effective immediately upon publication.
- State Policy · OH
Ohio Legislature Debates Bill to End Medicaid Managed Care for 3 Million Enrollees
Ohio lawmakers are considering Senate Bill 386 and a House companion bill, the Medicaid Savings Act, which would dismantle the state's Medicaid managed care system currently serving approximately three million enrollees. The bipartisan legislation would shift Ohio away from its managed care delivery model. The bill is under active debate in Statehouse committee rooms. If enacted, this would represent one of the largest managed care program terminations in recent state Medicaid history, affecting every MCO operating in Ohio.
Monday, July 20 · 23 stories
- Industry
KFF Poll Finds Public Uncertainty Dominates Vaccine Myth Responses
A new KFF tracking poll on health information and trust reveals that uncertainty over common vaccine myths is more prevalent among the public than firm belief or denial. The analysis categorizes respondents into consistent myth believers, consistent myth deniers, and a "mixed middle" group that expresses uncertainty. The poll provides insight into public attitudes that may affect vaccine uptake and health plan member engagement strategies. Results suggest health plans may need tailored communication approaches for populations with varying levels of vaccine hesitancy and misinformation exposure.
- Industry
Clover Health Discloses Data Breach in Securities Filing
Clover Health reported a data breach in a securities filing last week. The Medicare Advantage insurer has not yet determined what type of data was exposed or how many individuals were affected. The company is investigating the incident and has not provided a timeline for breach notification or remediation. Clover operates Medicare Advantage plans in multiple states and serves tens of thousands of enrollees.
- State Policy
Georgia and Maine Evaluate Respite Care Programs to Improve Caregiver Outcomes
Georgia and Maine conducted evaluations of their respite care programs to assess effectiveness in supporting family caregivers and inform future state investments. The evaluations examined how respite services affect caregiver burden, health outcomes, and care continuity for individuals receiving long-term services and supports. Results are being used to guide state policy decisions on respite service design, reimbursement levels, and eligibility criteria. This work reflects growing state focus on caregiver support as a cost-effective strategy to maintain community-based care and reduce institutional placement.
- Managed Care
Dementia Care Facilities Face Resident-on-Resident Violence Despite Oversight
An examination of health inspection reports and court records by KFF Health News reveals recurring violence between residents with dementia in nursing homes and assisted living facilities, including fatal assaults. The review documents patterns where facilities miss warning signs and fail to implement adequate safeguards to prevent resident-on-resident incidents. The findings highlight systemic gaps in dementia care protocols and supervision practices across long-term care settings. For Medicaid managed care organizations contracting with these facilities for long-term services and supports, the findings underscore quality oversight and member safety obligations.
- Federal Policy
CMS Launches Risk-Based Survey Process for Higher-Performing Nursing Homes September 8
CMS announced nationwide implementation of a Risk-Based Survey process for qualifying nursing homes starting September 8, 2026, per QSO-26-14-NH. The RBS allows State Survey Agencies to use fewer resources surveying higher-performing facilities and redirect them toward lower-performing providers. Qualifying facilities must meet specific performance thresholds to be eligible for the streamlined survey approach. This changes how survey resources are allocated across skilled nursing facilities participating in Medicare and Medicaid.
- Managed Care
Specialty Pharmacy Economics Require Comprehensive Cost Management Beyond Drug Trend
Specialty drug costs continue rising, but traditional specialty drug trend metrics fail to capture the full economic picture for payers. A comprehensive view of specialty pharmacy economics includes rebates, dispensing fees, patient assistance programs, and site-of-care differentials that significantly affect net costs. Managed care organizations that analyze total cost of care rather than gross trend alone can identify opportunities to steer utilization to lower-cost sites and negotiate more favorable arrangements with specialty pharmacies and manufacturers. The analysis suggests payers should evaluate specialty pharmacy performance using net cost metrics that account for all payment flows, not just claims data.
- Federal Policy
CMS Updates PAMA Lab Data Reporting FAQ Ahead of July 31 Deadline
The Centers for Medicare & Medicaid Services has released an updated FAQ on Protecting Access to Medicare Act private payer data reporting requirements for hospital outreach laboratories. The deadline is July 31, 2026, for laboratories to report private payer clinical diagnostic laboratory data for services furnished during the first six months of 2025. Reporting must include Healthcare Common Procedure Coding System codes, associated private payer rates, and volume data. CMS has published a guide and additional resources to help hospital outreach laboratories determine their reporting obligations.
- Federal Policy
NBC News Seeks Sources on Medicaid Work Requirement Implementation Effects
NBC News is soliciting interviews with Medicaid beneficiaries, providers, and advocates regarding impacts of newly implemented Medicaid work requirements. The outlet is gathering first-hand accounts of how work mandates are affecting access to coverage and care delivery. This follows federal approval of state Section 1115 waivers authorizing work and community engagement requirements as a condition of Medicaid eligibility. The solicitation indicates work requirements are now actively in effect in at least some states, triggering coverage losses or administrative burdens for beneficiaries and compliance obligations for managed care plans.
- Federal Policy
CMS Proposes Major Changes to Remote Monitoring Payment in 2027 Fee Schedule
CMS released the calendar year 2027 Medicare Physician Fee Schedule proposed rule on July 14, 2026, proposing significant changes to payment and coverage requirements for remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) services. The changes respond to Office of Inspector General scrutiny of these services. The proposed rule affects how Medicare pays for remote monitoring services used in chronic disease management and post-discharge care. Comments on the proposed rule are typically due 60 days after publication in the Federal Register.
- Legal
Federal Judge Blocks CMS Rule Expanding Catastrophic ACA Plans
A federal judge issued a stay Thursday halting implementation of a CMS final rule that would have expanded access to catastrophic health plans in the ACA marketplace. The court found the policies were likely to increase costs and reduce access to comprehensive coverage. The ruling blocks the administration's changes pending further litigation. While the decision directly affects the ACA individual market, Medicaid managed care organizations operating in dual or integrated programs may see indirect effects on coverage transitions and risk pool composition.
- State Policy · MS
Mississippi Exchange Premiums Rise as State Remains Without Medicaid Expansion
Health insurance premiums on Mississippi's federally-facilitated marketplace continue to increase while the state has not expanded Medicaid eligibility under the Affordable Care Act. Low-income workers above the poverty line face higher out-of-pocket costs for exchange coverage, while those below 100% of the federal poverty level remain ineligible for both exchange subsidies and Medicaid. The coverage gap affects Mississippi residents who would qualify for Medicaid in expansion states but have no affordable coverage option in Mississippi. Mississippi is one of ten states that have not adopted Medicaid expansion as of 2026.
- Managed Care · MS
Mississippi Delta Hospital Closure Spurs Local Reopening Campaign After Maternal Death
Local leaders in Mississippi's Delta region are attempting to reopen a closed rural hospital following the 2021 roadside death of Harmony Ball-Stribling, a pregnant woman, and her unborn daughter. The closure left the community without nearby obstetric and emergency services. The effort faces substantial obstacles, as rural hospital closures are rarely reversed once facilities shut down. The campaign highlights ongoing maternal health access challenges in rural Medicaid populations, particularly in states with limited maternity care infrastructure.
- Federal Policy
Medicare Part D Now Covers GLP-1s for Weight Loss Under New CMS Policy
Insurance coverage for GLP-1 medications used for weight loss has changed for approximately 56 million Americans. The policy shift affects Medicare Part D beneficiaries and potentially other federal health programs. The coverage expansion comes as GLP-1 drugs like Ozempic and Wegovy gain widespread use for obesity treatment. Medicare previously covered these medications only for diabetes, not weight management alone, making this a significant benefit expansion with major cost implications for plans and enrollees.
- State Policy · FL
Florida Counties Face $420M Medicaid Bill as Property Tax Revenue Declines
Florida's 67 counties will pay nearly $420 million toward state Medicaid spending this fiscal year, according to state economists. Miami-Dade County faces the largest share at $69.4 million, followed by Broward at $34.7 million and Hillsborough County. The county obligation comes as Florida counties anticipate declining property tax revenue. This county-level Medicaid cost-sharing arrangement represents mandatory local government contributions to the state's Medicaid program budget.
- Federal Policy
Federal Public Health Cuts Hamper Response to Cyclosporiasis Outbreak
Reduced federal disease surveillance capacity and public health staffing cuts are hampering state and federal response to a cyclosporiasis outbreak, according to public health experts. Michigan issued warnings in early July after detecting cases, but officials cite diminished federal support for tracking foodborne illnesses. The outbreak comes amid broader reductions in CDC surveillance programs and staffing. The article links these capacity constraints to recent federal budget cuts affecting public health infrastructure.
- State Policy · NE
Nebraska Secures Temporary Medicaid Work Requirement Waiver for Dawson County After Plant Closure
Federal officials approved a temporary hardship exemption from Nebraska's Medicaid work requirements for Dawson County following the closure of a Tyson Foods plant that eliminated approximately 3,000 jobs. Governor Jim Pillen directed the state Department of Health and Human Services to request the exemption last month. The waiver temporarily suspends work requirement compliance for affected Medicaid enrollees in the county. This represents a significant operational accommodation for managed care organizations serving the region, as they will need to adjust eligibility tracking and member communications during the exemption period.
- State Policy
KFF Examines State Strategies to Protect Pregnant Women from Medicaid Work Requirements
KFF published an analysis examining how states may structure Medicaid work reporting requirements to protect coverage for pregnant and postpartum women. The analysis reviews state options for exemptions, verification processes, and coverage continuity mechanisms as states implement work and community engagement requirements. States must balance federal compliance with maternal health access as work requirements return to consideration. For managed care organizations, the analysis highlights operational challenges in identifying exempt populations, managing enrollment disruptions, and maintaining continuity of prenatal and postpartum care under varying state policies.