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Wednesday, July 1 · 12 stories
- Federal Policy
CMS Schedules Webinar on Interim Final Rule for Medicaid Community Engagement Requirements
The Centers for Medicare and Medicaid Services will host a webinar on July 9, 2026 from 12-1 p.m. ET to discuss an interim final rule on Medicaid community engagement requirements. The webinar follows CMS's issuance of new federal regulations governing work and community engagement provisions in state Medicaid programs. The session will provide technical guidance on the rule's implementation requirements and compliance expectations. Managed care organizations operating in states pursuing community engagement waivers will need to understand reporting, enrollment, and member communication obligations under the new federal framework.
- Legal · NY
HHS OIG Suspends Federal Funding to New York Medicaid Fraud Unit
The HHS Office of Inspector General notified New York on June 30 that federal grant funds to the state's Medicaid fraud control unit are suspended effective July 1, 2026. The unit receives approximately $60 million annually in federal funding. The suspension affects the state's capacity to investigate and prosecute Medicaid fraud, including cases involving managed care organizations. No end date for the suspension was specified in the OIG letter.
- Industry
Four Chemotherapy Drugs Remain in Shortage Until October
Cisplatin, carboplatin, oxaliplatin, and ifosfamide remain in active shortage, with full resupply of some formulations not expected until October 2026, according to the American Society of Health-System Pharmacists. These chemotherapy drugs are essential for treating breast, lung, ovarian, testicular, bladder, and head and neck cancers. Manufacturers have provided updated timelines for when supply will normalize. The shortages affect hospitals and health systems managing cancer treatment protocols.
- Managed Care
Hurricane Flooding Extends Home Health Treatment Times by Two Weeks
New research finds that hurricanes and related flooding cause significant disruptions to home health services, adding nearly two weeks to treatment times and reducing rates of successful discharge to the community. The decentralized structure of home health care makes both providers and payers particularly vulnerable to extreme weather events. The findings highlight operational and quality risks for managed care organizations that contract for home-based services, especially those serving dual-eligible populations and members with complex care needs who rely on consistent in-home support.
- State Policy · CA
California Schools Face Delays Implementing Newsom Mental Health Initiative Five Years After Launch
Five years after Governor Gavin Newsom launched an initiative to center mental health services in California public schools, many schools have struggled to implement the program and hundreds have not yet begun participation. The initiative aimed to transform schools into hubs for youth mental health services, but implementation challenges have delayed rollout across the state. The slow adoption affects access to behavioral health services for Medicaid-eligible children who rely on school-based care. No specific timeline for expanded implementation was reported.
- Federal Policy
Georgetown Hosts Webinar on Medicaid Federal-State Financing Basics
The Georgetown University Center for Children and Families held a webinar on June 30, 2026 covering foundational Medicaid financing concepts. The session explained the federal-state partnership structure, mandatory federal funding not subject to annual appropriations, and state financing mechanisms for their matching share. The webinar targeted audience members seeking to understand basic Medicaid funding mechanics. A recording will be made available on Georgetown's website.
- State Policy · WA
Washington State Launches WA Cares Long-Term Care Insurance Program July 1
Washington's WA Cares Fund, the nation's first publicly administered long-term care insurance program, begins providing coverage on July 1, 2026. The program offers eligible workers up to $36,500 in lifetime benefits for long-term services and supports, funded through a 0.58% payroll tax. Dozens of applications have already been submitted. The launch follows years of legislative debate and program delays since the payroll tax collection began in 2023.
- Federal Policy · WA
CMS Launches WISeR Gold Card Exemption Program July 6 in Washington State
CMS will launch the WISeR (Worthy of Individual Systematic Exemption and Review) gold-carding exemption program on July 6, 2026, in Washington state, with quarterly rollouts planned for five additional states. The program exempts certain high-performing providers from prior authorization requirements based on performance metrics. Medicaid managed care organizations operating in Washington and the subsequent rollout states will need to implement gold card criteria and modify prior authorization workflows. The initiative aims to reduce administrative burden for providers with strong approval track records while maintaining utilization management oversight for other providers.
- State Policy · NJ
New Jersey Legislature Passes Employer Fee Targeting Firms With 50+ Medicaid-Enrolled Workers
New Jersey lawmakers approved legislation imposing fees on employers with at least 50 workers enrolled in Medicaid, projected to generate $145 million in state revenue. The fee targets companies whose employees rely on public coverage, effectively shifting costs to employers for their workforce's health benefits. The measure now heads to the governor for signature. This represents a novel state financing mechanism that could affect Medicaid managed care enrollment patterns and employer benefit decisions.
- State Policy · MT
Montana Lacks Staff and Data Systems as Medicaid Work Requirements Near Implementation
Montana's health department has not hired the staff needed to review work requirement applications and lacks access to claims data required to verify medical exemptions as implementation approaches. The state only recently identified qualifying diagnoses for exemptions. These operational gaps raise questions about the state's readiness to administer work requirements without inappropriate coverage losses. The timing and specific effective date are not specified in the available content.
- State Policy · WI
Wisconsin Postpartum Medicaid Extension Takes Effect July 1, Covering 16,000 Mothers
Wisconsin's 12-month postpartum Medicaid coverage extension becomes effective July 1, 2026, extending coverage from the previous 60-day limit. The state became the 49th to adopt the extension when legislation was signed in March 2026. The Wisconsin Department of Health Services estimates the policy will provide continuous coverage to approximately 16,000 mothers annually. The extension addresses maternal health outcomes and coverage continuity for postpartum enrollees in Wisconsin's Medicaid program, including managed care plans.
- Federal Policy
AHA Opposes Bill Adding IRS Schedule H Reporting Requirements for Tax-Exempt Hospitals
The American Hospital Association submitted comments June 30 to the House Ways and Means Committee opposing H.R. 9504, the Tax-Exempt Hospital Transparency Act, ahead of a scheduled July 1 markup. The bill would add reporting requirements to hospitals' Schedule H IRS forms, affecting nearly two-thirds of all hospitals. While the AHA acknowledged improvements from an earlier draft — including removal of a parallel for-profit tax calculation and inclusion of standardized definitions — it maintains serious concerns about administrative and financial burdens, particularly requirements focused on financial assistance reporting that exclude Medicaid shortfall and other community benefit components. The bill includes carve-outs for small facilities but still requires eventual compliance.
Tuesday, June 30 · 12 stories
- Managed Care
Cityblock CEO: Most Health Care AI Invests in Billing, Not Care Delivery
Dr. Toyin Ajayi, CEO of Cityblock Health, argues that approximately 60 percent of health care AI investment focuses on billing, coding, and risk adjustment rather than care delivery. Cityblock serves over 100,000 Medicaid and dual-eligible members across ten states. Ajayi contends that redirecting AI investment toward care delivery for high-need populations can lower costs while improving outcomes. She discusses how Cityblock currently uses AI to enhance care and patient experience for Medicaid managed care enrollees.
- Federal Policy
GAO Adds Fourth Priority Recommendation for Social Security Administration
The Government Accountability Office identified one additional priority recommendation for the Social Security Administration in June 2026, bringing the total to four open priority recommendations. SSA has not implemented any of the three recommendations GAO identified in May 2025. The priority areas include preventing potential overpayments in Disability Insurance, improving online application access for Social Security benefits, and managing IT investments cost-effectively. GAO emphasizes these recommendations warrant urgent attention from SSA leadership to strengthen internal controls, improve service delivery, and identify opportunities for efficiency and cost savings.
- State Policy
NASHP Releases Five-State Behavioral Health Workforce Policy Academy Results
The National Academy for State Health Policy published findings from a multi-state policy academy focused on strengthening the behavioral health workforce. Five states participated in the initiative to develop and implement workforce development strategies. The report includes success stories and resources documenting state-level approaches to addressing provider shortages and building capacity. The findings are relevant to Medicaid managed care organizations operating in states that participated or considering similar workforce development partnerships with state agencies.
- Federal Policy
Trump Administration Obesity Drug Agreement Faces Implementation Issues
The Trump administration's negotiated agreement with Eli Lilly and Novo Nordisk regarding obesity medication pricing and coverage is encountering implementation problems. The deal, which was intended to expand access to GLP-1 medications while controlling costs, contains unspecified loopholes or structural issues affecting its execution. The problems impact how these high-cost medications are covered and reimbursed under federal health programs. Medicaid managed care organizations should monitor whether state programs adjust coverage policies or capitation rates in response to these federal-level complications.
- Legal · TX
AstraZeneca Pays $34 Million to Settle Texas Medicaid Kickback Claims
AstraZeneca agreed to pay $34 million to resolve allegations brought by the Texas Attorney General that the company paid kickbacks to improperly influence prescriptions reimbursed by Texas Medicaid. The settlement resolves claims that the pharmaceutical manufacturer violated anti-kickback statutes through payments that influenced prescribing behavior for drugs covered under the state's Medicaid program. The settlement does not include an admission of liability but ends the state's enforcement action against the company.
- Industry
PBM Trade Group Escalates Advocacy Against Drugmakers Following Congressional Overhaul
The leading pharmacy benefit manager lobbying organization is intensifying its advocacy campaign against pharmaceutical manufacturers after Congress enacted comprehensive PBM reform legislation earlier this year. The pharmaceutical industry has long blamed PBMs for high drug costs, culminating in legislative action this past winter. The lobbying escalation suggests ongoing tension between PBMs and drugmakers over responsibility for drug pricing and the implementation of new federal oversight provisions that affect both sectors.
- Managed Care · IL
Chicago Safety-Net Hospital Faces Closure Over Medicaid MCO Payment Delays
Roseland Community Hospital on Chicago's South Side is struggling to make payroll due to delayed payments from CountyCare, Cook County's largest Medicaid managed care organization. The facility barely met its June 30 payroll and CEO Tim Egan described the financial situation as critical. The hospital serves a predominantly Medicaid population in an underserved area. Payment delays from Medicaid MCOs threaten the facility's ability to remain operational.
- Federal Policy
ONC Awards New Contract to Oversee TEFCA Data Exchange Framework
The Office of the National Coordinator for Health Information Technology (ONC) has awarded a new contract to oversee the Trusted Exchange Framework and Common Agreement (TEFCA), the federal framework governing nationwide health information exchange. The move comes as the volume of health records exchanged through TEFCA increases significantly. The new oversight contractor will monitor compliance with TEFCA's technical and legal requirements for data sharing among qualified health information networks. This expansion of oversight signals federal emphasis on ensuring secure, standardized data exchange as TEFCA adoption accelerates.