All stories
Jump to date
Saturday, August 29 · 36 stories
- Federal Policy
KFF Brief Details State Medicaid Enterprise Systems Spending and Federal Oversight
KFF published an informational brief examining the IT systems states use to administer Medicaid programs, including claims processing, eligibility determination, and provider enrollment. The brief covers federal funding mechanisms for state Medicaid IT systems, CMS oversight requirements for systems modernization projects, and common implementation challenges states face. It provides context on how states finance and manage enterprise systems critical to program operations, enrollment, and payment accuracy.
- Federal Policy
CMS Finalizes FY 2027 IRF Payment Rule with 2.6% Rate Increase
CMS issued the final rule for inpatient rehabilitation facility payment rates effective October 1, 2026. The rule implements a 2.6% payment rate increase for FY 2027, resulting in an estimated $280 million increase in aggregate IRF payments. The rule updates wage index values, adjusts the case-mix group relative weights, and modifies quality reporting program requirements. While the rule primarily affects Medicare IRF payments, it may have indirect implications for Medicaid beneficiaries who receive post-acute rehabilitation services in dual-eligible or Medicaid-participating IRFs.
- Federal Policy
CMS Issues FY 2027 Hospice Payment Rate Update and Quality Reporting Requirements
CMS released the final rule updating hospice wage index values and payment rates for FY 2027 (October 1, 2026 through September 30, 2027). The rule implements a market basket update and wage index changes affecting hospice reimbursement rates. It also finalizes modifications to the Hospice Quality Reporting Program, including quality measure updates and reporting requirements that hospices must meet to avoid payment reductions. The updates take effect October 1, 2026.
- Federal Policy
CMS Marks One-Year Anniversary of Health Technology Ecosystem Launch
CMS issued a readout celebrating the first year of its Health Technology Ecosystem initiative. The ecosystem aims to modernize health data exchange and interoperability across Medicare, Medicaid, and other programs. CMS highlights progress on data-sharing standards, API implementation, and partnerships with states and plans over the past year. For Medicaid managed care organizations and state agencies, this signals continued federal investment in technical infrastructure that will require ongoing system upgrades and compliance with evolving interoperability requirements.
- Federal Policy
CMS Proposes New Pathway for Immediate Medicare Coverage of FDA-Approved Devices
CMS issued a procedural notice inviting comment on a proposed pathway to align Medicare coverage determinations with FDA device approvals, potentially enabling immediate coverage for certain breakthrough medical devices upon FDA clearance. The notice seeks stakeholder input on framework design, eligibility criteria, and implementation mechanisms. Comments are due 60 days after Federal Register publication. If finalized, this pathway could reduce coverage uncertainty for medical device manufacturers and accelerate beneficiary access to innovative technologies, though Medicaid coverage determinations remain state-specific and not directly governed by Medicare pathways.
- Federal Policy · AK
CMS Awards $160 Million for Telehealth Technology Deployment in Alaska
CMS announced $160 million in funding to deploy advanced telehealth technologies in Alaska, including drone-based prescription delivery and surgical robotics. The initiative aims to expand access to care in rural and remote areas where traditional healthcare infrastructure is limited. State Medicaid agencies and managed care organizations serving Alaska beneficiaries will need to coordinate with providers on technology implementation and reimbursement frameworks. The funding represents a significant federal investment in addressing geographic barriers to care for Medicaid enrollees in frontier communities.
- Federal Policy · GA
CMS Awards $93.3 Million to Georgia for Telehealth Expansion and Rural Surgical Robotics
CMS awarded $93.3 million in federal funding to Georgia to expand telehealth services and advance surgical robotics in rural areas. The funding supports infrastructure for remote care delivery and robotic surgery capabilities in underserved communities. Awards are available immediately for eligible Georgia providers and health systems. The investment aims to address rural healthcare access gaps that affect Medicaid beneficiaries who rely on safety-net providers in non-urban areas.
- Federal Policy · VA
CMS Awards Virginia $122 Million for Healthcare Access and Workforce Expansion
The Trump Administration announced $122 million in federal funding for Virginia to expand healthcare access, strengthen the healthcare workforce, and support innovation. The funding will support multiple programs including Medicaid initiatives, community health centers, and workforce training. Details on specific allocation amounts, eligible providers, and timeline for fund distribution were not provided in the announcement. The funding reflects broader federal efforts to address healthcare workforce shortages and access gaps in states.
- Federal Policy
CMS Launches ACCESS Accountable Care Innovation Model for Providers
The Centers for Medicare and Medicaid Services has developed ACCESS, a new accountable care model for healthcare providers and organizations. The model represents CMS's latest approach to value-based care arrangements, offering an alternative framework for providers considering accountable care participation. Healthcare organizations are evaluating whether the model aligns with their operational capabilities and patient populations. The model follows CMS's broader strategy of expanding alternative payment models beyond traditional fee-for-service arrangements.
- Federal Policy
MACPAC Submits Comment Letter on Medicaid Program Integrity to CMS
The Medicaid and CHIP Payment and Access Commission (MACPAC) submitted a comment letter to CMS in response to a request for information on combatting fraud, waste, and abuse in federal health care programs. MACPAC's letter addresses four areas: eliminating ineffective or redundant program integrity activities and requirements, promoting high-value program integrity activities, identifying barriers to program integrity, and providing evidence-based findings and recommendations. The comment letter reflects MACPAC's policy research and advisory role to Congress on Medicaid program integrity issues.
- Federal Policy
CMS Issues FY 2027 IPPS Final Rule with Limited Medicaid Provisions
CMS released the FY 2027 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS final rule, effective October 1, 2026. The rule primarily updates Medicare payment rates and policies for acute care hospitals and LTCHs. While the rule focuses on Medicare reimbursement, hospitals participating in both Medicare and Medicaid may see operational impacts related to quality reporting, graduate medical education, and uncompensated care payment adjustments that can affect their broader financial position. The rule has minimal direct Medicaid policy implications but may influence hospital participation and capacity in both programs.
- Federal Policy
MACPAC Issues March 2026 Report with HCBS Workforce Recommendation and Behavioral Health Analysis
The Medicaid and CHIP Payment and Access Commission (MACPAC) released its March 2026 Report to Congress covering four policy areas: a recommendation to strengthen the home- and community-based services workforce, behavioral health services in Medicaid and CHIP, Medicaid coverage for justice-involved youth, and coverage for children in foster care. The report was delivered to Congress in March 2026. MACPAC reports typically inform federal legislative activity and CMS policy development, particularly regarding long-term services and supports financing, behavioral health integration, and coverage for vulnerable populations.
- Federal Policy
MACPAC Analyzes Fraud, Waste, and Abuse Measurement in Medicaid Program Integrity
The Medicaid and CHIP Payment and Access Commission (MACPAC) released an issue brief examining fraud, waste, and abuse in Medicaid using government data sources. The brief defines these program integrity concerns, reviews measurement methodologies, and provides an overview of federal and state program integrity responsibilities. The analysis identifies documented instances of integrity issues across the Medicaid program. This resource offers Medicaid agencies and managed care organizations a framework for understanding program integrity risks and measurement approaches as they design compliance and oversight strategies.
- Federal Policy
MACPAC Comments on Proposed Rule for Interoperability Standards and Drug Prior Authorization
The Medicaid and CHIP Payment and Access Commission submitted comments to HHS Secretary Robert F. Kennedy, Jr. on proposed rulemaking addressing interoperability standards and prior authorization requirements for prescription drugs. The proposed rule would implement new interoperability standards for payers, including state Medicaid programs and managed care plans. MACPAC's letter provides the Commission's assessment of the rule's provisions and their potential impact on Medicaid program operations, drug access, and administrative burden for states and plans.
- Federal Policy
CMS Releases State Toolkit for ABA Oversight and Autism Service Protections
CMS published a new toolkit to help states strengthen oversight of Applied Behavior Analysis (ABA) services for children with autism in Medicaid and CHIP. The toolkit provides guidance on monitoring provider qualifications, service quality, and care coordination to prevent harmful practices and ensure medically necessary treatment. States can use the resources immediately to enhance program integrity and beneficiary protections. This matters because ABA is a significant behavioral health expenditure across state Medicaid programs, and inconsistent oversight has led to quality concerns and potential fraud.
- Federal Policy · WA
CMS Announces Emergency Flexibilities for Washington State Public Health Crisis
CMS has announced emergency resources and regulatory flexibilities to assist Washington state in responding to a declared public health emergency. The flexibilities allow the state to modify service delivery requirements, adjust provider enrollment procedures, and access expedited waiver authority. These measures take effect immediately and remain in place for the duration of the emergency declaration. The announcement provides operational relief for Washington's Medicaid program, enabling rapid response to urgent health system needs without standard administrative timelines.
- Federal Policy · ND
CMS Awards North Dakota Funding for Coordinating and Connecting Care Initiative
CMS has approved funding for North Dakota to launch the Coordinating and Connecting Care Initiative, a program designed to improve care coordination and integration across Medicaid services. The initiative targets beneficiaries with complex medical and behavioral health needs, including those requiring long-term services and supports. Implementation details, effective dates, and specific funding amounts were not provided in the available information. The program aims to reduce fragmentation in care delivery and improve health outcomes for high-needs Medicaid populations.
- Federal Policy
CMS Updates SSI and Spousal Impoverishment Standards for 2026
CMS released updated Supplemental Security Income (SSI) and spousal impoverishment standards effective for 2026. The bulletin provides revised income and resource thresholds that states must apply when determining Medicaid eligibility for aged, blind, and disabled individuals, as well as protections for spouses of institutionalized individuals. These standards affect eligibility determinations for coverage of long-term services and supports. State Medicaid agencies must implement these updated figures in their eligibility systems and processes.
- Federal Policy
CMS Issues 2026 Federal Poverty Level Standards for Medicaid Eligibility
CMS released the 2026 Federal Poverty Level standards in an informational bulletin dated January 23, 2026. The updated income thresholds apply to Medicaid and CHIP eligibility determinations starting February 2026. States must update their eligibility systems and Modified Adjusted Gross Income (MAGI) conversion tables to reflect the new FPL amounts. The guidance affects income-based eligibility for millions of Medicaid and CHIP beneficiaries nationwide, requiring states to adjust eligibility thresholds and redetermination processes.
- Federal Policy
MACPAC June 2026 Report Addresses Community Engagement, Prior Authorization Automation, MCO Accountability
The Medicaid and CHIP Payment and Access Commission released its June 2026 Report to Congress covering seven policy areas. Key chapters examine community engagement requirements in Medicaid, automation in prior authorization processes, managed care accountability mechanisms, access to residential treatment services for Medicaid-enrolled youth, and transitions to adult coverage for children and youth with special health care needs. The report provides policy recommendations and analysis for congressional consideration on these topics. MACPAC reports typically inform federal legislative and regulatory activity in Medicaid and CHIP.