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Monday, September 28 · 31 stories
- State Policy · IN
Indiana Projects $5.3 Billion in Reserves by June 2027
Indiana closed fiscal year 2026 with nearly $4 billion in reserves and projects $5.3 billion in reserves by June 30, 2027 — 22% of revenues — as monthly collections have exceeded forecasts for ten consecutive months. Not all reserves are available for new spending: the total includes dedicated funds for Medicaid contingency ($274.7 million), state tuition ($739.6 million), and the Rainy Day Fund ($1.12 billion), and over $1.1 billion may be needed to reimburse the highway fund for the summer gas tax holiday. If reserves exceed 12.5% of appropriations in 2027, state law triggers an automatic taxpayer refund. The state's FY 2026-2027 budget cut real spending by 7% after April 2025 revenue forecasts fell short; legislators may revisit those cuts if the December 2026 forecast shows continued growth.
- State Policy · OH
Ohio Infant Mortality Rate Falls to 6.6 per 1,000 Births, Black Infants Still Die at 2.5 Times White Rate
Ohio's infant mortality rate dropped to 6.6 deaths per 1,000 live births, the lowest in a decade, but remains above the national average of 5.36. Black infants die at a rate of 12.6 per 1,000 births — more than 2.5 times the white infant rate of 5.1 — and providers report systemic disrespect and racism in care delivery. The state's latest biennial budget allocated $18 million annually for infant vitality programs, down from the House's proposed $20 million, and $5 million for maternal health programs, down from the governor's $7.5 million request. Advocates cite recent federal Medicaid funding cuts — estimated to cost Ohio $33 million over 10 years — as contributing to rural maternity ward closures and reduced access for Medicaid-eligible pregnant individuals.
- Federal Policy · TX
CMS Awards $51 Million for Rural Texas Nutrition and Chronic Disease Prevention Programs
CMS announced a $51 million federal funding award for nutrition and chronic disease prevention programs targeting rural Texas communities. The award aims to address health disparities in rural areas through improved access to nutrition services and chronic disease management. The programs will affect Medicaid beneficiaries in rural Texas counties through expanded community-based health interventions. This funding matters for state Medicaid agencies and managed care organizations operating in rural Texas markets, as it may create new care coordination requirements and community partnership opportunities to address preventable chronic conditions among Medicaid populations.
- Industry
Centene Reports Multiple Executive Departures Following $6.7 Billion Loss
Centene has experienced widespread leadership turnover in 2026, spanning state health plan executives to C-suite roles, following a $6.7 billion loss in 2025. The loss was primarily driven by a non-cash goodwill impairment related to HR 1 and the company's declining market value, alongside a 91.9% medical loss ratio. The departures signal organizational instability at one of the nation's largest Medicaid managed care organizations. Centene serves Medicaid beneficiaries across more than 30 states, making leadership continuity significant for state agency oversight and member care continuity.
- State Policy · OR
Oregon Providers Sue to Block Rule Prioritizing Criminal Defendants for Mental Health Beds
Oregon mental health providers and hospitals challenged a 2025 state rule requiring residential facilities to prioritize criminal defendants from the Oregon State Hospital over civil and voluntary patients, regardless of clinical need. The Oregon Health Authority adopted the rule to comply with a federal court order requiring the state to admit criminal defendants from jail to the state hospital within one week, with contempt fines exceeding $4 million. Providers argue the rule discriminates against non-forensic patients, commandeers private facilities to fulfill state obligations, and undermines clinical decision-making. The merged case was heard by the Oregon Court of Appeals on September 22, 2026, with no decision timeline announced.
- State Policy · CO
Colorado Considers Cutting Peer Support Services After 286% Cost Increase
Colorado lawmakers are targeting cuts to Medicaid-funded peer support services for addiction recovery after program spending increased 286% since the state authorized payment for peer counseling in 2021 through bipartisan legislation. The rapid cost growth has prompted state officials to examine whether to scale back or restructure the benefit. The timing of any benefit changes has not been announced. This matters for managed care organizations and behavioral health providers delivering substance use disorder services through Colorado Medicaid, as peer support has become a standard component of recovery-oriented care models.
- Federal Policy
CMS Launches Quality Partnership With 37 States to Shift Medicaid Measures Toward Health Outcomes
CMS announced a new quality measurement partnership with 37 states to refocus Medicaid quality metrics on health outcomes rather than process measures. The initiative launches immediately and will develop and test outcome-based measures over the next 18 to 24 months. The shift affects how state Medicaid agencies and managed care plans will be evaluated for quality performance, requiring changes to quality strategies, managed care contracts, and potentially capitation rate methodologies. States participating in the partnership will pilot new outcome measures before broader adoption across the Medicaid program.
Friday, September 25 · 27 stories
- Legal
Labcorp Settles Multistate Data Breach Investigation for $2.28 Million
Labcorp agreed to pay $2.28 million to 44 state attorneys general to resolve an investigation into a 2019 data breach at its former debt-collection vendor, American Medical Collection Agency (AMCA). The breach at AMCA's parent company, Retrieval-Masters Creditors Bureau, exposed personal information of more than 27.5 million people nationwide. The settlement resolves state enforcement actions stemming from the vendor's inadequate data security practices. For Medicaid managed care organizations and providers using third-party vendors for billing and collections, this enforcement action underscores state regulators' willingness to hold covered entities accountable for vendor data security failures affecting patient information, including Medicaid beneficiaries.
- Industry
Report Finds 340B Hospitals Spend Less on Charity Care Than Non-340B Peers
A new report finds hospitals participating in the 340B drug pricing program spend less on charity care than non-participating hospitals, contrary to the program's intent to support safety-net care. The findings intensify ongoing debate over 340B program integrity and whether participating hospitals deliver commensurate community benefits. Critics argue the program has expanded without corresponding patient benefits, while hospital groups dispute the methodology of such studies. The report has no immediate regulatory implications but may inform future congressional or CMS oversight of 340B hospital eligibility and accountability measures.
- Industry
Home-Based Care Providers Deploy AI, Outreach to Address Referral Bottlenecks
Home-based care providers report that referral processing, maintenance, and development remain persistent operational challenges, according to industry leaders interviewed by Home Health Care News. Companies are responding with AI-powered tools, clinician-led outreach initiatives, and strengthened relationships with franchise owner-operators to streamline referral workflows. These operational adjustments aim to reduce administrative friction in care coordination. For Medicaid managed LTSS and home and community-based services programs relying on home-based care networks, improvements in referral efficiency may affect network adequacy and care access.
- Federal Policy
Census Bureau Proposes Eliminating Race and Ethnicity Data Collection
In September 2026, the Census Bureau issued a proposed rule that would prohibit the collection of race and ethnicity data in the decennial census and exclude many noncitizen immigrants from the apportionment count. The changes would affect how Medicaid programs identify disparities in access, quality, and outcomes for beneficiaries. If finalized, the rule would limit state Medicaid agencies' and managed care organizations' ability to stratify performance data, target interventions, and comply with federal health equity reporting requirements that rely on census-based demographic benchmarks. The proposed changes matter because Medicaid programs use census race and ethnicity data to establish stratified quality measures, identify underserved populations for outreach and enrollment, and allocate resources for programs addressing maternal health, behavioral health, and chronic disease disparities.
- Legal · TN
Planned Parenthood Sues Tennessee AG Over Investigation Demanding Patient Records, Donor Details
Planned Parenthood of Tennessee and North Mississippi filed a legal challenge in Davidson County Chancery Court on Wednesday to block Attorney General Jonathan Skrmetti's investigative demand for donor information, provider credentials, and medical records of patients who received abortion referrals or gender-affirming care. The Sept. 3 demand letter targets the organization's post-abortion-ban services — providing information and out-of-state abortion referrals — and seeks records of patients treated for gender dysphoria, including named individuals and all minors who received gender-affirming care after July 1, 2023, when Tennessee's ban on such care for minors took effect. Planned Parenthood argues the demands violate free speech protections and constitute political intimidation; the AG's office says it has authority to request information when state law violations may have occurred. Abortion Care Tennessee disclosed this week it faces a similar investigation targeting medication abortion referral services.
- Federal Policy
New Customs Requirements Set to Disrupt Canadian Prescription Imports October 22
The Wall Street Journal reports that new customs requirements taking effect October 22, 2026, could disrupt access to prescription drugs for millions of Americans who purchase medications from Canadian and other foreign mail-order pharmacies. The change affects individuals who rely on imported pharmaceuticals for cost savings. The timing and scope of enforcement will determine how many consumers and which medication categories face immediate supply interruptions. For Medicaid programs, this could increase formulary pressure if beneficiaries who previously self-paid for imported drugs now seek coverage through state plans, and may affect dual-eligible populations managing Medicare Part D coverage gaps.
- Federal Policy
AHA Urges Permanent Ban on 340B Rebate Models in SECURE 340B Act Comments
The American Hospital Association submitted comments on September 23 supporting the bipartisan SECURE 340B Act introduced in July, urging Congress to permanently prohibit rebate models in the 340B drug pricing program. The legislation combines hospital-sought protections with new program requirements. AHA stated it shares the bill's goals while seeking the rebate ban provision. This affects how safety-net hospitals and Medicaid providers access discounted pharmaceuticals under 340B, with potential implications for pharmacy carve-outs and drug purchasing arrangements in Medicaid managed care.
- Legal
Warren, Wyden Introduce Bill to Ban Corporate Practice of Medicine Nationwide
In its September 25 publication, Foley & Lardner reports that Senators Elizabeth Warren, Ron Wyden, and Jeff Merkley, along with three House members, introduced the Stop Corporate Takeovers of Physicians Act on September 16, 2026. The legislation would impose federal restrictions on corporate practice of medicine (CPOM), targeting private equity ownership structures and management services organization (MSO) arrangements commonly used in physician practice acquisitions. If enacted, the bill would affect how private equity firms and corporate entities structure their investments in physician practices, potentially requiring restructuring of existing MSO-based transactions that rely on management agreements to circumvent state CPOM restrictions. The legislation matters for Medicaid managed care organizations and providers because many MCO networks include physician groups owned through MSO structures, and federal CPOM restrictions could disrupt network composition, provider contracting models, and care delivery arrangements.
- Legal
DOJ and State MFCU Enforcement Rises in Applied Behavior Analysis Billing
Epstein Becker & Green reports that Department of Justice and state Medicaid Fraud Control Unit enforcement activity targeting applied behavior analysis (ABA) providers has increased. The firm advises ABA providers to strengthen compliance programs by monitoring state Medicaid billing rules, scope-of-practice requirements, CMS guidance, and recent OIG audit findings. No specific enforcement actions or effective dates are identified. The guidance addresses compliance risk management for ABA providers billing Medicaid, particularly for behavioral health services.
- Federal Policy
NAMD Submits Comments on CMS Medicaid Enterprise Systems IT Standards RFI
The National Association of Medicaid Directors submitted comments to CMS in response to a request for information on Medicaid Enterprise Systems IT standards. The RFI solicited stakeholder input on technical standards and interoperability requirements for state Medicaid IT systems. State Medicaid agencies are directly affected as these standards will shape future MES certification requirements and enhanced federal funding eligibility. The timing matters because CMS is gathering input to inform future rulemaking on MES modernization and MITA framework requirements.
- Federal Policy
CMS Issues Federal Funding Methodology for Basic Health Program Year 2027
CMS released an informational bulletin outlining the federal funding methodology for the Basic Health Program (BHP) in program year 2027. The guidance details how CMS will calculate federal payments to states operating BHPs — currently Minnesota and New York — for coverage of low-income individuals ineligible for Medicaid but below 200% of the federal poverty level. The methodology takes effect for the program year beginning in 2027. This matters for the two BHP states because the federal payment formula directly determines their program budgets and affects whether BHP remains financially sustainable compared to Marketplace coverage.
- Legal · TN
OIG Finds Tennessee Improperly Claimed Millions in Federal Medicaid Reimbursement for Targeted Case Management
The HHS Office of Inspector General determined that Tennessee claimed federal Medicaid reimbursement for targeted case management services that failed to meet federal and state requirements. The audit identified millions of dollars in improper payments during the review period. Tennessee must repay the improper federal share and strengthen its oversight of targeted case management claims to ensure compliance with Medicaid program requirements. The finding underscores OIG's ongoing scrutiny of state compliance with service-specific billing standards and federal claiming accuracy.
- Industry
Healthcare Executives Prioritize Revenue Cycle and Utilization Management Technology Investments
A new survey finds healthcare providers are directing IT investment toward revenue cycle management tools, while payers focus technology spending on utilization management solutions. The findings reflect strategic priorities tied to financial performance and care management efficiency. The survey did not specify implementation timelines or investment amounts. This trend matters for Medicaid managed care organizations balancing administrative cost ratios with effective care management and accurate claims processing.
