All stories
Jump to date
Friday, September 25 · 27 stories
- Industry
AHA Launches Week-Long Campaign on Maternal and Child Health
The American Hospital Association will run its Better Health for Mothers and Babies Awareness Week from September 28 through October 2, 2026. The campaign will share hospital and health system stories, resources, and promising practices related to maternal health, neonatal and pediatric care, workforce development, public policy, innovation, and community partnerships. Daily themes include maternal health advances, NICU Awareness Day on September 30, pediatric care innovations, and policy and workforce strategies. The AHA will host a webinar on pediatric behavioral healthcare on September 30 at 2 p.m. ET and provide social media materials, discussion guides, and resources throughout the week for hospitals and health systems to participate.
- State Policy · CA
Watsonville Community Hospital Reports $10M Loss in Six Months, Considers Service Cuts
Watsonville Community Hospital in California lost $10 million in the last six months and $22.4 million in 2025, according to a hospital spokesperson. The hospital's board reviewed potential operational changes at a September 22 retreat, including growth opportunities and possible service closures, amid an $85,000 daily cash shortfall. The hospital's financial distress may affect access to care for Medicaid beneficiaries in the Watsonville area, particularly if services are reduced or eliminated.
- Industry
BCBS Study Finds Hospital AI Billing Tools Added $942M in Excess Costs
The Blue Cross Blue Shield Association released a second study estimating that hospitals' use of AI-assisted billing tools generated approximately $942 million in excess costs to BCBS plans over two years. The findings contribute to an ongoing dispute between hospitals and payers over AI-driven billing and claims practices. The study did not specify a timeframe for the two-year period or detail methodology. For Medicaid managed care organizations contracting with hospitals that deploy AI billing software, the findings suggest potential cost pressures similar to those documented in commercial insurance, though no Medicaid-specific impact data was provided.
- Industry
Aveanna, Addus, and Pennant Discuss 2027 Growth Strategies at Jefferies Conference
Three publicly traded home-based care providers — Aveanna Healthcare, Addus HomeCare, and the Pennant Group — presented at the 2026 Jefferies Healthcare Services and Technology Conference, outlining their growth strategies for 2027 beyond new patient referrals. The presentations occurred last week and focused on how the industry's largest operators plan to expand. These companies serve Medicaid beneficiaries through home health, personal care, and related services, often under managed care contracts or state Medicaid programs. Their growth strategies will affect LTSS service capacity, provider network adequacy, and care delivery models in Medicaid managed care.
- Industry
John Oliver Episode Spotlights UnitedHealth Vertical Integration Amid Cyberattack and Earnings Decline
In a September 20 episode, late-night host John Oliver questioned UnitedHealth Group's current structure amid heightened scrutiny of its vertical integration. The segment follows a period marked by a major cyberattack, declining earnings, and broader regulatory and public attention to the company's combined insurance and provider operations. No specific policy action or enforcement is reported. The episode reflects growing public and political discourse around health care consolidation, particularly involving firms that operate both health plans and clinical services.
- State Policy · AR
Arkansas Awards $54.6M in Second Rural Health Transformation Program Round
Arkansas awarded $54.6 million to dozens of recipients in the second funding round of a federal rural healthcare program, state officials announced Thursday. The Rural Health Transformation Program, established through the 2025 One Big Beautiful Bill Act, provides $50 billion to states over five years for projects supporting rural healthcare infrastructure and services. The awards support facility improvements, workforce recruitment, telehealth expansion, and care coordination initiatives across rural communities. For Medicaid managed care plans and providers operating in rural Arkansas counties, these investments may strengthen network capacity and access in historically underserved areas where network adequacy has been challenging.
- Legal · IA
Iowa Medicaid Fraud Elimination Task Force Defers Staffing Recommendations
Iowa Attorney General Brenna Bird stated Thursday that the state Medicaid Fraud Elimination Task Force, established by Governor Kim Reynolds on July 1, will address staffing and funding recommendations for the Medicaid Fraud Control Unit at future meetings rather than immediately. The task force is charged with submitting a final report at a date not specified in the source article. Critics have called for increased resources for fraud control efforts. The development affects Iowa's Medicaid program integrity operations and state enforcement capacity.
- State Policy · NC
North Carolina Restores Perinatal Quality Collaborative After Medicaid Funding Dispute
North Carolina has restored funding for the Perinatal Quality Collaborative of North Carolina, enabling dozens of hospitals statewide to participate in maternal and newborn care research beginning next year. The collaborative lost funding in October 2025 due to a Medicaid funding dispute, delaying planned research projects that were originally scheduled to launch in 2025. The restoration allows the state's hospitals to resume quality improvement work targeting maternal and perinatal outcomes. This matters for North Carolina providers and state Medicaid officials managing maternal health initiatives under heightened federal scrutiny of maternal outcomes.
- Federal Policy
CMS Seeks Comment on Generic Clearance for State Plan Amendments and Waiver Information Collections
CMS has published a Federal Register notice requesting public comment on one or more information collection requests under its existing Paperwork Reduction Act generic clearance umbrella (control number 0938-1148). The umbrella, approved in April 2021, covers Medicaid and CHIP state plan amendments, waivers, demonstrations, and reporting requirements. Comments are due 60 days from publication. The generic clearance process allows CMS to expedite approval of voluntary, low-burden information collections that do not raise substantive policy issues, streamlining the agency's ability to request information from states without full PRA review for each individual collection.
- Federal Policy
CMS Re-Establishes Data Match With Treasury Do Not Pay System
CMS has re-established a computer matching program with the U.S. Department of the Treasury's Do Not Pay Working System, administered by the Bureau of Fiscal Service. The match enables CMS to verify payment eligibility and prevent improper payments across Medicare and Medicaid by cross-referencing beneficiary and provider data against federal databases tracking death records, excluded parties, and debarred entities. The re-establishment continues an existing fraud prevention tool used by CMS to support program integrity efforts. The match affects CMS payment operations and supports state Medicaid agencies' ability to identify ineligible providers or payments flagged through federal screening.
- Federal Policy
Senate Finance Committee Advances Chris Klomp Nomination for HHS Deputy Secretary
The Senate Finance Committee on September 24, 2026, advanced Chris Klomp's nomination for deputy secretary of the Department of Health and Human Services by a 15-12 vote, sending it to the full Senate. Klomp currently serves as director of Medicare and deputy administrator at CMS. The nomination now awaits a floor vote. If confirmed, Klomp would hold the second-highest position at HHS, with oversight authority spanning CMS, including Medicaid and CHIP operations, along with other departmental programs.
- State Policy · ID
Idaho Lawmakers Seek Payment, Prior Authorization Protections in Medicaid Transition
Idaho's Medicaid Review Panel heard updates on the state's transition to a new service delivery model, with legislators emphasizing the need for timely provider payments and prior authorization decisions. The article does not specify what new model Idaho is adopting, when the transition takes effect, or what triggered the legislative focus. Medicaid recipients testified on service coordination concerns. The development suggests Idaho is restructuring its delivery system with legislative oversight of operational safeguards for providers and beneficiaries.
- State Policy · NY
190,000 New York CDPAP Caregivers File for Union Election with 1199SEIU
Caregivers in New York's Consumer-Directed Personal Assistance Program (CDPAP) have filed for a union election with 1199SEIU United Healthcare Workers East. If successful, 190,000 self-directed Medicaid home care workers would join the union. The filing sets the stage for a vote that could reshape labor relations in New York's largest self-directed personal care program. For Medicaid managed care plans administering CDPAP benefits, unionization could affect caregiver wage rates, contracting terms, and administrative costs tied to CDPAP services.
- State Policy · DE
Delaware Awards $23M to Local Health Centers Ahead of Federal Medicaid Cuts
Delaware has awarded $23 million to three local medical centers as the state prepares for federal Medicaid funding reductions set to take effect later this year. The awards are part of Delaware's strategy to stabilize its healthcare infrastructure as both Medicaid cuts and rising commercial insurance rates threaten access. The investments target health centers serving Medicaid and uninsured populations, positioning safety-net providers to absorb increased demand as federal support declines. The timing reflects state anticipation of coverage losses and shifts in payer mix once federal cuts are implemented.
Thursday, September 24 · 28 stories
- Industry
LHC Group Reports Patient Data Breach After Employee Phishing Attack
LHC Group, a home health and hospice provider owned by UnitedHealth Group's Optum, disclosed a data breach stemming from a voice phishing (vishing) attack on an employee. The company became aware of the incident on April 7, 2026, and issued a public notice in September 2026. Patient information was exposed in the breach. The notice does not specify the number of affected individuals or what types of patient data were compromised.
- Industry
Hospital CEOs Prioritize Budget Increases for 2027 Amid Medicaid Cuts
Hospital and health system CEOs are finalizing 2027 budget priorities as the industry faces deepened Medicaid cuts and revised 340B rebate policies from the Health Resources and Services Administration. The article identifies which budget lines executives are increasing and decreasing in response to these pressures. For Medicaid-dependent providers, these strategic budget shifts signal how hospitals are absorbing state and federal reimbursement reductions and addressing operational sustainability under constrained Medicaid revenue.
- Federal Policy
CMS Halts ACA Broker Registrations for 2027, Terminates 760,000 Enrollments
CMS announced Tuesday it is freezing new broker registrations for the 2027 marketplace open enrollment period and terminating coverage for more than 760,000 individuals the agency has identified as unauthorized enrollees. The broker registration pause aims to reduce fraud in the exchanges; the agency did not specify which populations or enrollment circumstances triggered the coverage terminations. The registration freeze affects brokers seeking new marketplace access for plan year 2027. The actions reflect heightened federal scrutiny of marketplace enrollment integrity following reports of unauthorized sign-ups and agent misconduct in certain states.
- Federal Policy
KFF Analysis Finds TrumpRx Prices Below OECD Average for 17 of 32 Brand-Name Drugs
A Peterson-KFF Health System Tracker analysis compared prices for 32 brand-name drugs on TrumpRx.gov—a federal portal launched in February 2026 offering medications from manufacturers that signed voluntary pricing agreements with the White House—to publicly listed prices in 11 wealthy OECD countries. TrumpRx prices were lower than the OECD peer average for 17 drugs and higher for 15; TrumpRx had the lowest price for 5 drugs and the highest for 13. The analysis does not assess whether these negotiated prices affect Medicaid or Medicare reimbursement, whether domestic prices outside TrumpRx have changed, or how the retail prices compare to net costs after rebates in Medicaid or other public programs.
- Federal Policy · DE
CMS Awards $23 Million to Delaware for Rural Health Center Modernization and Mobile Care
CMS announced nearly $23 million in federal funding to Delaware for rural health center modernization, mobile care expansion, and chronic disease management infrastructure. The award supports facility upgrades, mobile health units, and technology improvements in underserved rural areas. The funding is available immediately for eligible health centers and state agencies to draw down for approved projects. For Medicaid, this matters because rural health centers serve significant Medicaid populations, and improved infrastructure and mobile capacity can expand access for beneficiaries in areas where provider shortages limit care availability.
- State Policy
KFF Tracker Compiles Abortion Ballot Initiatives for November 2026 Election
KFF has published a tracker reviewing abortion-related ballot initiatives currently slated for November 2026 across multiple states. The brief examines how these measures may impact abortion access depending on election outcomes. While abortion ballot initiatives do not directly regulate Medicaid coverage or managed care operations, they can affect reproductive health coverage requirements for state Medicaid programs and managed care plans if measures pass that expand or restrict abortion access. State Medicaid agencies and MCOs operating in states with ballot measures may face subsequent coverage policy changes.