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Thursday, September 24 · 28 stories
- 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.
- State Policy
NASHP Convenes States on Children's Behavioral Health Service Delivery Models
The National Academy for State Health Policy (NASHP) reports it convened states through a policy academy focused on strengthening behavioral health services for children and youth. Participating states worked on expanding service capacity, supporting the behavioral health workforce, and improving care coordination across systems. The initiative addresses persistent challenges in children's behavioral health access and integration, particularly relevant for states expanding Medicaid-covered behavioral health benefits and managed care network adequacy requirements. Details on specific state participants, policy commitments, or timelines were not provided in the source material.
- Federal Policy
CMS Administrator Oz Predicts AI Will Drive Up Healthcare Costs Before Reducing Them
CMS Administrator Dr. Mehmet Oz stated Wednesday that artificial intelligence will initially increase healthcare costs by accelerating medical billing before delivering long-term savings. He described AI as likely to "turbocharge" billing processes in the near term. The comments suggest CMS anticipates cost pressure from AI adoption across the healthcare sector, including Medicaid programs and managed care plans investing in AI-driven administrative tools. No timeline or policy response was specified.
- State Policy · AR
Arkansas Launches Outreach Campaign for Medicaid Work Requirements Starting January
Arkansas Department of Human Services released an outreach toolkit Thursday including flyers, posters, text messages, and videos to inform Medicaid expansion enrollees about work requirements taking effect in January. The requirements will apply to certain expansion population members. Affected enrollees will need to meet work, education, or qualifying activity thresholds to maintain coverage. The campaign reflects Arkansas's move to implement community engagement requirements following federal approval.
- Federal Policy · AR
CMS Awards Arkansas $54.6 Million for Chronic Disease, Maternal Health, and Rural Workforce
CMS awarded Arkansas $54.6 million in federal funding to support chronic disease management, maternal healthcare services, and rural health workforce development. The funding will flow to Arkansas Medicaid and other state programs to expand access to care in underserved areas and improve health outcomes for vulnerable populations. The award takes effect in federal fiscal year 2027. This matters for Arkansas Medicaid stakeholders because it will fund network expansion, provider recruitment, and care coordination for high-need populations, potentially affecting managed care plan responsibilities and provider contracting requirements.
- Federal Policy
Trump Administration Claims All States Accepted GENEROUS Drug Pricing Model, Several States Deny Enrollment Decision
Trump administration officials announced that all states have agreed to participate in the GENEROUS model, a federal initiative designed to provide lower drug prices to state Medicaid programs. However, officials in multiple states say they have not committed to participation and are still evaluating whether GENEROUS offers better value than existing manufacturer rebate arrangements. Pricing details for the GENEROUS model remain unavailable to the public. The discrepancy raises questions about enrollment claims and creates uncertainty for state Medicaid agencies making coverage and financial planning decisions.
- Federal Policy
GAO: Five State MMRCs Drove 12-Month Postpartum Medicaid Extensions Through Mortality Reviews
In a report released September 24, 2026, the Government Accountability Office found that Maternal Mortality Review Committees in five states successfully recommended extending Medicaid postpartum coverage to 12 months, which those states subsequently adopted. GAO reviewed 10 MMRCs and found all consider federal and state laws as factors affecting maternal mortality, with committees commonly making recommendations on care coordination, mental health and substance use, health equity, reproductive health, and health care workers. CDC provides approximately $134 million over 2024-2029 to support 52 state and territorial MMRCs and monitors performance through regular meetings, required reports, and site visits. The findings demonstrate how state-level mortality review processes directly influence Medicaid coverage policy decisions aimed at reducing preventable maternal deaths, particularly those linked to chronic conditions like severe hypertension in the postpartum period.
- State Policy · FL
Florida ABA Task Force to Hear Managed Care Plans on Autism Therapy Delivery
A Florida task force examining applied behavior analysis service delivery for children with autism and special needs will convene Monday to hear from managed care organization representatives, including Simply Healthcare, Sunshine Health, and Humana Healthy Horizons. The task force is considering potential changes to how the state structures and delivers ABA therapy through its Medicaid program. The meeting follows earlier sessions exploring current delivery models and stakeholder concerns about access and reimbursement.
- State Policy · SD
CMS Awards South Dakota $13 Million for Mobile Crisis Response and Behavioral Health Expansion
CMS awarded South Dakota $13 million to expand behavioral health services and establish a statewide 24/7 mobile crisis response service. The funding will support crisis intervention teams, workforce development, and infrastructure to improve access to behavioral health care across the state. Implementation timing was not specified in the announcement. The investment addresses South Dakota's behavioral health access gaps and aligns with federal priorities to expand crisis services as alternatives to emergency department utilization.
- Legal · MO
Missouri Medicaid Enrollee Sues Over Trump Administration Work Requirement Exemption Rule
A Missouri Medicaid enrollee has filed a lawsuit challenging a Trump administration rule governing work requirement exemptions, alleging procedural failures resulted in coverage loss. The enrollee, Emily Byrd of Kansas City, lost Medicaid coverage twice due to what the complaint describes as duplicate letters, late notices, and inconsistent information from the Missouri Department of Social Services despite submitting requested documentation. The lawsuit targets federal rules on exemption processes tied to Medicaid work requirements. The case adds to ongoing litigation over state work requirement programs and their administrative burden on beneficiaries.
- Federal Policy
OIG Finds CMS Medical Loss Ratio Data Validation Process for Medicaid MCOs Has Gaps
The HHS Office of Inspector General found that CMS's process for verifying the accuracy of medical loss ratio data submitted by states for Medicaid managed care organizations has limitations that may affect oversight. The report identifies weaknesses in how CMS validates state-reported MLR data used to determine whether MCOs meet federal standards requiring at least 85% of capitation payments go toward medical care and quality improvement. OIG's findings affect CMS's ability to ensure compliance with MLR requirements and identify MCOs that may owe remittances to states. The report matters for state Medicaid agencies responsible for collecting and reporting MLR data and for managed care plans subject to MLR requirements and potential remittance obligations.
- Federal Policy
Federal Rules Expected to Cut Medicaid Provider Payments by $50 Billion Across 36 States
A peer-reviewed Health Affairs analysis estimates that new federal rules will force 36 states to reduce annual Medicaid payments to doctors and hospitals by more than $50 billion in total. The payment cuts could reduce the number of providers willing to participate in Medicaid. The analysis warns of significant implications for provider network adequacy and beneficiary access to care across affected states.
- Industry
Health System CEOs Cite Medicaid Funding Cuts as Top 2027 Priority
Health system CEOs report Medicaid funding reductions as a leading concern heading into 2027, alongside affordability pressures, workforce shortages, and care delivery transformation. The executives describe balancing operational fundamentals with strategic innovation as they plan for multiple simultaneous challenges. The article does not specify which states are implementing cuts, when reductions take effect, or the scale of anticipated funding impacts. For health systems with significant Medicaid patient volume, funding uncertainty affects budget planning, service line decisions, and payer contracting strategies.
- State Policy · NC
UNC Health Pardee Opens Adolescent Behavioral Health Inpatient Unit in Hendersonville
UNC Health Pardee has opened an inpatient adolescent behavioral health center in Hendersonville, North Carolina, serving teens in Henderson and surrounding counties experiencing mental health crises. The new facility addresses a regional gap in youth psychiatric services. The opening is relevant to North Carolina Medicaid given that Medicaid covers approximately half of all children in the state and is a major payer for behavioral health services, including inpatient psychiatric care for eligible adolescents.
- Industry · NC
North Carolina Treasurer Calls for Scrutiny of Atrium-WakeMed Combination
North Carolina Treasurer Brad Briner is urging state and federal regulators to scrutinize the proposed combination of WakeMed Health & Hospitals and Atrium Health, arguing the deal could reduce competition and raise healthcare costs. The Wake County Board of Commissioners voted 5-2 on September 21, 2026, to approve the proposed combination. The merger would unite two major North Carolina health systems operating in separate geographic markets. For Medicaid managed care organizations, hospital system consolidation can affect network adequacy, contract negotiations, and provider rate leverage in counties where state Medicaid contracts require adequate provider networks.
- State Policy · RI
Rhode Island Outlines Rural Health Projects Under $156M Federal Award
Rhode Island is developing plans for its $156.17 million allocation from a nationwide rural healthcare funding program enacted in July 2026. The state is working to finalize project details ahead of an October federal deadline. The funding is part of a $50 billion national initiative targeting rural health infrastructure and services. Rhode Island Medicaid agencies and providers serving rural populations should monitor how these dollars will be deployed and whether Medicaid-funded services or facilities are included in the state's implementation plan.
