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Thursday, September 24 · 28 stories
- State Policy · VT
Vermont FQHC Opens Three 340B Pharmacies Amid Statewide Closures
North Star Health, a Federally Qualified Health Center, opened pharmacies in Springfield and Londonderry, Vermont, and Charlestown, New Hampshire, in September 2026, leveraging 340B drug pricing to charge patients less than commercial pharmacies. Vermont lost 28 pharmacies between 2019 and 2024, leaving pharmacy deserts in Windsor and Rutland counties where North Star operates. The Springfield pharmacy began operations in November 2025 for out-of-pocket and commercial patients and now contracts with Medicare and Medicaid. The 340B discount allows North Star to offset losses from low primary care and behavioral health reimbursement, according to CEO Josh Dufresne.
- Federal Policy · ID
Idaho Task Force Convenes to Oversee $186 Million Rural Health Transformation Grant Distribution
Idaho's Rural Health Transformation Program Implementation Task Force held its first meeting September 23, 2026, to oversee distribution of $186 million in federal rural health grants awarded under the nationwide $50 billion Rural Health Transformation Program enacted through the One Big Beautiful Bill Act. The state received over 250 applications totaling more than $300 million for a $97 million provider infrastructure opportunity and faces an October 30 deadline to award all first-year funding. Idaho received less than the anticipated $200 million due to scoring criteria that disadvantaged states with low rural population density and low provider density, though the state scored highly on alignment with administration priorities including school fitness programs and SNAP restrictions.
- Legal
DOJ Revises False Claims Act Manual to Clarify Enforcement Standards
The Department of Justice updated its False Claims Act manual on September 18, 2026, reinstating and expanding a 2017 policy that subregulatory guidance cannot impose legal obligations beyond those established by statute or regulation. The revision aims to promote fairness and effective enforcement in fraud cases. The change affects how DOJ evaluates and pursues False Claims Act cases, including those involving Medicaid providers and health plans. The updated standards took effect immediately upon publication.
- State Policy · IN
Indiana FSSA Issues RFP for Second Short-Term Residential Facility for Disabled Adults
The Indiana Family and Social Services Administration issued a request for proposals for a provider to operate a 10-20 bed short-term residential facility for intellectually disabled adults with severe behavioral, psychiatric, or medical needs. The facility would replace a co-ed facility that closed in 2024 and address a service gap, particularly for women, as Indiana's only existing comprehensive rehabilitative management needs facility serves men only. The current per diem rate for such facilities is $703. Disability advocates have raised concerns that the new facility, combined with recent changes to Medicaid waiver assessments that have resulted in higher denial rates, could signal a shift toward institutionalization rather than community-based care.
- Federal Policy
CMS Administrator Oz Announces AI Fraud Detection Priority at Oracle Summit
CMS Administrator Mehmet Oz, speaking at the Oracle Health and Life Sciences Summit, identified AI-driven fraud detection as a top agency priority, drawing parallels to banking sector tools that pushed fraudulent activity into healthcare. The announcement signals CMS intent to deploy advanced detection technology across its programs. Timing for implementation was not specified. For Medicaid state agencies and managed care plans, this represents a coming shift in program integrity oversight and potential new reporting or compliance requirements once CMS operationalizes the approach.
- State Policy · NC
North Carolina Medicaid Launches Expedited Reverification for High-Risk Providers
North Carolina Medicaid has initiated an expedited, off-cycle reverification process targeting certain high-risk providers. Affected providers must complete the reverification process to maintain enrollment status, with failure potentially resulting in disenrollment from the state's Medicaid program. The initiative creates immediate due diligence considerations for providers undergoing transactions, as enrollment status could be subject to accelerated review outside the standard cycle. This action follows federal program integrity requirements that permit states to conduct targeted reverifications of providers posing elevated financial or compliance risk.
- State Policy · KY
Kentucky Planned Parenthood Vows to Continue Operations After Medicaid Termination
Planned Parenthood announced it will maintain operations in Kentucky following termination from the state's Medicaid program. The organization stated it remains committed to serving patients in Kentucky despite the ban. The termination affects Medicaid beneficiaries' ability to receive reimbursed services at Planned Parenthood locations. This development follows broader state efforts to exclude certain family planning providers from Medicaid networks, requiring affected beneficiaries to seek covered services from alternative Medicaid-enrolled providers.
Wednesday, September 23 · 26 stories
- Industry
Off-Label GLP-1 Prescribing Rose 15-Fold From 2021 to 2025, Study Finds
A study published in Obesity analyzed medical records from over 92 million U.S. adults and found that off-label use of GLP-1 medications — prescribing to patients without documented obesity or diabetes — increased 15-fold between 2021 and 2025. The research documents a surge in prescribing outside FDA-approved indications during a period of intense commercial and clinical interest in GLP-1s for weight management. For Medicaid programs, rising off-label use raises questions about pharmacy benefit management, prior authorization protocols, and whether state fee-for-service or managed care plans are covering GLP-1s for conditions not meeting medical necessity criteria tied to approved diagnoses.
- Industry
Becker's Analysis Examines Health System Preparedness for Cell and Gene Therapy Scale-Up
In a commentary piece, Becker's Hospital Review examines operational challenges health systems face as the cell and gene therapy pipeline expands beyond rare disease applications into broader patient populations. With more than 35 FDA-approved cell and gene therapies now on the market and additional approvals expected, the article explores infrastructure, workflow, and care delivery model changes required to administer these treatments at scale. The piece is oriented toward hospital systems and does not address Medicaid-specific coverage, reimbursement, or managed care contract implications for these therapies. While Medicaid programs and managed care organizations will eventually confront CGT coverage and payment policy questions as utilization grows, this particular analysis focuses on provider delivery system readiness without Medicaid program context.
- State Policy · TN
Tennessee Hospital to Resume Labor and Delivery Services in Spring 2027
Henry County Hospital in Paris, Tennessee will restore maternity services beginning spring 2027, according to a September 22 announcement from West Tennessee Healthcare. The hospital has recruited an additional physician to its women's health team to support the resumption of deliveries. The restoration addresses a gap in local access to obstetric care in the region. For Medicaid agencies and managed care plans serving pregnant beneficiaries in rural Tennessee, this represents restoration of a delivery site that affects network adequacy and access to maternity benefits in Henry County.
- Federal Policy
GAO Finds State Coordination Gaps in VR and Medicaid HCBS Employment Services
In a September 2026 report, GAO examined how vocational rehabilitation (VR) and Medicaid home- and community-based services (HCBS) programs fund employment services for individuals with intellectual or developmental disabilities in Georgia, Pennsylvania, and Washington. Employment service providers reported administrative burden and service gaps when navigating two separate state agencies, including confusion over when VR closures must occur before Medicaid HCBS employment services can begin. States typically fund services sequentially — VR first, then Medicaid HCBS — rather than braiding multiple funding streams simultaneously. Federal agencies issued joint guidance in 2022 encouraging coordination strategies, but provider-reported challenges persist.
- Industry
KFF Survey Finds Health Care Costs Drive Care Delays and Medication Rationing Among Women
KFF's 2026 Women's Health Survey found that health care costs remain a major barrier for women ages 18–64, resulting in delayed care, medication rationing, and reductions in spending on basic necessities. The nationally representative survey, which included both women and men, documented the financial burden health care expenses place on women specifically. While the survey findings address broader health system affordability challenges, Medicaid managed care organizations may see implications for their predominantly female enrollee populations, particularly regarding access barriers and cost-related care avoidance patterns.
- Managed Care
Commonwealth Fund Reviews State Options for Addressing Medicaid MCO Performance Issues
The Commonwealth Fund published guidance on how state Medicaid agencies can address underperforming managed care plans through contractual tools and staff oversight strategies. The analysis covers corrective action plans, financial penalties, contract suspension, and systematic performance monitoring approaches states can deploy when plans fail to meet quality, access, or administrative standards. The guidance emphasizes strategic prioritization of enforcement resources and graduated remedies. State Medicaid agencies managing MCO contracts gain a framework for structuring performance oversight and escalating interventions when plans fall short of contractual obligations.
- Legal · FL
Florida Sues Insulin Manufacturers and PBMs Over Alleged Price Inflation Scheme
Florida Attorney General James Uthmeier filed suit in Miami-Dade County Circuit Court against Eli Lilly, Novo Nordisk, Sanofi, and three pharmacy benefit managers, alleging they inflated insulin list prices and paid rebates that increased costs for consumers. The lawsuit accuses the companies of a coordinated pricing scheme involving diabetes medications. The action reflects growing state enforcement efforts targeting pharmaceutical pricing practices that affect state Medicaid pharmacy expenditures and beneficiary access to essential medications. The complaint follows similar insulin pricing litigation in other states.
- State Policy · NM
New Mexico Approves 11 of 13 Regional Behavioral Health Plans
The committee tasked with rebuilding New Mexico's behavioral healthcare infrastructure has approved 11 of 13 regional plans, with two regional plans remaining for approval. The chair provided the update to the interim Legislative Finance Committee on Tuesday. The approvals represent progress toward statewide implementation of a restructured behavioral health delivery system. This development directly affects how behavioral health services will be organized and delivered across New Mexico's Medicaid program.
- State Policy · AR
Arkansas Child Uninsured Rate Reaches Decade High at 7.7 Percent
Arkansas Advocates for Children and Families reports that 57,000 Arkansas children — 7.7% of the state's child population — were uninsured in 2024, an increase of 7,000 from the previous year and the highest level in a decade. Hispanic children face the highest uninsured rate at nearly 14%, and foreign-born children are more than seven times more likely to be uninsured than U.S.-born children. The report attributes rising uninsurance to Medicaid disenrollment following pandemic-era continuous enrollment protections and warns that federal Medicaid spending cuts under H.R. 1 will create additional instability. Arkansas' Medicaid expansion program, covering more than 200,000 low-income adults, faces an uncertain future after the Trump administration denied the state's renewal request.
- Federal Policy
NAMD Submits Comments on Proposed Health Care-Related Tax Hold Harmless Rule
The National Association of Medicaid Directors submitted comments on September 21 responding to a CMS notice of proposed rulemaking that would amend the indirect hold harmless threshold for health care-related taxes. Health care-related taxes are a key financing mechanism states use to draw down federal Medicaid matching funds, and the hold harmless provisions limit the extent to which states can return tax revenue to providers. The proposed rule would modify the threshold that triggers federal hold harmless scrutiny, directly affecting state Medicaid financing flexibility and the permissible structure of provider tax arrangements.
- Federal Policy
Becker's Compiles 20 CMS Policy Actions Under Trump Administration in 2026
In its compilation titled 'CMS under Trump: 20 key actions,' Becker's Hospital Review reports CMS has advanced coverage, payment, and program integrity changes throughout 2026. The actions span Medicare and Medicaid payment reforms, ACA marketplace oversight, prior authorization requirements, fraud enforcement, and new value-based care models. The compilation provides an overview of major federal healthcare policy developments across both Medicare and Medicaid programs during the current administration. For Medicaid stakeholders, the relevant subset of these 20 actions may include Medicaid-specific payment policy changes, program integrity enforcement affecting Medicaid managed care, and ACA marketplace changes affecting dual-eligible populations.
- Legal · NY
OIG Finds New York Made Unallowable Capitation Payments for Incarcerated Enrollees
The HHS Office of Inspector General determined that New York made unallowable managed care capitation payments on behalf of incarcerated Medicaid enrollees. Federal law prohibits federal Medicaid funding for services provided to incarcerated individuals, with limited exceptions for inpatient hospital care. The audit findings indicate the state made capitation payments to managed care organizations for enrollees who were incarcerated during the coverage period. OIG recommendations typically require states to refund the federal share of identified overpayments and implement corrective actions to prevent future unallowable payments.
- Industry
Becker's Tracks 14 Healthcare Bankruptcies in 2026 to Date
Becker's Hospital Review is tracking healthcare organization bankruptcies in 2026, reporting 14 filings year-to-date. The publication notes an upward trend from 15 bankruptcies in 2024 to 20 in 2025, attributing financial pressures to workforce shortages, rising operational costs, and declining reimbursement rates. The article appears to be an ongoing tracker compiling bankruptcy filings as they occur rather than reporting a specific bankruptcy event.