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Monday, August 3 · 10 stories
- Federal Policy
Rural Emergency Hospital Model Faces Uncertain Future Under One Big Beautiful Bill Act
The Rural Emergency Hospital (REH) designation, created by Congress to stabilize small rural hospitals through Medicare payments for emergency and outpatient services without inpatient beds, is now threatened by provisions in the One Big Beautiful Bill Act. While some hospitals have successfully converted to the REH model to remain operational, others closed before or after conversion. The law's impact on REH payment rates and eligibility remains unclear as CMS develops implementation guidance. State Medicaid agencies and managed care plans in rural service areas face potential network adequacy challenges if REH facilities close or lose viability.
- Federal Policy
HHS Secretary Kennedy Says Trump Directed Investigation of Autism-Vaccine Link
HHS Secretary Robert F. Kennedy Jr. stated in a CNN interview that President Trump has directed him to investigate perceived links between autism and vaccines. Kennedy confirmed the Wall Street Journal's reporting on the matter. The statement signals potential federal review of vaccine policy and safety monitoring under the current administration. No timeline or specific investigative framework has been announced.
- Federal Policy
CMS Finalizes 2.3% IPPS Rate Increase, Mandatory Joint Replacement Bundled Payment Model for FY 2027
CMS finalized its fiscal year 2027 Inpatient Prospective Payment System (IPPS) rule on July 31, establishing a 2.3% payment rate increase for acute care and long-term care hospitals. The rule introduces the first mandatory, nationwide episode-based payment model for joint replacement procedures covering knee, hip, and ankle replacements. The rule takes effect October 1, 2026 (FY 2027 start). This matters for Medicaid because many state programs base their hospital payment rates on Medicare methodologies, and the bundled payment model could influence state approaches to managing orthopedic services under managed care and fee-for-service arrangements.
- Federal Policy
CMS Proposes Ban on Outsourced Remote Patient Monitoring for Medicare
CMS released the CY 2027 Physician Fee Schedule proposed rule restricting remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) under Medicare. The proposal would prohibit outsourcing of RPM/RTM services and revise reimbursement methodology, reversing 2026 expansions that lowered data-transmission thresholds and added new billing codes. The proposed changes would take effect January 1, 2027 if finalized. State Medicaid agencies that follow Medicare payment policies or allow RPM under managed care contracts may face operational and reimbursement changes if states align telehealth coverage with Medicare rules.
- Federal Policy
HRSA Proposes Second Attempt at 340B Rebate Model After Initial Failure
The Health Resources and Services Administration announced a new proposal to allow rebate models in the 340B drug pricing program, marking its second attempt in 2026 after an earlier effort failed. The proposal would change how covered entities receive 340B discounts, moving from upfront discounts to post-purchase rebates. Hospital associations immediately opposed the plan, arguing it would create cash flow problems and administrative burdens for safety-net providers. If finalized, the rebate model could affect how Medicaid providers, particularly disproportionate share hospitals and federally qualified health centers, manage pharmaceutical costs.
- Federal Policy
Trump Administration Attributes ACA Enrollment Drop to Fraud Crackdown Amid Premium Increases
The Trump administration, through HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz, is attributing a significant decline in Affordable Care Act marketplace enrollment primarily to fraud prevention efforts rather than rising premiums. The administration's position contrasts with evidence that premium increases have driven many enrollees to drop coverage. This framing has implications for how federal officials justify enrollment declines and potential future policy decisions around marketplace subsidies and eligibility verification. The dispute centers on whether coverage losses stem from legitimate fraud detection or affordability barriers created by higher premiums.
- Federal Policy
HHS Announces Revised 340B Rebate Model Pilot for Medicare Negotiated Drugs Starting January 2027
HHS issued a notice announcing a revised 340B Rebate Model Pilot Program that allows qualifying drug manufacturers to use rebates rather than upfront discounts for certain 340B-eligible drugs. The pilot is limited to drugs included on the CMS Medicare Drug Price Negotiation Selected Drug Lists for 2026 and 2027. Manufacturers must submit participation plans to HRSA by August 24, 2026, with approval decisions by September 24, 2026, and approved models taking effect January 1, 2027. The AHA opposes the pilot, citing concerns about administrative burdens, cash-flow disruptions, and compliance costs for hospitals serving vulnerable populations, and is considering legal options to block implementation.
Friday, July 31 · 6 stories
- Federal Policy
Updated Brief Examines Medicaid Coverage Among Early Childhood Educators Using 2024 Data
A coalition including the Center for Law and Social Policy and the National Association for the Education of Young Children has republished a brief examining Medicaid coverage among early childhood educators, incorporating 2024 data and recent federal policy developments. The brief analyzes how Medicaid serves this workforce population and discusses implications of federal actions over the past year. Early childhood educators represent a low-wage workforce with high rates of Medicaid enrollment. The updated analysis provides current context for policymakers and stakeholders assessing coverage needs in this sector.
- Federal Policy
KFF Poll Shows Limited Public Awareness of Mifepristone Amid FDA Review
A KFF Health Tracking Poll finds limited public awareness of mifepristone safety and prevalence as the FDA conducts a re-review of the abortion medication. The poll, conducted in July 2026, shows that voters prioritizing abortion policy discussions in the 2026 midterm elections are disproportionately Democrats. The survey results come during an ongoing federal regulatory review process that could affect access to medication abortion. While mifepristone is used in some state Medicaid programs for covered abortion services, this poll focuses on general public awareness rather than Medicaid program operations or coverage policies.
- Federal Policy
CMS Sets Aug. 12 Deadline for Essential Community Provider Applications and Renewals
The Centers for Medicare & Medicaid Services requires current and prospective essential community providers to submit new applications or renew existing ones by August 12, 2026. ECPs include federally qualified health centers, rural health clinics, Ryan White HIV/AIDS Program providers, Title X family planning providers, Indian healthcare providers, and critical access hospitals. CMS encourages existing ECPs to complete annual renewal even without changes to maintain current information for Health Insurance Marketplace issuers seeking ECP network partners. The designation affects providers serving predominantly low-income and medically underserved populations.
- Federal Policy
Republicans Campaign on Healthcare Cost Reduction After Voting for Federal Funding Cuts
Republican candidates who voted for the One Big Beautiful Bill Act, which reduced federal healthcare funding, are now running campaign ads positioning themselves as advocates for lower healthcare costs. The messaging pivot comes as these lawmakers face potential voter backlash over cuts to federal health programs. The timing suggests positioning ahead of upcoming elections, though the article does not specify effective dates or implementation timelines for the funding reductions. This matters for Medicaid stakeholders because federal funding cuts to healthcare programs typically flow through to Medicaid, potentially affecting state budgets, eligibility, benefits, or provider rates.
- Federal Policy
CMS Issues Final Rule on Medicaid Provider Tax Requirements
The Centers for Medicare & Medicaid Services has released a final rule addressing Medicaid provider tax requirements. The rule follows closely after the agency's Medicaid work requirement interim final rule, which has a comment deadline of July 31, 2026. The provider tax rule affects how states can structure health care-related taxes to help finance their Medicaid programs. This action impacts state Medicaid agencies' financing strategies and their ability to leverage provider taxes for federal matching funds.
- Federal Policy
Georgetown Center for Children and Families Submits Comments on Medicaid Work Requirements Interim Final Rule
The Georgetown University Center for Children and Families submitted comments to CMS regarding the interim final rule implementing Medicaid work reporting requirements mandated by H.R. 1. The rule establishes federal requirements for states to implement work reporting for certain Medicaid beneficiaries. The comments address implementation concerns and potential impacts on beneficiary enrollment and coverage continuity. The rule affects state Medicaid agencies responsible for implementing work reporting systems and health plans managing enrollment and disenrollment processes.
Thursday, July 30 · 8 stories
- Federal Policy · MO
Missouri Faces $150M Liability for SNAP Error Rate Under 2025 Federal Law
Missouri must cover 10% of federal nutrition assistance costs starting in 2027 — approximately $150 million — if it fails to improve benefit payment accuracy under the One Big Beautiful Bill Act passed in July 2025, according to U.S. Department of Agriculture data released last week. The law imposes financial penalties on states with high error rates in SNAP administration. While SNAP is administered separately from Medicaid, both programs often share eligibility systems, caseworker resources, and administrative infrastructure at state agencies, meaning operational improvements or staff reallocations to address SNAP error rates could affect Medicaid eligibility processing capacity and timeliness.
- Federal Policy
KFF Survey Details Health Impacts of 2025 Reconciliation Coverage Losses for Immigrants
A KFF survey conducted in Fall 2025 examines health and health care experiences of uninsured immigrant adults, providing baseline data on how the 2025 reconciliation law's coverage restrictions affect lawfully present immigrants who lost Medicaid eligibility. The survey captured experiences of immigrant adults age 18 and older during the initial implementation period of the reconciliation law. The findings offer insight into coverage disruptions, access barriers, and health outcomes among immigrant families affected by the federal policy changes that eliminated or restricted Medicaid eligibility for certain lawfully present immigrants.
- Federal Policy
CMS Seeks Input on Potential Overhaul of CPT Coding System
On July 14, CMS published a Request for Information in the CY 2027 Physician Fee Schedule Proposed Rule seeking feedback on potential reforms to the AMA's Current Procedural Terminology (CPT) coding system. The RFI explores sweeping changes to how medical procedures and services are coded and billed across Medicare and Medicaid. CMS has not specified an effective date; this is an information-gathering exercise ahead of potential future rulemaking. The inquiry could affect how Medicaid fee-for-service and managed care organizations code, reimburse, and track healthcare services, with implications for payment accuracy, prior authorization processes, and claims administration.
- Federal Policy
Commerce Order Bans Census Bureau Privacy Methods, Threatens Medicaid Enrollment and Utilization Data
On June 4, 2026, the Commerce Department issued Administrative Order 216-26 banning "noise infusion" privacy techniques in Census Bureau and Bureau of Economic Analysis data products, effective immediately. The order affects data systems that state Medicaid agencies and researchers rely on for enrollment projections, eligibility determination, and program evaluation, including American Community Survey data used to estimate uninsured rates and demographic trends. Census Bureau officials have warned the ban may compromise their ability to release small-area statistics while protecting respondent privacy, potentially limiting availability of county-level data critical for Medicaid managed care network adequacy assessments and CHIP outreach.
- Federal Policy
CMS Finalizes 2.4% SNF Payment Increase for FY 2027, Expands Quality Reporting
CMS issued a final rule July 29 updating the skilled nursing facility prospective payment system for fiscal year 2027, increasing aggregate payments by 2.4% (3.3% market basket minus 0.9% productivity adjustment). The rule also revises the SNF Quality Reporting Program by removing two COVID-19 vaccination measures, shortening data reporting timelines, and requiring facilities to submit assessment data for all patients regardless of payer source. Changes take effect October 1, 2026. The all-payer reporting requirement expands data submission obligations beyond Medicare to include Medicaid and other payers.
- Federal Policy
Bipartisan Bill Directs CMS to Add Stuttering Screening to EPSDT
Sens. Jim Banks (R-Ind.) and Andy Kim (D-N.J.) introduced the Kidd's Stuttering Act on Wednesday, directing CMS to add stuttering and fluency screening to Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services. The legislation would require Medicaid to cover screening and treatment for stuttering in children enrolled in the program. If enacted, state Medicaid agencies and managed care organizations would need to ensure network adequacy for speech-language pathology services and update coverage policies to include fluency disorder screening as part of well-child visits.
- Federal Policy
HHS Launches National Behavioral Health Quality Pledge with Insurers and Providers
HHS Secretary announced July 29 that dozens of insurers, medical societies, providers, and behavioral health experts have pledged to strengthen behavioral health systems through improved access, quality measurement, patient-centered recovery services, and whole-person care integrating behavioral and physical health. The voluntary initiative commits participants to advancing best practices in mental health and addiction treatment. HHS positioned the effort as part of the administration's broader strategy to address addiction and mental illness and improve long-term patient outcomes.