All stories
Jump to date
Tuesday, September 22 · 36 stories
- Federal Policy
White House Posts Fraud Ledger Tracking Task Force Findings Since January 2025
The White House has published a Fraud Ledger documenting fraud, waste, and corruption identified by a presidential task force established by executive order in March 2025. The task force is chaired by the Vice President and includes representatives from 11 federal agencies. The ledger serves as a public record of enforcement and recovery actions across federal programs. The article itself fact-checks the ledger's claims, though the specific findings and their application to Medicaid programs are not detailed in the excerpt provided.
- Industry
CommonSpirit Revenue Cycle Leader Outlines AI Guardrails for Denials Management
CommonSpirit Health's system lead for denials management, Deborah Greer, MD, discussed how the health system is implementing artificial intelligence in denials and appeals processes while maintaining physician oversight. Greer emphasized that physician decision-making authority must remain central even as AI tools are deployed by both hospitals and health plans to speed review and denial processes. The article addresses how major health systems are navigating the operational and clinical implications of AI-driven prior authorization and denials management. No specific policy changes or effective dates are identified.
- Federal Policy · MO
CMS Awards $45 Million to Missouri Rural Hospitals for Infrastructure and Telehealth
CMS announced over $45 million in federal funding to support rural hospitals in Missouri for facility upgrades, telehealth services including psychiatric and maternal care consultations, and emergency medical services workforce training. The awards are part of broader federal rural health investment programs. Implementation timelines and specific facility allocations were not detailed in the announcement. The funding addresses critical access hospital infrastructure needs and care access gaps in rural Missouri communities.
- Managed Care
ACAP Launches Innovation Fund for Medicaid Health Plans
The Association for Community Affiliated Plans (ACAP) announced September 22, 2026, the launch of the ACAP Innovation Fund in partnership with Innovation Fund Management. The initiative is designed to drive innovation in Medicaid managed care, though specific investment focus areas, funding amounts, and eligibility criteria were not detailed in the announcement. The fund targets ACAP member plans, which are safety-net health plans serving Medicaid and other vulnerable populations. Details on application timelines and fund deployment are expected to follow.
- Federal Policy
CMS Proposed Rule on SNF Deregulation Under OMB Review
A proposed CMS rule affecting Medicare-participating skilled nursing facilities is under review by the Office of Management and Budget. The proposal appears aligned with prior CMS deregulatory efforts under the Trump administration. OMB review is the final step before a proposed rule is published in the Federal Register, after which a public comment period typically follows. The timing and scope of the proposal remain uncertain pending OMB clearance.
- Legal · CT
OIG Finds Connecticut DDS Failed to Monitor HCBS Waiver Compliance for Home Support Services
The HHS Office of Inspector General found that Connecticut's Department of Developmental Services did not ensure providers of individualized home support services fully complied with federal waiver requirements and state health and safety standards. The audit identified gaps in state oversight, including inadequate monitoring of service delivery, health and safety protocols, and provider compliance with waiver terms. OIG recommended that Connecticut strengthen oversight mechanisms to ensure providers meet federal Home and Community-Based Services waiver requirements. The findings highlight enforcement gaps that could affect beneficiary health and safety and federal waiver compliance.
- Federal Policy
White House Drug Affordability Plan May Exclude Key Medications from Medicaid Cost Controls
The Trump administration has released a plan intended to reduce drug costs for Medicaid beneficiaries, but the policy contains an exception that may exempt certain medications from cost controls. The exception could allow manufacturers to avoid pricing restrictions that would otherwise apply to Medicaid drugs. The policy's structure may create differential treatment across drug classes, with potential financial implications for state Medicaid programs and health plans managing pharmacy benefits. Details on implementation timeline and which specific medications qualify for the exception remain to be clarified.
- Federal Policy
Trump Administration Terminates ACA Coverage for 750K Enrollees Citing Fraud
The Trump administration announced Tuesday it will terminate Affordable Care Act marketplace coverage for approximately 750,000 enrollees identified as fraudulent, according to Vice President Vance. The administration estimates the cancellations will save $2.2 billion in federal subsidies. CMS Administrator Dr. Mehmet Oz stated the terminated enrollments represent non-existent individuals. The announcement did not specify an effective date for the terminations or detail the criteria used to identify fraudulent enrollment.
- Federal Policy
CMS Guidance Addresses Medicaid Immigrant Eligibility Restrictions Effective October 1, 2026
The 2025 reconciliation law imposed new Medicaid and CHIP eligibility restrictions for many lawfully present immigrants, with an effective date of October 1, 2026. CMS has issued implementation guidance addressing how states should apply these restrictions. The brief examines operational issues states will face in implementing the new eligibility rules and the impact on affected immigrant populations. The changes directly affect state eligibility systems, enrollment processes, and coverage for lawfully present immigrants who previously qualified for Medicaid and CHIP.
- Federal Policy
Out-of-Network Emergency Spending Declined After No Surprises Act Implementation
Analysis finds out-of-network emergency care spending has fallen since the No Surprises Act took effect in 2022, contrary to debate focused on arbitration costs. The law protects patients from surprise billing for emergency services they cannot choose. For Medicaid managed care plans with emergency coverage obligations, this federal benchmark on balance billing and dispute resolution may inform state approaches to network adequacy and emergency access requirements, particularly where Medicaid enrollees receive emergency care at out-of-network facilities.
- Industry
34 Academic Health Systems Acquire Community Hospitals Amid Financial Pressure
Academic health systems are acquiring distressed community hospitals at an accelerated pace driven by financial strain. Staffing shortages, aging infrastructure, heavy reliance on Medicaid and Medicare reimbursement, and rising payer denials are forcing community hospitals to seek partnerships or face closure. Large nonprofit and regional systems are absorbing these facilities as consolidation intensifies across the healthcare sector. The trend reflects broader market pressures affecting safety-net providers serving high Medicaid populations.
- Industry
Array Behavioral Care Launches Triage Service for Urgent Behavioral Health Cases
Array Behavioral Care announced a new triage service designed to help providers assess patients with urgent behavioral health needs and connect them to appropriate care settings. The service aims to streamline the urgent behavioral health assessment and referral process. The announcement did not specify implementation timelines or participating provider networks. This development reflects ongoing industry efforts to address behavioral health access challenges through care coordination tools.
- Industry · NC
Wake County Approves WakeMed-Atrium Health Merger, Sends Deal to State Review
The Wake County Board of Commissioners voted 5-2 on September 21, 2026 to approve the proposed merger between WakeMed Health & Hospitals and Atrium Health. The transaction now proceeds to North Carolina state regulatory review. The merger would combine Raleigh-based WakeMed with Charlotte-based Atrium Health, creating a larger health system footprint across the state. The deal has drawn scrutiny from local stakeholders during the county approval process.
- State Policy · VA
Virginia Survey Finds 51% of Families with Children Face Food Insecurity
A statewide survey commissioned by the Federation of Virginia Food Banks, Virginia Department of Social Services, and No Kid Hungry Virginia found 51% of families with children are food insecure, up from 42% in the final federal USDA survey that ended in 2025. The University of Chicago survey of 5,600 Virginians shows rising food insecurity amid inflation and SNAP eligibility changes under H.R. 1, which resulted in more than 100,000 Virginians losing benefits over the past year. The survey also found three out of four food-insecure adults have chronic conditions and three in five visited an emergency room or urgent care at least once in the past year. Governor Spanberger signed an executive order to streamline inter-agency coordination as H.R. 1 threatens 300,000 with Medicaid loss in 2027.
- State Policy
Rural Maternal Health Access Deteriorates Following H.R. 1 Passage
Rural maternal health care access has worsened following passage of H.R. 1, compounding pre-existing challenges including 109 rural hospital closures since 2005, workforce shortages, and low reimbursement rates. The legislation's impact on rural maternity services adds to infrastructure vulnerabilities affecting pregnant Medicaid beneficiaries in rural areas. State Medicaid agencies face mounting pressure to address maternal health deserts through alternative delivery models, enhanced reimbursement, or emergency transport solutions as traditional brick-and-mortar access points continue closing.
- Managed Care
Safety Net Health Plans Achieve Record Performance in NCQA Quality Ratings
Safety Net Health Plans, members of the Association for Community Affiliated Plans (ACAP), achieved record performance in the National Committee for Quality Assurance's (NCQA) 2026 health plan ratings. The announcement, released September 21, 2026, indicates improved quality measures among plans serving predominantly Medicaid and dual-eligible populations. These ratings affect star ratings, quality bonus payments, and auto-enrollment assignments for Medicaid managed care plans. The results suggest safety net plans—which disproportionately serve low-income and complex populations—are closing quality gaps with commercial-focused plans.
- Federal Policy
CMS Proposes RAPID Pathway to Accelerate Medicare Coverage for FDA-Approved Devices
CMS proposed the Regulatory Alignment for Predictable and Immediate Device (RAPID) pathway to coordinate FDA device approval with Medicare coverage decisions, compressing a typical five-year lag to 60-90 days. The pathway synchronizes regulatory approval and coverage determination processes from the outset. Manufacturers of breakthrough devices would participate in joint FDA-CMS reviews. This matters for Medicaid managed care organizations and state agencies because accelerated Medicare coverage pathways often influence state Medicaid coverage decisions and MCO formulary policies for medical devices and durable medical equipment.
- State Policy · OK
Oklahoma Transitions Four State Mental Health Clinics to Private Operation
Oklahoma's Department of Mental Health is privatizing four state-run certified community behavioral health clinics, with over 90% of affected state employees receiving job offers as part of the transition. The privatization effort shifts clinic operations from direct state management to private providers. The timing and effective date of the transition were not specified in the report. This matters for states considering similar CCBHC delivery model changes and for understanding workforce continuity during Medicaid behavioral health delivery system transitions.
- State Policy · MA
Massachusetts Proposes $2M to Expand Postpartum Mental Health Services Under Medicaid
Massachusetts Governor Maura Healey is requesting $2 million from the state legislature to expand the Welcome Family program, which provides free home nurse visits for postpartum mental health screening to new mothers. The expansion would increase coverage from 3,000 to 68,000 households annually. Several other states enacted similar legislation this year: Illinois mandated at-home mental health screenings for all new mothers, while Maryland and Virginia required Medicaid and other insurers to cover postpartum depression screenings. The Policy Center for Maternal Mental Health expects a 200% increase in state legislative activity on maternal mental health in the coming year.
- State Policy · RI
Rhode Island Redesigns Medicaid and Public Benefits Decision Notices for Clarity
Rhode Island has redesigned the decision notices sent to approximately 60,000 residents monthly regarding Medicaid coverage and other public benefits. The redesigned notices aim to make approval, denial, and change decisions easier to understand for beneficiaries. The changes took effect this month. The redesign matters for state agencies and health plans because clearer notices can reduce appeals, call center volume, and coverage gaps caused by beneficiary confusion about eligibility decisions.
