All stories
Jump to date
Friday, July 24 · 7 stories
- Federal Policy
CMS Mandates Notices for Medicaid Work Requirements as States Plan Broader Outreach
Federal regulations require state Medicaid agencies to notify enrollees affected by new work requirements, and most states are planning additional outreach including phone calls, public advertising, and social media. States face operational challenges meeting tight implementation timelines while complying with federal notice requirements. The brief examines state compliance strategies and the administrative burden of implementing work requirement communications across diverse enrollee populations.
- Federal Policy
KFF Poll: CDC Trust Stable While Confidence in Trump, State Officials Declines
A July 2026 KFF tracking poll finds public trust in the CDC as a health information source has stabilized after steep declines between 2020 and early 2026, while trust in President Trump and state government officials as health information sources has decreased over the past six months. The poll marks a potential inflection point in public confidence in federal health agencies following years of erosion. For Medicaid agencies and health plans managing public health messaging around coverage, benefits, and care access, understanding shifting trust dynamics affects member communication strategies and credibility of guidance tied to federal or state sources.
- Federal Policy
CMS Proposes Medicare Payment Category for Clinical Decision Support Software
CMS released proposed rules on July 2 and July 14, 2026 establishing a new Medicare payment category called Software as a Medical Service (SaMS) for software that supports clinical decision-making through algorithmic analysis. The proposals appear in the CY 2027 Hospital Outpatient Prospective Payment System and Physician Fee Schedule proposed rules. This represents CMS's first structured approach to paying separately for clinical decision support software under Medicare. Comments on the proposed rules are typically due 60 days after publication in the Federal Register.
- Federal Policy
House Bill Proposes EHR Implementation Grants for Home Health and Post-Acute Providers
The Connecting Health and Records Technology for Seniors (CHARTS) Act has been introduced in the U.S. House of Representatives to provide up to $500,000 grants for home health, long-term care, and post-acute care providers to implement electronic health records and improve health information sharing. The legislation aims to reduce implementation costs and administrative burden for providers serving Medicare and Medicaid beneficiaries. If passed, the grants would support interoperability efforts critical to care coordination for dual-eligible and Medicaid long-term services and supports populations. The bill is in the early legislative stage with no timeline for passage.
- Federal Policy
CMS Halts Premium Tax Credit Reconciliation Enforcement After Court Injunction
CMS issued implementation guidance July 22 following a federal district court injunction that blocked eight provisions of its 2027 notice of benefit and payment parameters final rule. The injunction, issued July 16, prevents enforcement of provisions set to take effect July 20. CMS directed exchanges to immediately stop removing or denying advance premium tax credits for applicants who failed to file and reconcile prior years' credits, effective for plan years 2026 and 2027. The agency also reinstated the automatic 60-day extension for resolving household income data inconsistencies.
- Federal Policy
Poll Shows Most Americans Reject Claims of Widespread Medicaid Beneficiary Fraud
A new poll finds that most Americans do not believe Medicaid beneficiaries are the primary source of program fraud, contradicting recent allegations from some Republican leaders. Respondents view current fraud enforcement rhetoric as politically motivated rather than substantive. The poll results come amid ongoing congressional and administrative debates over program integrity measures, oversight authority, and enforcement resource allocation. Public perception could influence state Medicaid agency priorities and federal oversight emphasis as policymakers weigh beneficiary-focused versus provider-focused fraud detection strategies.
Thursday, July 23 · 8 stories
- Federal Policy
KFF Brief Reviews U.S. Abortion Data Trends Through 2026
A KFF brief examines U.S. abortion data sources and trends before and after the Dobbs decision, analyzing factors affecting abortion rates and projecting potential policy changes under the current administration and Congress. The analysis covers state-level variations in access and utilization following the overturning of Roe v. Wade. The brief provides context for understanding how federal and state policy changes may continue to shape abortion access and Medicaid coverage decisions.
- Federal Policy
CMS Proposes Provider Enrollment Changes Across All Provider Types in 2027 Home Health Rule
CMS published a proposed rule on July 6, 2026, that includes provider enrollment changes applicable to all provider and supplier types, not just home health agencies. The changes are designed to strengthen program integrity across Medicare and Medicaid. The rule appears in the Calendar Year 2027 Home Health Prospective Payment System Proposed Rule. Comments are due 60 days after publication in the Federal Register.
- Federal Policy
Urban Institute Finds Postpartum Coverage Gains Stalling Among New Mothers
The Urban Institute reports that health insurance coverage for new mothers in the first year postpartum has improved in recent years but progress has stalled, according to Census Bureau American Community Survey data. The analysis examines uninsured rates among women ages 19 and older who gave birth within the past year. The findings come as states navigate the end of Medicaid continuous enrollment and implementation of the American Rescue Plan's optional 12-month postpartum coverage extension. The report signals potential erosion of maternal coverage gains that have reduced coverage gaps during the critical postpartum period.
- Federal Policy · VA
Virginia Hospitals Project $31B Medicaid Loss Under Proposed CMS Rule
A proposed CMS rule implementing last summer's reconciliation bill includes Medicaid payment cuts to healthcare facilities that Virginia hospitals say go beyond what Congress authorized. Hospital systems contend the rule would reduce state Medicaid funding by $31 billion. The public comment period closed this week. The rule affects facility reimbursement under Medicaid and represents CMS's interpretation of reconciliation bill directives that hospital chains argue exceeds legislative intent.
- Federal Policy
CMS Proposes CY 2027 Hospital Outpatient Payment and ASC Policy Changes
CMS issued the Calendar Year 2027 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center proposed rule affecting hospitals participating in Medicare. The proposed rule includes significant payment and policy changes for hospital outpatient services and ASCs. The rule establishes payment rates and updates operational policies for calendar year 2027. While focused on Medicare payment systems, managed care organizations contracting with hospitals for Medicaid services should monitor for potential cost-shifting effects and policy precedents that states may adopt.
- Federal Policy
Partnership for Medicaid Issues Statement Opposing Coverage Reduction Policies
The Partnership for Medicaid released a statement on May 9, 2025, expressing concerns about unspecified policy changes that could reduce Medicaid coverage and access to care. The statement does not identify specific rules, proposals, or effective dates. No federal guidance or rulemaking is referenced in the brief announcement. The Partnership for Medicaid is a coalition that includes Medicaid Health Plans of America among its members.
- Federal Policy
CMS Clarifies Home Health Acceptance-to-Service Requirements in Survey Guidance
CMS issued updated survey guidance on July 16, 2026, clarifying home health agencies' obligations under the acceptance-to-service standard in the Home Health Agency Conditions of Participation. The standard, which took effect in January 2025, requires agencies to develop, implement, and maintain policies governing patient acceptance. The guidance provides surveyors and agencies with clearer expectations for compliance. For Medicaid managed care organizations contracting with home health providers, this guidance affects network adequacy assessments and provider compliance monitoring.
- Federal Policy
CMS Announces Public Data Release Under OPEN Government Data Act
CMS will release new public data assets in machine-readable formats under the OPEN Government Data Act, part of the Foundations for Evidence-Based Policymaking Act of 2018. The data release aims to support fraud, waste, and abuse identification while promoting transparency and accountability. CMS states it has balanced transparency objectives with protection of sensitive information. The notice does not specify which datasets will be released or when they will become available.
Wednesday, July 22 · 7 stories
- Federal Policy
Trump Announces 100% Tariff on Imported Generics Effective August 2028
President Trump announced Tuesday via social media that imported generic drugs will face a 100 percent tariff beginning in August 2028 unless manufacturers relocate production to the United States. The tariff is described as a penalty designed to reshore generic pharmaceutical manufacturing. Generic drugs constitute the majority of Medicaid pharmacy spending, and most generics dispensed in the U.S. are manufactured overseas or contain active pharmaceutical ingredients from foreign suppliers. The two-year implementation timeline provides MCOs and state programs time to assess potential pharmacy cost impacts and supply chain disruptions.
- Federal Policy
CMS Proposes Tighter Remote Patient Monitoring Requirements in 2027 Physician Fee Schedule
CMS published a proposed rule on July 16, 2026, that would tighten requirements for remote patient monitoring (RPM) services in the Calendar Year 2027 Medicare Physician Fee Schedule. The changes respond to Office of Inspector General reports flagging program integrity concerns about RPM billing. The proposed rule affects how providers document and bill for remote monitoring services under Medicare. Comments on the proposed rule are typically due 60 days after publication in the Federal Register.
- Federal Policy
Webinar Examines H.R.1 Impact on Medicaid Maternal and Infant Health Programs
A webinar titled 'Medicaid Connections: Maternal and Infant Health and Justice' addresses how H.R.1 legislation affects Medicaid-funded maternity care. The session focuses on reproductive justice and optimizing Medicaid to fund holistic, culturally centered care including midwifery and doula services. As the nation's largest payer for maternity care, Medicaid plays a central role in addressing systemic health inequities for maternal and infant populations. The webinar provides guidance for policymakers on funding structures that support comprehensive perinatal services.
- Federal Policy
CMS Proposes Ban on Medicare Payment for Third-Party Remote Patient Monitoring
CMS has issued a proposed rule that would prohibit Medicare payment for remote patient monitoring services delivered by third-party vendors. Health systems, physician groups, and telehealth trade associations are opposing the proposal, citing concerns about disrupted RPM programs and unclear reimbursement alternatives. The proposal has prompted some organizations to pause RPM expansion plans and appears to conflict with congressional support for broader telehealth access. If finalized, the policy would require Medicare providers to deliver RPM services directly rather than through vendor arrangements.
- Federal Policy
Rural Hospital CEO Criticizes $50B Federal Rural Health Transformation Program Structure
A rural hospital CEO has publicly criticized the $50 billion Rural Health Transformation Program, which launched last year following Medicaid cuts under HR-1. Rural health executives are questioning the program's design, citing concerns that states control funding distribution, eligible uses are narrowly defined, and the structure may not adequately address care access challenges in communities affected by Medicaid reductions. The criticism reflects broader implementation concerns among rural providers about whether federal support will effectively reach facilities serving Medicaid populations.
- Federal Policy
AHA Urges CMS to Scale Back Medicaid State-Directed Payment Limits in Proposed Rule
The American Hospital Association submitted comments July 21, 2026, opposing portions of a CMS proposed rule implementing reconciliation-mandated changes to Medicaid state-directed payments. The rule proposes new limits on targeted fee-for-service payments and SDP design that exceed statutory requirements. CMS projects the rule would reduce Medicaid payments by $510.1 billion over 10 years—more than triple the Congressional Budget Office estimate of $149.4 billion. AHA argues the cuts would reduce care access, worsen workforce shortages, and threaten hospital financial viability, urging CMS to rescind provisions beyond what Congress required and mitigate SDP reductions.