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Friday, October 2 · 48 stories
- Industry · WA
MultiCare Health System Launches New Medicare Advantage Plan
MultiCare Health System, a 13-hospital nonprofit system based in Tacoma, Wash., announced on Oct. 1 the launch of MultiCare Health Plan, a wholly owned subsidiary. Its first product will be a Medicare Advantage HMO with drug benefits, available for the 2027 plan year in three Washington counties, supported by independent physician association Physicians of Southwest Washington. Karen Decaran-Voigt, a longtime payer and provider executive with prior roles at Molina, UnitedHealth, CommonSpirit and Elevance, will lead the new plan. The move comes as MultiCare pursues an affiliation with Samaritan Health Services, whose own health plan continues to offer Medicaid and D-SNP products, and runs counter to a broader trend of health systems shutting down their own insurance plans amid rising costs.
- Industry
Home Care Providers Expand Dementia, Behavioral Health Offerings
In an HHCN+ members-only analysis, Home Health Care News reports that dementia care and behavioral healthcare are shifting from niche differentiators to baseline expectations for home-based care providers serving older adults. The piece cites examples including HomeWell Care Services exploring expanded dementia support, VNS Health's Dementia Care at Home program launched in 2023, Empath Health's new dementia education program in Florida, and specialist firms like Author Health building businesses around older adults' behavioral health needs. The author argues providers don't need to own these service lines outright but must have a credible plan, internal training, partnerships, or specialized programs, to address cognitive and behavioral health needs as more patients aim to age in place. No regulatory action or new policy is announced; the piece reflects industry strategy trends.
- State Policy · MN
Minnesota Individual, Small Group Insurance Rates to Rise 17% in 2027
Minnesota's Department of Commerce announced average 2027 premium increases of 17% for individual and small group health insurance plans, affecting roughly 203,000 individual market enrollees and 184,000 small group enrollees. This marks a second consecutive year of double-digit hikes, following a 22% individual market increase and 14% small group increase in 2026. State officials cited rising medical and drug prices, increased utilization, and growth of "profit-driven entities" in healthcare delivery and financing as drivers. The announcement coincided with a state Senate hearing where health economists linked hospital consolidation, including a newly announced merger between Essentia and HealthPartners, to rising premiums, and comes amid reduced federal premium tax credits and election-year political blame-shifting.
- Federal Policy
CMS Opens 340B Part D Claims Data Repository for Voluntary Use
CMS launched its 340B Part D claims data repository on October 1, allowing covered entities and third-party administrators to begin submitting claims data voluntarily. CMS has proposed requiring mandatory submissions starting January 1, 2027. To support entities during the transition, CMS has published a user guide, companion guide, fact sheet, and FAQ. The repository is intended to improve tracking of 340B drug claims under Medicare Part D.
- Federal Policy
CMS Finalizes GLOBE Model Testing International Drug Rebate Benchmark
CMS finalized its Global Benchmark for Efficient Drug Pricing (GLOBE) Model on Sept. 30, a mandatory test of an alternative manufacturer rebate calculation under the Medicare Part B Inflation Rebate Program. Instead of the current domestic pricing benchmark, the model uses a benchmark derived from international pricing data. After public comment, CMS excluded biosimilars, orphan-only drugs, plasma-derived products and certain cell and gene therapies, and carved out manufacturers already participating in its GENEROUS Model, leaving only four manufacturers expected to be required to participate. The model will apply to Medicare beneficiaries in a randomly selected subset of geographic areas covering about 25% of Original Medicare beneficiaries. CMS now estimates $440 million in savings over the seven-year performance period, sharply lower than its earlier $12 billion projection.
- Industry · OK
Oklahoma Critical Access Hospital Plans Staffing, Contract Cuts for 2027
In a Becker's Hospital Review report, Arbuckle Memorial Hospital CFO Denise Welch describes how the Sulphur, Oklahoma critical access hospital is preparing its 2027 budget amid financial pressure. The hospital plans to cut staffing redundancies and hold outside contract spending flat rather than reduce wages, which Welch says would hurt amid competitive labor markets. Welch said the hospital will continue investing in technology and informatics infrastructure to avoid care delays and reduce outside exposure, while updating fully depreciated building infrastructure to maintain its current reimbursement status. The comments illustrate budget tradeoffs facing small rural hospitals heading into 2027.
- State Policy · NM
NM House Candidates Clash Over Medicaid in District 3 Race
Incumbent U.S. Rep. Teresa Leger Fernández (D) faces state Rep. Martin Zamora (R-Clovis) in the Nov. 3, 2026 general election for New Mexico's 3rd Congressional District. In an interview with Source NM, Leger Fernández criticized Trump administration and Republican-backed cuts to Medicaid and food assistance, citing 10,000 New Mexico children who lost federal benefits due to the One Big Beautiful Bill, and said she would prioritize legislation to increase healthcare providers in rural areas. Zamora, who did not respond to interview requests, has campaigned on property rights, energy jobs, crime and border security rather than healthcare. The race will determine representation for a largely rural northern and eastern New Mexico district with significant Medicaid-dependent populations.
- Industry · TN
Vanderbilt Health's FY2026 Margin Jumps on TennCare Payments, Acquisition
Vanderbilt Health reported fiscal 2026 operating income of $452 million (4.7% margin), up from $255 million (3.0% margin) in fiscal 2025, per its Sept. 30 financial report. Operating revenue rose 12% to $9.5 billion, driven by higher surgical, procedural, ambulatory and pharmacy volumes, while expenses grew 9.9% on staffing and drug cost increases. The system recognized $230 million in fiscal 2026 from TennCare's Hospital Investment Program, a supplemental Medicaid payment program using an average commercial rate approach, up from $179 million the year prior. Vanderbilt also completed full acquisition of Tennova Healthcare-Clarksville in February, and net income rose to $775 million from $424 million.
- State Policy · IA
Iowa Candidates Clash Over Medicaid, Immigration in Debate
Iowa state Rep. Lindsay James (D) and Republican Joe Mitchell debated Thursday ahead of the 2026 race for the state's 2nd Congressional District seat. Mitchell accused James of supporting Medicaid and SNAP access for undocumented immigrants, citing her vote against a measure requiring immigration status and residency verification for benefit eligibility; James called the characterization dishonest and said Iowans are her priority. The candidates also sparred over border security, immigration enforcement funding, and data-center tax incentives. The seat is open because incumbent Rep. Ashley Hinson is running for U.S. Senate.
- State Policy · NJ
NJ Advocates Demand Oversight After Opioid Funds Misspent
New spending reports released Thursday show New Jersey state, county, and municipal officials spent opioid settlement funds on bounce houses, DJs, dirt bike demonstrations, ice cream events, graduation parties, and other questionable items instead of core addiction treatment and prevention priorities. The $60 million spent over the past year is part of $1.1 billion New Jersey will receive through 2038 from drug manufacturers, distributors, and pharmacies to resolve opioid lawsuits. Harm reduction advocates, including the New Jersey Organizing Project and Sea Change Recovery Community, are calling for tighter oversight, pointing to prior criticism from the former state comptroller and attorney general over similar misuse, including a $45 million diversion to hospitals facing federal Medicaid cuts. Municipalities were singled out as the "worst offenders" of stretching definitions of prevention and treatment barriers to justify spending.
- Industry · FL
Survey Finds Mothers Face Major Barriers to Mental Healthcare Access
Count on Mothers and Inseparable released "Pulse Check 2026: Mothers on Mental Health, Care, and the Systems Around Their Families," a survey of 2,818 U.S. mothers and primary female caregivers conducted May 7-27. The report finds 50% of mothers nationally (48% in Florida) struggled with their own mental health in the past month, and 39% had a child needing behavioral health support in the past year, with 47% of those receiving only partial care or none due to barriers. Among parents facing barriers, 56% reported at least one insurance-related problem. Notably, mothers with employer-sponsored insurance reported less confidence their plans would cover adequate mental health care than mothers covered by Medicaid or CHIP, with only 6% of Medicaid mothers reporting no confidence in coverage versus higher distrust among commercially insured respondents.
- State Policy · ME
LePage, Dunlap Spar Over Medicaid in Maine House Debate
Maine Morning Star reports that Republican Paul LePage and Democrat Matt Dunlap clashed in their first debate for Maine's open 2nd Congressional District seat, sparring over healthcare policy including Medicaid. Dunlap backed restoring expired ACA marketplace premium subsidies, which 85% of Maine's 61,000 CoverME.gov enrollees relied on, and voiced long-term support for universal healthcare; LePage opposed Medicaid expansion and defended federal Medicaid cuts, citing a $50 billion rural health funding program as an offset. LePage also repeated claims of widespread Medicaid fraud in Maine, though the state's most recent federal payment error rate was 2.4%, below the 3.2% national average, with only about 0.1% of spending confirmed incorrect. The debate occurred Oct. 1, ahead of the election to replace outgoing Rep. Jared Golden.
- State Policy · SD
South Dakota House Candidates Clash Over Tariffs, Medicaid Work Requirements
At an Oct. 1 debate co-hosted by South Dakota Public Broadcasting and South Dakota News Watch, Republican Marty Jackley and Democrat Nikki Gronli, candidates for South Dakota's U.S. House seat, sparred over tariffs, energy costs and the One Big Beautiful Bill Act's healthcare provisions. Jackley criticized Trump's push to import Argentine beef but otherwise backed Trump's tariff approach, while Gronli said tariffs and the Iran conflict have driven up costs for farmers and families. On Medicaid, Jackley defended the law's new work requirements as a fraud-prevention measure and praised sending rural health transformation dollars (South Dakota has received $189 million so far) to states to decide how to spend. Gronli argued the law's cuts to Medicaid and other programs would harm residents who depend on them. The general election is Nov. 3.
- Industry
BHB Commentary: Outside Investors Improve Autism Therapy Accountability
In a Behavioral Health Business commentary, the author argues that the autism therapy industry's reputational scandals stem not from private equity or outside capital involvement, but from a lack of external accountability among founder-owned, independently run providers. The piece cites ABA Centers of America, Piece By Piece Autism, The Perfect Child, and Stepping Stones Behavioral Solutions, all organizations facing billing fraud, Medicaid scrutiny, or federal investigation, as examples lacking outside board oversight or capital-partner governance. The author contends that private equity and family office investors, while not guarantors of ethical conduct, tend to impose governance controls, compliance infrastructure, and risk oversight that founder-led organizations often cannot afford on their own. The commentary frames bringing in outside capital as a maturation step for an industry historically short on standardized oversight.
- Federal Policy
Georgetown CCF Submits Comments on Senate Finance RFI on Health Coverage
Georgetown University's Center for Children and Families (CCF) submitted comments responding to a Request for Information from Senate Finance Committee Ranking Member Ron Wyden on policy proposals to improve access, quality, and affordability of health coverage nationally. The RFI sought stakeholder input on a broad range of proposals affecting health coverage, including Medicaid and CHIP. CCF's submission reflects the organization's positions on how these proposals would affect children's and families' coverage. The specific policy recommendations and their implications for state Medicaid programs are detailed in CCF's full submission.
- Industry
BRG Study Finds 340B Drug Margin Hit $142 Billion in 2025
In its "6 study notes" roundup, Becker's Hospital Review reports on an October Berkeley Research Group study estimating patients and payers spent $244.3 billion on 340B drugs in 2025, more than double 2021's $108.4 billion. BRG calculates a "340B drug margin", the gap between covered entities' discounted acquisition cost and what patients and payers are later charged, at $142.2 billion in 2025, over double the 2021 figure. Commercial insurers bore 63% of that margin, Medicare 25%, and Medicaid managed care 7%, while Medicaid fee-for-service generates no margin since it reimburses at acquisition cost. BRG attributes growth to hospital acquisition of off-site clinics, expanded hospital participation, and a surge in contract pharmacies from roughly 1,300 in 2010 to about 35,000 today.
- State Policy · OR
Oregon Panel to Send Lawmakers Universal Health Plan by Dec. 1
A nine-member Universal Health Plan Governance Board, created by the Oregon legislature in 2023, will deliver a proposal to lawmakers by December 1 for a single-payer system covering medical, vision, dental, and mental health benefits for all residents starting in 2032, with no premiums, deductibles, or copayments. Lawmakers could vote on the plan in the 2027 session or send it to voters as a 2028 ballot measure. The plan would replace insurance premiums and out-of-pocket costs with new corporate and personal taxes funding a single payment pool for all providers, and would make Oregon the first state with single-payer coverage if adopted. Similar ambitions exist in California, New York, and Washington, but prior single-payer efforts in Vermont and ballot measures in Colorado, Oregon, and California have all failed amid industry opposition.
- State Policy · VA
Federal Funding Cuts End Virginia Medicaid Coverage for Legal Immigrants
In its morning headlines roundup, Virginia Mercury highlights a VPM report that federal funding cuts have ended Medicaid eligibility for thousands of legal immigrants in Virginia. The coverage losses stem from changes in federal funding tied to the Trump administration's policy actions, affecting legal immigrants who previously qualified for the program. The roundup also includes unrelated Virginia election and news items. No specific effective date or population count is detailed in the source material beyond the general claim of thousands losing access.
- Federal Policy · OH
Census Bureau Delays Poverty Data Amid Medicaid, SNAP Cuts
The Census Bureau has indefinitely delayed its American Community Survey, a key dataset tracking state and local poverty, income, insurance and housing trends, just as deep federal safety-net cuts take hold. The bureau attributes the delay to a new Commerce Department order banning "noise infusion," a privacy-protection technique, though some scientists quoted in Science magazine suspect political motives. Researchers say the gap leaves them unable to measure the state-level impact of the One Big Beautiful Bill Act's roughly $1 trillion in Medicaid cuts and $187 billion in SNAP cuts, plus the expiration of ACA subsidies that caused Ohio's Medicaid-adjacent marketplace enrollment to drop 32.4%, the largest decline of any state. No new release date has been set.
- Legal
DOJ Memo Prioritizes Healthcare Fraud in Corporate Investigations
An Oct. 1 memo from Assistant Attorney General Colin McDonald directs the Justice Department's National Fraud Enforcement Division to prioritize healthcare fraud, including controlled substance distribution and FDCA violations, as one of four focus areas for corporate investigations. Prosecutors must weigh 10 factors when deciding on charges or plea agreements, including corporate management's knowledge of schemes, efforts to conceal fraud from government auditors, and conduct causing substantial harm to taxpayer-funded programs. The division, formed in April from the former Criminal Division Health Care Fraud Unit, is using data analytics to accelerate new investigations and will develop whistleblower incentive programs, including for participants in misconduct. The policy also directs prosecutors to follow existing self-disclosure and cooperation credit guidance while avoiding overly broad enforcement.