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Thursday, October 1 · 10 stories
- Federal Policy
HHS Clarifies Use of SUD Records for Medicaid Work Exemptions
The HHS Office for Civil Rights issued guidance clarifying how 42 CFR Part 2 confidentiality rules for substance use disorder patient records interact with Medicaid community engagement requirements. The notice explains when state Medicaid agencies may use Part 2 records to verify whether an applicant or beneficiary qualifies as a "specified excluded individual" exempt from the work requirements established by the July 2025 reconciliation law. It includes examples illustrating permitted circumstances for this verification use. The guidance helps states implement exemption determinations without running afoul of federal SUD confidentiality protections.
- Federal Policy
Seven Healthcare Laws, Including Medicaid Eligibility Limits, Start Oct. 1
Becker's Hospital Review rounds up seven federal and state healthcare laws taking effect October 1, including a federal provision narrowing Medicaid eligibility for many lawfully present noncitizens under Section 71109 of HR 1, which limits federal eligibility for certain immigrant groups. The roundup also covers Connecticut's certificate-of-need overhaul and Maryland's new hospital staffing framework among other state-specific changes. These laws affect state Medicaid agencies administering eligibility determinations, health plans serving affected populations, and hospitals in Connecticut and Maryland. The changes take effect October 1, 2026.
Wednesday, September 30 · 8 stories
- Federal Policy
CMS Weighs Ending Weekly COVID Data Reporting for LTC Facilities
In a client alert, Bond Schoeneck & King reports that CMS is reportedly considering sunsetting pandemic-era requirements that long-term care facilities report COVID-19 and other respiratory illness data weekly to the CDC's National Healthcare Safety Network. The requirement currently applies to nursing homes and other CMS-regulated long-term care providers. No formal rule or timeline has yet been issued, and the firm characterizes the change as reported rather than confirmed. Nursing facilities have tracked and submitted this surveillance data throughout the pandemic as a condition of participation compliance matter.
- Federal Policy
Commerce Defines Exemptions to New 100% Pharma Import Tariff
The 100% Section 232 tariff on patented pharmaceuticals and related pharmaceutical ingredients took full effect September 29 for companies not covered under the earlier July 31 implementation date. The Commerce Department's Bureau of Industry and Security has specified which specialty pharmaceutical products qualify for a 0% tariff rate and which countries are eligible for exemptions. Drug manufacturers, importers, and distributors must now determine whether their products fall under the exempt categories or face the full tariff. The distinction affects sourcing and pricing decisions across the pharmaceutical supply chain.
- Federal Policy · NC
CMS Awards $20 Million for Rural North Carolina Telehealth Upgrades
CMS announced a $20 million funding award to expand telehealth access and upgrade healthcare technology infrastructure across rural North Carolina. The funding targets rural providers and communities, aiming to improve access to care through technology and connectivity improvements. Details on the specific funding mechanism, distribution timeline, and eligible recipients were not fully specified in the announcement. The initiative reflects continued federal attention to rural healthcare access, which is a persistent challenge for rural Medicaid beneficiaries and the providers who serve them.
- Federal Policy
HHS Report Links Gender-Affirming Care to Radicalization Risk
HHS has issued a report suggesting gender-affirming care "may" contribute to radicalization among transgender people, drawing criticism from advocates and clinicians who say it mischaracterizes established treatment models and frames transgender identity as illegitimate or dangerous. The report is described as part of a broader agency effort to undermine confidence in standard-of-care approaches to transgender health. No new rule, waiver, or coverage change is described in the source material; the report itself is the development. Critics note the claims lack clear methodological grounding and could be used to justify future restrictions on coverage or clinical guidance affecting transgender Medicaid beneficiaries.
- Federal Policy
Senate Democrats Question HHS Over Delayed Pediatric COVID Vaccine Access
Senate Minority Leader Chuck Schumer and other top Senate Democrats sent a letter to CDC Director Erica Schwartz and HHS Secretary Robert F. Kennedy Jr. questioning an apparent delay in making COVID-19 vaccines available to low-income children through a federal program. The lawmakers are seeking answers about why access through this program has stalled and what HHS plans to do to restore timely vaccine availability. The letter does not specify a response deadline in available reporting. Low-income children who rely on federally funded vaccine access programs, often coordinated with state Medicaid and CHIP populations, are the primary group affected by any delay.
- Federal Policy
Census Bureau Proposes 2030 Rule Changing Residency, Apportionment Rules
In a resource brief, State Health and Value Strategies examines a Census Bureau proposed rule, published September 10, 2026, that would overhaul 2030 Census residence criteria and demographic data collection, alongside a new Disclosure Avoidance Order changing privacy protection methods for public data products. The residency proposal would exclude many non-citizens from population counts and establish a new January 3–April 1 enumeration period, while also excluding undocumented immigrants and other groups from congressional apportionment counts. State health agencies rely on Census products like the American Community Survey and Current Population Survey for Medicaid and CHIP funding formulas, coverage monitoring, disparity analysis, and program cost projections. Comments on the proposed rule are due October 13, 2026, giving states a limited window to weigh in on changes that could ripple through health policy data infrastructure.
- Federal Policy
Trump Administration Withholds Health Funds Before Fiscal Year Deadline
The Trump administration has declined to spend billions of dollars in congressionally appropriated health program funding, risking its expiration at the fiscal year-end on Wednesday. Democratic lawmakers and some Republicans argue the withholding violates federal law governing appropriated funds. The impasse tests whether Congress will act to compel spending of the funds before they lapse. The story does not specify which health programs or dollar amounts are affected.
- Federal Policy
Bipartisan Bill Would Make PACE a Mandatory Medicaid Service
Reps. Debbie Dingell (D-Mich.) and John Moolenaar (R-Mich.) introduced the PACE Access Improvement Act on Sept. 24, which would make the Program of All-Inclusive Care for the Elderly a mandatory Medicaid service rather than a state option. The bill also aims to ease requirements so PACE providers can expand in-home care access. States currently choose whether to offer PACE, which serves frail, dual-eligible seniors who qualify for nursing home care but wish to remain in the community. If enacted, the measure would require all state Medicaid programs to cover PACE, likely spurring growth in the number of PACE organizations and enrollees nationwide.
Tuesday, September 29 · 4 stories
- Federal Policy · MT
CMS Awards $8.7 Million for Rural Montana Ambulance Upgrades
CMS announced $8.7 million in federal funding to purchase new ambulances and medical equipment for rural emergency medical service providers across Montana. The funding is intended to help rural communities replace aging equipment and improve emergency response capacity. Federal officials framed the award as part of a broader push to support rural health infrastructure. Specific implementation timelines and grant recipient details were not detailed in the announcement.
- Federal Policy
States Face Deadline to Join Medicaid International Drug Pricing Pilot
In its D.C. Diagnosis newsletter, STAT reports that Wednesday is the deadline for states to opt into GENEROUS, a pilot program letting Medicaid access drugs at prices available abroad. Separately, the Senate health committee will vote Wednesday on three HHS nominees, but not on Heidi Overton, the nominee to lead the FDA, whose confirmation now won't be decided until after the Senate returns Nov. 9. CMS Administrator Mehmet Oz is also traveling to Texas to promote CHOICE arrangements, which let employers give workers tax-free funds to buy ACA Marketplace coverage.
- Federal Policy
CMS Ends Automatic Medicare Add-On Payments for Breakthrough Devices
CMS has finalized removal of the pathway that let FDA "breakthrough"-designated devices automatically qualify for supplemental Medicare payments, including new technology add-on payments and transitional pass-through payments, without demonstrating substantial clinical improvement or novelty. Device manufacturers are affected most directly, since new breakthrough-designated products will need to meet standard evidentiary requirements to secure extra payment starting in October. The change follows an August CMS rule finalizing the policy shift. While this is a Medicare payment policy change, Medicaid stakeholders should track it because device coverage and payment precedents set in Medicare often influence state Medicaid fee schedules and managed care benefit design for the same technologies.
- Federal Policy
Medicaid Work Requirements Set to Begin in 2027, CBO Projects Coverage Losses
New federally mandated Medicaid work requirements are scheduled to take effect at the start of 2027, and the nonpartisan Congressional Budget Office estimates the changes could leave 8 million more people nationally without health insurance. Patients and caregivers are voicing concern about how the requirements will affect their coverage and access to care. NBC News reports on these concerns ahead of implementation. State Medicaid agencies and beneficiaries have roughly a year to prepare for eligibility verification and enrollment changes.
Monday, September 28 · 9 stories
- Federal Policy
Trump Administration Plans to Reshore Production of 86 Key Drugs
According to a Sept. 25 Bloomberg report cited by Becker's Hospital Review, the Trump administration is developing an initiative to move manufacturing of 86 essential medicines to the U.S. within 18 months. Under the plan, the Office of Management and Budget would solicit proposals from healthcare industry stakeholders on how to reshore production of drugs on the list. The report does not specify an effective date or regulatory vehicle for the initiative. Because many of the listed medicines are generics commonly used in Medicaid populations, supply chain shifts could affect drug availability and pricing that state Medicaid pharmacy programs and MCOs manage.
- Federal Policy
CMS Cancels 760,000 ACA Enrollments, Halts New Broker Sign-Ups
CMS cancelled roughly 760,000 individual Affordable Care Act Marketplace enrollments and imposed a temporary moratorium on registering new agents and brokers for plan year 2027, effective September 22, 2026. The action accompanies enhanced verification requirements aimed at curbing improper or unauthorized enrollments in ACA plans. Agents, brokers, health plans, and affected consumers must adjust to stricter oversight and potential enrollment disruptions during the moratorium period. Morgan Lewis reports the moves signal a broader shift toward more aggressive CMS scrutiny of Marketplace enrollment integrity.
- Federal Policy
Study Finds Sudden Infant Death Widening Black-White Mortality Gap
A study published Sept. 22 in JAMA Network Open found that the gap in infant mortality rates between Black and white babies widened between 2020 and 2024, with sudden unexpected infant death identified as the largest single driver of the disparity. Researchers analyzed federal birth and infant death records covering nearly 58 million live births to reach these findings. The study does not describe a specific policy action or regulatory change tied to the findings. For Medicaid programs, which finance a large share of births and infant care, the research underscores persistent racial disparities in birth outcomes relevant to maternal and infant health initiatives.
- Federal Policy
Senate Democrats Question Kennedy Ethics Compliance on Vaccine Lawsuit Divestment
Senate Democrats are questioning whether HHS Secretary Robert F. Kennedy Jr. potentially violated his ethics agreement by allegedly concealing an arrangement to collect money from a settlement with a vaccine manufacturer. Kennedy pledged to divest from the lawsuit during his confirmation process last year. The senators' inquiry raises concerns about potential conflicts of interest at the federal agency overseeing Medicaid and other health programs. The matter is significant for Medicaid stakeholders because Kennedy's leadership of HHS includes oversight of CMS, which administers the Medicaid program and sets immunization policy affecting coverage requirements for state programs and managed care plans.
- Federal Policy
CMS Proposes Reduced Payment for Same-Day Evaluation and Procedure Services
CMS has proposed a rule to reduce Medicare payment for evaluation and management services performed on the same day as a procedure, paying full price for the more expensive service and a reduced rate for the second to account for shared costs. The change would affect how providers bill Medicare Part B for same-day services, such as when a dermatologist evaluates a patient and immediately performs a removal procedure during the same visit. The proposal aims to eliminate duplicative billing and reduce out-of-pocket costs for Medicare beneficiaries, who currently pay copayments based on the full rate for both services. The rule would lower costs for patients and taxpayers by preventing Medicare from paying twice for overlapping service components.
- Federal Policy
SAMHSA Awards $247.9 Million in Behavioral Health Grants
The Substance Abuse and Mental Health Services Administration announced September 25 that it awarded $247.9 million in grants to expand access to addiction treatment, mental health services, and recovery support. The funds will support school-based mental health services, trauma treatment for children and families, overdose reversal efforts by first responders and communities, and employment support for people in recovery. The awards take effect immediately for grantees nationwide. For state Medicaid agencies and managed care organizations, these federal grants represent new resources that may complement or coordinate with Medicaid-funded behavioral health services, particularly for populations eligible for both programs.