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Monday, September 21 · 26 stories
- Industry
Home Care Agencies Urged to Pilot AI Tools Before Deployment to Avoid Operational Risks
Home care agencies face growing risks from adopting unvetted artificial intelligence and other technologies without thorough evaluation. Industry experts recommend piloting tools in limited settings before full deployment, scrutinizing vendor contracts for liability and performance terms, and demanding evidence-based proof of efficacy claims. Poor technology choices can result in operational disruptions, compliance gaps, and unexpected costs. The guidance targets agencies serving populations including Medicaid LTSS beneficiaries.
- State Policy · AR
Arkansas Schedules January Special Election for Senate District 18 Following Dismang Resignation
Arkansas Governor Sarah Huckabee Sanders set a January 5, 2027 special election to fill the Senate District 18 seat vacated by former Republican Sen. Jonathan Dismang, who resigned this week to become vice president of external affairs for Arkansas Electric Cooperatives. A special primary will coincide with the November 3 general election. Dismang, who served as an architect of Arkansas' Medicaid expansion, leaves Republicans with a 27-6 majority in the state Senate. Candidates have until noon September 24 to file for the vacancy in the district covering White County and parts of Faulkner and Cleburne counties.
- Industry
New Federal Student Loan Limits May Restrict Medical School Access
New federal limits on student borrowing are taking effect that may restrict access to medical school at a time when physician shortages are resulting in patients waiting weeks or months for appointments. The policy affects medical school affordability for prospective students. The exact timing of implementation and specific borrowing caps are not detailed in the available excerpt. The change could compound existing physician workforce shortages affecting healthcare access nationwide.
- Legal
Federal Judge Dismisses Challenge to Title X Grant Process Changes
A federal judge in Pennsylvania dismissed a lawsuit filed by the National Family Planning and Reproductive Health Association and the Family Health Council of Central Pennsylvania challenging HHS's revised Title X grant application process. The plaintiffs alleged the new alignment review requirements politicized funding decisions and violated statutory intent, but U.S. District Judge Jennifer P. Wilson ruled they did not demonstrate sufficient concrete harm to establish standing. The revised 2027 funding round shifts Title X priorities from contraception access to pregnancy promotion and family formation, though HHS removed language allowing outright rejection based on alignment review after the lawsuit was filed.
- Industry · MD
Maryland Insurers Request Long-Term Care Premium Increases Up to 300%
Four Maryland insurance companies have requested state approval for steep premium increases on long-term care insurance policies that would double or triple costs for thousands of seniors over five years. The rate hike requests were filed last week and await approval from state officials. If approved, the increases would affect existing policyholders' annual premiums beginning in the near term. The proposals reflect the broader financial pressures facing the long-term care insurance market, where carriers have struggled with underpriced policies and higher-than-expected claims.
- State Policy · DE
Delaware Officials Call Healthcare Spending Unsustainable, Eye Global Hospital Budgets
Delaware health officials told the Delaware Health Care Commission that current healthcare spending trends are unsustainable and threatened state budgets. Secretary of Health and Social Services Christen Linke Young said the state should pursue global budgeting models for hospitals, similar to Maryland's approach that sets fixed annual prices for services. Medicaid managed care organizations are already losing money despite rate increases, according to state Medicaid director Andrew Wilson, diverting funds from schools and infrastructure. Officials said providers must find efficiencies while the state creates market conditions incentivizing value-based care.
- State Policy · CA
California Requires Health Plans to Connect Callers to Live Agent Within 15 Minutes
California enacted legislation requiring large health care entities, including health plans, managed care organizations, PBMs, and pharmacies, to transfer callers from AI chatbots to human customer service representatives within 15 minutes upon request. The requirement applies to inquiries about medication refills, transfers, denied claims, prior authorizations, and specialist referrals. Hospitals obtained a broad exemption from the mandate. The law takes effect on a date not specified in this summary, and applies to large health care entities operating in California.
- State Policy · AR
Arkansas Medicaid Spending Rose $400M in Fiscal 2026, Finance Secretary Tells Lawmakers
Arkansas Medicaid spending increased $400 million between July 1, 2025 and June 30, 2026 compared to the prior year, according to Finance and Administration Secretary Jim Hudson's testimony to state legislators on September 18, 2026. The increase aligned with the Department of Human Services' fiscal 2026 operating plan. Hudson urged lawmakers to maintain full Medicaid funding going forward. The spending increase reflects rising enrollment, utilization, or rate pressures in the Arkansas Medicaid program.
- State Policy · CO
Colorado Faces $1.6B Budget Deficit Driven by Rising Medicaid Costs
Colorado projects a $1.6 billion state budget deficit for fiscal year 2027-28, driven primarily by escalating Medicaid costs. The shortfall reflects ongoing healthcare cost growth pressures that state lawmakers must address through budget adjustments, potential service cuts, or revenue increases. Colorado operates a managed care delivery system serving over 1.5 million Medicaid enrollees. The deficit timing suggests state agencies and health plans should anticipate potential capitation rate pressures, benefit changes, or provider rate adjustments in upcoming budget negotiations.
- Federal Policy
Trump Administration Launches Drug Pricing Initiative for State Medicaid Programs
The Trump administration announced a new federal initiative to offer discounted pharmaceuticals to state Medicaid programs, with reported participation from all states. The program, referred to as GENEROUS, aims to reduce prescription drug costs for Medicaid enrollees. Key operational details including pricing mechanisms, implementation timelines, and specific drug categories covered remain undisclosed. The initiative represents a federal effort to lower pharmaceutical spending in Medicaid, though states and managed care organizations await guidance on program structure and participation requirements.
- Industry · AZ
Ascension Sells Arizona Medicaid Plan Stake to Aetna
Ascension has sold its ownership interest in an Arizona Medicaid managed care plan to Aetna. The transaction allows Ascension to exit insurance risk while Aetna acquires a stake in a plan with a profitable dual-eligible member base. The deal reflects ongoing consolidation in Medicaid managed care, with payers seeking scale in high-acuity populations. Financial terms and the effective date of the transaction were not disclosed.
- State Policy · LA
Louisiana Estimates 58,000 Medicaid Enrollees May Need Steps to Meet January Work Requirements
Louisiana's health department projects approximately 58,000 Medicaid recipients may need to take additional steps to comply with new federal work requirements effective January 2027. The estimate indicates the potential scale of administrative burden and coverage risk facing the state's Medicaid program as implementation approaches. State agencies must prepare verification systems, outreach campaigns, and exemption processing to minimize coverage loss among working-age adults. The timeline gives Louisiana roughly three months to finalize operational readiness.
- State Policy · NJ
New Jersey Faces Loss of Medicaid Coverage for 25,000 Legal Immigrants October 1
A federal Medicaid eligibility change will terminate coverage for approximately 25,000 legal immigrants in New Jersey effective October 1, 2026. The policy shift affects noncitizen residents currently enrolled in the state's Medicaid program. New Jersey officials and advocates are assessing the impact on affected enrollees and state program operations. The change represents one of several federal policy modifications now affecting Medicaid eligibility for noncitizen populations.
- Federal Policy
All States Apply for CMS Medicaid Drug Pricing Program
All 50 states, Washington, D.C., and Puerto Rico have applied to participate in a CMS arrangement designed to reduce Medicaid drug costs, with 40 states and Puerto Rico already signing agreements. President Trump announced the milestone Friday, characterizing the program as delivering significant savings to state Medicaid programs. The timing and specific mechanics of the drug pricing arrangement were not detailed in the announcement. The development signals broad state interest in federal cost-containment tools for Medicaid pharmacy spending.
- Federal Policy
CMS Launches Medicaid Drug Payment Model with Participating States
CMS announced participating states in a new Medicaid drug payment model aimed at reducing prescription drug costs for Medicaid beneficiaries. The model will test alternative reimbursement methodologies for prescription drugs in Medicaid programs. Participating states will implement the model beginning in 2027, with CMS providing technical assistance and evaluating outcomes over a multi-year period. The initiative targets cost reduction while maintaining access to necessary medications for Medicaid enrollees.
Friday, September 18 · 34 stories
- Industry
12 Million Americans Lack Broadband Access for Telehealth, Study Finds
New research indicates approximately 12 million Americans cannot access telehealth services due to unavailable or inadequate broadband infrastructure, with the majority residing in rural areas. The study highlights ongoing digital divide challenges that limit virtual care delivery in communities that could benefit most from remote access to healthcare providers. While telehealth utilization has grown across Medicaid programs since the pandemic, this infrastructure gap affects beneficiaries' ability to access covered services in underserved areas. The findings underscore persistent barriers to care delivery models that states and managed care plans have increasingly incorporated into benefit design.
- Industry
60 Hospitals Close Departments or End Services Citing Financial Pressures, Staffing Shortages
Becker's Hospital Review compiled 60 hospital department closures and service discontinuations reported since January 1, 2026. Healthcare organizations cite financial challenges, efforts to focus on higher-demand services, and staffing shortages as primary drivers. The closures affect various service lines across facilities nationwide. The trend reflects ongoing operational pressures facing hospitals that may affect Medicaid beneficiaries' access to care depending on the services eliminated and markets affected.
- Managed Care
Health Systems Report Claims Automation Gap with Payers Creating Revenue Cycle Pressure
Revenue cycle executives at 17 health systems report that payers are now reviewing and denying claims at volumes and speeds that providers cannot match, creating what they describe as an unsustainable financial asymmetry. The automation gap affects providers' ability to respond to denials and prior authorization requests in real time. The imbalance is intensifying as payers deploy AI and automation tools faster than health systems can adopt corresponding technology. For Medicaid managed care organizations and their provider networks, this dynamic accelerates existing tensions over claims processing, prior authorization burden, and network adequacy tied to provider financial stability.
- Industry
One-Third of Privately Insured Adults Carry Medical Debt, Commonwealth Fund Reports
A Commonwealth Fund study found that one-third of privately insured adults have unpaid medical debt to healthcare providers, demonstrating that medical debt affects insured populations beyond emergency care scenarios. The findings highlight ongoing affordability challenges even among those with commercial coverage. The research underscores systemic issues with cost-sharing structures and provider billing practices affecting access to care. For Medicaid managed care organizations, the data provides context for understanding financial barriers facing dual-eligible populations and individuals cycling between coverage types.
- Federal Policy
Law Firm Comments on CMS Proposed Rule for Remote Monitoring Payment Under 2027 Physician Fee Schedule
Epstein Becker Green submitted comments to CMS on September 14, 2026, regarding the 2027 Physician Fee Schedule Proposed Rule, focusing on payment and coverage policies for device-enabled remote monitoring services furnished to Medicare beneficiaries. The comments were submitted on behalf of health care practices providing these services. The Proposed Rule affects Medicare Part B payment rates and policies that will take effect in calendar year 2027, with the comment period having closed in mid-September 2026.