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Monday, July 20 · 8 stories
- Federal Policy
NBC News Seeks Sources on Medicaid Work Requirement Implementation Effects
NBC News is soliciting interviews with Medicaid beneficiaries, providers, and advocates regarding impacts of newly implemented Medicaid work requirements. The outlet is gathering first-hand accounts of how work mandates are affecting access to coverage and care delivery. This follows federal approval of state Section 1115 waivers authorizing work and community engagement requirements as a condition of Medicaid eligibility. The solicitation indicates work requirements are now actively in effect in at least some states, triggering coverage losses or administrative burdens for beneficiaries and compliance obligations for managed care plans.
- Federal Policy
CMS Proposes Major Changes to Remote Monitoring Payment in 2027 Fee Schedule
CMS released the calendar year 2027 Medicare Physician Fee Schedule proposed rule on July 14, 2026, proposing significant changes to payment and coverage requirements for remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) services. The changes respond to Office of Inspector General scrutiny of these services. The proposed rule affects how Medicare pays for remote monitoring services used in chronic disease management and post-discharge care. Comments on the proposed rule are typically due 60 days after publication in the Federal Register.
- Federal Policy
Medicare Part D Now Covers GLP-1s for Weight Loss Under New CMS Policy
Insurance coverage for GLP-1 medications used for weight loss has changed for approximately 56 million Americans. The policy shift affects Medicare Part D beneficiaries and potentially other federal health programs. The coverage expansion comes as GLP-1 drugs like Ozempic and Wegovy gain widespread use for obesity treatment. Medicare previously covered these medications only for diabetes, not weight management alone, making this a significant benefit expansion with major cost implications for plans and enrollees.
- Federal Policy
Federal Public Health Cuts Hamper Response to Cyclosporiasis Outbreak
Reduced federal disease surveillance capacity and public health staffing cuts are hampering state and federal response to a cyclosporiasis outbreak, according to public health experts. Michigan issued warnings in early July after detecting cases, but officials cite diminished federal support for tracking foodborne illnesses. The outbreak comes amid broader reductions in CDC surveillance programs and staffing. The article links these capacity constraints to recent federal budget cuts affecting public health infrastructure.
- Federal Policy
Planned Parenthood Medicaid Funding Prohibition Excluded from GOP Reconciliation Framework
Republicans' reconciliation 3.0 framework omits language that would prohibit Medicaid funding from flowing to abortion providers like Planned Parenthood, prompting intensified activism from anti-abortion groups. The exclusion marks a potential shift in Republican legislative strategy on reproductive health provider funding within Medicaid. No timeline for final reconciliation language has been announced. The omission affects managed care organizations that currently contract with or reimburse Planned Parenthood affiliates for covered Medicaid services in states that have not already enacted provider exclusions.
- Federal Policy
Final Medicaid Work Requirement Rules Mandate Medical Documentation for Exemptions
Final federal regulations on Medicaid work requirements require enrollees to regularly obtain documentation proving they are too sick to work, potentially from medical providers. The rules place physicians in the position of certifying functional capacity and work ability for program eligibility purposes. The regulations took effect immediately upon publication. The documentation requirements create new administrative workflows for managed care organizations coordinating member exemptions and provider interactions.
Friday, July 17 · 14 stories
- Federal Policy
GAO Finds CMS Marketplace Controls Fail to Prevent Unauthorized Agent Enrollment Actions
A Government Accountability Office report released July 13, 2026 finds that CMS lacks adequate controls to prevent health insurance agents and brokers from making unauthorized enrollments and plan switches in the federal Health Insurance Marketplace. Consumer complaints of confirmed unauthorized activity grew more than fourfold from 2023 through 2025, with at least 160,000 applications in plan year 2024 showing likely unauthorized changes. While CMS implemented new consent procedures in 2024, GAO found they do not prevent all unauthorized actions because they are not consistently applied and identity verification is limited. CMS is exploring additional controls for the 2027 open enrollment period but has not finalized decisions.
- Federal Policy
Trump Administration Rescinds Nursing Home Staffing Rule, Shifts Inspection Priorities
The Trump administration has rescinded the Biden-era nursing home staffing rule, shifted federal inspection priorities from routine surveys to complaint-driven inspections, and suspended the deadline for nursing homes to report detailed ownership information. These policy changes affect federal oversight of nursing home safety and quality standards under Medicare and Medicaid certification. The changes are currently in effect. The shifts matter because many Medicaid managed care organizations contract for long-term care services in nursing facilities or operate programs with nursing home placement responsibility, making federal certification standards and inspection frequency directly relevant to network adequacy, quality oversight, and member safety obligations.
- Federal Policy
CMS Seeks Public Comment on Clinical Laboratory Improvement Amendments Regulations
On July 16, 2026, CMS and CDC announced they are seeking public input on regulations implementing the Clinical Laboratory Improvement Amendments of 1988 (CLIA), which have been in effect since 1992. The agencies are soliciting stakeholder feedback on various issues related to the current laboratory regulatory framework. The request for information signals potential modernization of CLIA regulations that govern clinical laboratory testing and quality standards. Public comments will inform whether CMS pursues regulatory changes to laboratory certification, personnel standards, quality control, or proficiency testing requirements.
- Federal Policy
CMS Proposes CY 2027 Physician Fee Schedule with QPP Updates
On July 14, 2026, CMS released the proposed rule for the calendar year 2027 Medicare Physician Fee Schedule, covering physician payment rates and Quality Payment Program policies. The proposed rule affects Medicare Part B physician reimbursement and MIPS/APM requirements. Comments are typically due 60 days after Federal Register publication. While the PFS primarily governs Medicare fee-for-service payments, changes to payment methodologies and quality measures often influence Medicaid managed care rate-setting, value-based purchasing arrangements, and provider network strategies.
- Federal Policy
340B Program Spending Reached $100 Billion in 2025, Federal Data Shows
Federal data shows 340B drug discount program spending reached $100 billion in 2025, marking continued growth despite regulatory efforts to limit program expansion. The spending increase reflects rising program enrollment and pharmaceutical costs. The growth trajectory affects Medicaid managed care organizations through potential impacts on pharmacy reimbursement rates, contract pharmacy relationships, and state efforts to recoup 340B savings through supplemental rebate programs. Regulators continue efforts to address program growth concerns.
- Federal Policy
CDC Nominee Schwartz Backs Vaccines at Confirmation Hearing
Erica Schwartz, President Trump's nominee to lead the Centers for Disease Control and Prevention, voiced support for vaccines, including COVID-19 shots, during her confirmation hearing. Her pro-vaccine position differs from that of Health and Human Services Secretary Robert F. Kennedy Jr., who has expressed skepticism about vaccine safety. The hearing did not produce a commitment from Schwartz to maintain independence from Kennedy's influence. If confirmed, Schwartz would oversee federal vaccination policy and public health guidance that affects Medicaid covered populations.
- Federal Policy
CMS Proposes CY 2027 Physician Fee Schedule with Part B Payment and Quality Program Updates
CMS published a proposed rule updating the physician fee schedule for calendar year 2027, along with changes to Medicare Part B payment policies, Quality Payment Program requirements, and Medicare Shared Savings Program rules. The proposal also codifies the Medicare Prescription Drug Inflation Rebate Program established under the Inflation Reduction Act of 2022 and updates policies for rural health clinics, federally qualified health centers, ambulance services, and clinical laboratory fee schedules. While primarily Medicare-focused, the rule affects providers participating in both Medicare and Medicaid managed care networks, potentially impacting provider contracting, rate negotiations, and network adequacy for dual-eligible populations. Comments are due 60 days after Federal Register publication.
- Federal Policy
CMS Seeks Comment on Generic Medicaid and CHIP Information Collection Activities
The Centers for Medicare & Medicaid Services is requesting public comment on proposed generic information collection activities under control number 0938-1148 (CMS-10398). The generic clearance process covers low-burden, voluntary collections related to Medicaid and CHIP state plan amendments, waivers, demonstrations, and reporting. Comments are due 60 days after publication in the Federal Register on July 16, 2026. The umbrella approval allows CMS to expedite certain data requests without full Paperwork Reduction Act review when collections do not raise substantive policy issues.
- Federal Policy
KFF Poll Shows Voter Focus on Health Costs, Republican Priority on Program Fraud
A new KFF Health Tracking Poll finds health care costs are the top health care priority for voters ahead of the 2026 midterm elections. More than half of Republican voters identify fraud in government health programs as an extremely important campaign issue, aligning with current Trump administration enforcement priorities. Most voters believe at least some fraud exists in government health programs, though voters perceive higher fraud levels in tax systems, defense spending, and foreign aid. The smallest share of voters perceives fraud in ACA marketplace programs.
- Federal Policy
Pharmacy Groups Warn Revised ACIP Charter Could Delay Vaccine Recommendations
Nine pharmacy organizations wrote to HHS Secretary Robert F. Kennedy Jr. on July 9, 2026, warning that CDC's revised charter for the Advisory Committee on Immunization Practices (ACIP), issued June 25, could undermine the evidence-based framework for U.S. immunization policy. The letter follows a year of ACIP restructuring. The groups expressed concern that changes to ACIP's charter and processes could delay vaccine access and recommendations. For Medicaid managed care organizations, ACIP recommendations determine vaccine coverage requirements under EPSDT and adult preventive services, making any disruption to the committee's timeline or evidentiary standards operationally significant.
- Federal Policy
CMS Launches Risk-Based Survey Process for High-Performing Nursing Homes Nationwide
CMS announced July 16 nationwide implementation of a risk-based survey process for high-performing nursing homes, effective September 2026 following state agency training. Approximately 12% of nursing facilities will initially qualify based on criteria including five-star ratings, zero harm citations, and accurate data submission. Qualifying facilities receive streamlined recertification surveys and a new Care Compare icon, though state agencies retain authority to use traditional surveys when safety concerns arise. All nursing homes continue receiving surveys at least every 15 months regardless of performance tier.
- Federal Policy
SNAP and Medicaid Eligibility Changes May Reduce School Meal Program Participation
Federal changes to SNAP and Medicaid eligibility could reduce the number of students qualifying for free school meals under USDA's Community Eligibility Provision. USDA uses enrollment in means-tested programs including Medicaid as a benchmark to determine which high-poverty school districts can offer universal free meals without collecting individual applications. Reductions in SNAP or Medicaid enrollment—whether through eligibility restrictions, administrative changes, or state policy decisions—could push schools below CEP thresholds, forcing districts to return to individual meal applications and potentially reducing meal participation among eligible low-income students. The timing of these changes depends on pending federal SNAP and Medicaid policy actions.
- Federal Policy
DHS Finalizes Public Charge Rule Tying Medicaid and CHIP Receipt to Immigration Bonds
The Department of Homeland Security on July 16 finalized a rule rescinding 2022 public charge regulations and establishing that receipt of Medicaid or CHIP will breach public charge bonds for immigrants. The final rule removes previous exemptions and the 2022 Public Charge Inadmissibility Framework definitions. It takes effect 60 days after Federal Register publication, likely in mid-September 2026. The change may reduce Medicaid and CHIP enrollment among eligible immigrant populations, affecting managed care plan membership and revenue.
- Federal Policy
CMS Issues Interim Final Rule Imposing Work Reporting Requirements on Medicaid Beneficiaries
CMS has published an interim final rule establishing work reporting requirements for certain Medicaid beneficiaries. The rule requires states to implement reporting systems for work activities as a condition of eligibility for non-exempt populations. The requirements take effect for state implementation planning immediately, with full compliance deadlines to be determined by state plan amendments. This marks a significant shift in Medicaid eligibility policy affecting managed care organizations' enrollment processes, member communication obligations, and systems for tracking beneficiary compliance with work requirements.