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Thursday, July 16 · 8 stories
- Federal Policy
CMS Proposes Payment Model Changes for Remote Patient Monitoring and Clinical AI
The Centers for Medicare and Medicaid Services has proposed significant changes to how it pays for remote patient monitoring (RPM) and clinical artificial intelligence tools. The proposal would restructure payment models for these technologies under Medicare. The changes affect how health plans and providers bill for AI-enabled clinical decision support and remote monitoring services. CMS has opened the proposal for public comment, with implementation timing to be determined following the comment period.
- Federal Policy
Senate Questions CDC and HHS Nominees on Vaccine Policy Alignment
Two Trump administration health nominees—Erica Schwartz for CDC Director and Sean Kaufman for an HHS position—faced Senate scrutiny on July 15, 2026, over their willingness to challenge administration positions on vaccines. Both Democrats and some Republicans expressed concern about the nominees' reluctance to break with administration policy. The hearing centered on whether the nominees would maintain agency independence on vaccine policy and public health guidance. Confirmation votes have not been scheduled.
- Federal Policy
CMS Releases 2027 Notice of Benefit and Payment Parameters
The Centers for Medicare & Medicaid Services has released the 2027 Notice of Benefit and Payment Parameters (NBPP). The NBPP sets annual requirements for qualified health plans offered through the ACA marketplaces, including actuarial value standards, cost-sharing limits, and payment methodologies. While the NBPP primarily governs marketplace plans, provisions may affect Medicaid managed care organizations that operate dual marketplace and Medicaid lines of business, particularly regarding quality measurement alignment, rating approaches, and administrative standards. The final rule typically takes effect for the plan year beginning January 1, 2027.
- Federal Policy
Health Plan Associations Urge Congress to Extend Affordable Connectivity Program Funding
Six health plan trade associations, including MHPA and ACHP, jointly urged Congress to extend funding for the Affordable Connectivity Program (ACP), which provides broadband subsidies to low-income households. The program's funding is set to expire, threatening internet access for eligible Medicaid beneficiaries. The associations argue that loss of broadband connectivity would undermine telehealth access, care coordination, and health plan communications with members. Congressional action is needed to continue the subsidy program.
- Federal Policy
CMS Proposes Standardized Payment Structure for Clinical Software and AI Tools
The Centers for Medicare & Medicaid Services announced plans to develop a standardized payment framework for clinical software and artificial intelligence tools that incorporates patient outcome measures. The proposed structure would establish consistent reimbursement methodology across Medicare and Medicaid for digital health technologies currently paid through fragmented billing codes or bundled into other services. CMS has not specified an implementation timeline or comment period. For Medicaid managed care organizations, this signals potential changes to how digital therapeutics, clinical decision support tools, and AI-driven care management platforms are covered and reimbursed under capitated arrangements.
- Federal Policy
Acting AG Pledges Federal Action to Restrict Mail Order Mifepristone
Acting Attorney General Todd Blanche told Republican senators he will prioritize stopping abortion medication from being mailed to patients if confirmed. Blanche specifically opposes the Biden-era policy that permitted mail distribution of mifepristone but did not detail enforcement mechanisms or timeline. The commitment signals potential federal action against telehealth abortion services and mail-order pharmacy dispensing of medication abortion. Any DOJ enforcement action could affect Medicaid managed care plans that cover telehealth reproductive services and pharmacy benefits including mifepristone.
- Federal Policy
AHA Urges CMS to Preserve Essential Health Benefits Coverage Standards in RFI Response
The American Hospital Association submitted comments July 15 responding to a CMS request for information on potential modifications to the Affordable Care Act's Essential Health Benefits framework. AHA supported updating EHBs to reflect changes in healthcare delivery but warned against changes that would reduce coverage adequacy. The association emphasized that affordability requires adequate benefits, not just lower premiums, and cautioned that reduced benefits, narrower standards, or increased cost-sharing would increase patient financial exposure. CMS is reviewing the EHB framework, which establishes minimum coverage requirements for comprehensive insurance.
- Federal Policy
KFF Poll Finds Fraud in Government Health Programs Resonates with Republican Voters Ahead of Midterms
A KFF Health Tracking Poll released July 16, 2026, shows that 55% of Republican voters consider addressing fraud in government health programs, including Medicaid and Medicare, extremely important for candidates in the 2026 midterms. Most voters perceive at least some fraud in government health programs, though voters report higher fraud concerns in the tax system, defense, and foreign aid. The poll indicates health care costs remain the top health priority overall. The findings suggest fraud and program integrity messaging may gain prominence in congressional campaigns as midterm elections approach.
Wednesday, July 15 · 2 stories
- Federal Policy
Latham & Watkins Publishes July 2026 Drug Pricing Digest
Latham & Watkins LLP released its July 2026 Drug Pricing Digest, a recurring compilation tracking developments in the Medicaid Drug Rebate Program, 340B Program, Medicare drug pricing policy, and state pharmaceutical law. The digest appears to be a monthly or periodic roundup of regulatory and legislative activity affecting prescription drug pricing and market access. No specific policy changes or rulemakings are described in the brief excerpt provided. The digest serves as a reference tool for stakeholders monitoring evolving drug pricing regulations across federal programs including Medicaid.
- Federal Policy
HHS Abandons Proposed Rule Threatening Medicare and Medicaid Funding Cuts Over Gender-Affirming Care
The Department of Health and Human Services will not finalize a proposed rule that threatened to withhold Medicare and Medicaid funding from states and providers offering gender-affirming care to minors. The decision ends what would have been the most aggressive federal attempt to restrict such care nationally through payment policy. The withdrawal means existing Medicaid coverage policies for gender-affirming services remain governed by state discretion and existing federal non-discrimination requirements. No timeline for future rulemaking has been announced.
Tuesday, July 14 · 3 stories
- Federal Policy
CMS Requests Technical Input on PBM Compensation and Affiliate Practices
On June 18, 2026, CMS published a Request for Information seeking stakeholder input on pharmacy benefit manager services, compensation structures, affiliate relationships, and data collection practices. The RFI aims to gather technical details that will inform future rulemaking on PBM operations under Medicare Part D. Comments are due approximately 60 days from publication in the Federal Register. While focused on Part D, PBM transparency requirements and data standards developed through this process could eventually extend to Medicaid managed care pharmacy operations.
- Federal Policy
Home Care Workers Face Pay Cuts as Medicaid Reimbursement Rates Fall
Home care workers providing services to Medicaid beneficiaries are facing potential pay reductions that could affect workforce stability in the home and community-based services sector. The pay cuts stem from changes in Medicaid reimbursement rates, threatening the financial security of direct care workers who provide essential LTSS services. The workforce disruption could affect continuity of care for Medicaid managed care enrollees who rely on home care services. For MCOs with LTSS contracts, caregiver turnover and recruitment challenges may increase as workers leave the sector.
- Federal Policy
988 Lifeline Volume Up 15% Year-Over-Year as States Answer More Calls In-State
The 988 Suicide and Crisis Lifeline handled 15% more contacts in March 2026 compared to March 2025, and volume is nearly 50% higher than two years prior. States are increasingly routing calls to in-state crisis centers, where counselors have better knowledge of local mental health and substance use resources. The growth reflects sustained demand for crisis services as the lifeline enters its fourth year of operation. For Medicaid managed care organizations, rising 988 utilization signals growing behavioral health crisis service needs and potential downstream impacts on emergency department use and member engagement.
Monday, July 13 · 13 stories
- Federal Policy
Partnership for Medicaid Urges Congress to Reject Medicaid Cuts
The Partnership for Medicaid, a coalition of clinicians, providers, safety net health plans, and counties, issued a statement February 7, 2025 calling on Congress to reject proposed cuts to the Medicaid program. The statement does not specify which legislative proposals or budget reconciliation measures are targeted. No timeline for congressional action is provided. The coalition represents stakeholders across the Medicaid delivery system, including managed care organizations.
- Federal Policy
SAMHSA Awards $794 Million in Block Grants for Community Mental Health and Substance Use Services
The Substance Abuse and Mental Health Services Administration distributed $794 million in block grant funding to states and territories for community-based mental health services and substance abuse treatment and prevention programs. The funding was distributed in February 2026 across all states and U.S. territories. This matters for Medicaid managed care organizations because block grant-funded community providers often serve as essential network partners for behavioral health services, and state allocation decisions may affect provider capacity, referral patterns, and care coordination requirements for Medicaid enrollees.
- Federal Policy
SAMHSA Announces $231M Funding Opportunity for 988 Lifeline Administration
The Substance Abuse and Mental Health Services Administration announced a $231 million funding opportunity to administer the 988 Suicide & Crisis Lifeline. The 988 Lifeline operates a national network of over 200 local crisis contact centers managed by a SAMHSA-funded network administrator. In 2025, the lifeline received more than 8 million contacts from help seekers via call, text, chat, and ASL videophone. The funding opportunity will support continued administration of the crisis response infrastructure that Medicaid managed care organizations increasingly coordinate with for behavioral health crisis services.
- Federal Policy
SAMHSA Awards $98M for Hepatitis C Elimination Initiative Pilot
The Substance Abuse and Mental Health Services Administration awarded $98 million for a Hepatitis C Elimination Initiative Pilot on September 24, 2025. The funding supports efforts to eliminate hepatitis C, which disproportionately affects individuals with substance use disorders who are frequently enrolled in Medicaid managed care behavioral health programs. Medicaid managed care organizations with behavioral health carve-ins or specialty behavioral health contracts may see increased screening and treatment activity for hepatitis C among their members. The initiative reflects federal prioritization of addressing co-occurring conditions in populations with substance use disorders.
- Federal Policy · PA
SAMHSA Awards $2M to Expand CCBHC Services for Homeless in Philadelphia
SAMHSA awarded $2 million in supplemental funding to Merakey Philadelphia to launch a pilot program expanding Certified Community Behavioral Health Clinic (CCBHC) services in the Kensington neighborhood. The program targets homeless individuals with mental illness and substance use disorders to facilitate treatment access. The funding supports service expansion in a neighborhood with significant behavioral health needs. This represents federal investment in the CCBHC model, which many states use through Medicaid demonstration programs to deliver comprehensive behavioral health services with enhanced federal matching funds.
- Federal Policy
SAMHSA Awards $43M to States for Youth Opioid Recovery Housing
The Substance Abuse and Mental Health Services Administration announced $43 million in supplemental funding for State Opioid Response (SOR) program grantees to expand recovery housing services for young adults ages 18-24. The funding is available immediately to existing SOR grantees. This supplements existing SOR grant awards and targets a population often transitioning out of foster care or juvenile justice systems, many of whom are Medicaid-eligible. The investment aims to fill gaps in residential recovery support for young adults with opioid use disorder.
- Federal Policy
SAMHSA Opens $69M in Grant Funding for Mental Health and Suicide Prevention Programs
SAMHSA announced $69.1 million in available grant funding across three behavioral health programs: the Children's Mental Health Initiative (CMHI), Implementing Zero Suicide in Health Systems, and Assisted Outpatient Treatment (AOT). The funding opportunities target serious mental illness treatment and suicide prevention services. Applications are now open for eligible providers and health systems. For Medicaid managed care organizations with behavioral health carved-in or carved-out arrangements, these grants may affect network adequacy, crisis service capacity, and partnerships with community providers receiving federal funding.