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Thursday, September 17 · 30 stories
- State Policy · IN
Indiana Proposes Expanded Resident Rights and HCBS Standards for Residential Care Facilities
The Indiana Department of Health has issued a second public comment notice on proposed amendments to Residential Care Facility regulations. The rulemaking would expand resident rights protections, incorporate federal Home and Community-Based Services setting requirements into state assisted living regulations, and create new eviction procedures for facilities. The proposal affects residential care facilities serving Medicaid HCBS waiver beneficiaries in Indiana. Public comment is now open on the revised proposal, which builds on an earlier version published this year.
- Federal Policy
GAO Finds CMS Oversight of State Medicaid Eligibility Error Corrective Actions Inadequate
The Government Accountability Office concluded that CMS inconsistently enforces required evaluations and conducts limited analysis of state corrective action plans (CAPs) addressing Medicaid eligibility errors identified through Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC) programs. CMS accepted CAPs missing federally required elements and does not systematically analyze errors and corrective actions across states to determine effectiveness. GAO reviewed PERM reports from 2019-2025 and MEQC results from seven states, finding caseworkers were the most prevalent root cause of errors, with specific causes falling into four categories including verification failures and system processing errors. GAO recommends CMS collect all required CAP elements and conduct cross-state analyses to better support states in reducing eligibility errors and improper payments.
- State Policy · TX
Texas Hospitals Regain $12 Billion in Medicaid Funding After Federal Dispute Resolved
Texas hospitals will receive $12 billion in Medicaid funding following resolution of a nearly year-long dispute with CMS. The impasse had threatened hospitals with $27 million in daily losses. The restoration of funds ends uncertainty over supplemental payment programs that support hospitals serving Medicaid and uninsured populations. The resolution allows Texas to continue making these payments under terms acceptable to federal regulators.
- Legal · TX
Texas Family Sues Attorney General Paxton Over Denied Abortion Leading to Maternal Death
The family of Tierra Walker, a 37-year-old Texas woman who died from preeclampsia in 2024, filed a lawsuit Wednesday against Texas Attorney General Ken Paxton and doctors who denied her an abortion. Walker experienced seizures, blood clots, and hypertensive crisis at four months pregnant and requested abortion care multiple times before her death. The lawsuit challenges enforcement of Texas abortion restrictions that allegedly prevented medically necessary care. This case follows several wrongful death and civil rights lawsuits filed nationwide challenging state abortion laws and their impact on maternal health outcomes.
- State Policy · VT
Vermont Physician Argues Against Cutting Graduate Medical Education Funding Amid Federal Medicaid Reductions
A Vermont physician defends graduate medical education (GME) investment in response to recent state debate about physician training costs and retention rates. The letter notes that commercial payers are bearing increased GME costs as federal Medicaid dollars decline and federal funding for public health and substance use programs is cut. Vermont's physician retention rate trails the national average, which the author attributes to the state's challenging healthcare climate and reliance on federal grants rather than state funding for residency programs. The letter opposes cutting medical education as a cost-control measure.
- State Policy · WV
West Virginia Legislator Questions $1.17M Rural Health Grant to Wellness Organization
West Virginia awarded Spotted Owl Health Organization $1.17 million in federal Rural Health Transformation program funds to establish employer-based worksite clinics, prompting concerns from Del. Gary Howell that the Kanawha County wellness organization lacks experience in multi-employer healthcare delivery and has never administered grants exceeding $50,000. Health Secretary Arvin Singh defended the merit-based selection and noted the state can claw back funding if performance milestones are not met. West Virginia received $199 million in Rural Health Transformation program funding from CMS for 2026, part of a five-year initiative to expand rural healthcare access.
- Federal Policy · CT
Four Connecticut Rural Hospitals Receive $46 Million in Federal Rural Health Grants
Charlotte Hungerford, Day Kimball, Sharon, and Windham Hospitals received $46 million in federal grants through the Rural Health Transformation Program to expand imaging, telehealth, and transport services. Day Kimball Hospital received the largest share at $20.2 million to replace trailer-based MRI services and expand patient monitoring. Connecticut received $154 million total under the program, with the remaining $104 million funding workforce development, maternity services, and mobile health initiatives across the state. CMS monitors fund deployment through annual progress reports that determine subsequent funding levels.
- Managed Care
National Health Law Program Calls for State Enforcement of Behavioral Health Network Adequacy Standards
The National Health Law Program is urging states to strengthen enforcement of network adequacy requirements for behavioral health services in Medicaid managed care plans. The organization highlights gaps in provider networks that leave enrollees unable to access timely mental health and substance use disorder treatment. States have existing authority under federal Medicaid managed care regulations to monitor network adequacy through time and distance standards, appointment wait times, and secret shopper surveys. The recommendation comes as states face ongoing challenges ensuring adequate behavioral health provider networks in managed care arrangements.
- Federal Policy
21.4 Million U.S. Women Face Limited Access to Subsidized Contraception, New Analysis Finds
Power to Decide and Guttmacher Institute released updated county-level maps showing 21.4 million women needing subsidized contraception live in counties with limited access to publicly-funded family planning clinics. The analysis measures clinic capacity against demand among women earning under 250% of federal poverty level, revealing widespread gaps in Title X-funded services. Maricopa County, Arizona exemplifies the challenge with 29 publicly-funded clinics serving only 8% of nearly 300,000 women in need. The methodology focuses on brick-and-mortar clinics receiving federal or state family planning funds, using patient caseloads to estimate capacity and National Survey of Family Growth data to identify women who would use contraception if cost were not a barrier.
- Federal Policy
WEDI Opens Survey on CMS Prior Authorization Rule Readiness Through Oct. 9
The Workgroup for Electronic Data Interchange has launched a survey to assess industry readiness for CMS's interoperability and prior authorization final rule, with responses open through Oct. 9, 2026. The anonymous survey will gather aggregated data from health plans, providers, and other stakeholders on their implementation progress. WEDI will use the results to develop recommendations for CMS, inform stakeholders, and create industry guidance and educational materials on electronic prior authorization standards compliance.
- Federal Policy
CMS Expands ACCESS Model for Chronic Care Management
CMS announced an expansion of the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, which affects physician groups managing chronic conditions. The model offers alternative payment arrangements for chronic care coordination. The expansion creates new participation opportunities for physician practices, though specific effective dates and eligibility criteria were not detailed in the announcement. Physician groups managing Medicaid beneficiaries with chronic conditions should evaluate whether participation aligns with their care delivery infrastructure and payment model strategy.
- State Policy · NH
New Hampshire ACA Marketplace Enrollment Falls 8% After Enhanced Premium Tax Credits Expire
New Hampshire saw 4,868 fewer residents enrolled in ACA Marketplace plans in 2026 compared to 2025, an 8% decline, following the December 2025 expiration of Enhanced Premium Tax Credits. Nationally, enrollment dropped from 21.8 million to 19.2 million. The analysis by KFF used effectuated enrollment data, which reflects both non-enrollment and coverage loss due to non-payment of premiums. The decline coincides with broader federal Medicaid cuts under the One Big Beautiful Bill Act and new state Medicaid premium requirements in New Hampshire, raising concerns among community health providers about access to primary care and emergency department utilization.
- Federal Policy
CMS Renews DNV Healthcare Recognition as Hospital Accrediting Organization
CMS has approved DNV Healthcare USA Inc.'s application for continued recognition as a national accrediting organization for hospitals seeking Medicare or Medicaid participation. The approval allows DNV to continue surveying hospitals for compliance with CMS Conditions of Participation. The renewal takes effect September 17, 2026. This maintains DNV's status as one of several deemed status organizations that perform accreditation surveys in lieu of direct CMS or state agency surveys.
- State Policy · OR
Oregon Medicaid Overpaid $4.1M Due to Duplicate Enrollee IDs, Audit Finds
A state audit found Oregon's Medicaid program overpaid up to $4.1 million to healthcare organizations statewide due to duplicate enrollee identification codes that state officials failed to detect and correct. The system errors resulted in improper claims payments when the same beneficiaries were issued multiple IDs. The audit did not specify a timeline for recovery or corrective action, but the findings indicate ongoing financial integrity and claims processing vulnerabilities in Oregon's Medicaid system.
- State Policy · CO
Colorado Pediatric Clinics Close as Medicaid Cuts, Federal Eligibility Changes Hit Children's Coverage
Federal Medicaid cuts totaling $1 trillion and a 2% Colorado state reimbursement rate reduction are forcing pediatric clinic closures and coverage losses for children. Two pediatric clinics within 10 miles of Commerce City have closed entirely due to insufficient revenues. On October 1, 2026, new federal rules will cut Medicaid eligibility for immigrant children, affecting an estimated 7,000 Colorado children. Colorado projects up to 377,000 total Medicaid enrollees at risk of disenrollment, with children representing more than one-third of the state's Medicaid population.
- State Policy · MT
Medicaid Work Requirements Create Medical Exemption Decisions for Disability Enrollees
States implementing Medicaid work requirements must now determine which disability enrollees qualify for medical exemptions, adding administrative burden to existing eligibility processes. The requirements affect cancer survivors and other disabled beneficiaries who attempt to work but face losing coverage when income or work activity triggers reviews. States must review medical cases for a broader population of Medicaid enrollees to adjudicate exemption requests. The policy creates operational challenges for state eligibility systems already managing disability determinations.
- Federal Policy
Federal Budget Cuts May Force States to End Medicaid Meal Delivery Programs
Federal budget cuts are threatening state Medicaid meal delivery programs that provide medically-tailored meals to beneficiaries with specific dietary needs. Multiple states are considering ending these services despite evidence showing the programs improve health outcomes and reduce overall healthcare costs. The timing of specific state decisions varies, but the federal budget pressure is immediate. For state Medicaid agencies, this creates difficult choices between cutting services that demonstrably reduce hospital readmissions and emergency room use versus maintaining other coverage areas.
- State Policy · ID
Idaho Considers Home and Community-Based Services Cuts Amid Budget Pressures
Idaho lawmakers debated Medicaid cuts in January 2026, including reductions to home and community-based services for people with disabilities. The legislature ultimately adopted a narrower cut to disability services than initially proposed by the governor. Advocates express concern that ongoing state budget constraints and shifting federal positions may lead to further HCBS reductions. The story reflects broader tensions between state fiscal pressures and HCBS program sustainability.
- Federal Policy · NC
Federal Medicaid Restrictions in H.R. 1 Set to Take Effect in North Carolina
Sweeping federal Medicaid restrictions included in H.R. 1 are about to take effect in North Carolina, affecting the program that covers one in four state residents. North Carolina Medicaid Director Melanie Bush characterized these provisions as likely the most significant changes in the program's history. The new federal restrictions will fundamentally reshape how Medicaid operates in the state, though specific implementation details and effective dates require further clarification from the full article text.
Wednesday, September 16 · 26 stories
- State Policy · CA
California Poll Shows Tight Race on Billionaire Tax to Fund Medi-Cal Cuts
A Public Policy Institute of California poll finds 52% of likely voters support Proposition 40, which would impose a 5% one-time tax on billionaire assets to offset federal Medi-Cal cuts, but slim majorities also back two competing measures (Props. 41 and 42) that would nullify it. Under California law, if competing measures both pass, the one with the most yes votes prevails. The measure has divided labor and liberal groups, with Democratic leaders including gubernatorial candidate Xavier Becerra opposing it. Voters will decide in November 2026.
