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Wednesday, July 8 · 12 stories
- Federal Policy
MHPA Coalition Urges Congress to Protect Medicaid and CHIP Funding
Medicaid Health Plans of America led a coalition letter to Senate Finance and House Energy & Commerce leadership on March 3, 2025, expressing support for Medicaid and CHIP programs. The letter was sent to committee chairs and ranking members as Congress considers budget and program changes. The coalition advocates for preserving funding and program integrity during legislative discussions. This signals organized industry pushback against potential Medicaid cuts or restructuring under consideration in the 119th Congress.
- Federal Policy
House Subcommittee Considers Bipartisan Medicaid HCBS Strengthening Legislation
The House Energy & Commerce Health Subcommittee held a hearing on April 30, 2024, to consider legislative proposals addressing Medicaid access and program integrity. The Medicaid Health Plans of America submitted a statement for the record supporting bipartisan policy to strengthen home and community-based services and make related changes permanent. The hearing covered multiple proposals affecting Medicaid program operations and access to care. MHPA's statement signals managed care industry support for HCBS policy changes under congressional consideration.
- Federal Policy
MHPA Urges Changes to Draft Dual Eligible Care Integration Legislation
Medicaid Health Plans of America submitted recommendations on draft federal legislation aimed at improving care coordination and outcomes for dually eligible beneficiaries. The trade association expressed support for the bill's integration goals while raising concerns about specific provisions and requesting clarification on implementation details. The legislation seeks to better align Medicare and Medicaid services for the approximately 12 million Americans enrolled in both programs. MHPA's feedback reflects managed care industry priorities around dual eligible special needs plans (D-SNPs) and integrated care models.
- Federal Policy · CA
H.R. 1 Imposes Federal Medicaid Work Requirements, Cuts $1 Trillion Over Decade
In July 2025, President Trump signed H.R. 1 into law, reducing federal Medicaid funding by $1 trillion over ten years and establishing a federal work requirement for certain adult enrollees. The law mandates that covered adults work, attend school, or volunteer to maintain eligibility. The requirements apply to non-exempt adult populations and represent a fundamental shift from prior waiver-based work requirement approaches to a statutory federal mandate. States must implement compliance tracking and reporting systems, affecting MCO enrollment verification, eligibility redeterminations, and coverage continuity processes.
Tuesday, July 7 · 9 stories
- Federal Policy
CMS Launches Medicare GLP-1 Bridge Program with Fixed-Cost Access
The Centers for Medicare & Medicaid Services launched its Medicare GLP-1 Bridge program on July 1, 2026, offering select beneficiaries fixed-cost access to GLP-1 medications including Foundayo and Wegovy. The program arrives as GLP-1 use among US adults reached 11% in 2026, up from 3% in 2024, according to a July 7 Gallup poll. The new Medicare benefit structure establishes precedent for coverage of anti-obesity medications that could influence Medicaid managed care pharmacy benefits and prior authorization protocols. Medicaid MCOs should monitor whether states adopt similar fixed-cost or expanded coverage models for their programs.
- Federal Policy
HHS Postpones Preventive Services Task Force Meetings, Plans August Reboot with Eight New Members
The Department of Health and Human Services will announce eight new members of the U.S. Preventive Services Task Force and schedule the panel's first meeting in 17 months for late August. HHS canceled four prior meetings, removed two vice chairs in May, and allowed the 16-member panel to shrink to eight as terms expired without replacement. The task force grades preventive services that Medicaid expansion programs and most private insurers must cover without cost-sharing when rated A or B. Recommendations on prostate cancer screening, weight loss counseling, cervical cancer screening, perinatal depression, and alcohol abuse await votes or formal publication.
- Federal Policy
Proposed Medicaid Work Requirements Face Rural Service Delivery Challenges
A proposed federal rule implementing H.R. 1's Medicaid work and volunteer reporting requirements faces operational challenges in rural areas where postal service limitations may prevent beneficiaries from meeting documentation deadlines. The law, projected to result in 10 million Americans losing coverage, requires monthly work or volunteer activity reporting to maintain eligibility. Rural beneficiaries may face particular difficulty submitting timely verification due to mail delays and limited internet access. The rule remains in proposed form with implementation timing not yet finalized.
- Federal Policy
CMS Proposes 2.4% Outpatient Rate Increase With 340B Cuts and Site-Neutral Imaging Expansion
CMS released its proposed 2027 outpatient prospective payment system rule with a 2.4% base rate increase, significant reductions to 340B drug payments, and an expansion of site-neutral payment policies to off-campus imaging services. Provider groups say the combined effect of 340B cuts and site-neutral expansions could result in negative net payment updates for many hospitals. The rule is in proposed form, meaning CMS will accept public comments before issuing a final rule later this year. For Medicaid managed care organizations, these Medicare payment changes often influence hospital contracting strategies, network stability, and cost-shifting dynamics.
- Federal Policy
SHADAC Releases Administrative Cost Monitoring Guide for H.R.1 Medicaid Implementation
SHADAC published a monitoring guide for states implementing H.R.1's Medicaid structural changes, which include mandatory 80-hour monthly work requirements, elimination of continuous eligibility, and reduced federal match rates. The guide focuses on tracking administrative costs as states build new verification systems and comply with restrictions on retroactive coverage and presumptive eligibility. States face significant operational buildout with reduced federal funding, requiring new data infrastructure to verify work activities and manage increased enrollment churn.
- Federal Policy
CMS Re-Establishes Data Match With VA to Verify Minimum Essential Coverage for Marketplace Eligibility
CMS has re-established a data matching program with the Department of Veterans Affairs to verify whether Marketplace applicants are enrolled in VA health care programs that constitute minimum essential coverage. The match allows CMS to determine eligibility for Insurance Affordability Programs by checking VA enrollment status. The program takes effect July 7, 2026, under Privacy Act requirements. This represents continuation of an existing verification process used in Marketplace eligibility determinations.
- Federal Policy
602 Hospitals Face 50-75% Wider Deficits Under Federal Cuts, NNU Projects
National Nurses United released a report July 6 projecting that 602 financially vulnerable hospitals could see their combined deficit grow by 50% to 75% under the combined impact of Medicare sequestration, Medicaid cuts tied to HR 1, and the expiration of enhanced ACA marketplace subsidies. The report identifies these hospitals as particularly at risk from the confluence of federal payment reductions. The analysis warns of a preventable financial crisis affecting provider networks that serve Medicaid populations.
- Federal Policy
SAMHSA Opens $281 Million in Behavioral Health Grant Funding Across 15 Programs
The Substance Abuse and Mental Health Services Administration announced more than $281 million in grant funding opportunities across 15 programs targeting addiction, overdose prevention, mental illness treatment, and recovery services. The announcement was made on July 6, 2026. Applications are now open for eligible providers and organizations. This funding represents a significant federal investment in expanding behavioral health service capacity and infrastructure, with potential implications for Medicaid managed care organizations that coordinate or provide behavioral health services to their enrollees.
- Federal Policy · ID
Idaho to Distribute $186 Million in Federal Rural Health Transformation Grants
Idaho will distribute approximately $186 million in federal Rural Health Transformation grants over five years, funded by legislation passed in July 2025. The grants target infrastructure projects to improve rural healthcare delivery. State officials are encouraging local contractors to prepare for project implementation. The funding represents a significant federal investment in rural health infrastructure with potential implications for Medicaid provider networks in underserved areas.
Monday, July 6 · 4 stories
- Federal Policy
CMS Proposes Provider Enrollment and Billing Privilege Changes in Home Health Rule
CMS included proposed changes to Medicare provider enrollment regulations (42 CFR Part 424, Subpart P) in its July 1, 2026 Home Health Prospective Payment System proposed rule. The changes would affect requirements for providers and suppliers to obtain and maintain Medicare billing privileges. The proposed modifications are embedded in the home health payment rule rather than issued as standalone enrollment guidance. Comment periods and effective dates follow standard rulemaking timelines for proposed rules.
- Federal Policy
Medicaid Funding Restored for Planned Parenthood Healthcare Services After One-Year Ban
Medicaid funding for Planned Parenthood and other previously excluded healthcare providers has been restored after a one-year ban enacted by Republicans. The providers can now resume billing Medicaid for covered services excluding abortion. The restoration is effective immediately. This affects Medicaid managed care organizations' provider networks and member access to family planning, preventive care, and reproductive health services in states where these providers serve Medicaid enrollees.
- Federal Policy · OH
Ohio University Receives $10M from CMS Rural Health Transformation Fund
Ohio University will receive $10 million as the first award from CMS's Rural Health Transformation Program, designed to offset congressional Medicaid cuts. The Athens-based institution was selected from Ohio's allocation under the federal initiative. The program represents CMS's response to budget reductions affecting rural health infrastructure. Timing and specific use requirements for the funds were not detailed in the announcement.
- Federal Policy · CT
Connecticut Estimates Thousands Face Medicaid Loss Under New Federal Work Requirements
Connecticut officials project thousands of Medicaid beneficiaries could lose coverage when new federal work requirements take effect January 1, 2027. Congress and President Trump enacted the changes in an omnibus federal budget bill in July 2025. The requirements apply to able-bodied adults without dependents and mandate work, community service, or qualifying activities to maintain eligibility. Connecticut is preparing implementation plans and beneficiary outreach as the effective date approaches.
Friday, July 3 · 1 story
- Federal Policy
CMS and VA Launch Data Match to Verify Marketplace Subsidy Eligibility
CMS is establishing a new Privacy Act computer matching program with the Department of Veterans Affairs to verify eligibility for insurance affordability programs under the Affordable Care Act. The data match will allow CMS to cross-check applicant information against VA records to confirm subsidy eligibility for Marketplace coverage. The matching program follows standard Privacy Act protocols requiring advance notice before implementation. This affects how eligibility is determined for individuals who may qualify for both VA benefits and Marketplace subsidies, though it does not directly alter Medicaid managed care operations.
Thursday, July 2 · 5 stories
- Federal Policy
DEA Proposes Schedule I Classification for Synthetic Kratom Compound 7-OH
The Drug Enforcement Administration announced plans to temporarily classify 7-hydroxymitragynine (7-OH) and three related synthetic kratom compounds as Schedule I controlled substances, placing them in the same regulatory category as heroin and LSD. The classification applies to synthetic versions of the psychoactive compound found in kratom products. If finalized, the scheduling action would prohibit manufacture, distribution, and possession of these substances, with enforcement implications for entities handling these compounds. The timing of implementation and comment period was not specified in the available content.
- Federal Policy
Medicaid Coverage Reinstated for Non-Abortion Services at Planned Parenthood Clinics
Federal restrictions preventing Medicaid reimbursement for non-abortion services at Planned Parenthood have ended, restoring coverage for routine healthcare provided at these clinics. States now have discretion to determine whether Medicaid enrollees can access covered services at Planned Parenthood locations that remain operational. The change takes effect immediately, reversing a previous ban that prohibited Medicaid payment for any services delivered by Planned Parenthood providers, including primary care, family planning, STI testing, and cancer screenings. Medicaid managed care organizations must now determine network participation and reimbursement policies for these providers according to state guidance.