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Wednesday, September 16 · 26 stories
- Managed Care
New Guide Details Health Plan-Community Development Partnership Models
The Build Healthy Places Network and Association for Community Affiliated Plans released a guide for health plans and community development organizations on structuring partnerships and investments addressing social determinants of health, particularly housing. The guide provides frameworks for identifying partners, building trust, and aligning investments with community priorities. It arrives as federal housing policy creates new opportunities for cross-sector collaboration. The resource targets Medicaid health plans seeking to operationalize social determinants investments beyond traditional medical services.
- Industry
ASHP Advocates for Medicare Pharmacist Coverage, 340B Protections in Congressional Meetings
The American Society of Health-System Pharmacists (ASHP) is conducting Capitol Hill meetings on September 16 to advocate for three pharmacy priorities: expanded Medicare coverage of pharmacist-provided care, protections for the 340B Drug Pricing Program, and pharmacy residency training support. The advocacy day reflects organized pharmacy's push for provider status recognition and safeguarding discount drug programs. ASHP announced the legislative agenda in a September 15 news release ahead of member meetings with congressional offices.
- Legal · AR
Arkansas Pharmacies File First Lawsuit Against Express Scripts Under State PBM Payment Law
Twelve independent Arkansas pharmacies filed suit against Express Scripts, marking the first use of a 2025 state law authorizing pharmacies to sue pharmacy benefit managers for underpayments. The lawsuit tests new enforcement authority granted to pharmacies under Arkansas legislation targeting PBM reimbursement practices. The case could establish precedent for pharmacy challenges to PBM payment methodology in Arkansas and influence similar legislative efforts in other states. The outcome affects Medicaid managed care plans that contract with Express Scripts for pharmacy services and may impact PBM reimbursement practices across state Medicaid programs.
- Managed Care
Psychedelic-Assisted Therapy Poses Coverage and Implementation Questions for Medicaid Programs
As psychedelic-assisted therapies move toward FDA approval and market entry, Medicaid programs face emerging policy and operational questions around coverage criteria, administration protocols, and workforce requirements. These therapies, being developed for treatment-resistant depression and PTSD, differ from traditional pharmaceuticals in requiring intensive clinical supervision and specialized settings. Medicaid leaders must consider prior authorization frameworks, benefit design, provider network adequacy, and reimbursement models as these treatments enter the behavioral health landscape. Early planning is necessary given Medicaid's role as the largest payer of behavioral health services and the complex operational requirements these therapies will demand.
- Legal
DOL Warns Plans to Maintain Mental Health Parity Compliance Despite Non-Enforcement Posture
The Department of Labor, HHS, and Treasury have adopted a non-enforcement posture for the final Mental Health Parity and Addiction Equity Act regulations published in fall 2024, but are warning employers and health plans that compliance remains expected. The guidance signals that while the agencies are not actively enforcing the 2024 final rule, they continue to monitor mental health parity compliance more broadly. This creates compliance uncertainty for Medicaid managed care plans and other health plans that must determine which parity requirements remain enforceable and how to demonstrate compliance without clear enforcement standards.
- Federal Policy
2.3 Million Young Adults Could Lose Medicaid Under Big Beautiful Bill
The Urban Institute estimates 2.3 million young adults could lose Medicaid coverage under the Big Beautiful Bill, a federal legislative proposal. Actual disenrollment numbers will depend on state implementation choices, particularly how states design income verification and renewal processes. Young adults face higher disenrollment risk due to frequent address changes and participation in gig economy work that complicates income documentation. The findings highlight operational challenges states and managed care plans will face in maintaining continuity of coverage for this population.
- Managed Care
Webinar Announcement on Medicaid Substance Use Services and Justice System Integration
A webinar titled 'Medicaid Connections: Substance Use Health & Justice' has been announced, focusing on how 21st-century legislative and system changes have shifted substance use disorder treatment from punitive systems toward health-based responses through Medicaid. The webinar will examine the evolving role of Medicaid in providing substance use services and the ongoing inequities in access. An audio transcript is available for download.
- State Policy
Pediatricians Report Immigrant Families Avoiding Medicaid, CHIP Amid Immigration Enforcement Fears
Forty percent of pediatricians surveyed by the American Academy of Pediatrics report children in immigrant families are avoiding healthcare due to immigration status concerns, with 31% reporting families avoided applying for Medicaid, CHIP, or food assistance. The survey of over 1,600 pediatricians conducted April-June 2026 found urban pediatricians reported higher rates of families retreating from care (48%) compared to rural providers (32%). A new federal public charge policy effective September 20, 2026 allows immigration officers reviewing green card and visa applications to consider enrollment in Medicaid, CHIP, housing assistance, and food programs as grounds for inadmissibility, which pediatricians say will further deter eligible families from enrolling.
- Federal Policy
SAMHSA Awards Supplemental Prevention Grants to Alabama, Kansas, West Virginia Faith-Based Organizations
HHS announced September 15, 2026 supplemental funding through SAMHSA's Strategic Prevention Framework–Partnerships for Success program to Alabama, Kansas, and West Virginia. The awards support faith-based organizations and leaders in substance use prevention activities. The funding supplements existing state prevention grants. This expands federal support for community-based prevention infrastructure in states with significant substance use disorder prevalence, potentially affecting Medicaid behavioral health service utilization and costs.
- State Policy · LA
Louisiana Congressional Candidates Diverge on Medicaid Work Requirements, ACA Subsidies
Four candidates competing for Louisiana's 6th Congressional District seat have outlined sharply different healthcare positions ahead of the November 3, 2026 election. Democratic candidates Pat Forbes and Lindsay Garcia support restoring expired Affordable Care Act subsidies and repealing new Medicaid work requirements set to take effect in January 2027, which will require many enrollees to earn $580 monthly or complete 80 hours of volunteer work or school to retain benefits. Republican state Sen. Rick Edmonds opposes restoring ACA subsidies, favors expanded health savings accounts, and supports the work requirements as an incentive for job training. The requirements, enacted by the Trump administration and Congress in 2025, affect certain low-income Medicaid recipients starting January 2027.
- Industry
Addus HomeCare to Acquire AccentCare Personal Care Division for $275 Million
Addus HomeCare Corporation announced a $275 million acquisition of AccentCare's personal care division, expected to close in Q1 2027 at the earliest. The transaction is part of Addus's broader expansion strategy and will provide the company entry into new geographic markets. The deal represents strategic alignment as both companies focus on their core business lines. Addus executives have indicated additional large acquisitions are in the pipeline.
- Legal
Home-Based Care Providers Face Heightened Medicaid Program Integrity Oversight Amid AI Adoption
Home health and home-based care providers are experiencing increased Medicare and Medicaid program integrity scrutiny while navigating AI technology implementation. Providers are advised to prioritize AI governance, compliance protocols, and vendor management to mitigate regulatory risk. Recommended actions include conducting internal data reviews and compliance audits. The guidance addresses operational risks for providers serving Medicaid beneficiaries under heightened federal and state oversight of billing, documentation, and technology use.
- Legal · NC
Federal Court Ends 14-Year North Carolina Mental Health Settlement Oversight
U.S. District Judge James C. Dever III terminated court oversight of North Carolina's Transitions to Community Living program Monday, ending a 2012 settlement with the U.S. Justice Department. The settlement required North Carolina to transition people with serious mental illness from institutional settings to community housing with wraparound services. While the state exceeded some targets — housing 3,998 people against a 3,000 goal — an independent reviewer found the state failed to meet 2025 benchmarks for supported housing slots from adult care homes, providing only 1,022 of a required 2,000 slots. Both parties agreed to end oversight early despite gaps, citing substantial compliance overall.
- Industry · VT
Dartmouth Health and UVM Health Network Announce Over 600 Job Cuts
Dartmouth Health is eliminating 420 positions and UVM Health Network is laying off 199 staff, effective Oct. 1, 2026. Dartmouth is closing its Tele-ICU and Tele-ED services, the New England Alliance for Health collaborative, and an employee training program while consolidating executive roles. UVM Health is closing two patient care units and cutting positions across its six-hospital network in Vermont and New York. Both networks cite rising costs for drugs, supplies, and salaries combined with declining patient volumes and payment rates. The cuts are expected to save UVM Health $16.8 million annually.
- Federal Policy
Census Bureau Reports 2025 Income Growth and Poverty Decline Amid Safety Net Reductions
The Census Bureau's annual report shows median family income rose 2.6% in 2025 to $87,460, while the official poverty rate fell from 10.7% to 10.2%. Health insurance coverage remained stable. However, recent federal cuts to SNAP and enhanced ACA subsidies, along with pending stricter Medicaid work requirements, are expected to reverse these gains in future years. The supplemental poverty measure, which accounts for government benefits, showed 13.1% of Americans in poverty — unchanged from 2024.
- State Policy · AZ
Arizona GOP Gubernatorial Nominee Proposed Medicaid Elimination as State Senator in 2011
Andy Biggs, the Republican nominee for Arizona governor, introduced legislation as a state senator in 2011 to abolish Arizona's Medicaid program, citing unsustainable costs to taxpayers. The proposal sought to end state participation in Medicaid entirely rather than provide health coverage for low-income residents. As a gubernatorial candidate, Biggs' previous position on Medicaid elimination is resurfacing as voters and stakeholders assess his stance on the program. Arizona's Medicaid program currently covers approximately 2.4 million residents, including expansion populations adopted under the Affordable Care Act.
- State Policy · LA
Louisiana Awards Rural Health Grants to Tech Startups
Louisiana received over 200 applications from technology companies seeking $250,000 to $3 million in state funding to address rural health care gaps. The state is directing rural health dollars to unproven startups as traditional providers exit underserved markets. The initiative reflects a broader state-level trend of funding technology solutions where brick-and-mortar providers have closed or left. States are assuming financial and operational risk by investing public dollars in early-stage companies without demonstrated outcomes in Medicaid populations.
- Federal Policy
Census Reports 2025 Poverty Rate at Historic Low Amid Warnings of Medicaid, SNAP Cuts
The U.S. Census Bureau reported the 2025 official poverty rate fell to 10.2%, a historic low, while the supplemental poverty rate held steady at 13.1%. Median household income rose 2.6% to $87,460. Experts cautioned the data does not reflect 2026 federal policy changes, including major Medicaid and SNAP cuts enacted through last year's tax and spending legislation. The Congressional Budget Office estimates 15 million people will lose health coverage by 2034, and SNAP enrollment for children already dropped 1.2 million between July 2025 and July 2026.
- Managed Care
Network Health Launches Epic Prior Authorization API Ahead of 2027 CMS Deadline
Network Health has implemented Epic's prior authorization application programming interface (API) in advance of CMS's January 1, 2027 interoperability rule deadline. The rule requires insurers to deploy APIs for patient access, provider access, provider directory, payer-to-payer data exchange, and prior authorization. Network Health is among the early adopters working with Epic to meet these requirements before the mandate takes effect. The implementation aims to streamline prior authorization processes between the health plan and providers using Epic's electronic health record system.
- Federal Policy · ME
Maine Analysis Links $4,300 Household Cost Increase to Expired ACA Premium Tax Credits
A Maine Center for Economic Policy analysis attributes rising household costs to federal policy changes, including the January 2026 expiration of enhanced Affordable Care Act premium tax credits for marketplace plans. Healthcare costs represent the largest driver, with families enrolled in marketplace plans seeing significant premium increases while those with employer coverage were less affected. Maine's individual market premiums rose 14.8% for 2027, reflecting declining enrollment by healthier members after subsidies expired. The analysis also cited rising gas, heating oil, and tariff-related costs, but healthcare policy changes had the most direct impact on affected households.
