All stories
Jump to date
Thursday, July 2 · 5 stories
- Federal Policy
CBO Projects Medicaid Enrollment and Spending Decline Through 2036 Under Reconciliation Law
The Congressional Budget Office's February 2026 projections show significant reductions in Medicaid enrollment and federal spending over the next decade following passage of the 2025 reconciliation law. The analysis compares current projections to pre-reconciliation baselines, quantifying the impact of policy changes including eligibility restrictions, state flexibility provisions, and federal funding modifications. CBO accounts for both legislative changes and updated economic assumptions in projecting enrollment trends and program costs through 2036. The projections provide the first comprehensive federal assessment of how reconciliation provisions will reshape Medicaid program size and federal financial participation.
- Federal Policy
GAO Reports $12 Billion in Federal Medicaid and Medicare Spending for Assisted Living in 2024
The Government Accountability Office reports that federal Medicaid and Medicare spending for services provided in assisted living facilities totaled at least $12 billion in 2024, including $3.5 billion in federal Medicaid spending and $8.5 billion in Medicare spending. Forty-four states cover assisted living services through their Medicaid programs, with 29 states using home- and community-based services (HCBS) waivers as of March 2025. GAO notes the $12 billion figure is likely an undercount due to data limitations, as assisted living facilities are not uniformly defined or consistently identified in program data. Medicare generally does not cover assisted living services but covers other health care such as hospice in these settings.
- Federal Policy
OIG Finds Part D Plans Cover Most Drugs Used by Dual Eligibles in 2026
The HHS Office of Inspector General reviewed Part D plan formularies for 2026 and found that plans generally include drugs commonly prescribed to dual-eligible beneficiaries. The analysis examined formulary coverage patterns for medications frequently used by individuals enrolled in both Medicare and Medicaid. The report provides insight into whether dual eligibles have adequate access to needed medications through Part D coverage. This matters for Medicaid managed care organizations that coordinate benefits for dually eligible members and must ensure continuity of pharmacy coverage across programs.
Wednesday, July 1 · 4 stories
- Federal Policy
CMS Schedules Webinar on Interim Final Rule for Medicaid Community Engagement Requirements
The Centers for Medicare and Medicaid Services will host a webinar on July 9, 2026 from 12-1 p.m. ET to discuss an interim final rule on Medicaid community engagement requirements. The webinar follows CMS's issuance of new federal regulations governing work and community engagement provisions in state Medicaid programs. The session will provide technical guidance on the rule's implementation requirements and compliance expectations. Managed care organizations operating in states pursuing community engagement waivers will need to understand reporting, enrollment, and member communication obligations under the new federal framework.
- Federal Policy
Georgetown Hosts Webinar on Medicaid Federal-State Financing Basics
The Georgetown University Center for Children and Families held a webinar on June 30, 2026 covering foundational Medicaid financing concepts. The session explained the federal-state partnership structure, mandatory federal funding not subject to annual appropriations, and state financing mechanisms for their matching share. The webinar targeted audience members seeking to understand basic Medicaid funding mechanics. A recording will be made available on Georgetown's website.
- Federal Policy · WA
CMS Launches WISeR Gold Card Exemption Program July 6 in Washington State
CMS will launch the WISeR (Worthy of Individual Systematic Exemption and Review) gold-carding exemption program on July 6, 2026, in Washington state, with quarterly rollouts planned for five additional states. The program exempts certain high-performing providers from prior authorization requirements based on performance metrics. Medicaid managed care organizations operating in Washington and the subsequent rollout states will need to implement gold card criteria and modify prior authorization workflows. The initiative aims to reduce administrative burden for providers with strong approval track records while maintaining utilization management oversight for other providers.
- Federal Policy
AHA Opposes Bill Adding IRS Schedule H Reporting Requirements for Tax-Exempt Hospitals
The American Hospital Association submitted comments June 30 to the House Ways and Means Committee opposing H.R. 9504, the Tax-Exempt Hospital Transparency Act, ahead of a scheduled July 1 markup. The bill would add reporting requirements to hospitals' Schedule H IRS forms, affecting nearly two-thirds of all hospitals. While the AHA acknowledged improvements from an earlier draft — including removal of a parallel for-profit tax calculation and inclusion of standardized definitions — it maintains serious concerns about administrative and financial burdens, particularly requirements focused on financial assistance reporting that exclude Medicaid shortfall and other community benefit components. The bill includes carve-outs for small facilities but still requires eventual compliance.
Tuesday, June 30 · 3 stories
- Federal Policy
GAO Adds Fourth Priority Recommendation for Social Security Administration
The Government Accountability Office identified one additional priority recommendation for the Social Security Administration in June 2026, bringing the total to four open priority recommendations. SSA has not implemented any of the three recommendations GAO identified in May 2025. The priority areas include preventing potential overpayments in Disability Insurance, improving online application access for Social Security benefits, and managing IT investments cost-effectively. GAO emphasizes these recommendations warrant urgent attention from SSA leadership to strengthen internal controls, improve service delivery, and identify opportunities for efficiency and cost savings.
- Federal Policy
Trump Administration Obesity Drug Agreement Faces Implementation Issues
The Trump administration's negotiated agreement with Eli Lilly and Novo Nordisk regarding obesity medication pricing and coverage is encountering implementation problems. The deal, which was intended to expand access to GLP-1 medications while controlling costs, contains unspecified loopholes or structural issues affecting its execution. The problems impact how these high-cost medications are covered and reimbursed under federal health programs. Medicaid managed care organizations should monitor whether state programs adjust coverage policies or capitation rates in response to these federal-level complications.
- Federal Policy
ONC Awards New Contract to Oversee TEFCA Data Exchange Framework
The Office of the National Coordinator for Health Information Technology (ONC) has awarded a new contract to oversee the Trusted Exchange Framework and Common Agreement (TEFCA), the federal framework governing nationwide health information exchange. The move comes as the volume of health records exchanged through TEFCA increases significantly. The new oversight contractor will monitor compliance with TEFCA's technical and legal requirements for data sharing among qualified health information networks. This expansion of oversight signals federal emphasis on ensuring secure, standardized data exchange as TEFCA adoption accelerates.
Monday, June 29 · 8 stories
- Federal Policy
Ten States Enter CCBHC Medicaid Demonstration as H.R. 1 Threatens Funding
Ten additional states have joined the Certified Community Behavioral Health Clinic (CCBHC) Medicaid demonstration program, expanding access to comprehensive community-based behavioral health services that meet federal certification standards. The expansion occurs as pending legislation H.R. 1 threatens the demonstration's continued funding. CCBHCs provide integrated behavioral health and physical health screening, crisis services, and care coordination under enhanced Medicaid payment structures. The timing creates uncertainty for managed care organizations with CCBHC network arrangements and for states planning implementation.
- Federal Policy
Senators Pursue $35 Insulin Cap for Private Insurance and Uninsured
U.S. senators are advancing legislation to extend the $35 insulin cost cap beyond Medicare to cover private insurance and uninsured individuals. The Medicare cap, enacted under the Inflation Reduction Act, currently applies only to Medicare Part D beneficiaries. The proposed expansion would affect Medicaid managed care organizations that coordinate care for dual-eligible beneficiaries and states with Medicaid pharmacy carve-ins where commercial insulin pricing dynamics affect beneficiary access. No effective date or legislative timeline is specified in the report.
- Federal Policy
CMS Final Rule on Prior Authorization Leaves Core Automation Challenges Unresolved
CMS has finalized rule CMS-0053-F addressing prior authorization processes, but the regulation does not solve the underlying interoperability and standardization problems that have prevented automation. The rule requires electronic submission of prior authorization requests, moving away from fax-based workflows. However, it does not establish the data standardization or system integration needed for true automation. Medicaid managed care organizations will need to implement new electronic workflows while still handling manual review processes, creating a compliance obligation without the operational efficiency gains the industry expected.
- Federal Policy
Latham & Watkins Digest Tracks June 2026 Drug Pricing and Rebate Developments
Latham & Watkins LLP published its third June 2026 digest tracking developments in drug pricing policy, including the Medicaid Drug Rebate Program, 340B Program, Medicare reforms, and state-level legislative activity. The digest compiles recent regulatory actions, guidance, and policy changes affecting pharmaceutical pricing and market access. The publication serves as an ongoing reference for tracking federal and state drug pricing policy developments. This tracker does not report a single new event but aggregates multiple developments from the period.
- Federal Policy
KFF Tracker Compiles Monthly Medicaid and CHIP Enrollment Data
The Kaiser Family Foundation maintains an ongoing tracker of monthly Medicaid and CHIP enrollment figures across states. The tracker aggregates enrollment data reported by states and CMS, providing a centralized resource for monitoring program size and trends. It is updated as new monthly data becomes available from state and federal sources. The tracker serves as a reference tool for analyzing enrollment patterns following policy changes such as the end of continuous coverage provisions.
- Federal Policy
GAO Faults HHS for Lacking Near-Term Goals in National Alzheimer's Project
The Government Accountability Office found that HHS has not set near-term, measurable goals for the National Alzheimer's Project despite having long-term objectives like reducing Alzheimer's risk. Without these goals, HHS cannot effectively collect performance data, assess progress across the multi-agency initiative, or communicate results to stakeholders. GAO acknowledged the project has contributed to achievements including FDA-approved disease-modifying treatments and diagnostic advances. The report recommends HHS adopt key performance management practices to better track federal investments spread across multiple agencies through 2035, when the project's current authorization expires.
- Federal Policy
Sanders Releases HHS Emails Showing Kennedy Pressured CDC on Vaccine Messaging
Senator Bernie Sanders released internal HHS emails indicating that HHS Secretary Robert F. Kennedy Jr. pressured the CDC to alter vaccine messaging and directed the CDC's vaccine advisory panel to restrict vaccine access. The emails document direct intervention in CDC communications and advisory processes. The release comes amid ongoing scrutiny of the administration's vaccine policy direction and its potential impact on public health programs.
- Federal Policy
Advocates Warn Federal Support for Home and Community-Based Services at Risk
Advocates for people with disabilities and older adults warn that federal support for home and community-based services (HCBS) may be weakening, 25 years after the Supreme Court's Olmstead decision established the right to receive long-term care at home rather than in institutions. The concern centers on potential policy changes that could reduce federal backing for community-based care options. This comes as Medicaid HCBS programs have grown substantially, with managed care organizations increasingly responsible for delivering and coordinating these services. Any reduction in federal support would directly affect MCO LTSS programs, reimbursement structures, and member access to community-based alternatives.
Friday, June 26 · 3 stories
- Federal Policy
MACPAC Releases 2026-2027 Meeting Agenda on Program Integrity and Federal Oversight
The Medicaid and CHIP Payment and Access Commission (MACPAC) has published its analytic agenda for the 2026-2027 meeting cycle. The agenda includes program integrity, the federal role in Medicaid oversight, and other policy areas that will be examined through public meetings and research over the next two years. MACPAC's work typically informs congressional deliberations and CMS policy development. Managed care organizations should monitor MACPAC proceedings as the Commission's recommendations often lead to regulatory or legislative changes affecting MCO operations, compliance requirements, and payment policy.
- Federal Policy
House Hearing Surfaces Partisan Split on CMS Medicaid Funding Deferrals
A House subcommittee hearing Thursday revealed sharp partisan divides over recent CMS actions deferring or threatening Medicaid funding in multiple states. State Medicaid directors defended program integrity efforts while Democratic members questioned why only Democratic-led states have faced funding actions despite administration claims the crackdown applies nationwide. The hearing focused on CMS's authority to withhold federal matching funds and the criteria used to identify states for enhanced scrutiny. The dispute centers on whether recent enforcement actions reflect objective program integrity standards or politically motivated targeting.