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Friday, June 26 · 3 stories
- Federal Policy
CMS Prioritizes IRA Implementation and PBM Reform in Drug Pricing Agenda
The Trump administration has placed drug pricing at the top of its health policy agenda, with CMS focusing on implementing Inflation Reduction Act provisions and pursuing pharmacy benefit manager reforms. The agency is working on Medicare price negotiation, inflation rebates, and Part D redesign while exploring PBM transparency and reform measures. These initiatives affect how Medicaid managed care organizations negotiate drug prices, manage pharmacy benefits, and coordinate with Medicare for dual-eligible beneficiaries. The timeline for specific regulatory actions remains under development.
Thursday, June 25 · 5 stories
- Federal Policy
KFF Tracker Compiles Federal Medicaid Program Integrity Actions by State
The Kaiser Family Foundation maintains an ongoing tracker of federal Medicaid program integrity developments and their state-specific implications. The resource documents CMS enforcement actions, audit findings, and compliance initiatives as they emerge across different states. The tracker serves as a reference for monitoring federal oversight activity affecting state Medicaid programs. It compiles information on federal actions rather than reporting a single policy change or rulemaking.
- Federal Policy
Cassidy Introduces Bill to Limit Hospital 340B Drug Discount Eligibility
Senator Bill Cassidy has introduced legislation to restrict eligibility for the 340B drug discount program, which allows certain hospitals and health centers to purchase outpatient drugs at steep discounts. The proposal comes as hospitals face broader federal funding pressures. While specific provisions are not detailed in the brief article, any 340B restrictions typically target hospital eligibility criteria, contract pharmacy arrangements, or program oversight. The timing is significant as hospitals already navigate budget constraints and prior 340B enforcement actions.
- Federal Policy
Bipartisan Bill Would Allow Direct Methadone Prescribing for Opioid Use Disorder
A bipartisan bill in Congress would end the requirement that methadone for opioid use disorder be dispensed only through specialty opioid treatment programs, allowing qualified practitioners to prescribe it directly like buprenorphine. The legislation would enable office-based prescribing and pharmacy dispensing of methadone, dramatically expanding access beyond the current clinic-only model. If enacted, the change would remove a longstanding barrier to medication-assisted treatment that has limited access particularly in rural and underserved areas. The timing and specific requirements for prescriber qualifications remain unclear pending legislative details.
- Federal Policy
CMS Projects U.S. Health Spending to Reach $5.7T in 2025, Driven by Utilization Growth
CMS actuaries project total U.S. health spending will reach $5.7 trillion in 2025, with growth primarily driven by increased utilization rather than unit cost increases. Prescription drug spending is accelerating sharply, particularly for GLP-1 medications used for diabetes and weight management. The utilization trend affects all payers including Medicaid managed care plans, which face rising pharmacy costs and member demand for high-cost specialty drugs. CMS expects spending growth to moderate in subsequent years as utilization patterns stabilize.
- Federal Policy
CMS Projects Home Health Spending Growth to Slow to 7.9% in 2026
CMS projects national home health care spending will grow 7.9% in 2026, down from 10.3% in 2025, according to a Health Affairs report on national health expenditure projections. The deceleration reflects moderating post-pandemic utilization trends while still indicating strong growth in the home health sector. The projections cover total national home health spending across all payers, including Medicare, Medicaid, and commercial insurance. For Medicaid managed care organizations with home health benefit responsibility or LTSS carve-ins, the projections signal continued upward pressure on capitated rates and medical expense ratios in the home health category.
Wednesday, June 24 · 3 stories
- Federal Policy
Senate Democrats Challenge Trump Administration's Moms.gov Site Over Crisis Pregnancy Center Listings
Eleven Democratic senators raised concerns about the Trump administration's Moms.gov website, launched on Mother's Day, which features resources from 2,750 pregnancy centers. The lawmakers argue the site directs families to crisis pregnancy centers rather than licensed medical providers. The site provides information for new and expecting mothers, but critics including Planned Parenthood contend these centers do not provide comprehensive medical care. The senators' letter signals potential congressional oversight of federal maternal health resource guidance.
- Federal Policy
Rural Hospitals Downsize Inpatient Care Under $50B Federal Transformation Fund
A $50 billion federal rural health transformation fund is driving hospitals to reduce inpatient capacity as states prioritize proven cost-saving models to qualify for funding. States are avoiding experimental approaches in favor of demonstrated strategies like downsizing acute care beds. The fund's structure incentivizes immediate cost reduction over innovation, according to health policy experts. Rural hospital consolidation and service line reductions may accelerate as a result.
- Federal Policy · IN
Indiana Joins CMS Pilot Using Oracle AI to Detect Medicaid Fraud
The Indiana Family and Social Services Administration is participating in a CMS pilot program that provides free access to Oracle's artificial intelligence software for Medicaid fraud detection. The AI will analyze claims data to identify suspect billing patterns including upcoding and other fraudulent activities. CMS is offering the software at no cost to state Medicaid agencies as part of a federal initiative to strengthen program integrity using advanced analytics. This represents a shift toward automated fraud detection that could affect provider billing scrutiny and audit patterns.
Tuesday, June 23 · 3 stories
- Federal Policy
Trump Administration Holds $2 Billion in HHS Grants Pending White House Review
The Trump administration has instituted a multi-step political review process requiring White House OMB approval for all HHS grant funding opportunities, delaying over $2 billion in congressionally appropriated funds. The process includes AI screening for flagged keywords like "harm reduction" and "gender," followed by political review at multiple levels through HHS Secretary RFK Jr.'s office and OMB. CDC delayed $728 million across 30 grants and SAMHSA held $286 million. State and local health departments, which receive approximately 25% of their funding from federal grants, face service cuts if delays continue. The policy applies to all FY 2026 funding opportunities including 988 suicide hotline expansion, outbreak response, and opioid treatment programs.
- Federal Policy
Supreme Court Could Review Executive Order Ending Birthright Citizenship
An opinion piece argues that if the Supreme Court upholds a recent executive order ending birthright citizenship, the policy could create significant public health consequences. The analysis suggests potential impacts on healthcare access and population health outcomes. The piece frames the issue through bioethics and public health lenses. No specific timeline for Supreme Court review is provided in the available content.
- Federal Policy · MN
New Federal Medicaid Rules Threaten Minnesota Mental Health System
New federal Medicaid regulations implementing provisions of the 2025 Congressional Budget Reconciliation Bill are set to impact Minnesota's mental health system. The regulations could affect the state's decades-long efforts to build a recovery-oriented mental health system focused on community integration and employment support. The changes appear to limit or restructure mental health coverage in ways that could disrupt existing service delivery models. Managed care organizations operating mental health programs in Minnesota will need to prepare for these changes.
Monday, June 22 · 2 stories
- Federal Policy
White House Proposal Threatens Federal Funding for Health Equity Research
A new White House proposal could disqualify significant portions of health disparities research from federal funding eligibility. Health equity researchers characterize this as potentially the most serious threat to their field's future. The proposal would subject health equity studies to heightened scrutiny in federal grant review processes. The change would affect how agencies like NIH and AHRQ evaluate research focused on racial, ethnic, and socioeconomic health disparities.
- Federal Policy
Congressional Democrats Push to Repeal CMS WISeR Model
Congressional Democrats have introduced legislation to repeal the Transforming Maternal Health (TMH) Model, commonly known as WISeR (Women in States Earning Rewards). The mandatory payment model, which ties Medicaid reimbursement to quality metrics for maternal health services, has faced criticism since its launch. Policy experts say the repeal effort's success remains uncertain given the current political landscape. If repealed, states and managed care organizations participating in the model would see changes to their maternal health payment structures and quality reporting requirements.
Friday, June 19 · 1 story
- Federal Policy
Federal Grant Delays Threaten Disability Research Institutions and Services
Federal agencies have delayed issuing grants to disability research institutions nationwide, creating uncertainty about program continuity and employment. The delays affect research centers that study and support services for people with disabilities, including those enrolled in Medicaid long-term services and supports. No timeline has been provided for when grant awards will resume. The disruption threatens institutional stability and could interrupt data collection and technical assistance that state Medicaid programs rely on for LTSS policy development.
Thursday, June 18 · 4 stories
- Federal Policy
Senate Democrats Investigate HHS Changes to Federal Vaccine Advisory Panel
Senate Democrats Ron Wyden and Maggie Hassan have launched an investigation into Health Secretary Robert F. Kennedy Jr.'s restructuring of the Advisory Committee on Immunization Practices (ACIP), the federal panel that issues vaccine recommendations. The senators are demanding communications and records showing who determined the legal and public health consequences of remaking the advisory committee. ACIP recommendations typically inform Medicaid and CHIP coverage decisions for vaccines under the Vaccines for Children program and mandatory coverage requirements for pediatric vaccines. The investigation seeks transparency around the decision-making process that led to changes in the federal vaccine policy infrastructure.
- Federal Policy
CMS Seeks Input on PBM Compensation Restrictions and Data Reporting for 2028 Implementation
CMS issued a request for information on pharmacy benefit manager compensation structures and business practices to inform implementation of new legislative requirements. The RFI focuses on two mandates taking effect in 2028: restrictions on remuneration PBMs and affiliates may receive for services related to Part D drug utilization, and new data reporting requirements. CMS is seeking technical input on PBM service arrangements, affiliate relationships, and compensation models. Comments will shape how CMS defines permissible PBM compensation and structures data collection requirements for Medicare Part D plans.
- Federal Policy
CDC Reports 1,415% Increase in Nitazene Overdose Deaths Since 2020
The CDC reported nitazene-involved overdose deaths increased from 27 in 2020 to 409 in 2024, marking a 1,415% rise in confirmed fatalities from these super-potent synthetic opioids. Nitazenes are spreading across the U.S. drug supply, often mixed with or sold as other substances. The sharp escalation indicates an emerging public health threat requiring enhanced overdose response capacity. This trend follows patterns seen with fentanyl's emergence in the illicit drug market over the past decade.
- Federal Policy
Trump Administration Finalizes Rule Tightening Medicaid Work Requirement Medical Exemptions
The Trump Administration finalized a rule that restricts medical frailty exemptions from the Medicaid work requirement enacted in the 2025 reconciliation law. The rule narrows exemptions for blindness, disability, substance use disorder, disabling mental disorders, and physical, intellectual, or developmental disabilities that impair ability to perform daily activities. The work requirement takes Medicaid coverage from enrollees who do not meet the requirement and do not qualify for an exemption. The rule is now in effect following finalization.
Wednesday, June 17 · 3 stories
- Federal Policy
HHS Announces $708 Million in Behavioral Health Funding Opportunities
HHS Secretary Robert F. Kennedy, Jr. announced $708 million in new funding opportunities for behavioral health programs, including $96 million for the STREETS (Safety Through Recovery, Engagement, and Evidence-based Treatment and Support) program targeting mental illness, addiction, and homelessness, plus $612 million for additional behavioral health initiatives. The funding opportunities are now posted and available for application. This represents significant new federal investment in community-based behavioral health infrastructure and services that Medicaid managed care organizations often coordinate or deliver.