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Wednesday, June 17 · 3 stories
- Federal Policy
Uninsured Population Grew in 2024, First Increase Since 2019
The number and share of Americans without health insurance increased in 2024, marking the first rise since 2019, according to KFF's analysis of American Community Survey data. The growth in uninsured individuals follows the end of Medicaid continuous enrollment protections that expired in March 2023, resulting in millions of eligibility redeterminations across states. The increase reverses a five-year trend of declining uninsurance rates and signals potential coverage losses that disproportionately affect low-income populations eligible for Medicaid. This shift has immediate implications for uncompensated care costs and emergency department utilization that MCOs and safety-net providers must absorb.
- Federal Policy
FDA Approves Third Over-the-Counter Naloxone Nasal Spray
The FDA approved Rextovy, a 4mg naloxone nasal spray, for over-the-counter sale in pharmacies, convenience stores, and online for emergency treatment of opioid overdose. This is the third OTC naloxone product approved by FDA. The approval expands consumer access to overdose reversal medication without a prescription. For Medicaid managed care organizations, this may affect pharmacy benefit management, member education strategies, and harm reduction program design, particularly for plans serving populations with substance use disorders.
Tuesday, June 16 · 7 stories
- Federal Policy
CMS Proposes Rule to Codify Medicare Drug Price Negotiation Program
CMS has issued a proposed rule to codify the Medicare Drug Price Negotiation Program and establish new policies for both the Negotiation Program and the Medicare Prescription Drug Benefit Program as required by the Inflation Reduction Act of 2022. The rule also proposes modifications to the fixed combination drug policy. The Negotiation Program allows Medicare to negotiate prices for certain high-cost drugs, which could affect formulary dynamics and pricing strategies for Medicare Advantage plans that include prescription drug coverage. The proposed rule sets the framework for how negotiated prices will be implemented and administered.
- Federal Policy
NHeLP Report Finds Electronic Asset Verification Creates Rural Medicaid Access Barriers
The National Health Law Program released a report examining how electronic asset verification systems in Medicaid create enrollment barriers for rural residents, particularly Black rural populations. The report identifies gaps in rural banking infrastructure and property transfer documentation that interfere with automated eligibility systems. The analysis focuses on how Medicaid agencies' reliance on electronic verification tools may disproportionately delay or deny coverage for applicants in areas with limited financial institution networks and informal property arrangements. The report provides recommendations for state Medicaid programs to address these verification challenges.
- Federal Policy
Medicare Coverage of Anti-Obesity Drugs Begins Next Month Under Temporary Program
Medicare will begin covering weight loss medications starting next month through a program designed as temporary but expected to face political pressure for permanence. The coverage represents a significant policy shift for Medicare, which has historically excluded anti-obesity drugs from its formulary. The program's implementation comes as GLP-1 medications like Wegovy and Zepbound have demonstrated clinical efficacy for weight management but carry substantial cost implications. While positioned as temporary, the coverage expansion may prove difficult to reverse once beneficiaries begin accessing these medications.
- Federal Policy
Senate Democrats Release Prescription Drug Pricing Policy Blueprint
Senate Democrats released a policy blueprint proposing measures to lower prescription drug costs ahead of the midterm elections. The proposals aim to address voter concerns about drug affordability and provide a counter-message to White House voluntary pricing initiatives. The blueprint reflects ongoing bipartisan interest in drug pricing reform but does not specify legislative text, implementation timelines, or comment periods. For Medicaid managed care organizations, potential reforms could affect pharmacy benefit management, capitation rate calculations, and prescription drug rebate programs.
- Federal Policy
MACPAC June 2026 Report Addresses Prior Authorization Automation and Managed Care Accountability
The Medicaid and CHIP Payment and Access Commission (MACPAC) released its June 2026 Report to Congress with recommendations on six policy areas affecting Medicaid managed care operations. The report addresses automation in prior authorization processes, managed care accountability measures, and access to residential treatment services, among other topics. The recommendations also cover community engagement requirements, services for youth with special health care needs, and the Program of All-Inclusive Care for the Elderly (PACE). These recommendations typically inform congressional legislation and CMS policy development over the following 12-24 months.
- Federal Policy · CO
FDA Approves Colorado Drug Importation Plan from Canada
The FDA approved Colorado's Section 804 importation program, allowing the state to import certain prescription drugs from Canada to reduce costs for residents. This marks the first operational approval under the 2020 FDA guidance that permits states to seek authorization for Canadian drug importation. The approval comes after years of state planning and federal review. Colorado must now finalize vendor contracts and operational logistics before importing drugs, with implementation timeline still uncertain.
- Federal Policy
HHS Secretary Kennedy Demands Explanation for Retracted Vaccine-SIDS Study
HHS Secretary Robert F. Kennedy Jr. sent a June 11 letter to the editor-in-chief of Toxicology Reports demanding justification for the removal of a 2021 study linking vaccines to sudden infant death syndrome. Kennedy has cited this research in support of proposed changes to childhood immunization schedules. The retraction raises questions about the scientific basis for potential federal policy shifts affecting Medicaid-covered pediatric vaccine programs. No timeline has been announced for HHS policy changes to childhood vaccination requirements.
Monday, June 15 · 2 stories
- Federal Policy
Medicaid State Directed Payment Spending Analyzed Before Federal Caps Take Effect
A new issue brief examines state spending on Medicaid state directed payments (SDPs) requiring prior CMS approval, providing baseline data ahead of new federal limits. The reconciliation law imposes caps on SDP spending that will take effect in the coming fiscal year, fundamentally altering how states can direct managed care payments to providers. The analysis covers SDP utilization patterns across states and payment types, including directed payment arrangements for hospitals, nursing facilities, and other providers. This data establishes the spending landscape before federal restrictions reshape state flexibility in directing managed care plan payments.
- Federal Policy
CMS Issues Final Rule on Medicaid Work Requirements for States
CMS released final regulations on June 1 governing how states implement Medicaid work requirements. The rule requires certain enrollees to prove they are working, completing job training, volunteering, or enrolled in educational programs to maintain coverage. States seeking to implement work requirements must comply with these federal standards. The rule affects millions of Medicaid enrollees and establishes the framework states must follow when designing and administering work requirement programs.
Friday, June 12 · 2 stories
- Federal Policy
CMS Issues Final Rule on Medicaid Work Requirements
The Trump administration has released final regulations establishing work and community engagement requirements for Medicaid beneficiaries. The rule allows states to require certain adult enrollees to work, volunteer, or participate in job training to maintain eligibility. Implementation details, exempt populations, and reporting requirements are now defined at the federal level. The rule affects millions of Medicaid enrollees and requires managed care organizations to implement tracking and verification systems.
- Federal Policy
CMS Announces Strict Budget Neutrality Requirement for Section 1115 Waivers
CMS announced Thursday it will implement a strict budget neutrality requirement for Medicaid Section 1115 demonstration waivers. The agency is providing states early notice of its intent to apply new budget neutrality standards to demonstrations. Section 1115 waivers allow states to test innovative approaches in Medicaid, including delivery system reforms and coverage expansions that often involve managed care organizations. The new standards will affect how states structure and finance waiver programs going forward.
Thursday, June 11 · 6 stories
- Federal Policy
GAO Projects Federal Debt Will Reach 251% of GDP by 2056 Without Policy Changes
The Government Accountability Office projects that under current spending and revenue policies, federal debt held by the public will reach 106% of GDP by 2029 and 251% of GDP by 2056. Projected deficits are driven primarily by growth in Social Security, Medicare, and other federal health care programs, with net interest costs becoming the fastest-growing portion of the federal budget. GAO recommends Congress and the administration establish fiscal rules, build consensus on deficit reduction, and address Social Security and Medicare trust fund shortfalls before depletion in 2032 and 2033. The report emphasizes that delayed action will require more dramatic policy changes.
- Federal Policy
GAO Finds DOJ Adult Trafficking Program Lacks Measurable Performance Goals
A January 2025 GAO report found that the Department of Justice does not set measurable near-term goals for its adult human trafficking survivor assistance program, unlike HHS programs and DOJ's minor survivor program which follow leading performance assessment practices. In fiscal year 2025, HHS awarded $7.5 million across two programs serving approximately 2,600 survivors, while DOJ awarded $45 million across two programs serving approximately 11,300 survivors. The report identifies provider shortages and other access barriers for behavioral health services. GAO recommends DOJ establish measurable near-term goals with targets and timeframes to better assess program effectiveness and progress toward supporting adult trafficking survivors.
- Federal Policy
Federal Court Deadline Looms on Mailed Abortion Medication Access
A federal court deadline on Monday could make mailing abortion pills illegal nationwide. The ruling would affect telemedicine providers who prescribe mifepristone and misoprostol to patients across state lines, including for medication abortion and miscarriage management. Providers currently rely on FDA guidance allowing direct-to-patient mailing of abortion medications approved during the COVID-19 public health emergency and maintained afterward. If the deadline results in restrictions, it could eliminate a key access pathway for medication abortion in states where in-person abortion services are limited or banned.
- Federal Policy
SAMHSA Opens $40 Million in Grants for Addiction Prevention and Behavioral Health Workforce
SAMHSA announced eight grant programs totaling $40 million to fund addiction prevention, behavioral health workforce development, child trauma services, and suicide prevention efforts. The funding opportunities are now open for application by eligible providers and organizations. Awards will support expanding access to behavioral health services and building provider capacity in underserved areas. For Medicaid managed care organizations, these grants may strengthen network adequacy by increasing the supply of behavioral health providers and services in their markets.
- Federal Policy
CMS Establishes Office of Health Technology and Products to Oversee Technology Modernization
CMS has created the Office of Health Technology and Products (OHTP) to lead enterprise-wide healthcare technology modernization and digital transformation across Medicare, Medicaid, CHIP, and other CMS programs. The office will oversee digital products and platforms in coordination with the CMS Chief Information Officer, who retains governance authority over IT infrastructure, cybersecurity, and enterprise architecture. The organizational change takes effect immediately through this statement of delegations. The new structure may affect how states and managed care organizations interact with CMS technology systems and digital service delivery initiatives.
- Federal Policy
Six States Report Higher-Than-Expected ACA Marketplace Attrition After Enhanced Subsidies Expired
State-level enrollment data through April 2026 from Arkansas, Colorado, Maryland, Massachusetts, New Mexico, and New York show significant coverage losses as enrollees canceled plans or stopped paying premiums following the expiration of enhanced ACA subsidies. Georgetown University analysis indicates attrition rates exceed initial federal projections. Congress did not renew the enhanced subsidies that had been in place, resulting in higher premium costs for marketplace enrollees. The coverage losses could affect Medicaid managed care organizations in states with integrated or coordinated care models between marketplace and Medicaid coverage.
Wednesday, June 10 · 5 stories
- Federal Policy
GAO Identifies 38 Priority Recommendations for HHS, Including Medicare and Medicaid Program Integrity
The Government Accountability Office has identified 38 priority recommendations for the Department of Health and Human Services as of May 2026, with seven new recommendations added in the past year. HHS has implemented four recommendations since May 2025. GAO is prioritizing two areas: strengthening Medicare and Medicaid program integrity and oversight, and improving public health program oversight and coordination. The recommendations aim to increase efficiency, reduce fraud and waste, and improve federal health care program operations. GAO sends these priority letters to agencies whose implementation could save significant federal funds or address high-risk issues.