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Tuesday, June 9 · 2 stories
- Federal Policy
HHS Escalates Medicaid Program Integrity Enforcement Across Multiple States
HHS has launched state-specific and nationwide actions targeting Medicaid program integrity, marking an escalation in federal oversight of state programs. The actions include audits, funding withholdings, and enhanced scrutiny of improper payments and eligibility determinations. States face increased federal review of their claims processing, provider enrollment, and payment accuracy systems. The brief identifies states likely to face heightened scrutiny and outlines enforcement priorities, though many details about timing and specific state selections remain unclear.
Monday, June 8 · 4 stories
- Federal Policy
HHS Affordability Czar Targets Provider Taxes and State-Directed Payments as Cost Drivers
Casey Mulligan, the Trump administration's healthcare affordability czar, identified provider taxes and state-directed payments as key drivers of healthcare cost inflation during a recent conference. He argued these mechanisms inflate spending beyond Medicaid and increase costs for employers and taxpayers. The remarks signal potential federal scrutiny of state financing arrangements commonly used in Medicaid managed care. No specific policy changes or timelines were announced.
- Federal Policy
HHS Autism Panel Endorses Controversial Communication Method Despite Scientific Criticism
Health Secretary Robert F. Kennedy Jr.'s newly formed autism panel is promoting a disputed communication method known as facilitated communication or spelling therapy, which has been widely rejected by mainstream medical and disability organizations. The technique involves a facilitator physically guiding an autistic person's hand to type or point at letters, with critics arguing it reflects the facilitator's thoughts rather than the individual's. Panel members include advocates of alternative treatments including camel's milk and stem cell injections. The panel's recommendations could influence federal autism research priorities and educational policies affecting Medicaid-funded services for children and adults with autism spectrum disorder.
- Federal Policy
Title X Funding Cuts and Policy Changes Drive Planned Parenthood Clinic Closures
Federal policy changes have led to decreased funding for Planned Parenthood, including provisions in the One Big Beautiful Bill Act and the withholding of Title X family planning funds from Planned Parenthood clinics. These funding cuts are resulting in clinic closures across multiple states. The changes affect access to family planning services, including contraception and STI screening, that many Medicaid managed care organizations rely on through network providers. The brief examines the scope of closures and the impact on the Title X program's provider network.
- Federal Policy
CMS Issues Final Rule Tightening Medicaid Work Requirement Exemption Standards
CMS has finalized new regulations governing exemptions from Medicaid work requirements, a policy change that healthcare advocates say will increase administrative complexity for both enrollees and state programs. The rule affects how states must document and verify exemptions for populations unable to meet work or community engagement requirements. Critics warn the changes could lead to coverage losses among eligible beneficiaries due to procedural barriers, even as work requirements themselves face ongoing legal challenges. The timing and implementation timeline remain unclear from the available information.
Friday, June 5 · 4 stories
- Federal Policy
Trump Administration Removes Civil Service Protections for Thousands of HHS Policy Staff
The Trump administration has reclassified thousands of HHS employees who shape policy to Schedule F status, stripping civil service protections and making them easier to terminate. The change affects staff across HHS agencies including CMS who develop regulations, guidance, and policy implementation. This action mirrors a similar executive order from Trump's first term that was rescinded by the Biden administration. The reclassification takes effect immediately and could lead to significant turnover among career staff who oversee Medicaid policy development and managed care oversight.
- Federal Policy
CDC Reports Over 2,000 Measles Cases in 2026, 93% Outbreak-Related
The CDC confirmed 2,030 measles cases in the U.S. as of June 4, 2026, with 1,890 cases (93%) linked to outbreaks. This total is rapidly approaching the full-year 2025 count. Measles is a highly contagious vaccine-preventable disease that poses particular risks to immunocompromised populations and young children. For Medicaid managed care plans, rising case counts may trigger increased EPSDT screening requirements, higher utilization of pediatric acute care and emergency services, and potential quality measure impacts related to childhood immunization rates.
- Federal Policy
FDA Launches Safety Review of Abortion Drug Mifepristone
The Food and Drug Administration has initiated a safety review of mifepristone, the abortion medication, according to an administration official. The retrospective analysis could lead to restrictions on the drug's use and distribution channels. Anti-abortion groups view this as a significant development that may result in tighter federal controls over medication abortion access. The timing and scope of the review have not been disclosed.
- Federal Policy
GOP Budget Law Cuts Threaten Coverage for Nearly 2 Million Children
The 2025 GOP budget law includes significant cuts to healthcare programs that are expected to result in higher premiums and changes to Medicaid eligibility rules. An estimated 2 million children could lose health insurance coverage as a result of these cuts. The changes are creating uncertainty around Medicaid coverage determinations and affordability challenges for families. The law represents a major shift in federal healthcare policy affecting both Medicaid and marketplace coverage.
Thursday, June 4 · 6 stories
- Federal Policy
States Deploy Rural Health Transformation Funding for Maternity Care Deserts
States are using federal Rural Health Transformation Program (RHTP) grants to address maternal health access gaps in rural counties, with a mandatory October 30, 2026 deadline to obligate first-year awards. Initiatives include financial supports to sustain low-volume labor and delivery units, emergency OB equipment for rural hospitals, and workforce expansion through doulas, community health workers, and certified nurse midwives. Over 130 rural labor and delivery units have closed since 2020, leaving one in three U.S. counties without hospital-based obstetric care. States including Alabama, Alaska, New Mexico, California, and Iowa are prioritizing maternal health infrastructure, telehealth-enabled prenatal care, and incentive payments for rural providers serving high-need populations.
- Federal Policy
Senator Cassidy Blames HHS Secretary Kennedy for Rise in Vaccine-Preventable Diseases
Sen. Bill Cassidy (R-La.) publicly blamed HHS Secretary Robert F. Kennedy Jr. for a resurgence in vaccine-preventable diseases, citing a New York Times report that hospitals are seeing illnesses previously controlled by childhood immunizations. The statement comes as doctors report increased cases of diseases they rarely encountered in recent years. The criticism targets Kennedy's well-documented skepticism of vaccines and his influence over federal health policy. No immediate policy change or enforcement action has been announced.
- Federal Policy
HHS Secretary Kennedy Pursues Access to Patient Medical Records Through State Health Information Exchanges
HHS Secretary Robert F. Kennedy Jr. is working with state health information exchanges to access Americans' medical records as part of an initiative examining autism and vaccine data. In Nebraska, a state nonprofit health information organization receiving federal funding is cooperating with the project. The effort involves collecting and analyzing health data from multiple states through existing health information sharing infrastructure. The scope and timeline of data access remain unclear, as does whether patient consent protocols or HIPAA safeguards will apply to the federal review.
- Federal Policy
Trump Administration Moves to Eliminate Federal DEI Initiatives
The Trump administration has taken action to eliminate diversity, equity, and inclusion (DEI) initiatives across federal agencies. The brief examines the status of these actions and their potential impact on racial health disparities. For Medicaid managed care organizations, these changes may affect federal health equity requirements, data collection mandates, and program priorities that have shaped health plan operations and reporting obligations. The brief does not specify effective dates for all changes, though the administration's directives are already underway.
- Federal Policy
GAO Finds Seven Agencies Failed to Meet Payment Integrity Reporting Requirements for High Improper Payment Rates
The Government Accountability Office identified seven federal agencies with programs reporting improper payment rates of 10 percent or higher for 2-4 consecutive years from fiscal years 2021-2024, including HHS Medicaid programs. Five of seven agencies lacked documented policies to ensure timely reporting to Congress as required under the Payment Integrity Information Act of 2019. GAO found that OMB guidance does not direct noncompliant agencies to submit required annual reports, limiting congressional oversight. The report recommends agencies establish formal procedures to ensure compliance with PIIA reporting requirements for programs with persistent improper payment issues.
- Federal Policy
CMS Interprets Medicaid Cuts Law Without Cancer Patient Protections Advocates Expected
CMS has issued guidance interpreting recent Medicaid legislation in a manner that cancer patient advocates argue fails to deliver promised protections from coverage cuts. Blood Cancer United's Gwen Nichols warns that vulnerable oncology patients face exposure to benefit reductions or coverage limitations despite congressional assurances. The interpretation affects how states and managed care organizations implement Medicaid changes affecting cancer treatment access and continuity of care. The guidance creates immediate operational uncertainty for MCOs managing oncology benefits and prior authorization protocols.
Wednesday, June 3 · 1 story
- Federal Policy
CMS Administrator Oz to Lead White House Press Briefing
Dr. Mehmet Oz, Administrator of the Centers for Medicare and Medicaid Services, will conduct the White House press briefing on Tuesday. He is filling in for press secretary Karoline Leavitt during her maternity leave, joining other Cabinet officials who have taken on briefing duties. The briefing may provide insight into CMS priorities and policy direction under the current administration. Managed care organizations should monitor for any announcements regarding Medicaid policy, regulatory changes, or administrative guidance that could affect program operations.
Tuesday, June 2 · 3 stories
- Federal Policy
OIG Reports Fourth Quarter 2025 Drug Pricing Comparison Shows ASP-AMP Spreads
The HHS Office of Inspector General released its quarterly comparison of Average Sales Prices (ASP) and Average Manufacturer Prices (AMP) for drugs in the fourth quarter of 2025. This routine report identifies drugs where ASP exceeds AMP by specified thresholds, which triggers potential Medicaid reimbursement adjustments under federal law. The data covers Medicare Part B drugs and provides transparency into pharmaceutical pricing differentials that affect both Medicare and Medicaid programs. CMS uses these comparisons to determine when Medicaid best price penalties may apply.
- Federal Policy
Lilly Threatens to End 340B Discounts for Hospitals That Don't Submit Claims Data
Eli Lilly issued a five-day ultimatum to hospitals participating in the 340B drug discount program, demanding they submit claims data or lose access to discounted pricing. The move escalates pharmaceutical manufacturers' ongoing efforts to restrict 340B eligibility and impose new compliance requirements on covered entities. Hospitals that fail to comply by the deadline will see their 340B discounts suspended. This follows similar manufacturer-led restrictions that have drawn pushback from HRSA and advocacy groups representing safety-net providers.
- Federal Policy
CMS Issues Interim Final Rule Imposing 80-Hour Monthly Work Requirement for Adult Medicaid Beneficiaries
CMS released an interim final rule Monday requiring certain adult Medicaid beneficiaries to meet an 80-hour monthly work requirement. The rule takes effect as an interim final rule, meaning it is immediately enforceable while CMS accepts public comments. Experts warn the requirement could reduce health coverage for home care workers, potentially disrupting LTSS workforce stability and service continuity for Medicaid managed care beneficiaries who rely on home-based services. The rule affects adult beneficiaries in non-expansion populations, though specific exemptions and state implementation timelines remain unclear from this brief announcement.
Monday, June 1 · 11 stories
- Federal Policy
GAO Finds HUD Cannot Track Service Coordinators Due to Data Quality Failures
A GAO report found that HUD lacks uniform data entry procedures for service coordinators in multifamily housing and cannot determine how many properties employ them or whether properties comply with program requirements. HUD also does not routinely analyze performance reports from service coordinators. Stakeholders reported service coordinators help residents avoid eviction and apply for Medicaid, but five studies showed mixed results on health, financial, and housing outcomes. Rural challenges include managing multiple funding sources, limited service providers, and long distances to services.