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Wednesday, September 9 · 12 stories
- Federal Policy
CMS EMTALA Citations Reach Highest Level in Over a Decade
Hospitals are receiving Emergency Medical Treatment and Labor Act (EMTALA) violation citations at record levels, according to CMS inspection data analyzed by Becker's Hospital Review. EMTALA requires hospitals to screen and stabilize anyone arriving at the emergency department regardless of ability to pay. The increased enforcement reflects heightened CMS scrutiny of emergency department compliance. This trend affects Medicaid-participating hospitals, which face potential termination from the program for serious or repeated EMTALA violations.
- Legal · LA
Louisiana Appeals Court Reviews Challenge to Telehealth Abortion Access
A federal appeals court is considering Louisiana's lawsuit seeking to terminate telehealth abortion access. The case challenges the legality of remote provision of medication abortion services. The timing and scope of any ruling remain uncertain. The outcome could affect Medicaid coverage of telehealth reproductive health services in Louisiana and potentially establish precedent affecting other states' telemedicine policies for abortion and related services.
- State Policy · ID
Idaho Holds State Agency Budgets Flat for FY 2028 After 2026 Cuts
Idaho's Division of Financial Management has published state agency budget requests for fiscal year 2028 (starting July 1, 2027), with instructions to agencies to submit only baseline funding requests and not restore prior cuts. Budget director Lori Wolff told reporters that non-discretionary spending for Medicaid, prisons, and public schools will consume most projected revenue increases, leaving minimal room for new spending. The Department of Health and Welfare budget request, which includes Medicaid, has not yet been published but is expected by September 15, 2026. Governor Little typically releases his proposed state budget in January before the legislature convenes to draft final appropriations.
- Managed Care · CA
California Orders Health Net to Extend Assisted Living Benefits Through December After Termination Violations
California's Department of Health Care Services issued a corrective action plan requiring Health Net to extend assisted living and home care services for approximately 3,500 Medi-Cal members through December 31, 2026, after finding eight deficiencies in how the insurer handled benefit terminations. The state cited failures to submit transition plans, move members to appropriate care, and improper service denials that endangered vulnerable members. Health Net faces potential fines of $25,000 per member per day for non-compliance. The insurer, which operates Medi-Cal plans in 10 counties, still plans to end the optional CalAIM benefit in January 2027, leaving members at risk of nursing home placement or homelessness.
- State Policy · GA
Georgia GOP Gubernatorial Candidate Pledges Medicaid Expansion Without Details
Republican gubernatorial candidate Rick Jackson announced plans to pursue Medicaid expansion in Georgia if elected, calling it an "intelligent" approach to closing the coverage gap. Jackson, a healthcare businessman, provided no specifics on how his expansion proposal would differ from traditional approaches or what form coverage would take. Georgia remains one of ten states that have not expanded Medicaid under the Affordable Care Act. The announcement represents a notable shift for a Republican candidate in a non-expansion state, but lack of detail makes operational and fiscal implications unclear.
- State Policy · NE
Nebraska Cuts Medicaid Funding for 900 Developmentally Disabled Using Algorithm
Nebraska has reduced Medicaid funding for nearly 900 people with developmental disabilities after implementing an algorithm-based eligibility determination system. The cuts affect individuals receiving long-term services and supports through the state's Medicaid program. Families report that the state is removing vital funding without clear explanation of how the algorithm calculates need or eligibility. The action raises questions about the use of automated systems in Medicaid eligibility and benefit determinations, particularly for vulnerable populations requiring intensive services.
Tuesday, September 8 · 16 stories
- Federal Policy
Congressional Democrats Challenge CMS Emergency Department Data Collection Initiative
Senate and House Democrats are opposing a Trump administration initiative to collect patient medical data from emergency departments, arguing it violates privacy protections and could deter individuals from seeking emergency care. The lawmakers are calling for the administration to halt the data collection effort. The timing of implementation and specific data elements targeted are not detailed in the available information, but the opposition suggests the initiative is either underway or imminent.
- State Policy
SHVS Tracker Compiles State Rural Health Transformation Program and Public Health Initiatives
State Health and Value Strategies published its regular State Health Updates tracker covering August 2026 state-level activity. The tracker documents Rural Health Transformation Program grant awards in Alabama ($144 million to 138 providers) and Arkansas ($149.3 million), plus state public health initiatives including California's new opioid helpline and social health council, Alaska's revised state health assessment, and Colorado's Long COVID convening. These updates reflect ongoing state implementation of federal rural health funding and state-level population health strategies.
- Industry · MA
Mass General Brigham Plan Drops Medicare Advantage Coverage for Dana-Farber Cancer Patients
Mass General Brigham's health plan has discontinued Medicare Advantage coverage for Dana-Farber Cancer Institute patients, coinciding with the organizations ending their long-standing partnership. The contract lapse affects Medicare Advantage enrollees who previously had in-network access to Dana-Farber oncology services through MGB's health plan. The change is effective as the two organizations wind down decades of clinical collaboration. This development impacts network adequacy and patient access for Medicare Advantage beneficiaries in the Boston market.
- State Policy · VA
Virginia Creates Digital Service to Modernize Benefits Systems After $52M IT Failure
Governor Abigail Spanberger named Andrea Fletcher, former CMS Chief Digital Officer, to lead Virginia's new Digital Service, a technology team charged with modernizing state computer systems and preventing costly contract failures. The initiative follows a $52 million loss on a failed child support enforcement system modernization under the previous administration. The team will help state agencies respond to federal funding and eligibility changes under H.R. 1, with early work focused on maintaining access to Medicaid and SNAP benefits. Fletcher previously led CMS's Digital Service team and established the federal government's first Open Source Program Office.
- State Policy
States Respond to Federal Medicaid Policy Changes, Advance Rural Health Infrastructure
Several states are implementing new policies and programs affecting Medicaid operations. Colorado's Medicaid agency is notifying members about upcoming federal eligibility changes from H.R. 1 effective January 1, 2027. Hawai'i announced $58 million in rural health transformation funding, including $45 million for workforce development and $13 million for ambulances and emergency communications. Idaho opened applications for $97 million in rural healthcare infrastructure grants. Kentucky's governor responded to congressional inquiry about Medicaid funding impacts. Louisiana reported a 59% reduction in opioid-related deaths between 2022 and 2025. California enacted legislation focused on suicide prevention for boys and young men.
- Legal · CA
California Failed to Report and Return $6.8 Million in Medicaid Fraud Unit Overpayments
The HHS Office of Inspector General found that California did not report and return $6.8 million in Medicaid overpayments identified through its Medicaid Fraud Control Unit cases from 2019 to 2022. California reported only $27.4 million of $34.2 million in identified overpayments to CMS and returned just $24 million. The state failed to track overpayments adequately and did not follow federal requirements for reporting and returning recovered funds within 60 days. OIG recommends California strengthen controls, return the unreported amounts, and provide technical assistance to counties on federal overpayment requirements.
- Legal · SC
OIG Finds South Carolina Failed to Monitor MCO Mental Health Parity Compliance on Prior Authorization
An HHS Office of Inspector General audit found that South Carolina's Medicaid agency did not ensure that three managed care organizations complied with federal mental health and substance use disorder parity requirements for prior authorization processes during the audit period. The state lacked adequate oversight mechanisms to verify that MCOs applied comparable prior authorization criteria and processes for behavioral health services as for medical/surgical benefits. OIG recommended that South Carolina strengthen monitoring protocols and ensure MCOs document parity compliance. The findings highlight enforcement gaps in the Mental Health Parity and Addiction Equity Act as applied to Medicaid managed care.
- Legal
CMS Announces $3.4 Billion Medical Equipment Fraud Enforcement Action
CMS has taken enforcement action against a medical equipment supplier fraud scheme totaling $3.4 billion. The action targets fraudulent billing practices involving durable medical equipment suppliers. While the press release does not specify the effective date of sanctions or detail which programs (Medicare, Medicaid, or both) were affected, enforcement actions of this scale typically involve multi-program billing fraud and can result in provider terminations, payment suspensions, and enhanced screening requirements. The action signals heightened federal scrutiny of DME billing across government health programs.
- Industry
Vertical Integration Drives Higher Patient Costs Through Facility and Pharmacy Steering
Vertically integrated health systems are increasingly directing patients to higher-priced facilities for procedures and requiring use of insurer-owned pharmacies that may not offer the lowest prices or stock prescribed medications. The practice affects patients across commercial and government-sponsored insurance, including Medicaid managed care enrollees who face steered networks and limited pharmacy access. The cost increases result from structural market consolidation rather than explicit policy changes, making them difficult for regulators and payers to address through traditional oversight mechanisms.
- State Policy · MN
Minnesota Rural Hospital Sustains Maternity Ward Amid National Closures
A rural Minnesota hospital has maintained its maternity ward operations while similar facilities nationwide continue closing obstetric services. The hospital's operational model may offer a replicable strategy for other rural providers facing financial pressures that force maternity unit closures. Rural maternity ward closures directly affect Medicaid beneficiaries, who account for approximately 42% of all U.S. births and face increased travel distances and reduced access to prenatal and delivery care when local services close.
- Managed Care
GLP-1 Prescriptions for Children Rose 30,000 Percent Since 2019
Prescriptions of GLP-1 medications for children increased more than 30,000 percent between 2019 and present, according to new data. Children with obesity-related conditions such as high cholesterol or sleep apnea were substantially more likely to receive GLP-1 prescriptions than those without these comorbidities. The dramatic rise in pediatric GLP-1 use reflects growing clinical acceptance of these medications for weight management in children with obesity-related health complications. This trend has significant implications for Medicaid managed care pharmacy budgets and prior authorization protocols, as GLP-1s are high-cost specialty medications and children represent a growing share of Medicaid enrollment.
- State Policy · CA
California Expands Assisted Living Coverage in Rural Counties After Advocacy Push
California launched a pilot program expanding Medi-Cal coverage for assisted living facilities in select rural counties, following advocacy by a family member whose sister faced limited long-term care options. The program addresses gaps in California's current Medi-Cal structure, which typically excludes assisted living from covered services except in limited circumstances. The pilot applies to designated rural counties where nursing home access is constrained. The expansion reflects growing pressure on California to diversify institutional long-term care options beyond nursing facilities, particularly in underserved areas where beneficiaries have few alternatives.
- State Policy · CA
California Gubernatorial Candidate Becerra Confronts Rising Uninsured as Medicaid Coverage Erodes
California faces a significant increase in its uninsured population as former HHS Secretary Xavier Becerra campaigns to become the state's next governor. The article reports a projected surge in uninsured individuals following recent Medicaid coverage losses, reversing historical coverage gains achieved during Becerra's tenure as federal health secretary. The timing creates a policy challenge for California's next administration, which will need to address coverage gaps through state programs and Medicaid eligibility policies. This matters for California's Medicaid program, which covers over 15 million residents and will face pressure to expand coverage or mitigate enrollment losses through policy changes.
- Industry
Rural Hospitals Accelerate M&A Activity Amid Anticipated Federal Medicaid Cuts
Rural hospital systems are pursuing mergers and partnerships in response to anticipated Medicaid funding reductions under the Trump administration. The consolidation wave is driven by financial survival concerns as rural facilities face revenue pressures from potential federal cuts. This activity is intensifying debate over healthcare market competition and care costs in rural communities. The timing and scope of any federal Medicaid reductions remain uncertain, but rural providers are acting preemptively to strengthen their financial positions through scale and integration.