All stories
Jump to date
Wednesday, September 2 · 25 stories
- Federal Policy
CMS Durable Medical Equipment Enrollment Moratorium Expires
CMS's moratorium on new durable medical equipment supplier enrollment has expired. The moratorium had temporarily halted new DME supplier applications in certain geographic areas as a program integrity measure. With the expiration, CMS will resume processing new DME supplier enrollment applications. The change affects Medicaid programs in states where DME suppliers seek to enroll and bill Medicaid for equipment and supplies, potentially expanding the DME provider network.
- Industry
AHA Webinar on Medicare Advantage Electronic Prior Authorization Implementation
The American Hospital Association is hosting a webinar on preparing for Medicare Advantage's electronic prior authorization mandate effective January 1, 2027. The session will feature representatives from AHA, CMS, and Epic discussing workflow integration, implementation challenges, and readiness strategies for hospital and health system leaders. The webinar focuses on operational preparation for the new Medicare Advantage requirement.
- Federal Policy
SAMHSA Awards $77 Million for Substance Use and Mental Health Services
The Substance Abuse and Mental Health Services Administration (SAMHSA) awarded $77 million in grants to strengthen substance use prevention, treatment, crisis services, and mental health services. Over $22 million of the total supports substance use prevention programs, announced as National Substance Use Primary Prevention Month concludes. The funding supports expanded behavioral health infrastructure and service capacity. The awards matter for Medicaid managed care organizations and providers that coordinate with SAMHSA-funded programs and integrate federal grant-supported services into Medicaid-covered behavioral health networks.
- Federal Policy
Congress Blocks OMB Grant Rule Through Dec. 11, Averting Federal Shutdown
Congress passed a continuing resolution Sept. 1 funding the government through Dec. 11 and temporarily blocking an OMB proposal to revise federal grant regulations. The proposal would give agencies broader authority to modify, suspend, or terminate grant awards based on evolving priorities, raising concerns from the American Hospital Association about funding predictability for multiyear investments in workforce, research, and infrastructure. The AHA has sought clarity on whether the rule would affect Medicare rural programs, CMMI arrangements, supplemental Medicaid payments, and Medicaid managed care capitation. The temporary block expires Dec. 11, leaving hospitals facing renewed uncertainty unless OMB withdraws or revises the proposal.
- State Policy · SC
South Carolina Medicaid Director Discusses HCBS Strategy and Legislative Relations
South Carolina Medicaid Director Eunice Medina outlined the state's approach to home and community-based services, legislative engagement, and member-centered policy in an interview with the National Association of Medicaid Directors. Medina discussed operational priorities for South Carolina's Medicaid program and strategies for maintaining stakeholder relationships. The interview provides insight into how one state Medicaid agency is structuring its leadership approach to HCBS and policy implementation. This offers state agencies and managed care organizations a window into South Carolina's current Medicaid direction under Medina's leadership.
- Managed Care
UnitedHealthcare, Aetna, BCBS Plans Implement Lab Testing and Provider Reimbursement Policy Changes
Six major health insurers implemented reimbursement policy changes effective September 1, 2026. UnitedHealthcare is tightening lab testing reimbursement across commercial, Medicare Advantage, and Medicaid plans, with Medicaid rollouts staggered by state from August through December. Changes include caps on allergen testing (20 allergens per year for patients 20+), limits on hepatic fibrosis testing to once every six months, and vitamin B12 testing restrictions to once every three months. BCBS Michigan is phasing out incident-to billing starting September 1, requiring enrollment-eligible clinicians to add modifier SA; by March 2027, clinicians with their own NPI must bill directly or face 80% fee schedule reimbursement. Molina Healthcare of Ohio is implementing new specialty medication administration site-of-care policies and revised buy-and-bill pharmacy policies for several drugs.
- State Policy · VA
Virginia Expands Medicaid Waiver Slots But Thousands Still Wait for Disability Services
Virginia has increased Medicaid waiver slots for individuals with intellectual and developmental disabilities, but demand continues to exceed capacity. Thousands remain on waiting lists after losing school-based special education services at age 22, facing a "services cliff." The state's expansion addresses some gaps but has not eliminated waitlists for long-term services and supports. This ongoing capacity shortfall leaves young adults with disabilities without continuity of care as they transition from educational to adult service systems.
- Federal Policy
Acting Attorney General Signals Federal Action to Restrict Abortion Access in All States
Acting Attorney General Todd Blanche told faith leaders on a private call hosted by the White House Faith Office that he plans to roll back abortion access nationwide, including in states with protective abortion laws. Blanche indicated the administration intends to reverse Biden-era protections for abortion access. The timeline and specific legal mechanisms for federal intervention were not detailed in available reporting. The development is significant for state Medicaid agencies and managed care organizations that cover abortion services under state law, potentially creating conflicts between federal directives and state coverage obligations.
- Federal Policy
Trump Executive Order Reduces Recommended Childhood Vaccine Schedule to 11 Core Immunizations
President Trump signed an executive order Monday advancing 'Make America Healthy Again' priorities by recommending 11 core childhood vaccinations instead of the current CDC schedule and directing agencies to split combined vaccines. The order takes effect immediately but applies only to federal recommendations, not state Medicaid EPSDT requirements, which mandate coverage of ACIP-recommended immunizations under federal law. The directive creates potential conflict between federal guidance and mandatory Medicaid Early and Periodic Screening, Diagnostic and Treatment benefits. State Medicaid agencies and managed care plans must continue covering all ACIP-recommended vaccines to maintain federal compliance and avoid audit findings.
- State Policy · VA
Virginia Governor Issues Executive Order Responding to Federal Medicaid Cuts
On August 25, 2025, Virginia Governor Abigail Spanberger signed Executive Order 20 establishing the "Keep Virginia Covered" policy to address federal Medicaid and SNAP reductions enacted through H.R.1. The federal legislation cuts approximately $1 trillion from Medicaid nationwide over 10 years, with Virginia projected to lose $1.8 to $2.6 billion annually in federal funding beginning in 2028. An estimated 300,000 Virginians are at risk of losing Medicaid coverage as a result. The executive order directs state agencies to develop strategies to mitigate coverage losses and maintain program access in the face of reduced federal support.
- State Policy · CA
Former California Lawmaker Calls for Unified Health Care Cost Control Strategy
A former California state legislator argues that California's health care system, costing over $400 billion annually, requires a cohesive long-term strategy rather than piecemeal legislative fixes. The author, who helped establish the California Office of Health Care Affordability (OHCA) and the state's all-payer claims database, contends that meaningful cost control demands data transparency, cross-sector coordination, and accountability mechanisms to counter fragmented policy approaches driven by competing interests. The commentary frames affordability as essential to maintaining public trust and access amid state budget pressures and federal funding uncertainty.
- Industry · VT
UVM Medical Center Limits Patient Sitters Amid Budget Cuts, Unions File Cease and Desist
University of Vermont Medical Center in June changed its policy limiting licensed nursing assistants from serving as patient sitters, instead prioritizing remote video monitoring and a capped pool of 17 designated clinical patient safety attendants per shift across 14 inpatient units and the emergency department. Staff unions on August 20 sent a cease and desist letter arguing the change jeopardizes patient safety and interferes with ongoing contract negotiations. The policy shift is part of $140 million in systemwide expense cuts as UVM Health Network faces a projected $14 million loss for fiscal year 2027, driven by lower commercial reimbursement from BlueCross BlueShield and pharmaceutical markup restrictions.
- Industry · MN
Sanford Health Completes North Memorial Acquisition After Agreeing to State Oversight
Sanford Health has completed its acquisition of North Memorial Health, finalizing the deal after agreeing to 10 years of state oversight and committing $600 million in investments. The agreement allows South Dakota-based Sanford to expand into the Twin Cities market. The oversight agreement addresses state concerns about the consolidation's impact on healthcare access and costs. The deal represents significant market consolidation in Minnesota's Twin Cities region.
- State Policy · CT
Connecticut Economic Report Warns Rising Unemployment Threatens SNAP, Medicaid Work Requirements
Connecticut Voices for Children released its annual State of Working Connecticut report Monday, finding low- and middle-income families face rising unemployment (5.2% statewide, tied for highest nationally) amid slow economic growth. The report warns that higher unemployment creates immediate challenges as federal changes requiring 80 hours monthly work to maintain SNAP and Medicaid benefits take effect, with jobs becoming harder to find. Black workers and younger workers face unemployment rates well above the statewide average. The advocacy group recommends state-level programs to offset federal cuts and policy reforms including affordable housing, child care, expanded unemployment insurance, and indexing income taxes to inflation.
- Industry
Referral Partners Balance Home Health and SNF Placements to Reduce Readmissions
Post-acute care referral partners are refining site-of-care decision-making to route patients appropriately between home health, skilled nursing facilities, and other settings. The focus is on matching patient needs with the right post-acute setting to prevent costly hospital readmissions. Effective placements require thorough documentation and communication across hospitals, SNFs, and home health agencies. The approach affects discharge planning workflows and care coordination for Medicare and Medicaid beneficiaries moving from acute to post-acute care.
- State Policy
Immigration Enforcement Drives Missed Pediatric Appointments, Delayed Medicaid-Covered Care
Healthcare providers report a surge in missed pediatric appointments and delayed care since January 2025 as immigration enforcement activity prompts families to avoid hospitals and clinics. Clinicians cite cases of children going without surgery, hearing aids, and ADHD medication — including U.S. citizen children on Medicaid whose parents fear being targeted through program enrollment data. ICE arrests reached 51,000 in July 2026, with an estimated 146,000 U.S. citizen children having had a parent detained since January 2025. Pediatricians report increased depression, anxiety, and missed developmental milestones among children in immigrant families, regardless of immigration status.
- State Policy · WV
West Virginia SNAP Enrollment Drops 4,000 Children Since Federal Benefit Cuts
West Virginia reports approximately 4,000 fewer children enrolled in the Supplemental Nutrition Assistance Program (SNAP) as of May 2026, one year after the One Big Beautiful Bill Act took effect in July 2025. The federal law made substantial cuts to nutrition assistance programs. State Department of Human Services data shows the decline in child enrollment following implementation of the federal benefit reductions. The enrollment drop reflects the impact of federal SNAP policy changes on low-income families who often qualify for both SNAP and Medicaid.
- State Policy · VA
Virginia ACA Enrollment Drops 94,000 After Federal Subsidies Expire
Virginia's ACA marketplace enrollment fell from 389,000 in 2025 to 295,000 as of September 2026, a decline attributed largely to expired federal subsidies for individuals between 138% and 250% of the federal poverty level. Virginia lawmakers allocated $150 million in the current state budget to create temporary state-level subsidies that will be available when marketplace enrollment opens in November, potentially saving eligible enrollees about 70% on monthly premiums. The relief is temporary; meanwhile, federal reconciliation legislation will impose Medicaid work requirements affecting over 500,000 Virginia enrollees and reduce immigrant coverage by approximately 5,800 individuals, with hospitals projecting a $31 billion reduction in state Medicaid funding over the next decade.
- State Policy
Life Insurance Cash Value Remains Countable Asset Under State Medicaid Eligibility Rules
Life insurance policies with cash surrender value count as resources under Medicaid eligibility determinations in most states, potentially disqualifying applicants whose other assets fall below resource limits. State Medicaid agencies must assess policy values during initial eligibility screening and ongoing estate recovery processes. The treatment varies by state policy, with some states exempting term policies or policies below certain face value thresholds. This affects long-term care applicants and beneficiaries subject to estate recovery, requiring careful asset verification by eligibility workers and estate recovery contractors.
- Federal Policy
Federal Rural Health Transformation Program Draws Criticism Over Lack of Transparency
The $50 billion federal Rural Health Transformation Program, created in summer 2025 as part of President Trump's One Big Beautiful Bill Act, faces criticism from policy groups for insufficient transparency one year into implementation. CMS will publish only an annual aggregate report, not proactively release individual state reports or funding recipient details, leaving transparency largely to states with widely varying disclosure practices. Multiple states have declined public records requests, held closed meetings, or sought to shield applications from public view. The five-year program was designed to offset anticipated Medicaid spending reductions of over $900 billion that disproportionately affect rural communities.
