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Thursday, September 3 · 11 stories
- State Policy · KS
Kansas Advocacy Report Calls for Medicaid Rate Increase, Maternal Health Reforms
The United Methodist Health Ministry Fund released a report urging Kansas to raise Medicaid obstetric reimbursement rates for the first time in over 30 years and expand maternity care access in underserved areas. The report recommends increasing insurance coverage, expanding telehealth, creating regional care partnerships, and coordinating community-based providers to address workforce shortages and maternal mortality — which has doubled in 20 years and is 75% higher for Black women than white women. The assessment targets geographic and racial inequities affecting Medicaid beneficiaries and low-income mothers, who face higher mortality risk. Implementation would require state budget action and policy changes to sustain obstetric services in rural hospitals, many of which have closed maternity units in the past decade.
- State Policy · OK
Oklahoma Warns 250,000 Medicaid Enrollees of New Federal Work Requirements
The Oklahoma Health Care Authority has notified over 250,000 SoonerCare enrollees that new federal work requirements may affect their Medicaid eligibility. Yellow letters were mailed last week instructing recipients how to maintain coverage. The state agency is implementing the federal mandate, which would require certain adult Medicaid beneficiaries to meet work, training, or community engagement activities to remain eligible. Implementation timing and specific exemption categories were not detailed in the announcement.
- State Policy · IL
Illinois Hospitals Face Billions in Losses Under Federal Medicaid Financing Changes
A new study finds that Illinois hospitals stand to lose billions of dollars due to federal changes in Medicaid financing policy. The analysis projects significant financial strain on hospital systems statewide as reimbursement structures shift. The changes will particularly affect hospitals that rely heavily on Medicaid revenue, potentially threatening access to care in vulnerable communities. Hospital associations are evaluating options to offset the anticipated revenue losses through state policy adjustments or supplemental payment programs.
- Federal Policy
CMS Permanently Waives Home Address Reporting for Telehealth Providers with Group Practice Enrollment
CMS has made permanent an enrollment flexibility allowing providers who furnish telehealth services from home to avoid reporting home addresses on Medicare enrollment applications, provided they maintain a separate physical practice location associated with a Medicare Part B-enrolled group practice. Affected providers can enroll and bill from their physical practice location as if services were furnished in person. The policy takes effect immediately and applies to both new enrollments and existing providers. The change reduces administrative burden and privacy concerns for clinicians providing telehealth from home while maintaining program integrity through group practice oversight.
- State Policy · CT
Connecticut Lawmakers Threaten Subpoena Over Hospital's Gender Care Agreement with DOJ
Connecticut House Human Services Committee co-chairs Matt Lesser and Jillian Gilchrest are threatening to subpoena Connecticut Children's Medical Center to obtain details of the hospital's settlement with the U.S. Department of Justice regarding gender-affirming care for minors. The DOJ announced in August 2026 that Connecticut Children's agreed to stop providing gender-affirming care to minors, including hormones and puberty blockers, and pay a monetary penalty plus $500,000 in additional medical care. The lawmakers sent a letter requesting copies of the agreement and all correspondence between the hospital and DOJ, citing state law granting committee chairs subpoena power. Connecticut Children's agreed to meet with lawmakers next week and stated it did not turn over patient health information during the investigation or settlement process.
- State Policy · RI
Rhode Island Governor Pledges $16M Medicaid Primary Care Rate Increase in 2027 Budget
Rhode Island Governor Dan McKee announced plans to include $16 million in his next budget to increase Medicaid reimbursement rates for primary care providers. The commitment follows a yearlong review by the state's Office of the Health Insurance Commissioner examining primary care payment rates. The proposal would take effect with the fiscal year 2027 state budget if McKee is reelected. The rate increase responds to chronic concerns about Medicaid primary care access and provider participation driven by below-market fee schedules.
- State Policy · PA
Pennsylvania Labor Agency Launches Proactive Wage Compliance Reviews of Home Care Providers
Pennsylvania's Department of Labor and Industry announced September 2, 2026, that it will proactively investigate Minimum Wage Act violations across home care agencies statewide, rather than waiting for worker complaints. The initiative targets an industry where nearly 40% of the state's wage complaints originate, affecting an estimated 100,000 home care workers. Agencies received legal demands for wage and hour records starting Wednesday. The state will focus on unpaid overtime, travel time between clients, and improper sleep-time deductions — common violations in a sector heavily reliant on Medicaid reimbursement for personal care services.
- State Policy
Self-Pay Hospital Visits Rise Following Medicaid Disenrollment, Epic Research Finds
Self-pay hospital visits are increasing as Medicaid enrollment declines following the end of pandemic-era continuous enrollment protections, according to an Epic Research study published August 31, 2026. The research documents rising uncompensated care across hospital settings linked to coverage losses in both Medicaid and ACA markets. The trend reflects ongoing fallout from Medicaid redeterminations that began in spring 2023, with states continuing to process eligibility reviews and disenroll individuals who no longer qualify or fail to complete renewal paperwork. State Medicaid agencies and safety-net hospitals face mounting financial pressure as former enrollees present for care without coverage.
- State Policy · TX
Texas Governor Defends State Medicaid Hospital Funding Amid Federal Scrutiny
Texas Governor Greg Abbott publicly defended the state's Medicaid hospital funding structure, which channels nearly $10 billion annually to hospitals. A spokesman stated Texas has not violated federal requirements that would disqualify the funding. The statement comes amid apparent federal scrutiny of the arrangement. The defense is notable given Texas leadership's typically reserved stance on Medicaid program operations.
Wednesday, September 2 · 25 stories
- Federal Policy
AHA Opposes CMS Home Health Payment Update and Enrollment Changes in CY 2027 Proposed Rule
The American Hospital Association submitted comments August 28, 2026 opposing CMS's proposed 2.4% payment update for home health services in calendar year 2027, calling it inadequate, and urging suspension of behavioral adjustments tied to the patient-driven grouping model. The proposed rule also includes Medicare provider enrollment changes affecting all Medicare-enrolled providers and suppliers. AHA warned the enrollment provisions would create significant reporting burdens and risk compliant providers' enrollment status. Comments urged CMS to finalize only narrowly tailored enrollment policies with objective standards and procedural safeguards protecting providers and beneficiary access.
- State Policy · VT
Vermont Spends $161 Million Annually Training Medical Residents With 50% Out-Migration Rate
Vermont invests $161 million per year training 320 medical residents and fellows at the University of Vermont Medical Center, retaining roughly 50 physicians annually — approximately half of graduates. The effective cost per retained physician exceeds $3 million, rising higher for longer programs like surgery. A letter writer contrasts this slow-pipeline approach with Southwestern Vermont Medical Center's published retention strategy for nursing staff, which avoids reliance on temporary travelers, and notes SVMC's own residency program won't produce retaining physicians until 2032.
- 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.
