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Saturday, August 29 · 64 stories
- Federal Policy
MACPAC Comments on Proposed Medicare Advantage Rule for Contract Year 2027
The Medicaid and CHIP Payment and Access Commission submitted comments to CMS on proposed Medicare Advantage policy and technical changes for contract year 2027. The letter focuses on dual eligible special needs plans (D-SNPs), which serve beneficiaries enrolled in both Medicare and Medicaid. MACPAC has prioritized D-SNPs given their widespread use and the coordination challenges between Medicare Advantage plans and state Medicaid programs. The comment letter addresses proposed changes affecting how these plans operate and coordinate care for dual eligibles.
- Federal Policy
Medicaid Transitions for Youth with Special Health Care Needs Face Coverage and Benefit Gaps
Medicaid covers nearly half of all children and youth with special health care needs (CYSHCN), but when they age out of children's Medicaid and transition to adult coverage, they face significant changes to benefits, provider networks, and care coordination. These transitions can result in coverage gaps and disruptions in medically necessary services. The challenges are particularly acute for youth who rely on pediatric specialists, EPSDT benefits, and care coordination programs that do not continue into adult Medicaid. State Medicaid agencies and managed care organizations must address transition planning, benefit continuity, and provider capacity to support this population.
- Managed Care
MACPAC Report Recommends Strengthening State Oversight Tools for Medicaid MCOs
The Medicaid and CHIP Payment and Access Commission released recommendations to improve accountability mechanisms for Medicaid managed care plans. The report identifies gaps in current state oversight practices and proposes enhanced tools for state Medicaid agencies to ensure MCO performance and compliance. MACPAC notes that despite managed care being the predominant delivery system, little is known about the accountability tools states actually deploy. The recommendations aim to strengthen both CMS and state-level oversight of managed care programs.
- Federal Policy
MACPAC Chapter Examines Medicaid Access to Residential Behavioral Health for Youth
The Medicaid and CHIP Payment and Access Commission released Chapter 4 of its report examining access to residential behavioral health treatment for children enrolled in Medicaid. Federal law requires that Medicaid provide behavioral health services to youth with disabilities, including those with intense treatment needs or who pose safety risks. The chapter addresses how states ensure appropriate access to residential treatment for youth who cannot be safely served in community or home settings. This review comes as states face pressure to expand community-based behavioral health capacity while maintaining necessary institutional options for high-acuity cases.
- State Policy
MACPAC Report Examines State Medicaid Agency Oversight Role in PACE Programs
MACPAC's June 2025 report to Congress identified questions about transparency in state and federal oversight of the Program of All-Inclusive Care for the Elderly (PACE). PACE provides integrated care to adults 55 and older who meet nursing facility level-of-care criteria but can live safely in the community. The report focuses on the role of state Medicaid agencies in overseeing these programs. The findings matter for states as they evaluate their oversight responsibilities and administrative capacity for PACE, which serves dual-eligible beneficiaries requiring nursing home level care.
- Federal Policy
MACPAC Issues Recommendations to Ease CYSHCN Transition to Adult Medicaid Coverage
MACPAC's Chapter 5 outlines recommendations to improve transitions to adult Medicaid coverage for children and youth with special health care needs (CYSHCN). The recommendations address challenges CYSHCN face when aging into adult eligibility, including simultaneous SSI age-18 redeterminations and shifts in coverage structures. The timing for implementation is not specified in the excerpt. This matters because CYSHCN transitions involve complex eligibility changes and service disruptions that affect state Medicaid agencies, managed care organizations managing pediatric and adult populations, and specialty providers serving this population.
- Federal Policy
KFF Brief Examines Medicaid Reimbursement for School-Based Services Under IDEA
A KFF brief analyzes how Medicaid finances health and related services delivered in school settings for students with disabilities. Federal law allows state Medicaid programs to reimburse schools for covered services provided to Medicaid-enrolled children when medically necessary and included in an Individualized Education Plan (IEP). The brief addresses the intersection of Medicaid payment policy and Individuals with Disabilities Education Act (IDEA) requirements. This affects state Medicaid agencies' payment methodologies for school-based services and managed care organizations' responsibilities when schools are in-network providers.
- Federal Policy
CMS Data Shows 89,659 Enrollees in PACE Program as of 2023
The Program of All-Inclusive Care for the Elderly (PACE) served approximately 89,659 individuals in 2023, according to newly released demographic data. PACE provides fully integrated Medicare and Medicaid services to individuals age 55 or older who meet nursing facility level of care criteria but can live safely in the community. The report characterizes the demographic composition of PACE enrollees. PACE operates as an alternative to institutional long-term care, with states and CMS sharing financial responsibility for dual-eligible beneficiaries.
- Federal Policy
H.R. 1 Medicaid Provisions Expected to Increase State Payment Error Rates
H.R. 1 introduces Medicaid work requirements and other eligibility changes that are expected to complicate state eligibility determinations and increase payment error rates. The legislation adds new verification requirements and eligibility criteria that states must administer, creating additional documentation burdens and potential error points in the Payment Error Rate Measurement (PERM) process. These changes take effect upon enactment, with states required to implement new systems and processes to manage the added complexity. States face heightened risk of federal scrutiny and potential financial penalties as error rates climb due to the more complex eligibility landscape.
- Managed Care
MACPAC Brief Examines Children's Behavioral Health Service Use in Medicaid and CHIP
MACPAC published a brief analyzing behavioral health service utilization among children enrolled in Medicaid and CHIP, who experience higher rates of conditions like anxiety, depression, autism spectrum disorder, and ADHD compared to privately insured children. The brief reviews state coverage requirements for pediatric behavioral health benefits under Medicaid and CHIP. It provides context for managed care organizations and state agencies on access patterns and coverage obligations for this population.
- State Policy · KY
Kentucky Medicaid Leaders Discuss Policy Implementation in NAMD Podcast
The National Association of Medicaid Directors released a podcast episode featuring Kentucky Medicaid officials discussing operational, policy, and financial management strategies. The discussion covers how state leaders translate federal and state policy directives into operational practice within Kentucky's Medicaid program. The episode is part of NAMD's Medicaid Leadership Exchange series, which provides peer-to-peer learning for state Medicaid directors and senior staff.
- Federal Policy
KFF Brief Details State Medicaid Enterprise Systems Spending and Federal Oversight
KFF published an informational brief examining the IT systems states use to administer Medicaid programs, including claims processing, eligibility determination, and provider enrollment. The brief covers federal funding mechanisms for state Medicaid IT systems, CMS oversight requirements for systems modernization projects, and common implementation challenges states face. It provides context on how states finance and manage enterprise systems critical to program operations, enrollment, and payment accuracy.
- Federal Policy
CMS Finalizes FY 2027 IRF Payment Rule with 2.6% Rate Increase
CMS issued the final rule for inpatient rehabilitation facility payment rates effective October 1, 2026. The rule implements a 2.6% payment rate increase for FY 2027, resulting in an estimated $280 million increase in aggregate IRF payments. The rule updates wage index values, adjusts the case-mix group relative weights, and modifies quality reporting program requirements. While the rule primarily affects Medicare IRF payments, it may have indirect implications for Medicaid beneficiaries who receive post-acute rehabilitation services in dual-eligible or Medicaid-participating IRFs.
- Federal Policy
CMS Issues FY 2027 Hospice Payment Rate Update and Quality Reporting Requirements
CMS released the final rule updating hospice wage index values and payment rates for FY 2027 (October 1, 2026 through September 30, 2027). The rule implements a market basket update and wage index changes affecting hospice reimbursement rates. It also finalizes modifications to the Hospice Quality Reporting Program, including quality measure updates and reporting requirements that hospices must meet to avoid payment reductions. The updates take effect October 1, 2026.
- State Policy
Seven States Advance Rural Health, Crisis Response, and Food Access Initiatives
Delaware selected three vendors to establish a statewide Food is Medicine system using Rural Health Transformation Program (RHTP) funds. Indiana launched a public-facing 988 crisis dashboard tracking call volume and response times. Iowa announced $10.5 million in competitive funding to create up to 14 new medical residency programs in rural areas. Maine will hold its inaugural 2026 MaineCare Provider Conference, funded by RHTP. Maryland awarded nearly $4 million to 44 organizations for fresh food access in food deserts, including $1.65 million from RHTP. Massachusetts announced members of its RHTP Community Advisory Council. Michigan enacted legislation expanding healthcare workforce access, addressing the opioid crisis, and supporting patient safety.
- Federal Policy
CMS Marks One-Year Anniversary of Health Technology Ecosystem Launch
CMS issued a readout celebrating the first year of its Health Technology Ecosystem initiative. The ecosystem aims to modernize health data exchange and interoperability across Medicare, Medicaid, and other programs. CMS highlights progress on data-sharing standards, API implementation, and partnerships with states and plans over the past year. For Medicaid managed care organizations and state agencies, this signals continued federal investment in technical infrastructure that will require ongoing system upgrades and compliance with evolving interoperability requirements.
- State Policy
Medicaid Directors in Three States Discuss Using Personal Experience to Guide Policy
The National Association of Medicaid Directors podcast features Medicaid leaders from Pennsylvania, Idaho, and Oregon discussing how their personal experiences inform program design and service delivery decisions. The directors describe approaches to simplifying enrollment and access, centering beneficiary perspectives in policy development, and translating lived experience into operational improvements. The conversation provides peer insights for state Medicaid agencies on incorporating beneficiary-centered design principles into program administration.
- Federal Policy
CMS Proposes New Pathway for Immediate Medicare Coverage of FDA-Approved Devices
CMS issued a procedural notice inviting comment on a proposed pathway to align Medicare coverage determinations with FDA device approvals, potentially enabling immediate coverage for certain breakthrough medical devices upon FDA clearance. The notice seeks stakeholder input on framework design, eligibility criteria, and implementation mechanisms. Comments are due 60 days after Federal Register publication. If finalized, this pathway could reduce coverage uncertainty for medical device manufacturers and accelerate beneficiary access to innovative technologies, though Medicaid coverage determinations remain state-specific and not directly governed by Medicare pathways.
- State Policy
SHVS Tracker Compiles State RHTP Awards and Medicaid Behavioral Health Actions
State Health and Value Strategies published its ongoing compilation of state Medicaid and health policy developments for August 2026. Notable items include Alaska's $4.5 million in Rural Health Transformation Program awards, California withholding funds from 10 county behavioral health plans for network adequacy failures, Florida's $188 million in rural healthcare funding, and Maryland's $80 million in RHTP grants for primary care, behavioral health, and dental access. The tracker also notes Kansas RHTP awards for community health worker and food-as-medicine programs. This is a recurring reference page, not a single policy action.
- State Policy
States Implement H.R. 1 Medicaid Work Requirements and Rural Health Transformation Programs in July 2026
In July 2026, states responded to H.R. 1 by communicating new Medicaid work reporting requirements and coverage changes for non-citizens to beneficiaries. States announced Rural Health Transformation Program (RHTP) grants and established advisory committees as part of federal rural health initiatives. Delaware enacted legislation expanding hospital financial assistance to patients below 300% FPL and imposing a two-year moratorium on for-profit hospital acquisitions through July 1, 2028. North Carolina established a Healthcare Affordability Commission via executive order to develop cost containment strategies. Multiple states reported Marketplace enrollment declines following expiration of enhanced federal premium tax credits.