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Saturday, August 29 · 64 stories
- Federal Policy · AK
CMS Awards $160 Million for Telehealth Technology Deployment in Alaska
CMS announced $160 million in funding to deploy advanced telehealth technologies in Alaska, including drone-based prescription delivery and surgical robotics. The initiative aims to expand access to care in rural and remote areas where traditional healthcare infrastructure is limited. State Medicaid agencies and managed care organizations serving Alaska beneficiaries will need to coordinate with providers on technology implementation and reimbursement frameworks. The funding represents a significant federal investment in addressing geographic barriers to care for Medicaid enrollees in frontier communities.
- State Policy · NH
New Hampshire Medicaid-Public Health Partnership Model Offers Lessons for State Integration Efforts
The National Association of Medicaid Directors published a case study on New Hampshire's approach to integrating Medicaid and public health operations. The partnership focuses on intentional collaboration, aligned priorities, and sustained leadership engagement between state Medicaid and public health agencies to improve population health outcomes. The case study provides operational lessons for other states seeking to strengthen coordination between their Medicaid programs and public health departments, addressing a growing priority as states work to address social determinants of health and prevention through Medicaid financing.
- Federal Policy · GA
CMS Awards $93.3 Million to Georgia for Telehealth Expansion and Rural Surgical Robotics
CMS awarded $93.3 million in federal funding to Georgia to expand telehealth services and advance surgical robotics in rural areas. The funding supports infrastructure for remote care delivery and robotic surgery capabilities in underserved communities. Awards are available immediately for eligible Georgia providers and health systems. The investment aims to address rural healthcare access gaps that affect Medicaid beneficiaries who rely on safety-net providers in non-urban areas.
- Industry
Hospital CEOs Navigate Site-Neutral Payment Pressures Amid Medicaid Changes
Health system CEOs are confronting multiple financial pressures, including Medicaid coverage and reimbursement changes under HR 1, ongoing 340B drug discount program policy challenges, and site-neutral payment considerations. These policy shifts are influencing where health systems invest and deliver care. The article features perspectives from executives at Valley Health and other systems on how they are adapting their care delivery and investment strategies in response to these combined pressures.
- Legal · OH
OhioHealth Settles DOJ Antitrust Case Over Managed Care Contracting Practices
OhioHealth entered a consent judgment with the U.S. Department of Justice and Ohio Attorney General resolving allegations that its managed care contracting practices violated federal and state antitrust laws. The settlement follows a DOJ complaint filed in February 2026 accusing OhioHealth of anticompetitive conduct in its health plan contracting. OhioHealth filed a motion to dismiss rather than answer the complaint but reached a consent judgment instead. The settlement takes effect immediately upon court approval. This matters for health systems and managed care plans negotiating provider contracts, as it signals DOJ enforcement priorities on contracting practices that may suppress competition or inflate reimbursement rates.
- Federal Policy · VA
CMS Awards Virginia $122 Million for Healthcare Access and Workforce Expansion
The Trump Administration announced $122 million in federal funding for Virginia to expand healthcare access, strengthen the healthcare workforce, and support innovation. The funding will support multiple programs including Medicaid initiatives, community health centers, and workforce training. Details on specific allocation amounts, eligible providers, and timeline for fund distribution were not provided in the announcement. The funding reflects broader federal efforts to address healthcare workforce shortages and access gaps in states.
- State Policy · ID
Idaho Council Targets High-Risk Counties for Opioid Settlement Spending
Idaho's Behavioral Health Council identified high-risk counties for opioid use disorder to guide state spending of opioid settlement funds. The council, comprising representatives from legislative, judicial, and executive branches, provides recommendations to lawmakers on behavioral health improvements. The targeting aims to direct settlement resources to areas with greatest need for opioid treatment and prevention services. This matters for Medicaid managed care organizations and providers operating in designated counties, as settlement-funded initiatives often complement or expand Medicaid-covered behavioral health services.
- Federal Policy
CMS Launches ACCESS Accountable Care Innovation Model for Providers
The Centers for Medicare and Medicaid Services has developed ACCESS, a new accountable care model for healthcare providers and organizations. The model represents CMS's latest approach to value-based care arrangements, offering an alternative framework for providers considering accountable care participation. Healthcare organizations are evaluating whether the model aligns with their operational capabilities and patient populations. The model follows CMS's broader strategy of expanding alternative payment models beyond traditional fee-for-service arrangements.
- Federal Policy
MACPAC Submits Comment Letter on Medicaid Program Integrity to CMS
The Medicaid and CHIP Payment and Access Commission (MACPAC) submitted a comment letter to CMS in response to a request for information on combatting fraud, waste, and abuse in federal health care programs. MACPAC's letter addresses four areas: eliminating ineffective or redundant program integrity activities and requirements, promoting high-value program integrity activities, identifying barriers to program integrity, and providing evidence-based findings and recommendations. The comment letter reflects MACPAC's policy research and advisory role to Congress on Medicaid program integrity issues.
- Federal Policy
CMS Issues FY 2027 IPPS Final Rule with Limited Medicaid Provisions
CMS released the FY 2027 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS final rule, effective October 1, 2026. The rule primarily updates Medicare payment rates and policies for acute care hospitals and LTCHs. While the rule focuses on Medicare reimbursement, hospitals participating in both Medicare and Medicaid may see operational impacts related to quality reporting, graduate medical education, and uncompensated care payment adjustments that can affect their broader financial position. The rule has minimal direct Medicaid policy implications but may influence hospital participation and capacity in both programs.
- Managed Care
KFF Brief Examines PBM Role in Medicaid Drug Spending and Distribution
KFF published an issue brief analyzing pharmacy benefit managers' role in Medicaid drug distribution and their potential impact on program spending. The brief responds to recent policymaker and stakeholder concerns that PBM practices may be driving increased Medicaid drug costs. The analysis comes as states and CMS scrutinize PBM contracts with managed care organizations, including spread pricing, rebate retention, and formulary management practices. The brief provides background for state Medicaid agencies and health plans evaluating PBM contract terms and transparency requirements.
- State Policy · AL
CMS Awards Alabama $144M for Behavioral Health, Emergency, and Maternal Care Expansion
CMS announced $144 million in federal funding for Alabama to strengthen mental health, substance use disorder treatment, emergency services, maternal care, and healthcare workforce development. The funding supports infrastructure improvements, service delivery enhancements, and provider recruitment across these critical service areas. The award is effective immediately and will flow through Alabama's Medicaid program and other federal health programs. This marks a significant federal investment in Alabama's safety net infrastructure, particularly for populations served by Medicaid.
- State Policy
NASHP Reports State Medicaid Expansion of Certified Midwife Coverage to Address Maternity Access
States are expanding Medicaid coverage to include certified professional midwives (CPMs) and certified midwives (CMs) as covered providers. The expansions aim to strengthen the maternal health workforce and improve access to maternity care services, particularly in underserved areas. States are using various policy mechanisms including state plan amendments and provider enrollment expansions to add these midwife categories to their Medicaid programs. The coverage expansions reflect state efforts to address maternal health outcomes and workforce shortages through broader provider networks.
- State Policy · WV
CMS Awards West Virginia $4.2 Million for Medical Transportation Expansion
CMS announced $4.2 million in federal funding to West Virginia to expand non-emergency medical transportation (NEMT) services for Medicaid beneficiaries. The funding supports improved access to medical appointments, prescription pickups, and other healthcare services for eligible enrollees. The award takes effect immediately as part of CMS's broader effort to address transportation barriers in rural states. West Virginia Medicaid agencies and contracted transportation brokers will administer the expanded services, which are expected to reduce missed appointments and improve care coordination for beneficiaries who lack reliable transportation.
- State Policy
States Submit First Beneficiary Advisory Council Annual Reports Under CMS Access Rule
States submitted their first Medicaid Beneficiary Advisory Council (BAC) annual reports in July 2026, as required under the May 2024 CMS Access Rule (§ 431.12). The reports, now publicly available from multiple states including the District of Columbia, document each state's initial year of BAC implementation, covering varied time periods and ranging from four to over seventy pages. First-year activities focused heavily on establishing the councils — recruiting members, setting operating procedures, developing bylaws, and providing foundational Medicaid education to BAC members. State Health and Value Strategies has compiled these reports in a public tracker, revealing substantial variation in reporting approaches, meeting documentation, and stages of organizational maturity as states built on existing enrollee engagement structures or created entirely new advisory bodies.
- State Policy
Rural Hospital Closures Could Force Hour-Plus Drives for Medicaid Maternity Patients in 14 States
An analysis released this week found that in 14 states, the closure of the nearest rural hospital or its obstetric unit would force many Medicaid patients to drive an hour or more to reach another hospital providing inpatient maternity care. Nationwide, the median drive time between hospitals offering inpatient maternity services to Medicaid patients would increase significantly if rural closures continue. The finding highlights access-to-care risks for Medicaid beneficiaries in rural areas, where hospital financial instability threatens obstetric service availability. States with high rural Medicaid enrollment and sparse hospital networks face the greatest risk of access gaps for pregnant women.
- Federal Policy
MACPAC Issues March 2026 Report with HCBS Workforce Recommendation and Behavioral Health Analysis
The Medicaid and CHIP Payment and Access Commission (MACPAC) released its March 2026 Report to Congress covering four policy areas: a recommendation to strengthen the home- and community-based services workforce, behavioral health services in Medicaid and CHIP, Medicaid coverage for justice-involved youth, and coverage for children in foster care. The report was delivered to Congress in March 2026. MACPAC reports typically inform federal legislative activity and CMS policy development, particularly regarding long-term services and supports financing, behavioral health integration, and coverage for vulnerable populations.
- Federal Policy
MACPAC Analyzes Fraud, Waste, and Abuse Measurement in Medicaid Program Integrity
The Medicaid and CHIP Payment and Access Commission (MACPAC) released an issue brief examining fraud, waste, and abuse in Medicaid using government data sources. The brief defines these program integrity concerns, reviews measurement methodologies, and provides an overview of federal and state program integrity responsibilities. The analysis identifies documented instances of integrity issues across the Medicaid program. This resource offers Medicaid agencies and managed care organizations a framework for understanding program integrity risks and measurement approaches as they design compliance and oversight strategies.
- Federal Policy
MACPAC Comments on Proposed Rule for Interoperability Standards and Drug Prior Authorization
The Medicaid and CHIP Payment and Access Commission submitted comments to HHS Secretary Robert F. Kennedy, Jr. on proposed rulemaking addressing interoperability standards and prior authorization requirements for prescription drugs. The proposed rule would implement new interoperability standards for payers, including state Medicaid programs and managed care plans. MACPAC's letter provides the Commission's assessment of the rule's provisions and their potential impact on Medicaid program operations, drug access, and administrative burden for states and plans.
- Managed Care
MACPAC Examines AI and Automation in Medicaid Prior Authorization Processes
MACPAC's Chapter 2 report examines how Medicaid payers and providers are incorporating artificial intelligence and automation into prior authorization workflows. The analysis covers automated systems using algorithms or AI to conduct portions of the PA process, which may reduce administrative burdens for plans and providers. The report assesses both the potential efficiency gains and risks associated with automated PA decision-making in Medicaid managed care and fee-for-service programs. MACPAC's findings inform federal and state policymakers considering guardrails or standards for PA automation technology.