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Thursday, August 27 · 16 stories
- State Policy · IN
Indiana Submits HIP 3.0 Section 1115 Waiver Application for Public Comment
On August 5, 2026, the Indiana Family and Social Services Administration published a draft Section 1115 waiver application for the Healthy Indiana Plan 3.0, seeking to implement policies from Indiana Senate Enrolled Acts 2 (2025) and 1 (2026) and the federal Working Families Tax Cuts Act. The draft is open for public comment before submission to CMS for federal approval. The waiver application reflects state legislative directives requiring operational changes to Indiana's Medicaid program. The timeline for CMS review and approval following the comment period will determine when these policies take effect for Indiana Medicaid beneficiaries, health plans, and providers.
- State Policy · OH
Ohio Senate Bill 315 Expands Medicaid Program Integrity Oversight Effective October 6
Ohio Senate Bill 315 takes effect October 6, 2026, bringing significant expansions to program integrity requirements, enforcement authority, and oversight mechanisms across Ohio's Medicaid program. The legislation affects providers, managed care organizations, and the state Medicaid agency with new compliance obligations and enforcement tools. The law represents a substantial shift in Ohio's approach to fraud prevention and program integrity enforcement. Medicaid stakeholders operating in Ohio face new compliance requirements and heightened scrutiny under the expanded authority.
- Federal Policy
Hospitals Launch Campaign Against $1 Trillion in Proposed Medicaid Cuts
Hospital associations are mobilizing opposition to proposed federal Medicaid cuts totaling $1 trillion, though prospects for reversal remain uncertain. The cuts would directly reduce payments to hospitals serving Medicaid beneficiaries, threatening provider networks and access to care. Healthcare systems are coordinating advocacy efforts targeting Congress and federal policymakers. The campaign reflects industry concerns about financial viability under reduced Medicaid reimbursement, particularly for safety-net hospitals with high Medicaid patient volumes.
Wednesday, August 26 · 12 stories
- Legal
Monogram Health Settles Medicare Advantage Upcoding Claims for $2.4 Million
Monogram Health, a home health company, will pay $2.4 million to settle Justice Department allegations that it overcharged Medicare Advantage plans through inflated diagnostic codes in contracts with Cigna and Humana. The settlement resolves claims that Monogram systematically upcoded patient diagnoses to increase risk-adjusted payments to MA plans. The enforcement action reflects continued federal scrutiny of diagnosis coding practices in Medicare Advantage, particularly involving delegated provider arrangements that impact plan payments.
- State Policy
KFF Analysis Maps Rural Hospital Maternity Care Access for Medicaid Enrollees
A KFF data note examines the availability of rural hospitals providing inpatient maternity care to Medicaid enrollees, analyzing potential access impacts if additional rural facilities close maternity units. The analysis assesses current service availability across rural geographies and models how closures would affect Medicaid beneficiaries' access to hospital-based maternity services. The research addresses ongoing rural hospital financial pressures and service line retractions that disproportionately affect Medicaid populations. State Medicaid agencies can use these findings to inform network adequacy standards, delivery system planning, and strategies to sustain maternity access in rural markets where Medicaid represents a significant payer share.
- Industry
Mark Cuban Discusses Pricing Transparency and Cost Plus Drug Company Model
Mark Cuban, founder of Cost Plus Drug Company, discussed healthcare pricing transparency and his approach to generic drug pricing in an interview with KFF Health News. Cuban's online pharmacy model focuses on transparent pricing for generic drugs. The discussion covers his views on broader healthcare system reform and price disclosure. The interview addresses how his direct-to-consumer pharmacy model differs from traditional pharmacy benefit manager arrangements.
- Federal Policy
KFF Tracker Compiles Trump Administration Executive Actions Affecting LGBTQ+ Health Coverage
KFF maintains an ongoing tracker of Trump administration executive actions with potential impacts on LGBTQ+ health coverage and access. The tracker catalogs executive orders, memoranda, and related actions by date, identifies provisions relevant to LGBTQ+ health, and documents potential coverage and access implications including related litigation. The compilation covers executive actions that may affect Medicaid coverage determinations, anti-discrimination protections, and gender-affirming care access for Medicaid beneficiaries. The tracker is updated as new executive actions are issued.
- Federal Policy
Senate Democrats Question HHS Secretary Kennedy on HPV Vaccine Lawsuit Divestment
Senate Democrats are scrutinizing whether HHS Secretary Robert F. Kennedy Jr. fully divested his financial interests in ongoing litigation against Merck's HPV vaccine Gardasil before his confirmation. Kennedy was involved in a lawsuit led by Wisner Baum challenging the vaccine prior to his appointment. The inquiry raises questions about potential conflicts of interest at the top of the agency that oversees Medicaid coverage policy, vaccine programs, and federal health initiatives. The matter could affect federal vaccine policy direction and Medicaid immunization coverage decisions.
- Industry
Home Health M&A Activity Increases After Four-Year Decline
Home health and hospice merger and acquisition activity is increasing after four consecutive years of decline. Industry analysts expect the proposed CY2027 home health rule and Medicare enrollment moratoria to drive further dealmaking through 2027. Transaction volume and valuations are both projected to rise. The trend affects home health agencies operating in Medicaid programs, particularly those serving dual-eligible beneficiaries or those considering consolidation strategies.
- Federal Policy
CMS Proposes Palliative Care Coverage Under Medicare Home Health Benefit in CY2027 Rule
CMS's proposed CY 2027 Home Health Prospective Payment System rule confirms that community-based palliative care may be covered under the existing Medicare home health benefit. The proposal affects home health agencies, hospices, and other providers serving frail and declining populations. The rule creates operational questions for providers in the near term and strategic opportunities for service delivery models going forward. Comment periods and effective dates follow standard Medicare rulemaking timelines for calendar year 2027.
- Legal
129 Groups Urge OIG to Create Anti-Kickback Safe Harbor for Clinical Trial Participant Expenses
The American Cancer Society Cancer Action Network and 128 other advocacy and professional groups submitted a comment letter to HHS OIG on August 24, 2026, requesting a new safe harbor under the federal anti-kickback statute. The proposed safe harbor would allow clinical trial sponsors to cover participants' travel, lodging, and other expenses without exposure to fraud and abuse liability. The comment period timing suggests OIG is considering rulemaking on this issue. For Medicaid providers participating in clinical trials, this matters because current anti-kickback constraints limit their ability to cover beneficiary costs, potentially reducing trial participation among Medicaid populations who face the greatest financial barriers to access.
- Industry
Home-Based Care Referrals Shift to Performance Metrics Over Relationships
Health systems and payers are increasingly steering patients to home health and home care agencies based on documented performance metrics rather than traditional referral relationships, according to industry leaders speaking at a recent Home Health Care News webinar. The shift prioritizes agencies that can demonstrate quality ratings, low hospitalization rates, fast patient acceptance times, broad payer network coverage, and capacity to manage complex cases. This trend affects how Medicaid managed care organizations and health systems select post-acute care partners and may influence which home health providers maintain or lose patient volume. The change reflects broader value-based care adoption and risk-based contracting in home-based services.
- State Policy · VA
Virginia Governor Orders Agencies to Prepare for Federal Medicaid and SNAP Changes
Virginia Governor Abigail Spanberger issued Executive Order 20 directing state agencies to prevent eligible residents from losing Medicaid and SNAP coverage as federal changes from H.R.1 take effect next year. The reconciliation bill passed by Congress last summer triggers implementation requirements for Virginia. The executive order aims to boost the state's readiness for the federal law's provisions affecting eligibility, enrollment, and benefits administration.
- State Policy · VT
Vermont Urged to Consider Medicaid Rate Increase to Preserve Rural Maternity Services
Vermont is being urged to evaluate a Medicaid payment increase modeled on New Hampshire's approach to sustain Brattleboro's at-risk birthing center. New Hampshire implemented a Medicaid reimbursement multiplier that successfully preserved rural maternity care access. The proposal calls on Vermont officials to analyze whether similar rate adjustments could prevent closure of the Brattleboro facility. The story highlights how targeted Medicaid payment policy can address provider viability challenges in underserved areas, particularly for maternal health services where closures directly reduce access for Medicaid beneficiaries in rural communities.
- Legal · FL
DOJ Settles with Complete Health MSO for $14.1M Over Compliance Allegations
The Department of Justice announced a $14.1 million settlement with Complete Health Partners Holdings, a Florida management services organization, to resolve allegations under the False Claims Act. The settlement, finalized August 4, 2026, addresses compliance failures at the MSO level that likely involve arrangements affecting federal health programs. The case highlights enforcement risks for management services organizations operating in or adjacent to Medicaid managed care markets. Specific compliance program deficiencies leading to the settlement offer instructive lessons for MSOs, Medicaid health plans, and affiliated provider organizations subject to federal fraud and abuse laws.
Tuesday, August 25 · 16 stories
- Federal Policy
CDC Reports Declining Kindergarten Vaccination Rates for 2025-2026 School Year
The Centers for Disease Control and Prevention released data showing decreased vaccination coverage for incoming kindergartners across all vaccines during the 2025-2026 school year, including measles, mumps, rubella, and tetanus. The decline in coverage rates coincides with President Trump's executive order directing changes to the childhood vaccine schedule. Lower vaccination rates increase disease outbreak risk among Medicaid-enrolled children, who represent approximately 40% of all children nationally. The data reflects growing vaccine exemption trends that may affect Early and Periodic Screening, Diagnostic and Treatment (EPSDT) service delivery and preventive care quality measures under managed care contracts.
- Industry
Pediatric Drugs Lead FDA Active Shortage List with 18 Products
Pediatric medications account for more active FDA-listed drug shortages than any other therapeutic category as of August 25, 2026, with 18 products in shortage. Anesthesia and cardiovascular drugs are tied for second with 10 active shortages each, followed by analgesia and addiction treatment medications with 9 shortages. The data comes from the FDA's drug shortage database tracking current supply disruptions across therapeutic categories.
- Industry
Elevance Names Patrick Fox President of Carelon Behavioral Services
Elevance Health appointed Dr. Patrick Fox as president of Carelon Behavioral Services, effective immediately. Fox, a forensic psychiatrist with health plan leadership experience, will oversee the behavioral health division serving Elevance's Medicaid, Medicare, and commercial lines of business. The appointment reflects Elevance's continued investment in behavioral health capabilities amid growing Medicaid managed care focus on mental health and substance use disorder services. Fox replaces the previous leadership at one of the nation's largest behavioral health benefit managers serving Medicaid populations.
- Managed Care
Medicare Advantage Plans Denied 12% of Prior Authorizations in 2025, KFF Finds
Medicare Advantage, Medicaid managed care, and ACA Marketplace plans denied between 12% and 18% of standard prior authorization requests in 2025, according to a KFF study. Denial rates varied widely among the largest insurers. The study highlights prior authorization burdens on providers, including home health agencies. The findings are current as of 2025 data.
- Legal · NV
Nevada Attorney General Declined Majority of Medicaid Fraud Referrals
Nevada Attorney General Aaron Ford's office declined more than half of Medicaid fraud referrals it received, according to reporting examining his prosecution record as he campaigns for governor. Ford defends his office's prosecution rate as high, stating many referrals lack sufficient evidence to pursue criminal charges. The article examines claims made in political advertisements criticizing Ford's handling of Medicaid fraud enforcement. This review comes as states face increasing scrutiny over program integrity and fraud prevention efforts.