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Monday, September 21 · 6 stories
- Federal Policy
Senators Reintroduce Bill Setting Federal Cybersecurity Standards for Hospitals
Sens. Mark Warner (D-Va.) and Ron Wyden (D-Ore.) reintroduced the Health Infrastructure Security and Accountability Act on September 17, 2026. The legislation would establish minimum federal cybersecurity standards for healthcare organizations and allocate $1.3 billion to help hospitals strengthen their defenses. The bill sets mandatory cybersecurity requirements for healthcare providers, addressing vulnerabilities exposed by recent ransomware attacks on hospital systems. If enacted, it would affect all hospitals and potentially apply to Medicaid providers serving beneficiaries through fee-for-service or managed care arrangements.
- Federal Policy
KFF Brief: 28.5 Million U.S. Residents Have Limited English Proficiency, Face Coverage Gaps
A KFF issue brief published in September 2026 reports that 28.5 million people ages five and older in the U.S. have limited English proficiency (LEP) as of 2024. The brief documents that individuals with LEP experience disproportionate gaps in health insurance coverage and poorer health outcomes due to language access barriers. Because people of color are more likely than White individuals to have LEP, these barriers amplify racial and ethnic health disparities. The brief provides an overview of coverage and care patterns for this population.
- Federal Policy
FDA Approves First Gene Therapy for Sanfilippo Syndrome Type A
The FDA approved Fayuvi (rebisufligene etisparvovec-hopf) on September 17, 2026, as the first treatment for mucopolysaccharidosis type IIIA (Sanfilippo syndrome type A) in pediatric patients. Fayuvi is a one-time intravenous gene therapy using adeno-associated virus serotype 9 to deliver a functional SGSH gene. The approval provides a treatment option for a rare pediatric genetic disease previously without FDA-approved therapies. State Medicaid programs and managed care plans will need to determine coverage and reimbursement policies for this specialty gene therapy.
- Federal Policy
Trump Administration Launches Drug Pricing Initiative for State Medicaid Programs
The Trump administration announced a new federal initiative to offer discounted pharmaceuticals to state Medicaid programs, with reported participation from all states. The program, referred to as GENEROUS, aims to reduce prescription drug costs for Medicaid enrollees. Key operational details including pricing mechanisms, implementation timelines, and specific drug categories covered remain undisclosed. The initiative represents a federal effort to lower pharmaceutical spending in Medicaid, though states and managed care organizations await guidance on program structure and participation requirements.
- Federal Policy
All States Apply for CMS Medicaid Drug Pricing Program
All 50 states, Washington, D.C., and Puerto Rico have applied to participate in a CMS arrangement designed to reduce Medicaid drug costs, with 40 states and Puerto Rico already signing agreements. President Trump announced the milestone Friday, characterizing the program as delivering significant savings to state Medicaid programs. The timing and specific mechanics of the drug pricing arrangement were not detailed in the announcement. The development signals broad state interest in federal cost-containment tools for Medicaid pharmacy spending.
- Federal Policy
CMS Launches Medicaid Drug Payment Model with Participating States
CMS announced participating states in a new Medicaid drug payment model aimed at reducing prescription drug costs for Medicaid beneficiaries. The model will test alternative reimbursement methodologies for prescription drugs in Medicaid programs. Participating states will implement the model beginning in 2027, with CMS providing technical assistance and evaluating outcomes over a multi-year period. The initiative targets cost reduction while maintaining access to necessary medications for Medicaid enrollees.
Friday, September 18 · 6 stories
- Federal Policy
Law Firm Comments on CMS Proposed Rule for Remote Monitoring Payment Under 2027 Physician Fee Schedule
Epstein Becker Green submitted comments to CMS on September 14, 2026, regarding the 2027 Physician Fee Schedule Proposed Rule, focusing on payment and coverage policies for device-enabled remote monitoring services furnished to Medicare beneficiaries. The comments were submitted on behalf of health care practices providing these services. The Proposed Rule affects Medicare Part B payment rates and policies that will take effect in calendar year 2027, with the comment period having closed in mid-September 2026.
- Federal Policy · KS
Kansas Receives $16.8M Federal Grant for Rural Health Tech and Transport
Kansas will receive $16.8 million in federal funding to expand telehealth, AI diagnostic tools, and patient transportation in rural areas. The funds are part of CMS's $50 billion Rural Health Transformation Program enacted in 2025, distributed across 14 organizations with $16.2 million for technology modernization and $780,000 for transportation coordination. The program was authorized through the One, Big Beautiful Bill Act, which also included $930 billion in Medicaid cuts over ten years.
- Federal Policy
Georgetown CCF Submits Comments on HHS Vaccination Policy RFI
The Georgetown University Center for Children and Families submitted comments to HHS responding to a Request for Information on federal vaccine recommendation categories and the role of shared clinical decision-making. The comments address how federal vaccination guidance affects clinical practice and policy implementation. The RFI reflects HHS consideration of potential changes to how vaccine recommendations are categorized and communicated to providers and patients. For Medicaid programs, this matters because federal vaccine recommendations drive EPSDT coverage requirements and Early and Periodic Screening, Diagnostic and Treatment mandates for children.
- Federal Policy
Census Bureau Releases 2025 Child Uninsured Data; ACS Release Delayed
The U.S. Census Bureau released Current Population Survey data for calendar year 2025 examining child uninsured rates, poverty, income, and health insurance trends. The American Community Survey, which typically releases simultaneously and provides larger sample sizes for state-level analysis, has not yet been published. The delay in ACS data limits the ability to conduct granular state and sub-state analysis of coverage trends. For state Medicaid agencies and advocates tracking coverage following recent policy changes, the absence of robust state-level data complicates assessment of enrollment shifts and children's coverage losses.
- Federal Policy
White House Announces 50-State Medicaid Drug Pricing Initiative
President Trump will announce that all 50 states will implement "most favored nation" pricing for certain Medicaid-covered drugs, according to an administration official. The announcement, scheduled for Friday with several governors present, would tie Medicaid drug prices to lower international reference prices. Implementation details including which drugs are covered, effective dates, and how this aligns with existing Medicaid best price and rebate requirements remain unclear. The initiative reflects ongoing White House focus on drug affordability as a voter priority.
- Federal Policy
HHS Secretary Kennedy Tells Anti-Vaccine Group Administration Supports Its Cause
HHS Secretary Robert F. Kennedy Jr. told Children's Health Defense, an anti-vaccine organization he previously led, that the Trump administration is a "strong and steadfast friend" to the group's cause. The remarks were delivered Thursday at a one-day conference. The statement signals potential alignment between federal health policy leadership and vaccine skepticism advocacy. This raises questions about future federal vaccine policy direction, including recommendations affecting Medicaid pediatric EPSDT requirements and childhood immunization standards.
Thursday, September 17 · 11 stories
- Federal Policy · CT
CMS Awards Connecticut $50 Million for Rural Hospital Infrastructure and Care Delivery
CMS announced $50 million in federal funding to Connecticut to support rural hospital infrastructure improvements and optimize care delivery systems. The funding targets rural hospital facilities and care coordination in underserved areas. Implementation timing and specific program requirements were not detailed in the announcement. The funding represents significant federal investment in rural healthcare capacity, potentially affecting Medicaid beneficiaries who rely on rural hospital access for both inpatient and emergency services.
- Federal Policy
HHS Secretary Kennedy Appoints Eight Members to U.S. Preventive Services Task Force
HHS Secretary Robert F. Kennedy Jr. appointed eight new members to the U.S. Preventive Services Task Force on September 17, 2026, through the Agency for Healthcare Research and Quality, bringing the panel to 16 total members. The task force issues evidence-based recommendations on clinical preventive services including screenings, counseling, and preventive medications. These recommendations directly affect Medicaid coverage requirements under the Affordable Care Act, which mandates coverage of USPSTF Grade A and B services without cost-sharing for certain populations.
- Federal Policy · SC
CMS Awards $167 Million to South Carolina for Rural Infrastructure and Health Technology
CMS announced $167 million in federal funding to South Carolina for rural health care infrastructure, health technology upgrades, and prevention programs. The funding will support construction of rural care sites and modernization of health IT systems. The announcement did not specify eligibility or implementation timelines. This matters for South Carolina Medicaid providers and health plans operating in rural service areas, as infrastructure investments may affect network capacity and care delivery models.
- Federal Policy
GAO Finds CMS Oversight of State Medicaid Eligibility Error Corrective Actions Inadequate
The Government Accountability Office concluded that CMS inconsistently enforces required evaluations and conducts limited analysis of state corrective action plans (CAPs) addressing Medicaid eligibility errors identified through Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC) programs. CMS accepted CAPs missing federally required elements and does not systematically analyze errors and corrective actions across states to determine effectiveness. GAO reviewed PERM reports from 2019-2025 and MEQC results from seven states, finding caseworkers were the most prevalent root cause of errors, with specific causes falling into four categories including verification failures and system processing errors. GAO recommends CMS collect all required CAP elements and conduct cross-state analyses to better support states in reducing eligibility errors and improper payments.
- Federal Policy · CT
Four Connecticut Rural Hospitals Receive $46 Million in Federal Rural Health Grants
Charlotte Hungerford, Day Kimball, Sharon, and Windham Hospitals received $46 million in federal grants through the Rural Health Transformation Program to expand imaging, telehealth, and transport services. Day Kimball Hospital received the largest share at $20.2 million to replace trailer-based MRI services and expand patient monitoring. Connecticut received $154 million total under the program, with the remaining $104 million funding workforce development, maternity services, and mobile health initiatives across the state. CMS monitors fund deployment through annual progress reports that determine subsequent funding levels.
- Federal Policy
21.4 Million U.S. Women Face Limited Access to Subsidized Contraception, New Analysis Finds
Power to Decide and Guttmacher Institute released updated county-level maps showing 21.4 million women needing subsidized contraception live in counties with limited access to publicly-funded family planning clinics. The analysis measures clinic capacity against demand among women earning under 250% of federal poverty level, revealing widespread gaps in Title X-funded services. Maricopa County, Arizona exemplifies the challenge with 29 publicly-funded clinics serving only 8% of nearly 300,000 women in need. The methodology focuses on brick-and-mortar clinics receiving federal or state family planning funds, using patient caseloads to estimate capacity and National Survey of Family Growth data to identify women who would use contraception if cost were not a barrier.
- Federal Policy
WEDI Opens Survey on CMS Prior Authorization Rule Readiness Through Oct. 9
The Workgroup for Electronic Data Interchange has launched a survey to assess industry readiness for CMS's interoperability and prior authorization final rule, with responses open through Oct. 9, 2026. The anonymous survey will gather aggregated data from health plans, providers, and other stakeholders on their implementation progress. WEDI will use the results to develop recommendations for CMS, inform stakeholders, and create industry guidance and educational materials on electronic prior authorization standards compliance.
- Federal Policy
CMS Expands ACCESS Model for Chronic Care Management
CMS announced an expansion of the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, which affects physician groups managing chronic conditions. The model offers alternative payment arrangements for chronic care coordination. The expansion creates new participation opportunities for physician practices, though specific effective dates and eligibility criteria were not detailed in the announcement. Physician groups managing Medicaid beneficiaries with chronic conditions should evaluate whether participation aligns with their care delivery infrastructure and payment model strategy.