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Friday, August 21 · 19 stories
- State Policy · ME
Maine DHHS Initiates Rulemaking on MaineCare Oversight After GOP Petition
Maine's Department of Health and Human Services began a rulemaking process Wednesday that could result in enhanced oversight of the state's Medicaid program, MaineCare. The action follows a June petition from Lead Maine, a Republican group led by Rep. Laurel Libby, which submitted over 3,500 signatures calling for stricter program oversight. The rulemaking timeline and specific oversight measures under consideration were not detailed in the announcement. Maine operates MaineCare through both fee-for-service and managed care arrangements.
- Legal
DOJ Issues Rule Reversing 25-Year Interpretation of ADA Olmstead Requirements
The Department of Justice has issued a new rule reversing its longstanding interpretation of the Americans with Disabilities Act's integration mandate under Olmstead v. L.C. The rule could allow states to scale back home- and community-based services that enable disabled individuals to avoid institutional care. The change takes effect immediately upon publication. This matters for state Medicaid agencies and LTSS providers because the Olmstead decision has driven HCBS expansion for decades — weakening federal enforcement of the integration mandate gives states new latitude to reduce HCBS funding or waitlist remediation without DOJ intervention.
- Federal Policy
KFF Brief Explains Medicaid Provider Tax Changes Under 2025 Reconciliation Law
KFF published an issue brief analyzing how the 2025 reconciliation law and implementing regulations change federal rules governing Medicaid provider taxes. The brief uses 2025-2026 Medicaid director survey data to describe current state provider tax structures and examines which states may be affected by new requirements. Provider taxes are a significant financing mechanism for state Medicaid programs, generating federal matching funds. The brief addresses five key questions about the policy changes and their state-by-state implications for Medicaid financing.
- State Policy · AR
Arkansas Providers Urge CMS to Grant Two-Year Extension for ARHOME Waiver
Dozens of Arkansas healthcare providers and organizations are pressing the federal government to approve the state's request for a two-year extension of its Medicaid expansion waiver, Arkansas Health and Opportunity for Me (ARHOME). CMS has verbally denied Arkansas's initial request for a five-year extension. The state is seeking the two-year period to develop a new Medicaid expansion model. The outcome will determine the future of coverage for hundreds of thousands of Arkansans enrolled through the state's alternative expansion approach.
- State Policy · CO
Colorado Suspends Medicaid Coverage for Youth Gender-Affirming Care Under Federal Rule
Colorado will suspend Medicaid coverage for certain gender-affirming care services for youth in response to a new federal rule prohibiting federal funding for such care. The change affects hundreds of transgender youth currently receiving services through Colorado's Medicaid program. The suspension takes effect as the state complies with the federal funding prohibition. This represents a significant shift in covered benefits for a vulnerable population and raises operational questions for managed care plans regarding care coordination and coverage determinations for affected enrollees.
Thursday, August 20 · 15 stories
- Federal Policy
HHS Nominee Kennedy Confuses Medicare, Medicaid, and ACA During Senate Hearing
Robert F. Kennedy Jr., President Trump's nominee for HHS Secretary, repeatedly confused Medicare, Medicaid, and Medicare Advantage during his February 5 Senate Finance Committee confirmation hearing. When asked about improving Medicaid, Kennedy claimed beneficiaries face high premiums and deductibles — features generally not present in Medicaid, which typically has minimal or no cost-sharing under federal law. Kennedy also stated he is enrolled in Medicare Advantage when discussing Medicaid policy. The remarks raised concerns among lawmakers and policy analysts about his understanding of the $800 billion Medicaid program and other health programs he would oversee if confirmed.
- Industry
Epic Launches AI Outpatient Visit Tool with Ochsner as First User
Epic Systems has released a new artificial intelligence tool designed to enhance outpatient office visits by extracting insights from patient records. Ochsner Health in Louisiana became the first health system to implement the tool. The technology aims to streamline clinical workflows by leveraging AI to analyze patient data during outpatient encounters. The development reflects Epic's broader strategy to integrate AI capabilities into its electronic health record platform.
- State Policy · MN
Minnesota Hospital Settles AG Claim Over Uninsured Patient Discount Calculations
Stevens Community Medical Center agreed to provide up to $1.4 million in refunds or debt reductions to resolve allegations by the Minnesota Attorney General that it improperly calculated discounts for uninsured patients. The settlement covers 3,478 patients who received services between April 1, 2020, and December 31, 2025. The case involves state enforcement of patient billing practices and charity care requirements, which can overlap with Medicaid program eligibility and hospital compliance with state Medicaid rules on presumptive eligibility and uncompensated care policies.
- Industry
R1 RCM Acquires Humata to Automate Prior Authorization Processing
R1 RCM acquired Humata, an AI-powered prior authorization platform, to automate claims processing and medical preapprovals. The acquisition aims to streamline revenue cycle operations by reducing administrative burden in the prior authorization process. The deal closed in August 2026, with integration timelines not yet disclosed. For Medicaid managed care plans and providers, this signals continued consolidation in the revenue cycle management sector and potential shifts in how AI tools are deployed for authorization workflows.
- Legal
Federal Court Decertifies 11 Clinics from 340B Program in Drugmaker Lawsuit
A federal district court in Washington, D.C. granted partial summary judgment to drugmakers including Amgen and Genentech on August 14, 2026, ordering 11 clinics' 340B certifications set aside for failing to meet statutory participation requirements. The ruling addresses longstanding disputes between drugmakers and covered entities over 340B program eligibility. The decision affects clinic access to discounted drugs under the 340B program and may signal stricter judicial scrutiny of covered entity qualifications.
- Legal
Federal Court Blocks Trump Administration Changes to Teen Pregnancy Prevention Grants
A federal district court in Washington, D.C., issued a temporary injunction halting the Trump administration's changes to the Teen Pregnancy Prevention (TPP) program that cut tens of millions in federal grants. The order pauses the administration's changes pending further litigation. The ruling affects organizations that lost federal funding abruptly under the policy shift. The injunction takes effect immediately.
- State Policy · IL
Cook County Illinois Medical Debt Relief Program Erases Over $1 Billion
Cook County, Illinois has erased more than $1 billion in medical debt through its relief initiative launched in 2022, the largest amount eliminated by any U.S. county. The program operates through a partnership with nonprofit Undue Medical Debt, which purchases and forgives medical debt at significantly reduced rates. The initiative affects residents of Cook County, which includes Chicago, who held qualifying medical debt. This approach represents a county-level intervention to address healthcare affordability challenges that can affect Medicaid eligibility and enrollment patterns.
- Federal Policy
CMS Establishes Privacy Act System for Nurses for Nursing Homes Program
CMS is establishing a new Privacy Act system of records for the Nurses for Nursing Homes Program (NNHP), which will collect personally identifiable information on individuals who apply for, participate in, or support the program. Records will include demographic data, professional licensure, education and training information, employment and nursing facility affiliation, payment information, and tax reporting. The system supports administration of a nursing workforce incentive program designed to strengthen staffing at Medicare and Medicaid-certified nursing homes, with a focus on underserved and rural communities. The notice was published August 20, 2026.
- Legal · IA
Iowa Attorney Sanctioned for Medicaid Fraud Scheme Involving Asset Transfers
Timothy Mark Anderson, a Garner, Iowa attorney, faces state licensing sanctions following his October 2025 conviction for false statements relating to a health care matter in a Medicaid fraud scheme. Anderson attempted to help a client qualify for Medicaid by improperly transferring assets, including involvement with a Rolls Royce. The case illustrates enforcement actions against professionals who assist in Medicaid eligibility fraud through improper asset sheltering or transfer schemes. State licensing sanctions follow the federal conviction, affecting Anderson's ability to practice law.
- State Policy · GA
Georgia Governor Suggests Ending Pathways Medicaid Work Requirement Program
Gov. Brian Kemp's administration indicated it may shut down Georgia Pathways to Coverage, the state's Medicaid work requirement program covering approximately 18,500 low-income adults. Patient advocates expressed alarm at the potential termination of the program, which is Kemp's signature Medicaid initiative. The timing and rationale for the potential closure were not detailed in available reporting. The development signals uncertainty for Georgia's limited Medicaid expansion pathway and the beneficiaries currently enrolled.
- State Policy · CA
California Dual Eligible Enrollees Lose Medi-Cal Coverage Due to Administrative Errors
Administrative and paperwork errors are causing dually eligible beneficiaries in California to lose Medi-Cal coverage, disrupting their access to care. These coverage losses affect beneficiaries who qualify for both Medicare and Medicaid, creating gaps in services and undermining trust in the health care system. The issue highlights ongoing challenges in eligibility redeterminations and enrollment processes for vulnerable populations. State agencies and health plans serving dual eligibles must address procedural barriers that lead to inappropriate disenrollment.
- State Policy · MO
Missouri Faces Medicaid Paperwork Crisis Ahead of January 2027 Work Requirements
More than 300,000 Missouri Medicaid enrollees lost coverage during unwinding, with 92% losing coverage due to procedural issues rather than ineligibility determinations. The state faces implementation of federal Medicaid work requirements effective January 1, 2027, following passage of constitutional amendment language in the Republican-led state House. The high rate of procedural terminations during unwinding raises operational concerns about the state's administrative capacity to manage work requirement compliance and documentation processes without causing additional inappropriate coverage losses for eligible beneficiaries.
- Legal · NY
New York Strengthens Medicaid Anti-Fraud Controls Under Federal Scrutiny
New York's Department of Health has adopted new program administrative measures to address federal concerns about oversight and compliance integrity in its Medicaid program, particularly for personal care and home health providers. The measures come as HHS scrutinizes the state for perceived gaps in program integrity controls. The changes appear designed to strengthen provider oversight and fraud prevention mechanisms in response to federal pressure. This development signals heightened compliance expectations for providers in these sectors and potential model requirements other states may face.
- Federal Policy
HHS Adds Two Peer Support Programs to Title IV-E Clearinghouse for Federal Reimbursement
The Department of Health and Human Services announced August 18 that its Administration for Children and Families added two behavioral health peer support programs to the Title IV-E Prevention Services Clearinghouse: Family-Based Recovery (in-home treatment for parents with addiction who have children ages 0-5) and Wellness Recovery Action Plan (peer-facilitated mental health and addiction recovery coaching). The additions allow all states to claim federal reimbursement for these services under Title IV-E prevention. This expands state options for using federal funds to support families with substance use disorders and mental health conditions in child welfare prevention programs.
- Managed Care · NY
Mount Sinai Stops Accepting New Patients with Centene Medicaid and Medicare Plans
Mount Sinai Health System in New York City has stopped accepting new patients enrolled in Centene's Fidelis Care Medicaid, exchange, and Medicare Advantage plans, as well as Wellcare Medicare Advantage plans. The health system removed public notices about the change from its website after initially posting them. The effective date and whether existing patients are affected remain unclear from available information. The move raises questions about network adequacy and access for Medicaid and Medicare Advantage enrollees in New York City, particularly those covered by Centene products.