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Thursday, August 13 · 24 stories
- State Policy · IA
Iowa Medicaid Fraud Task Force Explores Public Tip Collection Strategies
Iowa's Medicaid Fraud Elimination Task Force, convened by Governor Kim Reynolds in July, held its second meeting on August 12, 2026, to discuss strategies for soliciting fraud tips from the public. Attorney General Brenna Bird emphasized the need for more proactive collection and response to fraud reports. The 11-member task force will draft recommendations for the state on fraud prevention and detection approaches. This initiative signals Iowa's focus on strengthening program integrity mechanisms through public engagement.
- State Policy · NV
Nevada Cuts Out-of-State Behavioral Health Placements for Children by Over Half
Nevada has reduced out-of-state institutional placements for children with behavioral health needs by more than 50% over four years, following federal findings that the state was overrelying on such placements. The state achieved this through expanded community-based services and in-state treatment capacity. The changes address federal requirements under the Americans with Disabilities Act and Medicaid's integration mandate. This matters for state Medicaid agencies and managed care plans managing behavioral health benefits, as it demonstrates a viable pathway to comply with federal home and community-based services requirements while reducing high-cost institutional care.
- State Policy · CA
California Immigrants Drop Medi-Cal Coverage Despite Eligibility Under New Enrollment Rules
California's Medi-Cal program is experiencing enrollment declines among immigrant populations following implementation of new eligibility rules, despite many immigrants remaining eligible for full coverage. Program data show eligible immigrants are not reenrolling due to information gaps and lack of trusted communication channels about continuing coverage. The enrollment drop affects access to care for immigrant Medi-Cal beneficiaries. State agencies and managed care plans face challenges communicating eligibility rules and maintaining enrollment continuity during the transition.
- State Policy · IA
Iowa Gubernatorial Candidate Proposes Ending Medicaid Privatization
Democratic gubernatorial candidate Rob Sand announced policy priorities Wednesday that include ending Iowa's privatized Medicaid managed care program, along with raising the state minimum wage to $12 per hour and investing in farm economy diversification. The proposal represents a campaign platform position rather than pending legislation. If Sand were elected and the proposal advanced, it would fundamentally restructure Iowa's Medicaid delivery system, which has operated under managed care contracts since 2016. The timing and feasibility would depend on the 2027 legislative session and gubernatorial transition.
- State Policy · IA
Iowa Advocates Push to Remove Medicaid Earnings and Asset Limits for Working Disabled Beneficiaries
Advocates in Iowa are urging state lawmakers to eliminate income and asset limits in Medicaid programs that allow people with disabilities to work while receiving benefits. Currently, most states impose earnings caps and asset restrictions on these programs, which advocates argue discourage career advancement and higher-paying employment. The advocacy effort targets state-level policy changes to expand economic opportunity for disabled Medicaid enrollees without risking benefit loss. If enacted, such changes would affect eligibility and enrollment administration for Iowa's Medicaid program serving working individuals with disabilities.
- Managed Care
Medicaid MCOs Denied at Least 1 in 8 Prior Authorization Requests in 2025
Analysis of 2025 prior authorization data shows Medicaid managed care organizations denied at least 12.5% of standard prior authorization requests, with denial rates varying significantly across insurers. The data, which also covers Medicare Advantage and ACA Marketplace plans, reveals inconsistencies in insurer practices but includes methodological limitations that complicate interpretation. The findings come as state Medicaid agencies and CMS face pressure to improve prior authorization transparency and oversight of MCO utilization management practices.
- Legal · FL
Federal Appeals Court Questions Florida Medicaid Redetermination Process in Oral Arguments
A three-judge federal appeals panel questioned Florida officials during oral arguments over the state's Medicaid termination procedures following the end of the COVID-19 public health emergency. The lawsuit, filed three years ago, challenges how Florida conducted eligibility redeterminations and disenrolled beneficiaries after continuous enrollment protections expired. The court's scrutiny focused on the state's procedural compliance with federal notice and due process requirements. The case could affect how states manage Medicaid disenrollment processes and beneficiary protections during eligibility reviews.
- State Policy · IN
Indiana Lawmakers Seek Audit After Medicaid Disability Waiver Denials Jump to 6%
Democratic lawmakers in Indiana are demanding an independent audit of interRAI, an assessment tool the state's Family and Social Services Administration began using in January 2026. Disability waiver denials spiked to 6% this year from under 1% previously. The timing and scale of the increase has raised questions about the tool's calibration and impact on beneficiaries who need long-term services and supports. This matters for states using or considering similar standardized assessment tools for LTSS eligibility determination.
Wednesday, August 12 · 11 stories
- State Policy · KS
Kansas Faces $20.6M Federal Penalty Despite Lower SNAP Error Rate
Kansas reduced its Supplemental Nutrition Assistance Program (SNAP) error rate below 12% following passage of the One Big Beautiful Bill Act in 2025, but the state still faces a potential $20.6 million federal penalty. The penalty relates to error rate thresholds established under federal law. State officials have not indicated when the penalty determination will be finalized or whether Kansas plans to contest it. The development affects state budget planning and SNAP administrative operations.
- State Policy · WV
West Virginia Medicaid Work Requirements Launch January 1, 33,000 Beneficiaries Not Meeting Criteria
West Virginia's Medicaid work and volunteer requirements will take effect January 1, 2027, according to a briefing to state lawmakers by the Department of Human Services. An initial analysis found approximately 33,000 current Medicaid beneficiaries are neither meeting the federal work or volunteer requirements nor automatically exempt from them. The requirements were authorized under federal law and will require affected beneficiaries to demonstrate compliance to maintain coverage. This implementation affects a substantial segment of West Virginia's Medicaid population and follows years of legal challenges to work requirements nationwide.
- Federal Policy
Brookings Researchers Challenge CMS Data Underlying Medicaid Work Requirements Rule
Brookings Institution researchers have publicly criticized the data and assumptions CMS used to support its Medicaid work requirements rule, which imposed stricter documentation standards for enrollees claiming medical exemptions from work mandates. The rule, already facing litigation, required beneficiaries to provide more extensive proof of illness or disability to qualify for exemptions than stakeholders anticipated. The Brookings critique alleges CMS misrepresented or manipulated data to justify the policy. This matters because if the agency's analytical foundation is undermined, courts may be more likely to vacate the rule, and CMS may face pressure to withdraw or revise the policy.
- Federal Policy
March of Dimes: 5.8 Million Women Live in Maternity Care Deserts
A March of Dimes report finds that 5.8 million women live in counties without full access to maternity care, with one-third of U.S. counties classified as maternity care deserts — areas lacking hospitals or birth centers offering obstetric services. The report highlights geographic disparities in prenatal and delivery care access nationwide. These gaps affect Medicaid-covered pregnancies, as Medicaid finances approximately 42% of births nationally and faces network adequacy and provider participation challenges in underserved areas.
- Industry
Research Suggests GLP-1 Drugs May Reduce Birth Control Effectiveness and Boost Fertility
Emerging research indicates that GLP-1 receptor agonist medications may interfere with oral contraceptive effectiveness and potentially increase fertility in users. The mechanism appears related to GLP-1s' effects on gastric emptying and hormone metabolism, which could reduce contraceptive absorption and alter reproductive hormone levels. The timing and clinical significance remain under investigation, but the findings have immediate implications for prescribing guidance and patient counseling. For Medicaid programs covering GLP-1s for diabetes and obesity, this raises questions about contraceptive coverage coordination, prior authorization criteria, and member education protocols.
- State Policy · NC
North Carolina Hospitals Deploy Postpartum Wristbands as Medicaid Coverage Cuts Loom
North Carolina hospitals are implementing "I Gave Birth" wristbands to identify recent mothers and encourage emergency care-seeking when postpartum complications arise. The initiative is expanding across multiple states as the Trump administration pursues Medicaid cuts that threaten to reduce postpartum coverage. The wristbands aim to address maternal mortality by prompting clinical staff to recognize and treat postpartum complications. The timing coincides with growing concerns about access to postpartum care under proposed federal Medicaid reductions.
- Federal Policy · MA
Massachusetts Launches Member Notice Campaign on Federal Medicaid Eligibility Requirements
Massachusetts is mailing notices to MassHealth members this week informing them of federal eligibility requirement changes and actions needed to maintain coverage. Governor Healey characterized the federal requirements as burdensome. The notices aim to help members understand how the changes affect them and what steps they must take to avoid coverage loss. The campaign reflects state efforts to minimize enrollment disruption from new federal compliance mandates.
- State Policy · NV
Nevada Lawmakers Consider Maternal Health Protections, Medicaid Fraud Enforcement for 2027 Session
Nevada legislators discussed health policy priorities for the 2027 legislative session at an interim Health and Human Services committee meeting on August 12, 2026. The agenda includes a maternal health "momnibus" bill with multiple pregnancy and postpartum protections, enhanced Medicaid fraud investigation capacity, and streamlined state health agency reporting requirements. Child welfare funding reforms were deferred despite prior discussion. These proposals would affect Nevada Medicaid operations, managed care oversight, and provider compliance once the 2027 session convenes.
- State Policy · NY
New York Gets CMS Approval to Overhaul Medicaid Provider Enrollment and Revalidation
New York's Department of Health received CMS approval to implement a plan revamping the state's Medicaid provider enrollment and revalidation processes. The changes aim to improve oversight of New York's Medicaid program. The announcement follows a McDermott Will & Emery client alert from August 4, 2026, addressing Medicaid moratorium and ownership change issues in the state. The timing and scope of implementation will affect providers seeking enrollment or ownership changes in New York's Medicaid program.
- State Policy · IN
Indiana Medicaid Work Requirement Affects 300,000 Enrollees Starting January 2027
Indiana's Medicaid work requirement takes effect January 1, 2027, affecting an estimated 300,000 low-income enrollees. State officials confirmed the mandate applies to new applicants and existing members renewing coverage in January, but compliance systems and exemption procedures remain incomplete with the first deadline less than two months away. The requirement will impact non-exempt adults enrolled in Indiana's Medicaid expansion population. State agencies and managed care plans must finalize tracking, verification, and disenrollment protocols before implementation.
- Federal Policy
CMS Final Rule Bars Federal Medicaid, CHIP Funds for Pediatric Gender-Affirming Care
CMS issued a final rule prohibiting federal Medicaid and CHIP matching funds for gender-affirming care for minors, including puberty blockers, hormone therapy, and related surgeries such as mastectomies. The rule takes effect October 13, 2026. States will no longer receive federal financial participation for these services furnished to children enrolled in Medicaid or CHIP. The policy represents a federal prohibition on a category of care previously covered under state Medicaid programs' Early and Periodic Screening, Diagnostic and Treatment benefit and other authorities.
Tuesday, August 11 · 14 stories
- Legal
Drug Manufacturers Challenge State 340B Contract Pharmacy Laws in Illinois, South Dakota
AbbVie and Novartis filed suit against Illinois on August 7, 2026, seeking to block the state's new 340B contract pharmacy law. Three days later, a federal judge in South Dakota dismissed three separate lawsuits from AbbVie, AstraZeneca, and PhRMA challenging South Dakota's similar law. The legal battles center on state efforts to require drug manufacturers to honor 340B pricing at contract pharmacies. The outcome will determine whether states can enforce 340B contract pharmacy requirements against manufacturer restrictions.