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Tuesday, August 11 · 14 stories
- Federal Policy
Sequoia Project Names 19 Members to TEFCA Governing Council
The Sequoia Project updated its TEFCA Governing Council roster on August 10, 2026, naming 19 representatives from health systems, health information networks, technology vendors, and federal agencies. TEFCA is the ONC-overseen national framework for exchanging health data across qualified health information networks. The Governing Council advises on implementation and policy for the framework. The update reflects ongoing governance structure for the national interoperability initiative.
- Industry
DentaQuest Data Breach Affects 15 Million Individuals
DentaQuest, a dental and vision benefits administrator serving Medicaid managed care plans, reported a data breach affecting 15 million individuals — the largest breach reported this year. The company has notified affected individuals and implemented additional security controls following the incident. The breach affects Medicaid enrollees whose dental benefits are administered through DentaQuest's platform across multiple states.
- Industry
Humana Names J.P. Holland to Lead Medicaid Business
Humana appointed James "J.P." Holland as head of its Medicaid division, effective August 18, 2026. Holland previously served as an executive at Johns Hopkins. The move is part of a broader leadership restructuring announced by Humana in late 2025. The appointment comes as Humana continues to position Medicaid as a growth segment within its business portfolio.
- Industry
Healthcare Cybersecurity Risks Escalate Amid Regulatory Gaps and Consolidation
Healthcare industry experts warn that regulatory failures, inadequate funding, and consolidation are creating significant cybersecurity vulnerabilities that threaten patient safety. The vulnerabilities affect healthcare providers and payers, including Medicaid managed care organizations that hold sensitive beneficiary data and operate critical care delivery infrastructure. Security gaps expose health plans and providers to data breaches, ransomware attacks, and operational disruptions that can interrupt care access and compromise protected health information. Industry stakeholders characterize these cybersecurity weaknesses as patient safety issues requiring urgent attention.
- Federal Policy
Collins Bill Would Reset Medicare Home Health Rates, Expand CMS Fraud Authority
Sen. Susan Collins (R-Maine) introduced legislation to restore Medicare home health payment rates to pre-cut levels and provide CMS with expanded fraud prevention and detection authority. The bill targets home health payment integrity while reversing recent years of Medicare rate reductions. The proposal would affect Medicare home health providers' reimbursement and compliance obligations, though specific effective dates and fraud-fighting mechanisms are not detailed in available reporting. Home health agencies would see financial and operational impact if the bill advances.
- Managed Care · AL
Black Midwife Addresses Maternity Care Access Gaps in Alabama Rural Counties
More than half of U.S. counties lack labor and delivery hospitals, according to new March of Dimes research, creating maternity care deserts that disproportionately affect rural populations. A Black midwife in Alabama is working to fill these access gaps by providing services across underserved counties. The delivery system gaps are particularly acute for Black mothers, who face significantly higher maternal mortality and morbidity rates. For Medicaid managed care plans covering pregnant beneficiaries, this highlights ongoing network adequacy challenges in maternal health, particularly in rural service areas where most deliveries are Medicaid-financed.
- Federal Policy
Federal Government Plans $50 Billion Rural Health AI Initiative Despite Limited Evidence
The federal government is launching a $50 billion Rural Health Transformation Program focused on deploying AI health tools in rural communities. The initiative proceeds despite limited evidence that AI-based healthcare technologies improve access or patient outcomes in rural areas. Patient advocates and rural health experts have expressed concerns about the push for AI solutions without demonstrated effectiveness in underserved communities. The program's implementation timeline and specific Medicaid integration requirements have not been disclosed.
- Legal · SD
Federal Judge Upholds South Dakota Drug Discount Law for Rural Providers
A federal judge dismissed legal challenges to South Dakota legislation allowing rural healthcare providers to purchase discounted drugs and mark up sale prices to offset low Medicare and Medicaid reimbursement. AbbVie, manufacturer of Humira, sued the state in April 2025 challenging the law. The ruling takes effect immediately with the dismissal of the pharmaceutical manufacturer's lawsuit. The decision matters for rural providers in South Dakota who rely on drug discount programs to sustain operations amid inadequate Medicaid payment rates.
- State Policy · MD
Maryland Awards $80M to Expand Rural Primary Care, Behavioral Health, Dental Access
Maryland's Department of Health awarded $80 million to 41 grantees under the first round of the Rural Health Transformation Program on August 10, 2026. The funds will expand primary care, behavioral health, and dental services across Maryland's 18 designated rural areas. The program addresses workforce shortages and access gaps in underserved regions. For Maryland Medicaid managed care plans and providers, this represents new capacity and potential network expansion opportunities in rural markets where provider networks are historically thin.
- Federal Policy
Federal Policy Restricts Use of Funds for Fentanyl Test Strips
Federal officials have implemented a policy limiting how funds can be used to purchase fentanyl test strips, a harm reduction tool credited with preventing overdose deaths. The restriction affects organizations providing overdose prevention services, including those responding to mass overdose events. Harm reduction advocates report the policy will make distributing test strips more difficult. Federal officials justify the restriction by asserting the strips enable drug use.
- Federal Policy
Trump Executive Order Revises Federal Childhood Vaccine Schedule, Separates MMR
President Trump signed an executive order on August 10, 2026, revising federal childhood vaccine schedules by requiring separate measles, mumps, and rubella shots instead of the combined MMR vaccine and narrowing the list of immunizations recommended for all children. The order, titled Gold Standard Childhood Vaccine Recommendations, affects the federally recommended schedule that state Medicaid programs and health plans use for EPSDT coverage determinations. The changes take effect immediately for federal guidance, though state Medicaid agencies will need to determine whether and how quickly to align coverage policies with the revised schedule. This matters for state agencies and health plans because EPSDT requires coverage of ACIP-recommended vaccines, and any federal schedule changes trigger operational questions about coverage mandates, provider network readiness, and member communication.
- Federal Policy · WA
HHS Declares Public Health Emergency for Washington Wildfires, Enabling Section 1135 Waivers
HHS Secretary Robert F. Kennedy Jr. declared a public health emergency for Washington state on August 7, 2026, following President Trump's emergency declaration on August 4. The dual declarations enable Washington to request Section 1135 waivers, which allow temporary flexibility from certain Medicare, Medicaid, and CHIP regulatory requirements during the wildfire emergency. The Administration for Strategic Preparedness and Response has deployed regional staff to support state response efforts, and the Washington State Hospital Association is providing resources to assist providers.
- State Policy · IN
Indiana Plans Federal Waiver to Restore HIP Cost-Sharing for Adult Enrollees
The Indiana Family and Social Services Administration will seek a five-year CMS waiver to reinstate cost-sharing requirements for able-bodied adults enrolled in the Healthy Indiana Plan under a new HIP 3.0 iteration. The waiver would revive a modified version of Indiana's previous copayment model for this population. The timing of the waiver submission and CMS review process has not been specified. This represents a return to Indiana's earlier HIP approach requiring enrollee contributions, which had been modified or suspended under previous waiver terms.
Monday, August 10 · 21 stories
- Industry
Four States Report No Rural Hospitals at Closure Risk
A July 2026 Center for Healthcare Quality and Payment Reform analysis identified 700 rural hospitals at risk of closing nationwide, but found zero at-risk facilities in Delaware, Maryland, and two other states. The report examined financial vulnerability indicators across rural hospitals. While rural hospital closures can affect Medicaid beneficiaries' access to care, particularly in states with large rural Medicaid populations, this analysis focuses on overall hospital financial stability rather than Medicaid-specific policy or payment changes.
- Industry
Unionized CVS Pharmacists Authorize Strike Over Staffing and Working Conditions
Unionized CVS pharmacists in three states authorized a strike last week, citing inadequate staffing levels and demanding input into pharmacy operational decisions. The strike authorization does not guarantee a walkout will occur but signals escalating labor tensions at one of the nation's largest retail pharmacy chains. If pharmacists do strike, Medicaid beneficiaries relying on CVS pharmacies for prescriptions could face disruptions in medication access. The action reflects broader workforce challenges in retail pharmacy that affect Medicaid providers and managed care plans dependent on stable pharmacy networks.
- Legal · IA
Iowa Therapist Retains License Despite Fraud and Theft Convictions
The Iowa Board of Behavioral Health Professionals allowed Michelle Raye Stewart-Sandusky, a state-licensed marital and family therapist, to retain her license despite January 2026 convictions for business-related theft, fraud, and forgery. The board had charged her with offenses directly related to professional duties and responsibilities. The decision appears final as of August 2026. The case affects Medicaid provider enrollment standards and credentialing requirements for behavioral health professionals in managed care networks.
- State Policy
NASHP Webinar to Cover State Multisector Aging Plans and Caregiver Support
The National Academy for State Health Policy will host a webinar on September 17, 2026, at 2:00 p.m. ET examining how states are using multisector plans on aging to advance caregiver support initiatives. The session will explore state strategies for integrating caregiver support across health and social service systems. States are increasingly using Medicaid waiver authorities and state plan options to fund and coordinate caregiver respite, training, and support services as part of broader efforts to sustain home- and community-based services delivery.
- State Policy
NHeLP Intern Advocates for Medicaid Coverage of Climate-Informed Doula Services
A National Health Law Program intern argues that Medicaid should cover doula care tailored to climate-related pregnancy risks, including extreme heat, flooding, and natural disasters. The piece focuses on how environmental hazards affect maternal health outcomes and birth experiences. While doula coverage is expanding in many state Medicaid programs, the article addresses the intersection of climate impacts and maternal health services. The advocacy positions climate-conscious doula care as a health equity priority for pregnant Medicaid beneficiaries in vulnerable communities.
- Legal
CMS Releases ABA Toolkit as Federal Enforcement Targets Autism Therapy Providers
CMS has released a new Applied Behavior Analysis toolkit amid increasing federal enforcement scrutiny of autism therapy providers. The development coincides with congressional investigations into the ABA therapy industry. The toolkit and enforcement actions reflect heightened government attention to billing practices, medical necessity determinations, and compliance issues in the autism therapy sector. State Medicaid agencies, managed care organizations, and ABA providers face increased program integrity oversight as federal authorities target potential fraud and abuse in this growing service area.
- Federal Policy
Congressional Republicans Question State Use of Enhanced Federal Medicaid Matching Funds
Congressional Republicans have raised concerns about states leveraging increased federal matching dollars from Medicaid expansion, provider taxes, and state directed payments to grow their Medicaid budgets. The lawmakers argue that states are not adequately considering the fiscal impact on the federal government when utilizing these funding mechanisms. This scrutiny comes as Congress examines Medicaid financing structures and potential reforms to federal matching formulas. The development signals potential legislative or oversight activity that could affect state Medicaid financing strategies and the availability of enhanced federal matching rates.