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Wednesday, September 30 · 35 stories
- State Policy · MO
Missouri Releases Master Plan on Aging After Three-Year Process
Missouri published its "Aging with Dignity" Master Plan on Aging in February 2026, the result of a nearly three-year planning effort that gathered input from more than 10,000 residents. The plan is intended to coordinate policies and services for older adults across state agencies and community partners as Missouri's aging population grows. A Center for Health Care Strategies piece describes the plan's development and goals as a model of multisector coordination for aging services. The write-up does not specify an implementation timeline or funding mechanism.
- Federal Policy · NC
CMS Awards $20 Million for Rural North Carolina Telehealth Upgrades
CMS announced a $20 million funding award to expand telehealth access and upgrade healthcare technology infrastructure across rural North Carolina. The funding targets rural providers and communities, aiming to improve access to care through technology and connectivity improvements. Details on the specific funding mechanism, distribution timeline, and eligible recipients were not fully specified in the announcement. The initiative reflects continued federal attention to rural healthcare access, which is a persistent challenge for rural Medicaid beneficiaries and the providers who serve them.
- State Policy · AR
Sanders' Medicaid Work Requirements Ad Sparks Bipartisan Backlash
Arkansas Gov. Sarah Huckabee Sanders released a campaign ad depicting a Medicaid recipient playing video games and eating junk food instead of working, aimed at promoting the state's upcoming Medicaid work requirements. The ad drew criticism from both the NAACP, which called it stigmatizing and racially coded, and from some right-wing commentators who objected on different grounds. Arkansas's work requirements are set to take effect soon, requiring certain beneficiaries to document employment or qualifying activities to maintain coverage. The controversy highlights how politically charged messaging around Medicaid work requirements has become as states move to implement them.
- Legal · NY
HHS-OIG Denies Recertification of New York's Medicaid Fraud Unit
In a client alert, Harris Beach Murtha reports that HHS-OIG has denied recertification of New York's Medicaid Fraud Control Unit and suspended a substantial share of its federal grant funding, with a corrective action deadline of September 30, 2026. The firm notes this coincides with increased use of AI-driven claims analytics to flag potential fraud, creating heightened enforcement risk for New York Medicaid providers. The alert advises providers to review billing practices and compliance programs in light of both developments. No specific new enforcement action against individual providers is described beyond the MFCU funding suspension itself.
- State Policy · IN
Indiana Law Shifts Long-Stay Nursing Home Residents to Fee-for-Service
Indiana enacted House Enrolled Act 1277, a Medicaid reform law altering the state's PathWays for Aging managed care program and other long-term services and supports. Most provisions took effect July 1, 2026, but the law also directs a transition of certain long-stay nursing facility residents out of managed care and into fee-for-service Medicaid, with that transition beginning on a later timeline described in the update. Long-term care and HCBS providers, along with PathWays managed care plans, must adjust billing, care coordination, and enrollment processes to align with the new structure. The change affects how nursing facilities and HCBS providers interact with payers for affected residents going forward.
- Industry · MN
HealthPartners, Essentia Health Plan Merger Into 22-Hospital System
HealthPartners of Bloomington and Essentia Health of Duluth announced plans on Sept. 29 to merge into a combined 22-hospital health system, marking the third major deal involving a Minnesota-based system in 2026. The consolidation underscores accelerating hospital and health system M&A activity concentrated in Minnesota this year. Terms and a target closing date were not detailed in the announcement. HealthPartners also operates a Medicaid managed care plan, so the combined entity's scale could affect provider networks and negotiating leverage in the state.
- Federal Policy
HHS Report Links Gender-Affirming Care to Radicalization Risk
HHS has issued a report suggesting gender-affirming care "may" contribute to radicalization among transgender people, drawing criticism from advocates and clinicians who say it mischaracterizes established treatment models and frames transgender identity as illegitimate or dangerous. The report is described as part of a broader agency effort to undermine confidence in standard-of-care approaches to transgender health. No new rule, waiver, or coverage change is described in the source material; the report itself is the development. Critics note the claims lack clear methodological grounding and could be used to justify future restrictions on coverage or clinical guidance affecting transgender Medicaid beneficiaries.
- State Policy · PA
PA 7th District Rivals Split Sharply on Medicaid, ACA Cuts
Spotlight PA compares economic platforms of Rep. Ryan Mackenzie (R) and challenger Bob Brooks (D) in Pennsylvania's competitive 7th Congressional District ahead of the Nov. 3 election. Mackenzie backed the One Big Beautiful Bill Act, which includes roughly $1 trillion in Medicaid cuts over a decade plus new work requirements, more frequent eligibility checks, and higher cost-sharing; he says he continues working across the aisle on affordability measures and voted for a bill to extend enhanced ACA subsidies for three years. Brooks calls the law "God-awful" and wants to restore cuts to Medicaid, SNAP, and ACA subsidies, and supports moving toward universal coverage. The race is rated a toss-up, and the outcome could influence future congressional action on Medicaid financing and eligibility rules.
- Industry
Survey: ACA Subsidy Expiration Slowing Hospital Procedure Volumes
Becker's Hospital Review reports on a Sept. 23 Evercore ISI survey finding that nearly one in four hospital executives say the expiration of enhanced ACA premium subsidies has already begun slowing procedure volumes at their facilities. Evercore ISI, the equity research arm of investment bank Evercore, surveyed hospital executives to gauge early operational effects of the subsidy lapse. The findings suggest patients losing or facing higher-cost ACA marketplace coverage may be delaying or forgoing elective and other procedures. The survey signals early volume and revenue pressure for hospitals as coverage losses tied to the subsidy expiration ripple through the health system.
- Industry · CA
Former MemorialCare CEO Argues Fee-for-Service Undermines Care Value
In a California Health Care Foundation commentary, the former longtime CEO of MemorialCare argues that fee-for-service payment rewards volume over prevention and drives unsustainable cost growth in California's health system. The author, who sits on the advisory committee of the state's Office of Health Care Affordability, cites MemorialCare's own experience with alternative payment models (APMs), noting that shared-risk, population-based payment arrangements produced roughly 5% lower total spending and up to 25% lower pharmacy costs. The piece points to the state's four-tier APM framework, which ties higher tiers to population-based payment rather than per-service billing, as the direction payers and providers should move. The author calls for hospitals, insurers, public payers, providers, and drugmakers to collectively shift toward paying for care coordination and prevention rather than individual services.
- State Policy
Four States, Indiana Health System Erase $1.1B Medical Debt
Four states and an Indiana health system partnered with the nonprofit Undue Medical Debt in 2026 to erase more than $1.1 billion in residents' medical debt. The organization works by purchasing bundled medical debt at reduced rates and canceling it for qualifying individuals. Undue Medical Debt states it has eliminated more than $40 billion in medical debt nationwide since it was founded in 2014. The initiative affects residents carrying unpaid medical bills, many of whom may also be Medicaid-eligible or uninsured populations facing collections and credit impacts.
- State Policy · VT
Swenson: Vermont's Physician Exodus Threatens Care Access
In a VTDigger commentary, Matt Swenson, founder of Omnidex Solutions, argues that Vermont's healthcare debate focuses too narrowly on prices while ignoring a worsening access crisis. He cites recent layoffs at the University of Vermont Health network (199 positions affected) and Dartmouth Health (124 cuts plus eliminated vacant positions), alongside state data showing primary care physicians fell from 634 in 2004 to 529 in 2024. Swenson argues the Green Mountain Care Board's price regulation and movement toward reference-based pricing, while worthwhile, must be paired with an access-to-care dashboard tracking wait times, ER boarding, and practices' new-patient capacity. He also criticizes Gov. Phil Scott's conciliatory approach and argues single-payer financing reforms alone won't solve a shrinking physician pipeline.
- State Policy · VA
Virginia Democrats Warn of Medicaid, ACA Cost Strains Before Election
Virginia Democratic lawmakers and a nonprofit leader held a press call warning that healthcare affordability will worsen as more federal policy changes take effect, five weeks before the state's Nov. 3 elections. Expired enhanced ACA premium tax credits have already driven steep premium increases, with one Charlottesville resident's monthly premium rising from $235 to $1,336; Virginia's marketplace enrollment fell by 94,000 to 295,000 as of late August. Starting January 1, new Medicaid work and community engagement requirements (generally 80 hours monthly, with exemptions for pregnancy, medical frailty, and some caregivers) will apply to more than 500,000 Virginia enrollees, raising concerns about coverage loss from paperwork burdens. Gov. Spanberger has directed agencies to improve outreach, and the state legislature approved a $150 million premium assistance program for households between 138%-250% of the federal poverty level, though lawmakers say the state cannot fully offset federal cuts.
- State Policy · AR
Arkansas Governor Candidates Split on Medicaid Expansion, Postpartum Coverage
Arkansas's three gubernatorial candidates, Republican Gov. Sarah Huckabee Sanders, Democratic state Sen. Fred Love, and Libertarian Colt Shelby, offered differing views on the state's Medicaid expansion program ahead of the 2026 election. Sanders said conversations are underway on "the best path forward" after the Trump administration rejected the state's renewal request this summer because the program doesn't meet a new federal cost-neutrality provision; Arkansas has since requested a two-year extension. Love called for increased Medicaid enrollment and investment, citing rural hospital closures tied to low reimbursement rates, while Shelby said he hopes the extension request is granted and supports extending postpartum coverage to 12 months, calling it a "no-brainer." Arkansas remains the only state limiting postpartum Medicaid coverage to 60 days; Sanders opposes extending it, citing other insurance options for low-income residents.
- Industry
Poll Finds Wide Disparities in Americans' Health Care Affordability
A new data note reviews recent polling on Americans' struggles to afford health care, finding that uninsured adults, Black and Hispanic adults, and lower-income individuals report disproportionately higher rates of cost-related difficulty. The polling covers issues such as paying medical bills, affording premiums, and skipping needed care due to cost. No new policy or program change is described; the piece presents survey findings on affordability burdens across demographic groups. The findings underscore persistent gaps in cost protection tied to insurance status, race, and income.
- Industry
Modivcare Names Marsha Ramos CEO of Personal Care Unit
Home Health Care News reports that Modivcare has appointed Marsha Ramos as CEO of its personal care division. Ramos points to a potential Medicare home care benefit as a possible turning point for the personal home care industry, while cautioning that fraud, waste, and abuse concerns could undermine momentum for such a benefit. She also flagged near-term priorities around sustainable growth for the home-based care segment. The piece is drawn from an interview covering her outlook on industry direction and reform.
- Industry
AMA Report: Top Four PBMs Now Control 75% of Market
The American Medical Association's September 2026 Policy Research Perspective, drawing on Decision Resources Group data from 2022 to 2024, found the four largest pharmacy benefit managers now control 75% of the national market, up from 70% in 2022. The report documents continued consolidation among PBMs and insurers tracked over the study period. Becker's Hospital Review summarizes six key findings from the analysis. The data underscores ongoing concentration trends affecting drug pricing and negotiation leverage across the pharmaceutical supply chain.
- Industry · MI
Family Fights Nursing Home Over Sedating Drugs for Dementia Patient
A Michigan family's dispute over whether to sedate their mother, who has dementia and lives in a long-term care facility, highlights the continued widespread use of potent sedating medications on agitated dementia patients despite federal efforts to discourage the practice. The sons sought to keep their mother off the drugs, clashing with facility staff over her care. The case illustrates the difficult decisions families, guardians, and facilities face when balancing behavioral symptom management against the risks and side effects of antipsychotic and sedative medications. Federal oversight has pushed nursing homes to reduce inappropriate antipsychotic use, but enforcement gaps and staffing pressures continue to drive reliance on these drugs.
- Industry
Survey: Rural Voters Say MAHA Policies Haven't Reached Them
A KFF-Associated Press survey finds rural voters who support the Make America Healthy Again (MAHA) movement report that Trump administration health policy changes have not materially reached their communities. Respondents include rural residents who back the movement's goals but say they see little visible change in local health services or outcomes. The survey does not specify a policy effective date, but reflects an ongoing gap between federal health messaging and rural on-the-ground experience. The findings matter for rural health stakeholders, including Medicaid providers and state agencies, who must gauge whether federal initiatives are translating into resources or program changes at the community level.
- Federal Policy
Senate Democrats Question HHS Over Delayed Pediatric COVID Vaccine Access
Senate Minority Leader Chuck Schumer and other top Senate Democrats sent a letter to CDC Director Erica Schwartz and HHS Secretary Robert F. Kennedy Jr. questioning an apparent delay in making COVID-19 vaccines available to low-income children through a federal program. The lawmakers are seeking answers about why access through this program has stalled and what HHS plans to do to restore timely vaccine availability. The letter does not specify a response deadline in available reporting. Low-income children who rely on federally funded vaccine access programs, often coordinated with state Medicaid and CHIP populations, are the primary group affected by any delay.
