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Thursday, September 17 · 11 stories
- 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.
- Federal Policy
CMS Renews DNV Healthcare Recognition as Hospital Accrediting Organization
CMS has approved DNV Healthcare USA Inc.'s application for continued recognition as a national accrediting organization for hospitals seeking Medicare or Medicaid participation. The approval allows DNV to continue surveying hospitals for compliance with CMS Conditions of Participation. The renewal takes effect September 17, 2026. This maintains DNV's status as one of several deemed status organizations that perform accreditation surveys in lieu of direct CMS or state agency surveys.
- Federal Policy
Federal Budget Cuts May Force States to End Medicaid Meal Delivery Programs
Federal budget cuts are threatening state Medicaid meal delivery programs that provide medically-tailored meals to beneficiaries with specific dietary needs. Multiple states are considering ending these services despite evidence showing the programs improve health outcomes and reduce overall healthcare costs. The timing of specific state decisions varies, but the federal budget pressure is immediate. For state Medicaid agencies, this creates difficult choices between cutting services that demonstrably reduce hospital readmissions and emergency room use versus maintaining other coverage areas.
- Federal Policy · NC
Federal Medicaid Restrictions in H.R. 1 Set to Take Effect in North Carolina
Sweeping federal Medicaid restrictions included in H.R. 1 are about to take effect in North Carolina, affecting the program that covers one in four state residents. North Carolina Medicaid Director Melanie Bush characterized these provisions as likely the most significant changes in the program's history. The new federal restrictions will fundamentally reshape how Medicaid operates in the state, though specific implementation details and effective dates require further clarification from the full article text.
Wednesday, September 16 · 6 stories
- Federal Policy
2.3 Million Young Adults Could Lose Medicaid Under Big Beautiful Bill
The Urban Institute estimates 2.3 million young adults could lose Medicaid coverage under the Big Beautiful Bill, a federal legislative proposal. Actual disenrollment numbers will depend on state implementation choices, particularly how states design income verification and renewal processes. Young adults face higher disenrollment risk due to frequent address changes and participation in gig economy work that complicates income documentation. The findings highlight operational challenges states and managed care plans will face in maintaining continuity of coverage for this population.
- Federal Policy
SAMHSA Awards Supplemental Prevention Grants to Alabama, Kansas, West Virginia Faith-Based Organizations
HHS announced September 15, 2026 supplemental funding through SAMHSA's Strategic Prevention Framework–Partnerships for Success program to Alabama, Kansas, and West Virginia. The awards support faith-based organizations and leaders in substance use prevention activities. The funding supplements existing state prevention grants. This expands federal support for community-based prevention infrastructure in states with significant substance use disorder prevalence, potentially affecting Medicaid behavioral health service utilization and costs.
- Federal Policy
Census Bureau Reports 2025 Income Growth and Poverty Decline Amid Safety Net Reductions
The Census Bureau's annual report shows median family income rose 2.6% in 2025 to $87,460, while the official poverty rate fell from 10.7% to 10.2%. Health insurance coverage remained stable. However, recent federal cuts to SNAP and enhanced ACA subsidies, along with pending stricter Medicaid work requirements, are expected to reverse these gains in future years. The supplemental poverty measure, which accounts for government benefits, showed 13.1% of Americans in poverty — unchanged from 2024.
- Federal Policy
Census Reports 2025 Poverty Rate at Historic Low Amid Warnings of Medicaid, SNAP Cuts
The U.S. Census Bureau reported the 2025 official poverty rate fell to 10.2%, a historic low, while the supplemental poverty rate held steady at 13.1%. Median household income rose 2.6% to $87,460. Experts cautioned the data does not reflect 2026 federal policy changes, including major Medicaid and SNAP cuts enacted through last year's tax and spending legislation. The Congressional Budget Office estimates 15 million people will lose health coverage by 2034, and SNAP enrollment for children already dropped 1.2 million between July 2025 and July 2026.
- Federal Policy · ME
Maine Analysis Links $4,300 Household Cost Increase to Expired ACA Premium Tax Credits
A Maine Center for Economic Policy analysis attributes rising household costs to federal policy changes, including the January 2026 expiration of enhanced Affordable Care Act premium tax credits for marketplace plans. Healthcare costs represent the largest driver, with families enrolled in marketplace plans seeing significant premium increases while those with employer coverage were less affected. Maine's individual market premiums rose 14.8% for 2027, reflecting declining enrollment by healthier members after subsidies expired. The analysis also cited rising gas, heating oil, and tariff-related costs, but healthcare policy changes had the most direct impact on affected households.
- Federal Policy
CMS Adds Four Condition Tracks to ACCESS Model in Spring 2027
CMS announced September 15 that it will expand the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model to include four new condition tracks: heart failure, chronic obstructive pulmonary disease, substance use disorders, and tobacco cessation. The expansion takes effect in spring 2027. The addition broadens the model's scope beyond its current conditions, creating new opportunities for providers to participate in value-based care arrangements for these chronic conditions under Medicaid and Medicare.
Tuesday, September 15 · 5 stories
- Federal Policy
CMS Expands Medicare Coverage for Chronic Disease Management Including Substance Use Disorder
CMS announced new Medicare coverage options for chronic condition management, including substance use disorder, heart failure, and other common conditions. The changes expand covered services and payment mechanisms under Medicare fee-for-service and Medicare Advantage to support ongoing care coordination and monitoring. Implementation details and effective dates were not specified in the announcement. While this is a Medicare-focused policy, Medicaid agencies and dual-eligible special needs plans (D-SNPs) should monitor how these coverage expansions affect care coordination for dually-eligible beneficiaries, particularly for behavioral health and chronic disease management.
- Federal Policy
HHS Certifies 17th IDR Entity as No Surprises Act Disputes Increase
HHS has certified Physio Solutions (doing business as medlitix) as the 17th independent dispute resolution entity authorized to settle out-of-network payment disputes under the No Surprises Act. The certification comes amid growing volume of surprise billing arbitration cases and increased scrutiny of IDR entities by researchers and lawmakers. The No Surprises Act requires federal certification of dispute resolution entities to adjudicate payment disputes between providers and health plans when patients receive out-of-network emergency or certain facility-based care. The expansion of certified IDR entities affects Medicaid managed care plans that contract with out-of-network providers and face similar surprise billing scenarios under state law or federal Medicaid managed care regulations.
- Federal Policy
HHS Secretary Kennedy to Keynote Anti-Vaccine Group Conference
HHS Secretary Robert F. Kennedy Jr. is scheduled to deliver a keynote address at a Children's Health Defense conference this week. CHD is an anti-vaccine advocacy organization Kennedy co-founded and led before his appointment as HHS Secretary. Kennedy has attempted to distance himself from the organization over the past year. The appearance raises questions about potential conflicts between his official role overseeing federal health policy, including Medicaid, and his ongoing relationship with an organization that opposes vaccine mandates and promotes vaccine skepticism.
- Federal Policy
Maine Democrat Says Republicans Expect Future Congress to Restore Medicaid Cuts
Rep. Chellie Pingree (D-ME) reported that some Republican colleagues privately expect Democrats to reverse Medicaid cuts enacted by the current GOP majority. The comments, made over the weekend, suggest internal Republican divisions over health spending reductions already implemented. No specific cuts or timeline for potential restoration were detailed in her remarks. The statement highlights ongoing partisan disagreement over Medicaid funding levels ahead of future budget and appropriations cycles.
- Federal Policy
Trump Drug Price Initiative Narrows to One or Two Drugs as State Opt-In Deadlines Extended Twice
The Trump administration's initiative to deliver lower drug prices in Medicaid has contracted from an original promise covering all drugs to just one or two products, with state opt-in deadlines pushed back twice. States maintain voluntary participation in the scaled-back program. The repeated delays and scope reductions suggest implementation challenges and potentially limited uptake among states.
Monday, September 14 · 9 stories
- Federal Policy · GA
CMS Approves Georgia CHOICE Arrangements for Small Business Health Coverage
CMS, in coordination with the Small Business Administration, has formally recognized Georgia's CHOICE arrangements as an approved model for small business health coverage. The arrangements allow small businesses to pool resources for health benefits while maintaining compliance with federal standards. The approval takes effect immediately and provides a compliance pathway for Georgia small businesses seeking affordable coverage options. This matters for Medicaid stakeholders because CHOICE arrangements may intersect with Medicaid eligibility and coverage coordination, particularly for low-wage workers in small businesses who may cycle between employer coverage and Medicaid.