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Thursday, August 6 · 17 stories
- Industry
CVS Health Triples Net Income on Strong Health Plan Performance
CVS Health reported significantly increased net income in its second quarter 2026 earnings, driven primarily by strong profitability in its health plan business, which includes Aetna's Medicaid and Medicare Advantage lines. The company also announced a new GLP-1 medication agreement with Eli Lilly during the earnings call. The earnings report reflects improved performance across CVS's health insurance operations. Analysts characterized the results as exceptionally strong.
- Managed Care
Emergency Department Bias Against Addiction Patients Limits Access to Evidence-Based Treatment
A ProPublica investigation documents how emergency department staff frequently dismiss patients with substance use disorders, withholding evidence-based addiction medications like buprenorphine despite their proven safety and effectiveness. The report highlights systemic bias among clinical staff who view addiction patients with suspicion rather than as individuals requiring medical treatment. This treatment gap has direct implications for Medicaid managed care plans and providers, as substance use disorder benefits are mandatory Medicaid services and many states now require MCOs to cover medication-assisted treatment without prior authorization.
- State Policy · GA
Georgia Gubernatorial Candidates Differ on Medicaid Expansion at Chamber Event
Georgia's 2026 gubernatorial candidates outlined contrasting positions on Medicaid expansion at a Georgia Chamber of Commerce luncheon on August 5, 2026. Democrat Keisha Lance Bottoms and Republican Rick Jackson presented competing visions for the state's healthcare policy, with Medicaid expansion emerging as a key policy divide. The debate comes as Georgia remains one of ten states that has not expanded Medicaid under the Affordable Care Act. The outcome of the November election will determine whether Georgia pursues expansion, which would extend coverage to an estimated 450,000 low-income adults.
- State Policy · MI
Michigan Democratic Candidate Criticizes Medicaid Cuts in Federal Budget Legislation
Democratic primary winner William Lawrence criticized proposed Medicaid cuts in federal legislation referred to as the "One Big Beautiful Bill," during a campaign event at a Lansing hospital with healthcare providers and residents expected to be affected by the changes. The candidate used the event to renew calls for Medicare for All as an alternative to current Medicaid policy. The article does not specify the effective date or detailed nature of the Medicaid cuts referenced. This represents state-level political reaction to federal Medicaid policy changes still under consideration.
- State Policy · IN
Indiana Medicaid Returns $310 Million Surplus to State General Fund
Indiana's Family and Social Services Administration returned $310 million to the state general fund this year, reversing a prior $1 billion Medicaid deficit. FSSA Secretary Mitch Roob attributed the turnaround to agency reforms including regular financial reviews and must-return mailers. The surplus reflects improved program integrity and budget management within Indiana's Medicaid program. This development demonstrates how operational reforms can transform state Medicaid finances from deficit to surplus.
- Federal Policy
AHA Urges CMS to Lift Funding Caps in $50 Billion Rural Health Transformation Program
The American Hospital Association submitted comments to CMS on August 5, 2026, requesting changes to the Rural Health Transformation Program, which will distribute $50 billion to rural providers from FY 2026 through FY 2030. AHA urged CMS to eliminate a 15% cap on provider payments and a 20% cap on infrastructure and capital improvement funding for program years two through five. The association also requested that CMS work with Congress to allow states to revise initial applications, extend spending timelines for obligated funds, publicly post state-reported funding data, remove administrative barriers to hospital fund access, and ensure RHTP funds are separately reported on Medicare cost reports.
- State Policy · FL
Florida Auditor General Cites Delayed Access to Medicaid Unwinding Records
Florida's Auditor General reported that the Department of Children and Families significantly delayed providing records for an audit of Medicaid eligibility redeterminations following the end of the COVID-19 public health emergency. The audit report cites "Significant Audit Constraints" and recommends DCF management demonstrate commitment to accountability, transparency, and compliance with state law. The delay affected the auditor's ability to review how Florida handled the unwinding process that began in 2023. This raises questions about oversight and transparency in Florida's management of Medicaid eligibility operations during a period when millions of beneficiaries nationwide lost coverage.
- State Policy · OH
Ohio Home Care Workers Face Uncertainty as 100,000 Medicaid Recipients Await Policy Decision
Over 100,000 Ohio Medicaid beneficiaries receiving home and community-based services face uncertainty about the continuity of their care, according to a report from Dayton. The story profiles Dorothy Valentine, a longtime nursing home worker who understands both institutional and home-based care settings, highlighting growing concerns among home care workers and recipients about potential policy or funding changes. The article does not specify what precipitated the concerns or when any changes would take effect. The situation affects Ohio's LTSS delivery system and the workforce supporting community-based alternatives to institutional care.
Wednesday, August 5 · 20 stories
- State Policy · ME
Maine Community Coalition Mobilizes to Prevent Rural Birthing Center Closure
A grassroots coalition in Maine is working to prevent the closure of a rural labor and delivery center amid growing maternity care deserts nationwide. The community-led effort represents a strategic response to proposed facility closures that would eliminate local birthing services. The coalition's organizing reflects broader challenges rural communities face as hospitals close obstetric units due to financial pressures and workforce shortages. For Medicaid agencies and managed care plans serving rural populations, the fight highlights access challenges for pregnant beneficiaries who would face longer travel distances for delivery services.
- Federal Policy
Expert Panel Issues Guidelines on GLP-1 Use in Pregnancy
An international expert panel published systematic review and consensus guidelines on incretin-based medications (GLP-1s including semaglutide, liraglutide, dulaglutide, exenatide) in women's reproductive health, covering use before, during, and after pregnancy. The guidance, published in Obesity Reviews and based on 34 studies, provides counseling recommendations for clinicians treating patients on these medications. The guidelines address an emerging clinical question as GLP-1 use expands among women of reproductive age, including Medicaid beneficiaries with obesity and diabetes.
- Legal
Federal Courts Rule Hospices Deserve Deference on Six-Month Life Expectancy Determinations
Federal courts have issued several rulings favoring hospices in administrative appeals, particularly recognizing that hospices should receive deference when determining six-month life expectancy for patient eligibility. These rulings counter administrative law judge decisions that had reversed hospice eligibility determinations. The court decisions affect how hospices defend Medicare and Medicaid eligibility claims during audits and appeals. This development matters for hospices serving dual-eligible beneficiaries and state Medicaid programs that follow Medicare hospice coverage rules.
- Federal Policy
CMS Proposes 340B Cuts, Site-Neutral Payment Changes for 2027 Outpatient Rule
CMS released a proposed 2027 outpatient payment rule on July 2, 2026, that would cut billions from 340B drug payments and expand site-neutral payment policies affecting hospital reimbursement. The rule compounds financial pressure on hospitals already facing margin challenges, combining payment reductions that hospital finance leaders have previously fought separately. Comments on the proposed rule are due under the standard federal rulemaking timeline, typically 60 days from publication. The combined effect threatens Medicaid DSH hospitals and safety-net providers that rely heavily on 340B revenue and outpatient volume.
- State Policy
Seven States Improve Medicaid Access to Continuous Glucose Monitors Beyond Coverage Mandates
Seven states implemented strategies to strengthen access to continuous glucose monitors (CGMs) for Medicaid enrollees with diabetes, going beyond coverage policies to address utilization barriers. The Center for Health Care Strategies report examines how these states improved actual device uptake and diabetes care outcomes. The findings highlight operational approaches to bridge the gap between coverage on paper and real-world access. This matters for state Medicaid agencies and managed care plans working to translate diabetes technology coverage into measurable improvements in member health outcomes.
- Legal
District Court Requests Feasibility Briefing After Columbus II Oral Argument on 2027 NBPP Rule
Following July 8 oral argument in City of Columbus v. Kennedy, challenging CMS's 2027 Notice of Benefit and Payment Parameters Final Rule, the U.S. District Court for the District of Maryland ordered supplemental briefs on implementation feasibility. The Court asked parties to address whether relief could be granted without disrupting the 2027 Marketplace plan year and whether staying catastrophic-plan guidance would affect enrollees. The case involves provisions of the NBPP final rule affecting Exchange operations. Supplemental briefing timing will determine how quickly the Court rules and whether any injunction could affect 2027 plan year implementation.
- Legal · PA
DOJ Launches Philadelphia Medicaid Fraud Strike Force
The Department of Justice announced on August 4, 2026, the creation of a dedicated Medicaid fraud strike force in Philadelphia, expanding its Northeast Health Care Fraud Strike Force operations. The new unit will focus on investigating and prosecuting Medicaid fraud cases in the Philadelphia region. The announcement coincides with a parallel expansion of DOJ's West Coast Strike Force, signaling intensified federal enforcement activity targeting Medicaid program integrity. The move indicates heightened scrutiny of Medicaid providers, plans, and related entities operating in these regions.
- Industry
Hackensack Meridian Health Earns First Joint Commission AI Certification
Hackensack Meridian Health became the first health system to receive the Joint Commission's responsible health AI certification. The certification recognizes the system's AI governance structure, which it has been developing for several years. The Joint Commission and other private consortiums are establishing AI guardrails as federal regulations remain pending. This development reflects the healthcare industry's move toward voluntary AI standards in the absence of comprehensive federal regulatory frameworks.
- Managed Care · MD
Baltimore Launches Alternative 911 Response for Health Crises
Baltimore is creating a new 911 response service designed to address health crises before they escalate. The city will deploy alternative responders when people call 911 for certain health-related emergencies. The initiative aims to connect individuals to appropriate health services rather than traditional emergency response. For Medicaid managed care organizations and behavioral health providers, this represents a shift in crisis intervention that may affect emergency department utilization, care coordination requirements, and community-based crisis response networks.
- Federal Policy
CMS Re-Establishes Data Matching Program With Department of War for ACA Coverage Verification
CMS is re-establishing a Privacy Act matching program with the Department of War to verify minimum essential coverage under the Affordable Care Act through War Department health benefit plans. The matching program allows CMS to cross-reference enrollment data to confirm ACA coverage requirements are met. The notice was published August 5, 2026, under Privacy Act requirements. This routine administrative action maintains existing data-sharing arrangements between federal agencies for coverage verification purposes.
- State Policy
States Move to Restrict Medicaid Coverage of ABA Therapy for Autism
Multiple states are implementing new restrictions on Applied Behavior Analysis (ABA) therapy coverage for children with autism under Medicaid. The changes include stricter prior authorization requirements, reduced therapy hour caps, and new medical necessity criteria. State Medicaid agencies cite rising program costs and utilization management concerns as drivers for the policy shifts. The restrictions affect access to the primary evidence-based treatment for autism covered by Medicaid, which serves as the largest payer of autism services nationally.
- Federal Policy
Pediatricians Develop Independent Vaccine Guidance After CDC Policy Changes
Following changes to federal vaccine recommendations under the Trump administration, pediatricians and state health departments report they can no longer rely on CDC guidance as a trusted resource for families. Some providers are developing their own vaccine schedules and educational materials. The shift affects Medicaid-enrolled children, who comprise approximately 40% of the pediatric population and depend on EPSDT-mandated preventive services including immunizations. State Medicaid agencies may face inconsistent vaccine coverage determinations if provider guidance diverges from federal standards.
