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Wednesday, August 5 · 20 stories
- Industry · CA
UC Davis Launches Telenephrology Program for Rural Mendocino County
UC Davis Health is partnering with Adventist Health Ukiah Valley to provide remote nephrology services to patients in rural Mendocino County, California, a region that previously lacked local kidney specialty care. The telenephrology program connects UC Davis nephrologists in Sacramento with patients and clinicians at the 50-bed rural hospital. The partnership aims to expand access to specialty care in an underserved area through telehealth infrastructure. No timeline or operational details were provided in the brief announcement.
- State Policy · IN
Indiana to Implement Medicaid Work Requirements and New Eligibility Rules Over Next 18 Months
Indiana will implement new Medicaid work requirements and eligibility rules over the next 18 months, following a redetermination period that already removed hundreds of thousands of beneficiaries from coverage. The changes represent a second phase of enrollment restrictions after the unwinding of pandemic-era continuous coverage protections. The new requirements will determine whether additional beneficiaries lose Medicaid coverage. State agencies and managed care plans operating in Indiana will need to adjust operations to support compliance tracking and member communications around the work requirement policy.
- State Policy · CT
Connecticut Medicaid Considers Restricting HIV Medication Treatment Options
Connecticut's Medicaid program is considering implementing restrictions on HIV medication access that would limit available treatment options for beneficiaries. The proposed limitations would affect patients currently receiving or seeking HIV treatment through the state's Medicaid program. The timing and specific scope of the restrictions under consideration have not been publicly detailed. This development raises concerns about medication continuity and treatment adherence for Connecticut Medicaid beneficiaries living with HIV, particularly given clinical evidence supporting treatment choice in managing the condition.
- State Policy · NC
Study Finds Medicaid Expansion Did Not Reduce Firearm Suicides Among Most Men
A new study found that Medicaid expansion has not reduced firearm suicide rates among most men, despite documented improvements in health care access and behavioral health treatment availability for expansion populations. The research challenges assumptions about the relationship between Medicaid coverage and suicide prevention outcomes for male enrollees. The findings have implications for state Medicaid agencies and managed care organizations designing behavioral health interventions and measuring quality outcomes in expansion populations, particularly as states continue to evaluate the effectiveness of coverage expansions on mental health and mortality metrics.
- Managed Care
UnitedHealthcare Limits Lab Test Reimbursement Across Medicaid and Other Lines
UnitedHealthcare will implement new reimbursement limits on five categories of lab tests — allergen testing, liver fibrosis testing, in vitro chemotherapy sensitivity assays, testosterone blood tests, and vitamin B12 testing — effective September 1, 2026. The policies apply across the company's commercial, ACA exchange, Medicare Advantage, and Medicaid product lines. UnitedHealthcare Medicaid plans will be affected by the same utilization management criteria being applied to other lines of business. The changes will affect laboratory providers billing UnitedHealthcare Medicaid plans and could impact member access to certain diagnostic tests.
- Legal · PA
DOJ Charges 19 Defendants in $4M Medicare and Medicaid Home Health Fraud Scheme
The Department of Justice, in coordination with the U.S. Attorney's Office and Pennsylvania Attorney General, charged 19 defendants in a $4 million Medicare and Medicaid fraud scheme involving home health services. The alleged scheme included billing for services never rendered and submitting claims for unrealistic service hours. The charges were announced in early August 2026. The enforcement action signals continued federal and state scrutiny of home health billing practices, particularly phantom billing and time-based service inflation.
- Federal Policy
CMS Proposes Restrictions on Remote Patient Monitoring in 2027 Fee Schedule
CMS issued the CY 2027 Physician Fee Schedule Proposed Rule limiting remote patient monitoring and remote therapeutic monitoring services. The proposal restricts outsourced clinical staffing, imposes new billing requirements, and reduces reimbursement for certain services. Changes would take effect January 1, 2027. The restrictions reverse CMS's 2025 expansion of RPM/RTM access and could significantly affect Medicaid managed care organizations and providers using remote monitoring for chronic condition management, particularly for dialysis and other high-cost populations.
- Legal · ME
Maine Supreme Court Upholds $750M Medicaid Transport Contract with Modivcare
The Maine Supreme Court ruled Tuesday in favor of the state's 10-year, $750 million Medicaid non-emergency transportation contract with Denver-based Modivcare, ending a legal challenge by nonprofit provider Penquis. The decision allows Maine DHHS to proceed with the statewide contract, consolidating NEMT services under a single vendor. The ruling resolves a multi-year procurement dispute and establishes the operational framework for Medicaid transportation services statewide. The contract represents one of the largest NEMT procurements nationally and affects transportation access for Maine's Medicaid beneficiaries.
Tuesday, August 4 · 15 stories
- Federal Policy
HHS Secretary Kennedy Endorses Measles Vaccine Amid Outbreak Discussions
Health and Human Services Secretary Robert F. Kennedy Jr. endorsed the measles vaccine during a CNN interview on August 3, 2026, while making additional claims about other vaccines and RSV during ongoing measles outbreaks. The statement represents the Secretary's public position on measles immunization policy as the nation's top health official. The endorsement comes as federal and state health agencies manage measles outbreak response and vaccination campaigns. HHS guidance on childhood vaccinations influences state Medicaid EPSDT requirements, managed care quality metrics, and VFC program administration.
- Industry
MedCity News Publishes Sponsored Content on SNF Data Transparency for Health Plans
MedCity News published a sponsored article discussing how real-time clinical data sharing from skilled nursing facilities can help health plans identify member decline and prevent avoidable hospitalizations for long-stay residents. The piece frames SNF data transparency as a tool for earlier risk identification in long-term services and supports populations. No specific policy change, product launch, or implementation timeline is reported. This appears to be marketing content rather than news of a concrete development.
- State Policy · CA
California Medi-Cal Program Changes Prompt Beneficiary Outreach on Coverage Continuity
California's Medi-Cal program is undergoing changes that may affect some beneficiaries' coverage, though most enrollees will not be impacted. Beneficiaries are advised to update contact information with their county benefits office and monitor correspondence from county and state agencies to avoid unintended coverage loss. The guidance emphasizes the importance of maintaining current contact details to receive notices about eligibility determinations. State and county agencies are conducting outreach to prevent coverage disruptions during the transition.
- State Policy · CA
California Advises Medi-Cal Enrollees to Update Contact Information Amid Program Changes
California is advising Medi-Cal enrollees to update their contact information with county benefits offices as the program undergoes changes. Most enrollees will not see changes to their benefits, but the state is emphasizing the importance of monitoring mail from county and state agencies to ensure uninterrupted coverage. The guidance comes as the state works to manage transitions that could affect eligibility determination or benefit administration. Enrollees who fail to update contact information or respond to renewal notices risk coverage disruptions.
- Federal Policy
CMS Seeks Public Comment on Potential CPT Coding System Reforms in 2027 Fee Schedule Rule
CMS published a Request for Information on July 16, 2026, soliciting stakeholder feedback on potential reforms to the American Medical Association's Current Procedural Terminology (CPT) coding system. The RFI appears in the Calendar Year 2027 Physician Fee Schedule Proposed Rule (CMS-1848-P). Comments are due 60 days after Federal Register publication, typically in mid-September 2026. The inquiry signals CMS consideration of structural changes to how physician and outpatient services are coded and reimbursed across Medicare and Medicaid programs.
- Industry
Hospitals Report Rising Uninsured Rates Six Months After ACA Exchange Cuts
For-profit hospitals report financial strain from increased uninsured patients following cuts to Affordable Care Act exchanges that took effect six months ago. Hospital executives cite declining insurance coverage among patients as a drag on revenues. The trend reflects broader coverage losses stemming from federal policy changes to ACA subsidies and eligibility. While the article focuses on ACA exchange changes rather than Medicaid-specific policy, Medicaid programs may see increased enrollment pressure as individuals lose marketplace coverage.
- Managed Care · CA
California Health Plan Deploys AI to Prevent Medicaid Disenrollment Ahead of Work Requirements
A California Medicaid health plan is using artificial intelligence to automate appointment scheduling and paperwork reminders for enrollees facing new work requirements, aiming to reduce coverage losses during the compliance transition. The plan reports the AI system performs work equivalent to 40 staff members at significantly lower cost. The deployment comes as states prepare to implement work requirements that historically trigger coverage loss for eligible members who fail to complete verification processes. The approach raises questions about AI reliability, member experience, and whether automation adequately supports vulnerable populations navigating new administrative hurdles.
- Legal
HRC Sues Trump Administration Over Gender-Affirming Care Coverage Ban in Federal Employee Health Plans
The Human Rights Campaign filed a class-action lawsuit Monday challenging the Trump administration's ban on gender transition treatment coverage in federal employee health plans. The suit alleges the coverage ban violates federal sex discrimination protections in employment. The lawsuit does not directly target Medicaid or CHIP programs, though similar coverage restrictions could inform future Medicaid policy debates. The case centers on Federal Employees Health Benefits Program coverage, not state Medicaid programs.
- Federal Policy
CMS Issues FY 2027 IPPS Final Rule With GME, LTCH, and Quality Reporting Changes
CMS published its final rule updating Medicare inpatient prospective payment systems for acute care hospitals and long-term care hospitals for fiscal year 2027, effective October 1, 2026. The rule revises operating and capital payment rates, modifies graduate medical education policies for teaching hospitals, updates LTCH PPS rates, and changes requirements for hospital quality reporting programs. HHS also adopts updated health IT standards. While this is a Medicare rule, Medicaid managed care organizations and state agencies should monitor GME policy changes and quality measure updates that often influence Medicaid hospital payment methodologies and managed care contract requirements.
- Federal Policy
CMS Announces Healthcare Advisory Committee Virtual Meetings for FY 2026-2027
CMS has announced virtual public meetings of the Healthcare Advisory Committee (HAC) for fiscal year 2026-2027. The Committee advises the HHS Secretary and CMS Administrator on healthcare system improvements consistent with the Executive Order establishing the President's Make American Healthy Again Commission. The meetings are open to public participation. The announcement provides stakeholders advance notice of opportunities to observe federal healthcare policy deliberations.
- State Policy · IN
Indiana Families Report Coverage Losses During Medicaid Redetermination Process
Indiana families are losing Medicaid coverage despite submitting required documentation during the state's ongoing eligibility redetermination process. Parents report receiving termination notices after complying with verification requests, with some experiencing gaps in coverage for children despite resubmitting paperwork. The coverage losses appear tied to administrative processing issues during Indiana's unwinding of pandemic-era continuous enrollment protections. Affected families face immediate barriers to accessing care and prescription medications while attempting to restore coverage through state appeals processes.
- State Policy · FL
Florida Lawmaker Questions Continuing KidCare Continuous Eligibility Legal Fight
A Florida lawmaker is calling for the next governor to reconsider the state's ongoing litigation challenging federal continuous eligibility requirements for children in KidCare, Florida's CHIP program. Governor DeSantis has spent two years in court opposing the federal mandate that children remain enrolled for 12 months. The challenge has prevented implementation of a 2023 state law the governor signed. The legal dispute centers on whether Florida must comply with the federal continuous eligibility policy as a condition of receiving federal Medicaid and CHIP funding.
