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Tuesday, August 4 · 15 stories
- State Policy · CA
California Reverses Medi-Cal Expansion Amid Budget Shortfalls and Federal Restrictions
California is reversing decades of health coverage expansion, rolling back Medi-Cal eligibility and benefits in response to state budget shortfalls and new federal restrictions. The changes affect millions of California Medi-Cal beneficiaries who gained coverage through previous expansions. The timing and specific scope of cuts are detailed in a CalMatters documentary examining impacts at a Los Angeles clinic. This represents a significant shift in the nation's largest state Medicaid program, affecting managed care plans, providers, and beneficiaries who previously gained coverage.
- Federal Policy
HHS Officials Dispute State Concerns Over Medicaid Coverage Loss Projections
HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz are characterizing concerns about Medicaid coverage losses as "myths," while state Medicaid directors report that recent federal policy changes are expected to result in significant disenrollment. The dispute centers on whether new eligibility verification requirements, work requirements, or other administrative changes constitute "cuts" when they reduce enrollment. State agencies are preparing for increased disenrollment based on federal guidance issued in recent weeks. The disagreement highlights tension between federal policymakers and state administrators responsible for implementing Medicaid changes.
- Federal Policy
Federal Medicaid Work Requirements Exclude Homeless Individuals from Exemptions
Federal Medicaid work requirements do not include homelessness as an exemption category, despite assurances that vulnerable populations would receive waivers. Homeless individuals must meet work or community engagement requirements to maintain coverage, even though securing employment typically requires stable housing. The rule affects Medicaid beneficiaries experiencing homelessness in states that adopt work requirements. This gap exposes a population already facing barriers to healthcare access to potential coverage loss.
Monday, August 3 · 20 stories
- Federal Policy
Advocates Warn Trump Administration Budget Proposals Could Cut Medicaid Funding
On Medicaid's 61st anniversary, advocacy groups are raising concerns about potential funding cuts in budget proposals from the Trump administration. The warnings come as beneficiaries like 55-year-old Ivon Meneses rely on Medicaid for coverage of chronic conditions including asthma and diabetes. Advocates are highlighting the program's role as a safety net and the potential impact of federal budget actions on coverage and access. The timing of these warnings coincides with the program's July 30th anniversary, drawing attention to proposed changes that could affect state Medicaid budgets and beneficiary eligibility.
- Federal Policy
CMS Finalizes 2.3% Medicare Hospital Payment Increase for FY 2027
CMS issued a final rule increasing Medicare inpatient payment rates by a net 2.3% for FY 2027, reflecting a 3.2% market basket increase offset by a 0.9% productivity adjustment. The rule adds $2.9 billion in total hospital payments, including $228 million in DSH and uncompensated care payments and $779 million in new technology payments. The rule expands the Comprehensive Care for Joint Replacement bundled payment model nationwide starting January 1, 2028, making it mandatory for most acute care hospitals with accountability for spending and quality during inpatient stays and 90 days post-discharge. Changes to quality reporting programs include eight new measures for the Inpatient Quality Reporting Program and electronic prior authorization requirements extending to medical benefit drugs beginning in 2028.
- State Policy
NASHP Tracker Compiles State Hospital Reference-Based Pricing Initiatives
The National Academy for State Health Policy has published an ongoing overview tracking state efforts to implement hospital reference-based pricing tied to Medicare rates. The tracker compiles state purchaser initiatives aimed at controlling hospital price growth through payment rate caps or benchmarks. These state policies primarily affect state employee health plans, not Medicaid programs. The tracker serves as a reference resource for state policymakers monitoring hospital pricing approaches across states.
- Industry
Rural Health Systems Prioritize Strategic Tech Investment Over Volume Spending
Rural healthcare leaders are focusing on targeted technology investments rather than high-volume spending as they receive federal funding from the $50 billion Rural Health Transformation Program. The article examines how resource constraints are driving more intentional technology adoption decisions in rural health systems. Organizations achieving the strongest results are evaluating innovation based on practical impact rather than novelty. The piece outlines seven operational approaches rural providers are using to maximize technology investment returns.
- Federal Policy · ME
Medicaid Cuts in HR 1 Expected to Drop 31,000 Maine Enrollees, Strain Rural Hospitals
The "One Big Beautiful Bill Act" (HR 1), enacted in July 2025, imposed substantial Medicaid funding reductions and new administrative requirements. In Maine, approximately 31,000 enrollees are projected to lose coverage due to these administrative burdens. Those losing coverage are expected to shift to charity care at hospitals. The changes threaten financial stability for rural hospitals and local economies dependent on Medicaid reimbursement.
- State Policy · CA
California Cuts Medi-Cal Asset Limits 84% Effective July 2027
California will reduce Medi-Cal asset limits by 84% starting July 1, 2027. Current limits of $130,000 for an individual (plus $65,000 per additional household member, up to 10 people) will drop to $21,000 for one person. The change affects eligibility determination for Medi-Cal applicants and enrollees subject to asset tests. This represents a significant tightening of financial eligibility criteria that will reduce the asset threshold available to certain Medi-Cal populations.
- Federal Policy
Rural Emergency Hospital Model Faces Uncertain Future Under One Big Beautiful Bill Act
The Rural Emergency Hospital (REH) designation, created by Congress to stabilize small rural hospitals through Medicare payments for emergency and outpatient services without inpatient beds, is now threatened by provisions in the One Big Beautiful Bill Act. While some hospitals have successfully converted to the REH model to remain operational, others closed before or after conversion. The law's impact on REH payment rates and eligibility remains unclear as CMS develops implementation guidance. State Medicaid agencies and managed care plans in rural service areas face potential network adequacy challenges if REH facilities close or lose viability.
- Federal Policy
HHS Secretary Kennedy Says Trump Directed Investigation of Autism-Vaccine Link
HHS Secretary Robert F. Kennedy Jr. stated in a CNN interview that President Trump has directed him to investigate perceived links between autism and vaccines. Kennedy confirmed the Wall Street Journal's reporting on the matter. The statement signals potential federal review of vaccine policy and safety monitoring under the current administration. No timeline or specific investigative framework has been announced.
- Federal Policy
CMS Finalizes 2.3% IPPS Rate Increase, Mandatory Joint Replacement Bundled Payment Model for FY 2027
CMS finalized its fiscal year 2027 Inpatient Prospective Payment System (IPPS) rule on July 31, establishing a 2.3% payment rate increase for acute care and long-term care hospitals. The rule introduces the first mandatory, nationwide episode-based payment model for joint replacement procedures covering knee, hip, and ankle replacements. The rule takes effect October 1, 2026 (FY 2027 start). This matters for Medicaid because many state programs base their hospital payment rates on Medicare methodologies, and the bundled payment model could influence state approaches to managing orthopedic services under managed care and fee-for-service arrangements.
- Federal Policy
CMS Proposes Ban on Outsourced Remote Patient Monitoring for Medicare
CMS released the CY 2027 Physician Fee Schedule proposed rule restricting remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) under Medicare. The proposal would prohibit outsourcing of RPM/RTM services and revise reimbursement methodology, reversing 2026 expansions that lowered data-transmission thresholds and added new billing codes. The proposed changes would take effect January 1, 2027 if finalized. State Medicaid agencies that follow Medicare payment policies or allow RPM under managed care contracts may face operational and reimbursement changes if states align telehealth coverage with Medicare rules.
- State Policy · IN
Indiana Families Navigate Ongoing I/DD Waiver System Changes Since Late 2023
Indiana's Medicaid waiver system for individuals with intellectual and developmental disabilities has undergone continuous changes since late 2023, including new service rules, case management restructuring, and modified eligibility requirements. Families and providers are managing multiple policy shifts simultaneously while maintaining care continuity. The accumulated changes affect how services are authorized, delivered, and documented across Indiana's I/DD waiver programs. These reforms create operational uncertainty for MCE plans administering waiver services and providers contracted to deliver them.
- Legal · IA
Former Iowa Agency Directors Criticize Attorney General's New Medicaid Fraud Task Force
Two former directors of Iowa's Department of Inspections and Appeals publicly criticized Attorney General Brenna Bird's newly created Medicaid fraud task force, calling it political theater. Dean Lerner and Kevin Techau, who led the agency under previous Democratic governors, questioned the legitimacy and operational purpose of the task force announced Friday. The criticism comes as Bird, a Republican, establishes what she characterizes as enhanced fraud enforcement efforts. The statement represents rare public pushback from former state officials with direct program integrity experience.
- Federal Policy
HRSA Proposes Second Attempt at 340B Rebate Model After Initial Failure
The Health Resources and Services Administration announced a new proposal to allow rebate models in the 340B drug pricing program, marking its second attempt in 2026 after an earlier effort failed. The proposal would change how covered entities receive 340B discounts, moving from upfront discounts to post-purchase rebates. Hospital associations immediately opposed the plan, arguing it would create cash flow problems and administrative burdens for safety-net providers. If finalized, the rebate model could affect how Medicaid providers, particularly disproportionate share hospitals and federally qualified health centers, manage pharmaceutical costs.
- Managed Care · VA
Sentara Health to Drop Anthem Networks Dec. 31 Without New Rates
Sentara Health has notified Anthem that it will terminate commercial, Medicare, and Medicaid contracts effective December 31, 2026, unless the parties reach a new rate agreement. The contract dispute affects an estimated 380,000 Virginians enrolled in Anthem plans. Sentara has indicated it will not renew under current rate terms. The termination would force Anthem Medicaid managed care enrollees in Virginia to find new in-network providers or face out-of-network costs if the impasse continues through year-end.
- State Policy · IN
Indiana Medicaid Enrollment Drops 18.5% in One Year, Raising Uninsurance Concerns
Indiana's Medicaid enrollment declined by 343,000 people (18.5%) between June 2025 and June 2026, falling from 1.86 million to 1.51 million enrollees — one of the steepest drops nationally. The decline follows the end of Medicaid continuous coverage protections and completion of post-PHE redeterminations. Hospitals, providers, and advocates are concerned about rising uninsurance rates as former enrollees lose coverage. The enrollment reduction affects provider revenue, hospital uncompensated care levels, and managed care plan membership and capitation.
- State Policy · AR
CMS Denies Arkansas Medicaid Expansion Waiver Renewal Covering 200,000 Enrollees
The Centers for Medicare and Medicaid Services rejected Arkansas' request to renew its hybrid Medicaid expansion waiver, which currently covers more than 200,000 low-income adults. Governor Sarah Huckabee Sanders' office confirmed the verbal denial from CMS on Friday. The decision creates immediate uncertainty about whether Arkansas will continue expansion coverage, with potential coverage termination if no alternative arrangement is reached. Arkansas' expansion operates under a Section 1115 waiver with unique program features that required federal approval to continue.
- State Policy
HUD Point-in-Time Data Shows Trends in Homelessness Characteristics
This data note from KFF reviews trends in homelessness and characteristics of people experiencing homelessness using HUD's Point-in-Time count data. The analysis covers sheltered and unsheltered populations identified through annual surveys. While homelessness itself is not a Medicaid program issue, states increasingly use Medicaid waivers and health-related services to address housing instability among enrollees, particularly through LTSS and behavioral health programs. The data provides demographic and trend context relevant to state agencies designing targeted interventions.