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Thursday, July 30 · 22 stories
- State Policy · CO
Colorado Enacts ABA Provider Licensure Law With Medicaid Implications
Colorado Governor signed HB 26-1425 on June 2, 2026, establishing the Applied Behavior Analysis Practice Act. The law creates comprehensive licensing requirements for ABA practitioners and provider entities operating in Colorado, including facility licensing, professional liability insurance mandates, and provisions affecting Medicaid reimbursement. The legislation includes phased implementation timelines. ABA providers serving Colorado Medicaid beneficiaries must prepare for new credentialing, facility standards, and compliance requirements that will affect network participation and claims processing.
- Federal Policy
CMS Finalizes 2.3% IPF Payment Increase for FY 2027, Delays Outlier Cap
CMS issued a final rule July 29 increasing inpatient psychiatric facility payments by 2.3% ($60 million) for fiscal year 2027, reflecting a 3.2% market basket update minus a 0.9-point productivity adjustment. The rule finalizes an outlier payment cap but defers implementation until FY 2028 and excludes facilities with fewer than 50 stays annually. CMS also removes two quality reporting measures on alcohol and tobacco screening effective CY 2026/FY 2028 and modifies implementation of the standardized IPF Patient Assessment Instrument with a lower compliance threshold and extended timeline. Changes take effect October 1, 2026.
- State Policy · IA
Iowa Democratic Gubernatorial Candidate Pledges to End Medicaid Managed Care
A Democratic candidate for Iowa governor has announced plans to eliminate the state's private Medicaid managed care program if elected, which would make Iowa the second state to exit managed care after implementing it. The candidate characterized the current managed care system as "a disaster." Iowa transitioned to managed care several years ago, contracting with private health plans to administer Medicaid benefits. The outcome of the gubernatorial race will determine whether Iowa's Medicaid MCOs retain their contracts or face termination, affecting coverage for hundreds of thousands of enrollees.
- Legal
Texas District Court Vacates CMS Rule Excluding 1115 Waiver Days from DSH Calculations
On July 27, 2026, the U.S. District Court for the Northern District of Texas vacated a 2023 CMS regulation that excluded inpatient days covered by Section 1115 waiver uncompensated care funding pools from Medicaid disproportionate share hospital (DSH) day counts. This is the second time the court has struck down this rule in Covenant Medical Center v. Kennedy. The ruling affects how hospitals calculate their Medicaid patient volume for DSH payment eligibility. The decision takes effect immediately, allowing hospitals to include these waiver days in their DSH calculations until CMS takes further action.
Wednesday, July 29 · 20 stories
- Industry
Law Firm Publishes Explainer on Special Needs Trusts and Medicaid Eligibility
Lippes Mathias LLP published an educational article explaining how special needs trusts can preserve Medicaid and SSI eligibility for individuals with disabilities who receive inheritances, gifts, or legal settlements. The piece outlines how direct financial transfers can disqualify beneficiaries from needs-based programs, and describes trust structures designed to maintain eligibility while providing supplemental support. The article is a general educational resource for families and estate planners, not a policy development or regulatory action. It does not announce new guidance, legal precedent, or program changes affecting Medicaid administration.
- State Policy
Pennsylvania, Nevada, Wisconsin Medicaid Directors Detail Member Engagement Strategies
Three state Medicaid directors describe operational approaches for gathering and acting on member feedback, including advisory councils, community listening sessions, and embedding member voices in agency decision-making. The leaders discuss how they structure engagement to reach diverse populations, particularly members with complex needs, and translate input into policy and operational changes. These practices aim to improve program responsiveness and member experience across eligibility, benefits, and service delivery.
- State Policy · LA
Louisiana Enacts Commercial PBM Reimbursement Floor Using NADAC
Louisiana enacted Act 913 on June 12, establishing a commercial market reimbursement floor for pharmacy benefit managers that requires use of National Average Drug Acquisition Cost (NADAC) as the reimbursement benchmark. The law applies to commercial PBM arrangements and includes provisions intended to prevent cost-shifting to patients. The legislation took effect upon signing and affects how PBMs reimburse pharmacies in commercial insurance markets in Louisiana.
- Federal Policy
HHS Secretary Kennedy Convenes Health Plans and Providers on Behavioral Health Quality Pledge
HHS Secretary Robert F. Kennedy, Jr. held a roundtable with healthcare leaders, insurers, medical societies, and behavioral health providers who pledged to advance best practices for mental health and addiction treatment. The meeting occurred on July 29, 2026, at HHS headquarters in Washington. The voluntary commitments focus on improving care quality and patient outcomes across the behavioral health system. The initiative signals federal priority attention to behavioral health standards but lacks binding requirements or timelines for implementation.
- Federal Policy
KFF Analysis Finds SSI Applicants Face Coverage Risk Under Medicaid Work Requirements
KFF released a policy analysis examining how Medicaid work requirements could affect Supplementary Security Income (SSI) applicants. The analysis finds that SSI applicants are at heightened risk of losing Medicaid coverage due to challenges navigating the medical frailty exclusion verification process under work requirement policies. While individuals with disabilities are typically exempt from work requirements through medical frailty provisions, SSI applicants — who are in the process of establishing disability status — may struggle to document their conditions quickly enough to maintain continuous coverage. The analysis highlights operational barriers that could lead to coverage gaps for this vulnerable population.
- State Policy · OR
Oregon Medicaid Enrollees Face New Requirements Under HR1 Starting January 2027
Oregon Health Plan enrollees will be subject to new eligibility requirements beginning January 2027 under the One Big Beautiful Bill Act (HR1). The federal legislation mandates a slate of new requirements for Medicaid beneficiaries that Oregon must implement. The changes take effect in approximately six months. Oregon Medicaid agencies and managed care plans will need to modify systems, processes, and beneficiary communications to comply with the federal mandate.
- Industry
CHCS Report Examines Women's Financial Security Challenges Including Health Care Costs
The Center for Health Care Strategies published a report examining how caregiving responsibilities, health care costs, longer lifespans, and workforce participation patterns affect women's financial stability as they age. The analysis explores structural factors that create financial vulnerability among women over their lifetimes. While the report addresses health care costs as one component of women's financial challenges, it does not announce or analyze specific Medicaid policy changes, program rules, or managed care operations.
- State Policy
CHCS Report Outlines State Strategies to Address Social Isolation Among Older Adults
The Center for Health Care Strategies published a report examining how states and communities can help older adults build social connections and reduce isolation. The report identifies strategies for state Medicaid agencies and community organizations to support older adults in connecting to social resources. It addresses a population health priority relevant to states implementing Medicaid LTSS programs and managed care plans serving dual-eligible beneficiaries. The guidance is particularly relevant for states operating HCBS waivers and integrated care models where social determinants of health are increasingly incorporated into care management.
- State Policy · NM
New Mexico Launches Healthy Aging App for Older Adults via UNM Health Sciences
The University of New Mexico Health Sciences Center launched Vive Bien/Live Well, a healthy aging program designed to help older adults maintain health, independence, and quality of life. The program is funded by the New Mexico Health Care Authority and aligns with the World Health Organization's Integrated Care for Older People framework. The initiative targets the state's aging population with tools to support independent living and reduce care needs.
- Industry
High Interest Rates Create Buying Opportunities in Home-Based Care M&A
Higher borrowing costs have slowed merger and acquisition activity in the home-based care sector, but investors willing to enter the market now may benefit from more favorable deal terms. The slower dealmaking environment has made compliance screening a more important factor in transactions. Buyers able to absorb higher interest rates are finding opportunities as sellers face pressure to consolidate. The shift affects Medicaid managed care organizations and state agencies contracting with home health and home- and community-based services providers.
- Industry
Hospital-at-Home Programs Show Equivalent Readmission Rates for Heart Failure Patients
A study published in JAMA Network Open found that heart failure patients receiving advanced medical care at home had comparable post-discharge outcomes to those treated in traditional hospital settings, with no significant differences in readmission rates. The research supports hospital-at-home as a viable alternative care delivery model for heart failure management. The findings may inform future Medicaid coverage policies and managed care contracting decisions around alternative site-of-service arrangements. The study provides evidence on quality and safety parity between home-based and facility-based acute care for this high-cost, high-utilization condition.
- Industry
ACA Subsidy Expiration Boosts Payer Margins, Shifts Hospital Payer Mix
The expiration of enhanced ACA premium tax credits is improving profit margins for several health insurers while increasing uninsured volume at major hospital systems. The enhanced credits, which reduced exchange premiums for millions of enrollees, lapsed and are no longer available. Insurers are seeing improved margins as healthier enrollees drop coverage while sicker members remain, and as medical loss ratios decline. Hospitals report increased uninsured and self-pay volumes as former exchange enrollees seek care without coverage.
- Federal Policy
CMS Re-Establishes Data Match With OPM for Marketplace and Medicaid Eligibility Verification
CMS has re-established a Privacy Act matching program with the Office of Personnel Management to verify minimum essential coverage through OPM health benefit plans. The data match enables CMS and State Administering Entities to determine eligibility for qualified health plans through exchanges and insurance affordability programs, including Medicaid and CHIP. The match supports initial eligibility determinations, renewals, redeterminations, and appeals. Effective July 29, 2026, this routine data exchange ensures states can verify coverage status when individuals apply for Medicaid or marketplace subsidies.
- Federal Policy
ACAP and CHCS Launch Technical Assistance Series on Medicaid Work Requirements
The Association for Community Affiliated Plans and the Center for Health Care Strategies announced a learning and action series to help safety net health plans implement newly established Medicaid work requirements. The initiative will provide technical assistance to plans as they develop operational processes for verifying beneficiary compliance, managing exemptions, and coordinating with state agencies. The timing suggests recent federal policy changes have authorized or expanded work requirement programs in multiple states. Safety net plans serving Medicaid populations will need new systems for tracking work activities, processing beneficiary documentation, and managing potential coverage terminations for noncompliance.
- Industry
Rural Hospitals Closed at Triple the Opening Rate Since 2001, Yale Data Shows
Rural hospitals accounted for all net hospital losses in the United States between 2001 and 2023, closing at more than three times the rate they opened, according to Yale University's Health Care Affordability Lab data. The data tracks both openings and closures during this 22-year period. Rural hospital closures disproportionately affect Medicaid beneficiaries who rely on these facilities for emergency care, obstetric services, and behavioral health treatment, often with limited alternative access points.
- State Policy · CA
California Business Group Opposes November Ballot Measure on Billionaire Tax for Medi-Cal
A California business association leader is opposing a November 2026 ballot measure that would impose a tax on billionaires to address Medi-Cal funding shortfalls and rising living costs. The op-ed argues the measure would harm long-term economic growth despite potential short-term revenue gains. The ballot measure has not yet been voted on. This matters for California Medi-Cal stakeholders because the measure, if passed, could alter the state's Medicaid funding landscape and sustainability.
