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Tuesday, July 28 · 19 stories
- State Policy · CA
Los Angeles County Seeks Half-Cent Sales Tax to Shield Safety-Net Clinics from Medi-Cal Cuts
Los Angeles County voters will decide in June 2026 whether to approve a half-cent sales tax to generate approximately $1 billion annually for community health clinics. The proposed tax aims to protect safety-net providers from ongoing state Medi-Cal budget reductions and federal funding cuts. If approved, the measure would take effect following the June ballot. The initiative responds to financial pressures threatening clinic operations and access to care for Medi-Cal enrollees who rely on community clinics for primary care, behavioral health, and other essential services.
- Legal · NC
North Carolina Monitor Flags HCA for Potential Breach of Mission Hospital Sale Agreement
Dogwood Health Trust, the independent monitor overseeing HCA Healthcare's 2019 acquisition of Mission Hospital in North Carolina, notified the state attorney general that HCA may be in noncompliance with the sale contract. The two potential violations involve a federal warning in October 2025 that Mission risked losing Medicaid and Medicare participation status, and a second undisclosed issue. The monitor's role is to enforce conditions negotiated when HCA purchased the hospital, which serves as a critical safety-net provider in western North Carolina. The attorney general's office will determine whether enforcement action is warranted.
- State Policy · GA
Georgia Excludes HIV from Medically Frail Exemptions in Medicaid Work Requirement Proposal
Georgia's proposed Medicaid work requirement does not include HIV on its list of conditions qualifying beneficiaries as medically frail, meaning low-income Georgians living with HIV would need to meet work requirements to maintain coverage. The proposal is still under consideration by state officials. Advocates are questioning the exclusion, which could affect eligibility for vulnerable populations. The decision stands in contrast to other states that have included HIV in medically frail definitions for work requirement waivers.
Monday, July 27 · 19 stories
- Industry
Rural Hospitals Face New IT Compliance Pressures from HIPAA Security Rule Updates
Federal policymakers are increasing cybersecurity and AI requirements for healthcare providers, with proposed updates to the HIPAA Security Rule that would significantly expand compliance obligations. Rural hospitals face particular challenges implementing these requirements given constrained IT budgets and workforce capacity. The changes affect operational technology infrastructure, data security practices, and regulatory compliance frameworks. This matters for rural providers and safety-net systems already operating on thin margins, where IT investments compete with clinical priorities and workforce recruitment.
- Legal
CVS Moves to Dismiss Hospital Lawsuits Over 340B Savings Diversion
CVS Health filed motions to dismiss lawsuits brought by hospital systems in New York and Michigan alleging the company diverted 340B Drug Pricing Program savings. In a July 22 filing in the Eastern District of Michigan, CVS argued that University of Michigan Hospitals and Health Centers' lawsuit is a contract dispute rather than a 340B policy matter. The lawsuits center on allegations that CVS improperly retained savings intended for 340B-covered entities. The outcome could affect how pharmacy benefit managers handle 340B claims and reimbursements for safety-net providers, including Medicaid Disproportionate Share Hospitals.
- Industry
HCA Reports ACA Exchange Patients Dropping Coverage at Near One-to-One Rate in Q2
HCA Healthcare reported in its second quarter earnings that patients who previously had coverage through Affordable Care Act exchanges are going uninsured at nearly a one-to-one rate. CEO Sam Hazen acknowledged the trend is negatively impacting the company's financials. The shift increases uncompensated care costs for the nation's largest hospital operator. While the article focuses on commercial exchange coverage loss, the trend signals broader coverage instability that could increase Medicaid eligibility and enrollment as patients lose marketplace plans.
- Industry
Healthcare Spending Projected to Accelerate Amid Rising Utilization and Policy Changes
Healthcare spending is projected to increase sharply in coming years driven by higher medical utilization, according to multiple data sources. Contributing factors include H.R. 1 legislation that is restructuring Medicaid programs and the expiration of enhanced ACA subsidies, which may increase uninsured rates. The convergence of rising utilization and major policy shifts affecting coverage is expected to pressure healthcare costs across payers and providers. Medicaid program changes under H.R. 1 will directly affect state agencies, managed care organizations, and provider reimbursement structures.
- Federal Policy
HRSA Rural Maternal Health Program Reaches 8,600 Women Across Three States
The Health Resources and Services Administration's Rural Maternity and Obstetrics Management Strategies Program (RMOMS) improved prenatal and postpartum care access for more than 8,600 women through networks in Minnesota, Missouri, and West Virginia, according to a 2026 program report covering the second cohort. The program addresses maternal care gaps in rural areas where provider shortages and hospital closures limit access to obstetric services. RMOMS networks coordinate care across providers, implement telehealth, and expand midwifery services to maintain maternal health infrastructure in underserved communities. For Medicaid agencies and managed care organizations covering rural populations, the program demonstrates models for sustaining maternal care capacity where traditional hospital-based delivery is no longer viable.
- Legal
HHS-OIG Spring 2026 Report Details Oversight of $2.4 Trillion in Federal Health Spending
The HHS Office of Inspector General published its Semiannual Report to Congress covering October 1, 2025, through March 31, 2026. The report documents OIG's oversight activities across Medicare, Medicaid, and related public health programs, representing more than $2.4 trillion in annual federal health care spending. The report details enforcement actions, audit findings, and program integrity recommendations relevant to Medicaid programs and managed care plans. State Medicaid agencies and health plans should review the report for emerging enforcement priorities and compliance risks.
- State Policy
1.4 Million Uninsured in Ten Non-Expansion States Remain in Medicaid Coverage Gap
An analysis estimates 1.4 million uninsured individuals in the ten states that have not adopted Medicaid expansion remain in the coverage gap — earning too much for traditional Medicaid but too little to qualify for Marketplace premium tax credits. This population includes working adults, people of color, and individuals with disabilities. These individuals are ineligible for Medicaid because their states have not adopted the ACA's expansion to adults up to 138% of the federal poverty level and ineligible for Marketplace subsidies, which begin at 100% FPL. The analysis highlights the continued state-by-state variation in Medicaid eligibility and access to affordable coverage.
- Federal Policy
CMS Proposes Rule Implementing H.R. 1 Provider Tax Restrictions
CMS issued a proposed rule on July 21, 2026, implementing two of three provider tax restrictions from H.R. 1, which limits states' ability to use provider taxes to finance their Medicaid share. The rule prohibits new provider taxes and increases in existing taxes. This affects state Medicaid financing strategies and budget planning, with implications for how states fund their programs and potential pressure on state general funds. The proposal will proceed through standard notice-and-comment rulemaking.
- Legal
HHS Appeals Ruling Vacating Portions of 2025 Marketplace Integrity Rule
HHS and CMS filed an appeal in July 2026 challenging a Maryland federal district court's June 2026 decision that vacated portions of CMS's 2025 Marketplace Integrity and Affordability Rule. The underlying case was brought by the city governments of Columbus, Baltimore, and Chicago, along with other plaintiffs. The district court ruled on summary judgment to strike down specific provisions of the rule. The appeal will determine whether those provisions remain enforceable or are permanently set aside.
- Federal Policy
FDA Raises Safety Concerns About Compounded GLP-1 Drugs as Alternative to Ozempic
The FDA and physicians are expressing concern about compounded versions of GLP-1 drugs like Ozempic, which patients are increasingly using as cheaper, more accessible alternatives. These compounded formulations, while easier to obtain, carry serious safety risks according to medical experts. The issue affects Medicaid beneficiaries who may turn to compounded versions due to cost or access barriers with brand-name GLP-1s. This raises questions for state Medicaid programs about coverage policies, prior authorization criteria, and quality oversight for diabetes and weight management drugs.
- Industry
Danish Study Finds GLP-1 Drugs Reduce Long-Term Sick Leave by 17%
A study based on Danish data found that patients taking GLP-1 drugs experienced 17% fewer long-term work absences compared to those not on the medications. The research examined workplace absenteeism patterns among GLP-1 users. The findings suggest potential broader economic benefits beyond direct health outcomes. For Medicaid programs covering GLP-1s for weight management or diabetes, this data may inform cost-benefit analyses around coverage decisions, though workforce participation effects in Medicaid populations may differ from the Danish workforce studied.
- State Policy
National Association of Medicaid Directors Elects New Board Leadership
State Medicaid directors have elected a new board of directors for the National Association of Medicaid Directors (NAMD). The organization represents state Medicaid agencies in policy discussions with CMS and serves as the primary vehicle for state-to-state coordination on Medicaid program operations. The new board will guide NAMD's advocacy priorities and engagement with federal policymakers during a period of ongoing program changes. State agencies should monitor NAMD communications for shifts in organizational priorities or focus areas under the new leadership.
- Managed Care · CA
California Managed Care Plans Deploy Chief Health Equity Officers Under Medi-Cal Mandate
Medi-Cal managed care plans are required to employ chief health equity officers as part of California's strategy to address health disparities. These officers are implementing initiatives to reduce inequities in care delivery and outcomes across plan populations. The requirement affects all Medi-Cal MCOs operating in California. This represents a structural shift in how managed care plans address social determinants of health and health equity, requiring dedicated executive leadership and resources for disparities reduction.
- Industry
Bayada Deploys AI Clinical Decision Support to Reduce Home Health Hospitalizations
Home-based care provider Bayada is using AI-enabled clinical decision-support tools to identify patients at elevated risk of hospitalization earlier than traditional manual chart review. The tools synthesize electronic medical record data and clinical documentation to flag risk signals for care teams, enabling preventive interventions before conditions deteriorate. The approach aims to reduce avoidable acute care use among home health patients. This development matters for Medicaid managed care organizations that contract with home health agencies and bear financial risk for preventable hospitalizations, particularly in states with LTSS carved into managed care.
- Federal Policy
HHS Appeals Court Ruling Invalidating 2025 ACA Marketplace Rule Provisions
The Department of Health and Human Services filed an appeal to reinstate portions of a 2025 Affordable Care Act rule that a federal judge invalidated in June 2026. The invalidated provisions include shortened enrollment periods and stricter eligibility verification requirements for marketplace coverage. The appeal seeks to restore these requirements, which originally applied to ACA marketplace plans beginning with the 2026 plan year. The outcome affects marketplace operations and enrollment procedures, with potential implications for Medicaid-marketplace coordination on eligibility determinations and transitions between coverage types.
- State Policy
KFF Tracker Compiles State Rural Health Transformation Plans
KFF Health News is maintaining an ongoing database of state rural health transformation plans as they become available through state responses and public records requests. The tracker aims to compile approved plans across states. This is a standing resource updated as new state plans are obtained, not a report of a specific policy development or deadline.
- Federal Policy
CMS Proposes Mandatory Attestation Process for Off-Campus Hospital Outpatient Departments
The Centers for Medicare & Medicaid Services has proposed a new process requiring hospitals to submit provider-based attestations for off-campus hospital outpatient departments, converting what was previously a voluntary submission into a mandatory requirement. The proposed rule establishes a compliance framework for hospitals operating off-campus HOPDs under provider-based status. CMS has not specified an effective date or comment deadline in the available information. This change affects hospitals billing Medicare and Medicaid for services delivered at off-campus locations under provider-based arrangements, requiring new administrative processes to maintain compliance and avoid potential payment denials.