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Monday, July 27 · 19 stories
- State Policy · ID
Idaho to Implement Medicaid Expansion Work Requirements in 2027
Idaho will begin enforcing work requirements for Medicaid expansion enrollees in 2027, following state adoption of provisions from the federal One Big Beautiful Bill Act in April 2026. The Idaho Department of Health and Welfare will administer the requirements. State officials indicate most current expansion enrollees already meet the work requirement criteria, though specific exemption categories and compliance verification procedures have not been detailed.
- State Policy · NC
North Carolina AG Says Federal Medicaid Work Requirement Rule Shifts Millions to Counties
North Carolina's attorney general says a last-minute federal rule change regarding Medicaid work requirements will impose significant costs on counties. Congress included a medically frail exemption in last year's federal Medicaid work requirement law for individuals with serious or complex conditions like cancer, Parkinson's disease, and cystic fibrosis. The state AG contends recent federal regulatory changes will shift financial responsibility for administering or monitoring these exemptions to county governments, resulting in millions of dollars in unexpected local costs. The timing and specific implementation details of the rule change are causing concern about counties' ability to absorb these new expenses.
Friday, July 24 · 26 stories
- Legal · NY
New York Couple Spent Down Assets Before Accessing Medicaid Long-Term Care Coverage
A New York couple exhausted their retirement savings paying for healthcare before qualifying for Medicaid coverage, reflecting broader challenges with Medicaid eligibility rules for long-term care. The story illustrates how asset spend-down requirements can delay access to Medicaid-funded long-term services and supports for aging Americans who need care but have resources above eligibility thresholds. The couple's experience highlights ongoing policy tensions around Medicaid estate recovery, asset limits, and the financial burden on families navigating the transition from private pay to Medicaid coverage.
- Industry · IA
Democratic Lt. Governor Candidate Visits Youth Behavioral Health Facility in Iowa
Dave Muhlbauer, Democratic candidate for lieutenant governor in Iowa, visited Ember Recovery, a YSS-operated youth behavioral health facility in Cambridge, to discuss cannabis legalization policy and children's behavioral health treatment access. The visit focused on treatment accessibility for children with substance use and behavioral health needs. No specific policy proposals or program changes affecting Medicaid were announced during the visit.
- Industry
Study Finds GLP-1 Drugs Reduce Long-Term Sick Leave by 17 Percent
A study using Danish data found that patients taking GLP-1 medications had 17 percent fewer long-term sick leave absences compared to those not on the drugs. The research suggests potential workforce participation and productivity benefits beyond clinical outcomes for obesity and diabetes treatment. The findings may inform Medicaid coverage decisions and utilization management policies for GLP-1s, which have been subject to state budget scrutiny due to high costs. The study did not specify implementation timelines but reflects ongoing evaluation of these drugs' broader economic impacts.
- State Policy · WI
Wisconsin Medicaid Functional Screen Determines Long-Term Care Program Eligibility
Wisconsin Medicaid requires applicants for long-term care programs to pass a functional screen test in addition to meeting financial eligibility criteria. The functional screen assessment evaluates an individual's ability to perform activities of daily living and need for assistance to determine whether they meet the level of care required for program enrollment. The screen applies to programs including Family Care, IRIS, and institutional care. For applicants and providers, understanding functional screening requirements is critical to navigating Wisconsin's long-term care access and ensuring appropriate program placement.
- Federal Policy
No Surprises Act Disputes Rose 16% in Second Half of 2025
Providers and payers initiated 16% more disputes under the No Surprises Act in the second half of 2025 compared to the first half, according to new CMS data released July 23, 2026. Arbiters are closing cases more quickly and working through the backlog of disputes. The No Surprises Act primarily governs commercial insurance out-of-network billing disputes and does not apply to Medicaid managed care or fee-for-service.
- Federal Policy
CMS Mandates Notices for Medicaid Work Requirements as States Plan Broader Outreach
Federal regulations require state Medicaid agencies to notify enrollees affected by new work requirements, and most states are planning additional outreach including phone calls, public advertising, and social media. States face operational challenges meeting tight implementation timelines while complying with federal notice requirements. The brief examines state compliance strategies and the administrative burden of implementing work requirement communications across diverse enrollee populations.
- Industry
For-Profit Hospital Systems Report Higher-Than-Expected Uninsured Volume After ACA Subsidy Expiration
Major for-profit hospital operators including HCA Healthcare, Community Health Systems, and Tenet Healthcare reported in second-quarter 2026 earnings calls that ACA premium tax credit expiration produced larger-than-anticipated increases in uninsured patient volume. Patients who lost subsidized marketplace coverage are not transitioning to other insurance but instead remaining uninsured and continuing to seek care. The development affects hospital bad debt and charity care volumes effective second quarter 2026. This matters because increased uninsured volume at major hospital chains signals broader coverage losses that affect Medicaid-eligible populations through coverage transitions and emergency department utilization patterns.
- Industry
Rural Hospitals in Three States Form Regional Networks to Compete with Larger Systems
Independent rural hospitals in Minnesota, North Dakota, and Ohio are forming regional networks to gain scale and compete with consolidating health systems and payers, according to a Commonwealth Fund report published July 22, 2026. North Dakota's Rough Rider High-Value Network includes 23 critical access hospitals and launched with $3.5 million in funding. These networks aim to preserve local control while building collective bargaining power with payers and operational efficiencies. The consolidation trend affects Medicaid managed care plans contracting with rural providers and state agencies monitoring network adequacy in rural areas.
- Industry
Community Health Systems Reports Higher Uninsured Volume Pressures Q2 Financials
Community Health Systems reported second-quarter financial results reflecting higher-than-expected uninsured patient volumes, primarily attributed to patients dropping Affordable Care Act coverage. The for-profit hospital operator indicated these uninsured volumes are affecting revenue and margins more significantly than projected. The trend reflects broader ACA enrollment shifts impacting hospital payer mix. CHS joins other hospital systems reporting increased uncompensated care costs as commercial and subsidized coverage levels fluctuate.
- State Policy
KFF Tracker Compiles State Abortion Coverage Policies Across Medicaid and Exchange Plans
This interactive resource tracks state-level abortion coverage policies across Medicaid, private insurance, and ACA exchange plans as of 2025. The tracker shows the number of states with laws restricting abortion coverage in Medicaid and private insurance has increased since 2010. It provides a state-by-state breakdown of coverage restrictions, exceptions for life endangerment or other circumstances, and differences between Medicaid fee-for-service and managed care plan coverage. The tool allows Medicaid agencies, health plans, and advocates to compare abortion coverage rules across states and insurance types.
- State Policy · CA
California Medi-Cal Enrollment Drops 5% as 730,000 Disenroll Between June 2025 and March 2026
California's Medi-Cal program lost 730,000 enrollees—a 5% decline—between June 2025 and March 2026, according to California Health Care Foundation data analysis. Undocumented children and young adults experienced disproportionate coverage losses during this period. The enrollment decline follows the end of Medicaid continuous coverage requirements that had kept enrollment elevated during the public health emergency. State agencies and managed care plans should anticipate continued membership volatility and assess impacts on network capacity, risk adjustment, and community-based provider networks serving populations with higher disenrollment rates.
- Legal
HHS Delegates Exclusion Authority to CMS as Q1 2026 Revocations Surge 40%
On July 21, 2026, HHS Secretary Kennedy announced that CMS now has direct exclusion authority, previously held only by the HHS Office of Inspector General. CMS revoked 1,413 Medicare and Medicaid providers and suppliers in Q1 2026, a 40% increase over prior years and the largest quarterly surge on record. The delegation gives CMS "force multiplier" capacity to exclude providers from federal health programs based on fraud, abuse, or program integrity concerns. Medicaid managed care organizations must screen networks for excluded providers and may face increased mid-year terminations and provider adequacy challenges as revocation volumes accelerate.
- Industry
Major Health Insurers Shift Focus to Services Units in Q2 Earnings
UnitedHealth Group and Elevance Health reported second-quarter 2026 earnings showing increased reliance on their services divisions rather than traditional insurance operations. The companies continue to invest heavily in these non-insurance business units, accelerating a long-term diversification trend. This shift affects how major payers — many of which operate Medicaid managed care plans — allocate capital and structure their operations. The earnings reports reflect a broader industry pivot away from pure risk-bearing insurance models toward integrated care delivery and services.
- Legal · WA
Seattle Hospital, UNOS Sued Over Race-Adjusted Kidney Function Formula Delaying Transplant Eligibility
A lawsuit filed July 21, 2026 in U.S. District Court for the Western District of Washington alleges Swedish Medical Center and the United Network for Organ Sharing used a race-based kidney function formula that delayed the plaintiff's transplant waitlist eligibility by six years. The complaint challenges the use of race-adjusted eGFR calculations in determining transplant eligibility. The case follows broader clinical and policy shifts away from race-based algorithms in kidney function assessment. The outcome could affect transplant referral protocols and eligibility determinations for Medicaid beneficiaries with end-stage renal disease.
- Managed Care
Survey Finds 62% of Family Caregivers View Home Care as Long-Term Solution
A 2026 report from A Place for Mom found that 62% of family caregivers view home care as a long-term or permanent solution for aging in place, suggesting families are more likely to adjust home care hours than transition to institutional settings. The finding indicates sustained demand for home and community-based services. While the brief article does not provide detailed methodology or timing, the trend reflects ongoing caregiver preferences that influence LTSS utilization patterns and Medicaid HCBS program design.
- Industry
Home Health Care News Profiles Six Home Health Companies for 2026
Home Health Care News highlights six home health companies amid a 2026 landscape shaped by a Medicare enrollment moratorium aimed at combating fraud and increased federal program integrity enforcement. The article examines how these companies are positioned to navigate regulatory constraints that industry observers say may limit provider growth. The coverage appears focused on business strategy and market positioning rather than Medicaid-specific policy developments.
- Industry
Hospital Behavioral Health Programs Shift Performance Metrics to Long-Term Patient Outcomes
Hospitals are increasingly measuring behavioral health program success through long-term patient outcomes rather than traditional short-term metrics. The shift emphasizes performance measures aligned with care pathways and sustained patient improvement. This approach reflects growing recognition that acute-care metrics may not accurately capture behavioral health treatment effectiveness. The change affects how hospitals evaluate programs and allocate resources for behavioral health services.
- Federal Policy
KFF Poll: CDC Trust Stable While Confidence in Trump, State Officials Declines
A July 2026 KFF tracking poll finds public trust in the CDC as a health information source has stabilized after steep declines between 2020 and early 2026, while trust in President Trump and state government officials as health information sources has decreased over the past six months. The poll marks a potential inflection point in public confidence in federal health agencies following years of erosion. For Medicaid agencies and health plans managing public health messaging around coverage, benefits, and care access, understanding shifting trust dynamics affects member communication strategies and credibility of guidance tied to federal or state sources.