All stories
Jump to date
Wednesday, September 30 · 35 stories
- Industry
Becker's: 2027 Drug Pricing Changes Pose Cash Flow, Not Margin, Risk
In a Becker's Hospital Review commentary, the author argues that three federal drug pricing changes taking effect Jan. 1, 2027 should be understood primarily as a cash flow timing problem rather than a permanent margin loss for providers and pharmacies. The piece pushes back on recent coverage characterizing the changes as catastrophic, arguing the actual financial mechanics are more nuanced. The commentary frames the issue around how multiple federal changes converging on the same prescription create timing mismatches in reimbursement rather than structural profitability declines. The author's argument centers on encouraging providers and pharmacy stakeholders to reassess their operational and financial planning assumptions ahead of the effective date.
- State Policy · WV
WV Advocates Press State to Fix Autism Therapy Workforce Shortage
Advocates for children with autism in West Virginia are urging state officials to address a shortage of workers who provide applied behavior analysis and other therapy services covered by Medicaid. Families report long waitlists and difficulty accessing care due to insufficient numbers of trained providers, particularly in rural areas. The advocates are calling on state leaders to take action on reimbursement rates, provider recruitment, or other policy levers to expand the workforce. No specific legislative or regulatory proposal has yet been detailed in this report.
- Federal Policy
Census Bureau Proposes 2030 Rule Changing Residency, Apportionment Rules
In a resource brief, State Health and Value Strategies examines a Census Bureau proposed rule, published September 10, 2026, that would overhaul 2030 Census residence criteria and demographic data collection, alongside a new Disclosure Avoidance Order changing privacy protection methods for public data products. The residency proposal would exclude many non-citizens from population counts and establish a new January 3–April 1 enumeration period, while also excluding undocumented immigrants and other groups from congressional apportionment counts. State health agencies rely on Census products like the American Community Survey and Current Population Survey for Medicaid and CHIP funding formulas, coverage monitoring, disparity analysis, and program cost projections. Comments on the proposed rule are due October 13, 2026, giving states a limited window to weigh in on changes that could ripple through health policy data infrastructure.
- Federal Policy
Trump Administration Withholds Health Funds Before Fiscal Year Deadline
The Trump administration has declined to spend billions of dollars in congressionally appropriated health program funding, risking its expiration at the fiscal year-end on Wednesday. Democratic lawmakers and some Republicans argue the withholding violates federal law governing appropriated funds. The impasse tests whether Congress will act to compel spending of the funds before they lapse. The story does not specify which health programs or dollar amounts are affected.
- State Policy · MO
Missouri Lacks Mandatory Mental Health Screening for Pregnant Patients
Missouri's latest Pregnancy-Associated Mortality Review found mental health conditions and substance use disorder contributed to nearly a quarter of pregnancy-related deaths from 2019 to 2023, with 24 of 108 reviewed deaths attributed to these causes. Providers failed to complete mental health or other key screenings in 38 of the deaths reviewed, and nearly 80% of pregnancy-related deaths were deemed preventable, including all mental health and substance use deaths. Screenings for perinatal mental health conditions remain voluntary in Missouri rather than mandatory, and the state received a "C" grade in 2026 from the Policy Center for Maternal Mental Health, up from a D-minus in 2023. The mortality rate was 2.9 times higher for women on Medicaid than those with private insurance, and rural areas, especially northeast Missouri, saw the highest death rates and face acute shortages of mental health providers.
- State Policy · SD
South Dakota Ballot Measure Opponents Warn of Medicaid Expansion Repeal Risks
Opponents of South Dakota's Amendment I, on the Nov. 3 ballot, said Monday the measure would reduce health care access and shift costs to privately insured residents. Amendment I would automatically repeal Medicaid expansion if federal funding for the expansion population is reduced below current levels. South Dakota's Republican attorney general and other opponents oppose the measure, arguing it threatens coverage gained through expansion. The vote takes place November 3, and its outcome will determine whether the state's expansion population retains coverage if federal funding changes.
- Legal · CO
CWS Colorado Director Urges Congress Restore Refugee Medicaid Eligibility
In a Colorado Newsline commentary, Kristy Beachy-Quick of CWS (Church World Service) argues that federal law revoking Medicaid eligibility for refugees, asylees, humanitarian parolees, and trafficking survivors will harm vulnerable Coloradans starting October 1, 2026. She cites the 2025 federal reconciliation law (H.R.1) as eliminating this coverage for roughly 7,000 Coloradans, leaving chronic conditions untreated and shifting costs to hospitals, food banks, and nonprofits. The author contends refugees contribute significantly in taxes and economic activity, citing state estimates of $127.1 million in state/local taxes and $233.3 million in federal taxes paid by Colorado refugees in 2023. She calls on Congress to restore Medicaid eligibility for these humanitarian populations.
- State Policy · NE
Nebraska Early Data Shows Medicaid Work Requirement Verification Outcomes
A policy brief examines Nebraska's process for verifying compliance with Medicaid work requirements and reports early data on how enrollees subject to the requirement have fared. The brief details how the state confirms work, education, or other qualifying activities, and what share of affected enrollees have successfully verified compliance versus those at risk of losing coverage. Findings are relevant as more states implement or plan similar requirements following federal changes expanding work requirement mandates. The brief highlights administrative and verification challenges that could inform other states' implementation strategies.
- State Policy · CO
Colorado Warns Proposed Federal Rules Would Cut Medicaid Funding
Colorado officials say newly proposed federal rules would have a "disastrous" effect on Medicaid and other insurance funding streams, further straining an already stressed state budget. The state warns that lost federal funding under the proposal would force difficult tradeoffs in coverage and spending. Details on the specific federal rule's scope, comment deadline, and mechanism are not fully specified in the source report. State officials are raising alarms as the proposal moves through the federal rulemaking process.
- Federal Policy
Bipartisan Bill Would Make PACE a Mandatory Medicaid Service
Reps. Debbie Dingell (D-Mich.) and John Moolenaar (R-Mich.) introduced the PACE Access Improvement Act on Sept. 24, which would make the Program of All-Inclusive Care for the Elderly a mandatory Medicaid service rather than a state option. The bill also aims to ease requirements so PACE providers can expand in-home care access. States currently choose whether to offer PACE, which serves frail, dual-eligible seniors who qualify for nursing home care but wish to remain in the community. If enacted, the measure would require all state Medicaid programs to cover PACE, likely spurring growth in the number of PACE organizations and enrollees nationwide.
- Legal · NC
Whistleblowers Allege NC Officials Falsified Medicaid Tech Funding Bids
A newly unsealed federal lawsuit alleges former North Carolina health officials submitted false information to secure federal funding for a Medicaid technology overhaul, and that federal regulators approved the funding despite warning signs. Former state employees serving as whistleblowers brought the claims, which implicate both state Medicaid leadership and the federal approval process. The lawsuit was previously dismissed but the whistleblowers may seek to revive it. The case raises questions about oversight of federal matching funds for state Medicaid IT modernization projects.
Tuesday, September 29 · 26 stories
- Industry
RFK Jr., Vance Headline MAHA Summit on Health Policy Agenda
HHS Secretary Robert F. Kennedy Jr. and Vice President JD Vance are leading a daylong "Make America Healthy Again" summit in Washington on Tuesday, gathering Trump administration officials, health care and tech executives, and MAHA allies. Sessions cover health care affordability, food policy, and artificial intelligence, among other topics. The event is a policy and messaging forum rather than a rulemaking action, but it signals priorities that could shape future administration health initiatives. No specific Medicaid policy announcements are described in the available details.
- Industry
Covista Report Warns Clinician Shortage Will Double by 2040
A new report from healthcare education company Covista projects that the U.S. clinician shortage will double by 2040, warning of a looming workforce crisis across the health care system. The report highlights growing gaps in physicians, nurses, and other clinical staff that could strain care delivery nationwide. Covista argues the trend is not yet irreversible and points to workforce education and training strategies as potential mitigation steps. The report does not detail a specific timeline for policy action but frames the issue as an urgent, worsening trend.
- Industry
UnitedHealthcare Names Robert Hunter as New President
UnitedHealthcare has appointed Robert Hunter as president, tasking him with leading the company's "modernization agenda." The move is the latest in a series of leadership changes at parent company UnitedHealth Group as it seeks to rebuild its public image. No specific start date or further details on Hunter's mandate were provided beyond the modernization focus.
- Industry
McKinsey: AI Could Handle Up to 22% of Outpatient Care
A McKinsey & Co. analysis published Sept. 28 estimates AI could perform the clinical work behind 16% to 22% of U.S. outpatient claims, representing roughly 2 billion to 3 billion claims and 13% to 19% of outpatient spending. The analysis draws on 2024 commercial, Medicare and Medicaid claims data. It suggests a substantial share of outpatient services across payer types, including Medicaid, involve tasks that current AI capabilities could technically automate. The report does not specify implementation timelines or payer-specific adoption plans.
- Federal Policy · MT
CMS Awards $8.7 Million for Rural Montana Ambulance Upgrades
CMS announced $8.7 million in federal funding to purchase new ambulances and medical equipment for rural emergency medical service providers across Montana. The funding is intended to help rural communities replace aging equipment and improve emergency response capacity. Federal officials framed the award as part of a broader push to support rural health infrastructure. Specific implementation timelines and grant recipient details were not detailed in the announcement.
- Federal Policy
States Face Deadline to Join Medicaid International Drug Pricing Pilot
In its D.C. Diagnosis newsletter, STAT reports that Wednesday is the deadline for states to opt into GENEROUS, a pilot program letting Medicaid access drugs at prices available abroad. Separately, the Senate health committee will vote Wednesday on three HHS nominees, but not on Heidi Overton, the nominee to lead the FDA, whose confirmation now won't be decided until after the Senate returns Nov. 9. CMS Administrator Mehmet Oz is also traveling to Texas to promote CHOICE arrangements, which let employers give workers tax-free funds to buy ACA Marketplace coverage.
- State Policy
CHCS Outlines Strategies to Link Primary Care, Food Is Medicine
In a blog post, the Center for Health Care Strategies presents three strategies for state Medicaid agencies to strengthen primary care's role in connecting members to Food Is Medicine (FIM) interventions, such as medically tailored meals and produce prescriptions. The piece targets state Medicaid officials seeking to embed nutrition-related screening, referral, and care coordination into primary care workflows. It frames primary care providers as a key entry point for identifying food insecurity and directing members to FIM services. No specific regulatory or funding action is announced; the post offers programmatic guidance for states designing or scaling these efforts.
- State Policy · KS
Kansas Builds Sustained Medicaid-Public Health Coordination Model
In a NAMD snapshot, the association profiles Kansas's approach to bridging Medicaid and public health agencies through sustained, structured collaboration rather than one-off, crisis-driven coordination. The model relies on monthly cross-agency meetings, shared data governance arrangements, and joint initiatives covering newborn screening, infectious disease response, and rural maternal and infant health. State Medicaid agencies and public health departments are the primary audience, as the profile is meant to offer a replicable framework for other states seeking to formalize interagency coordination. No specific effective date or regulatory action is described; the piece functions as a case study of institutional practice.
- Legal · MD
UMMS Settles With Maryland AG Over Facility Fee Billing
University of Maryland Medical System agreed to pay more than $2.25 million in restitution to patients to resolve a dispute with the Maryland attorney general's office over outpatient facility fees. The settlement covers facility fees charged between January 1, 2017 and June 30, 2021, and was signed in September. Affected patients who were billed these fees during the covered period will receive refunds under the agreement. The case highlights continued regulatory scrutiny of hospital facility fee billing practices that affect commercially insured and government payer patients alike.