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Wednesday, July 8 · 37 stories
- State Policy
CHCS Report Outlines State Medicaid Strategies to Expand CGM Coverage
The Center for Health Care Strategies published a report examining how state Medicaid programs can expand access to continuous glucose monitors for beneficiaries with diabetes. The report addresses coverage policies, prior authorization requirements, and reimbursement strategies that states can implement to improve glucose management technology access. It highlights disparities in diabetes outcomes among Medicaid populations and presents policy options for removing barriers to CGM adoption. The recommendations are relevant for managed care organizations responsible for implementing durable medical equipment benefits and managing diabetes care quality metrics.
- Federal Policy
Health Care Coalition Seeks HHS Clarification on SUD Community Engagement Exemptions
ACAP and a coalition of health care organizations submitted a letter to HHS on February 7, 2026, requesting clarification on how Medicaid managed care plans should verify and document substance use disorder (SUD) treatment exemptions from community engagement requirements. The letter addresses operational challenges MCOs face in implementing exemption processes without clear federal guidance on documentation standards, member privacy protections, and coordination with SUD providers. The coalition seeks guidance on verification procedures to ensure eligible beneficiaries receive exemptions while maintaining compliance with federal requirements.
- Managed Care
ACAP Report Documents Safety Net Health Plan Chronic Disease Programs
The Association for Community Affiliated Plans released a report on January 15, 2026 documenting chronic disease management initiatives deployed by safety net health plans. The report highlights member-focused programs addressing conditions prevalent in Medicaid and dual eligible populations. Safety net health plans serving Medicaid beneficiaries can review documented approaches and potentially adapt models for their own populations. The report provides examples of operational interventions currently in use across ACAP member organizations.
- Managed Care
ACAP Proposes Five Dual SNP Demonstration Programs to Improve Care Coordination
The Association for Community Affiliated Plans released a report proposing five demonstration programs to leverage Dual Eligible Special Needs Plans (D-SNPs) for improved care coordination. The proposals target Medicare beneficiaries enrolled in D-SNPs, which serve individuals eligible for both Medicare and Medicaid. The report comes as CMS and states continue to pursue integrated care models for dually eligible populations. The proposals matter for Medicaid managed care organizations operating D-SNPs or seeking to expand dual-eligible programs, as they outline potential policy pathways for enhanced integration and coordination between Medicare and Medicaid benefits.
- State Policy · WA
Washington State Receives Recognition for Medicaid Reentry Program
Washington State has been recognized for its Medicaid reentry program serving justice-involved individuals. The program represents state-level implementation of policies enabling Medicaid coverage for incarcerated individuals in the period before release. This recognition highlights Washington's approach to establishing pre-release Medicaid enrollment and services. The program is part of broader state efforts to implement Section 1115 waiver authority or state plan amendments that allow Medicaid coverage for certain services during incarceration, particularly for individuals with behavioral health and substance use disorder needs.
- State Policy · GU
Guam Receives National Award for Medicaid IT System Modernization
Guam's Medicaid program received a national award for its innovative collaboration to modernize its IT systems and operations. The recognition highlights the territory's approach to upgrading its Medicaid infrastructure. The award comes from the National Association of Medicaid Directors. This modernization effort affects how Guam administers its Medicaid program, including managed care oversight, eligibility systems, and operational processes that impact health plans operating in the territory.
- Federal Policy
State Health Associations Urge Congress to Fully Fund Territory Medicaid and CHIP Programs
The Association of State and Territorial Health Officials (ASTHO) and the National Association of Medicaid Directors (NAMD) jointly called on Congress to provide full federal funding for Medicaid and CHIP programs in U.S. territories. Unlike states, territories receive capped federal Medicaid funding rather than open-ended matching funds, creating coverage gaps and program instability. The organizations advocate for parity in federal funding treatment between states and territories. This call comes as territories face recurring funding cliffs that threaten coverage for vulnerable populations.
- State Policy
State Medicaid Directors Report Section 1115 Waiver Approval Delays at CMS
The National Association of Medicaid Directors (NAMD) has raised concerns about delays and challenges in the Section 1115 waiver approval process at CMS. Section 1115 waivers allow states to test innovative approaches in their Medicaid programs, including managed care delivery system reforms, coverage expansions, and payment models. The delays affect states' ability to implement planned program changes and innovations. This matters for Medicaid managed care organizations because Section 1115 waivers frequently authorize new managed care authorities, quality initiatives, value-based payment arrangements, and coverage requirements that MCOs must operationalize.
- State Policy
NAMD Calls for Congressional Action to Improve Section 1115 Waiver Process
The National Association of Medicaid Directors is urging Congress to reform the Section 1115 waiver system to better support state innovation in Medicaid programs. NAMD argues the current waiver process limits states' ability to pursue program improvements aligned with health and wellness goals. The commentary does not specify particular legislative proposals or timelines. For Medicaid managed care organizations, waiver reforms could expand opportunities for state-MCO partnerships on value-based care, social determinants of health interventions, and delivery system innovations.
- Managed Care
NAMD Discusses Medicaid Coverage of GLP-1 Weight Loss Drugs
The National Association of Medicaid Directors addressed Medicaid coverage considerations for new anti-obesity medications in a discussion with VeryWellHealth reporters. The conversation focused on access and policy implications for Medicaid enrollees. As GLP-1 drugs like Wegovy and Zepbound gain FDA approval for weight loss, state Medicaid programs face coverage decisions affecting millions of beneficiaries. Medicaid managed care plans must navigate utilization management, prior authorization requirements, and budget impact as states determine whether and how to cover these high-cost medications.
- State Policy
NAMD Reports State Medicaid Budget Pressures in 2024
The National Association of Medicaid Directors released a discussion on budget challenges facing state Medicaid programs. States are confronting fiscal pressures as Medicaid enrollment stabilizes post-unwinding and healthcare costs rise. The document addresses how budget constraints affect program design, benefits, and provider rates. State Medicaid directors are navigating these fiscal realities while maintaining program coverage and quality requirements.
- Industry
Trump Officials Press Drug Industry to Onshore Generic Manufacturing
Secretary of State Marco Rubio, HHS Secretary Robert F. Kennedy Jr., and CMS Administrator Chris Klomp held a private meeting with pharmaceutical industry leaders to encourage domestic production of generic drugs. The officials are pushing companies to shift manufacturing capacity from overseas facilities, particularly from China and India, back to the United States. The timing and specific policy mechanisms for incentivizing onshoring were not detailed in the reporting. The initiative reflects ongoing federal concerns about pharmaceutical supply chain vulnerabilities that have periodically disrupted access to essential medications, including those covered by Medicaid managed care plans.
- State Policy · MN
Minnesota Counties Report Administrative Strain from Medicaid Renewal Processing
Minnesota counties are experiencing significant administrative burden processing Medicaid renewals following the end of the continuous enrollment period. Dual-eligible beneficiaries and tribal members report receiving inappropriate redetermination notices despite categorical eligibility protections. Counties cite inadequate state support and staffing shortages as renewal volumes exceed capacity. The processing delays affect timely coverage determinations for beneficiaries who should maintain continuous eligibility under federal and state rules.
- State Policy · AZ
Arizona Democrats Report Coverage Losses One Year After Federal Budget Reconciliation
Democrats in Arizona are reporting increased coverage losses among state residents one year after enactment of the "One Big Beautiful Bill Act," federal budget reconciliation legislation that reduced federal spending on healthcare programs including Medicaid. The officials indicate families in Arizona have experienced difficulty accessing public coverage. The law, signed by President Trump in 2025, included cuts to programs serving lower-income populations. State leaders are documenting the legislation's effects on Arizona's Medicaid program and beneficiary enrollment.
- Federal Policy
CMS Proposes Rule Codifying Medicare Drug Price Negotiation Program
On June 16, 2026, CMS published a proposed rule to codify the Medicare Drug Price Negotiation Program established by the Inflation Reduction Act of 2022. The rule would formalize existing program guidance, introduce new policy proposals, and establish the regulatory framework for drug selection, negotiation, re-negotiation, compliance monitoring, and civil monetary penalties. The proposed rule affects Medicare Part D plans and manufacturers. Public comments on the proposed rule are due approximately 60 days after publication in the Federal Register.
- Federal Policy
Partnership for Medicaid Issues H.R. 1 Community Engagement Implementation Guidance
The Partnership for Medicaid released recommendations for CMS and states on implementing community engagement requirements under H.R. 1. The guidance addresses operational considerations for managed care organizations tasked with verifying beneficiary compliance and coordinating exemptions. Implementation timelines and specific federal guidance remain pending. This matters because MCOs will likely bear responsibility for tracking work requirements, exemption processes, and related reporting — operational burdens that require system changes, vendor coordination, and potential contract amendments.
- Federal Policy
MHPA Warns Senate Against Budget Reconciliation Provisions Affecting Medicaid MCOs
Medicaid Health Plans of America sent a letter to Senate leadership urging caution on specific provisions in the House-passed budget reconciliation bill. The trade association outlined concerns about how reconciliation measures could affect Medicaid managed care operations and beneficiaries. The letter was addressed to Senate Majority Leader John Thune, Minority Leader Chuck Schumer, and Finance Committee leadership. The reconciliation bill is now under consideration in the Senate, with potential modifications before final passage.
- Federal Policy
Modern Medicaid Alliance Urges Congress to Reject Proposed Medicaid Cuts
The Modern Medicaid Alliance has issued a statement urging Congress to reject proposed cuts to Medicaid currently under consideration. The advocacy coalition warns the cuts would directly affect Medicaid beneficiaries' access to care. The statement comes as Congress debates budget reconciliation proposals that could significantly reduce federal Medicaid spending. Timing and specific legislative vehicles remain subject to ongoing negotiations.
- Federal Policy
MHPA Coalition Urges Congress to Protect Medicaid and CHIP Funding
Medicaid Health Plans of America led a coalition letter to Senate Finance and House Energy & Commerce leadership on March 3, 2025, expressing support for Medicaid and CHIP programs. The letter was sent to committee chairs and ranking members as Congress considers budget and program changes. The coalition advocates for preserving funding and program integrity during legislative discussions. This signals organized industry pushback against potential Medicaid cuts or restructuring under consideration in the 119th Congress.
- Federal Policy
House Subcommittee Considers Bipartisan Medicaid HCBS Strengthening Legislation
The House Energy & Commerce Health Subcommittee held a hearing on April 30, 2024, to consider legislative proposals addressing Medicaid access and program integrity. The Medicaid Health Plans of America submitted a statement for the record supporting bipartisan policy to strengthen home and community-based services and make related changes permanent. The hearing covered multiple proposals affecting Medicaid program operations and access to care. MHPA's statement signals managed care industry support for HCBS policy changes under congressional consideration.