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Thursday, September 10 · 6 stories
- Industry
Commentary Proposes Applying Pharmaceutical Sales Tactics to Medicaid Work Requirements and Enrollment
An opinion piece in MedCity News suggests that health equity advocates adopt pharmaceutical sales strategies to help Medicaid beneficiaries navigate work requirements, access exemptions, and enroll in health programs. The article argues these tactics could increase referrals to evidence-based interventions and improve enrollment in programs designed to reduce health disparities. No specific policy change or implementation timeline is described. The piece appears to be commentary on operational approaches rather than a report of concrete program or policy developments.
- Industry
Corporate Lobby Groups Backed Safety-Net Cuts Affecting Low-Wage Employees
Industry groups representing major low-wage employers praised tax cuts in the 2025 One Big Beautiful Bill Act while remaining largely silent on $1 trillion in Medicaid cuts and $186 billion in SNAP reductions over a decade, according to the Institute for Policy Studies' Executive Excess 2026 report. The report found that corporations including Walmart (16,000 employees on Medicaid in six states) and Kroger (2,800 on Medicaid) did not publicly oppose cuts to programs their own workforces depend on. The National Retail Federation was the only major industry group to mention the safety-net cuts, praising them for reducing fraud.
- Industry · NV
Nevada Congressional Candidates Diverge on Medicaid Work Requirements in 1st District Race
Rep. Dina Titus (D-NV) and state Sen. Carrie Buck (R-Henderson) are competing for Nevada's 1st Congressional District seat, which covers Downtown Las Vegas, the Strip, Henderson, and Boulder City. Both candidates agree on reinstating Affordable Care Act premium subsidies to prevent coverage loss and premium increases for thousands of Nevadans. The candidates differ on Medicaid work requirements, with implications for program eligibility and enrollment in Nevada's Medicaid expansion population. Both candidates also support deportation enforcement focused on violent criminals rather than all undocumented immigrants, a position relevant to emergency Medicaid utilization patterns.
Wednesday, September 9 · 1 story
- Industry · AR
Cambia to Assume Operational Control of Arkansas Blue Cross in October
Cambia Health Solutions is moving forward with an affiliation agreement to assume operational control of Arkansas Blue Cross and Blue Shield, with the transaction expected to close in October 2026. No assets are changing hands in the deal. The affiliation will place Arkansas Blue Cross's operations, which include the state's Medicaid managed care business, under Cambia's operational control. The transaction represents a consolidation in the Blue Cross Blue Shield system affecting one of Arkansas's major Medicaid health plans.
Tuesday, September 8 · 4 stories
- Industry · MA
Mass General Brigham Plan Drops Medicare Advantage Coverage for Dana-Farber Cancer Patients
Mass General Brigham's health plan has discontinued Medicare Advantage coverage for Dana-Farber Cancer Institute patients, coinciding with the organizations ending their long-standing partnership. The contract lapse affects Medicare Advantage enrollees who previously had in-network access to Dana-Farber oncology services through MGB's health plan. The change is effective as the two organizations wind down decades of clinical collaboration. This development impacts network adequacy and patient access for Medicare Advantage beneficiaries in the Boston market.
- Industry
Vertical Integration Drives Higher Patient Costs Through Facility and Pharmacy Steering
Vertically integrated health systems are increasingly directing patients to higher-priced facilities for procedures and requiring use of insurer-owned pharmacies that may not offer the lowest prices or stock prescribed medications. The practice affects patients across commercial and government-sponsored insurance, including Medicaid managed care enrollees who face steered networks and limited pharmacy access. The cost increases result from structural market consolidation rather than explicit policy changes, making them difficult for regulators and payers to address through traditional oversight mechanisms.
- Industry
Rural Hospitals Accelerate M&A Activity Amid Anticipated Federal Medicaid Cuts
Rural hospital systems are pursuing mergers and partnerships in response to anticipated Medicaid funding reductions under the Trump administration. The consolidation wave is driven by financial survival concerns as rural facilities face revenue pressures from potential federal cuts. This activity is intensifying debate over healthcare market competition and care costs in rural communities. The timing and scope of any federal Medicaid reductions remain uncertain, but rural providers are acting preemptively to strengthen their financial positions through scale and integration.
- Industry · IN
Indiana Launches $68 Billion Medicaid Managed Care Procurement for 1.5 Million Enrollees
Indiana has issued a procurement for its Medicaid managed care program covering approximately 1.5 million enrollees, representing $68 billion in total contract value. The RFP will determine which health plans deliver Medicaid services to Hoosiers under managed care arrangements. Contract awards will shape the state's Medicaid delivery system for the coming contract period. The procurement represents one of the largest Medicaid managed care procurements nationally and will directly affect existing MCO contracts, provider networks, and care delivery infrastructure across Indiana.
Monday, September 7 · 3 stories
- Industry
Rural Hospital Leader Argues Home-Based Care Reduces System Costs
A rural health care executive argues that providing care locally in rural communities generates system savings compared to patient transfers, but rate-setting bodies do not adequately account for these cost benefits. The author contends that policymakers making rural health care decisions need to hear directly from practitioners who deliver local care. The commentary emphasizes that rural care delivery models keeping patients near home are cost-effective but undervalued in current payment structures. No specific policy change or data is presented.
- Industry · IA
Rural Iowa Pharmacy Owner Cites PBM Reimbursement Pressures in Senate Candidate Stop
A rural Iowa pharmacy owner told Senate candidate Josh Turek his business lost over $100,000 in its first year because pharmacy benefit managers reimburse below drug acquisition costs, particularly for Medicare prescriptions. The owner said a 2025 Iowa PBM reform law, currently tied up in litigation, would not cover Medicare patients who represent the majority of his pharmacy's business. Turek called for federal PBM reform, noting that state-level action exempts federally administered programs like Medicare and creates a patchwork of standards.
- Industry · CA
24 Hour Home Care to Lay Off 738 Employees Following Health Net Contract Loss
24 Hour Home Care will lay off 738 employees effective September 15, 2026, according to a California WARN notice. The layoffs result from Health Net's planned discontinuation of personal care and homemaker services. The workforce reduction affects a home care provider serving Medicaid beneficiaries who rely on personal care services, typically covered under LTSS benefits in managed care contracts. The layoffs signal potential network adequacy concerns for Health Net's Medicaid line of business if personal care services are not transitioned to alternative providers.
Friday, September 4 · 6 stories
- Industry
WVU Medicine Launches Provider-Sponsored Health Plan as Joint Venture with Marshall Health and Valley Health
WVU Medicine has created Peak Health, a provider-sponsored health plan structured as a joint venture with Marshall Health Network and Valley Health. Unlike typical health system insurance arms designed to capture margin, Peak Health is built to redirect savings back to participating providers. The plan represents a provider-led approach to health insurance in West Virginia and Virginia markets. This matters for Medicaid stakeholders because provider-sponsored plans increasingly compete for Medicaid managed care contracts and can reshape network dynamics and provider reimbursement models in their markets.
- Industry
McKesson Confirms Data Breach Affecting Oncology and Medical-Surgical Customers
McKesson disclosed a cyberattack involving third-party applications that resulted in data theft affecting a subset of customers in its oncology and medical-surgical distribution businesses. The company confirmed unauthorized access occurred but has not yet specified the types of data compromised or the number of affected customers. The incident affects healthcare providers that rely on McKesson's pharmaceutical distribution and specialty pharmacy services. Medicaid health plans and state agencies contracting with affected providers may face downstream notification requirements depending on whether protected health information or Medicaid beneficiary data was accessed.
- Industry
HaloMD Claims No Surprises Act Saved $1 Billion on Emergency Spending
HaloMD, a medical billing firm, released a study claiming the No Surprises Act has reduced out-of-network emergency medical spending by at least $1 billion. Independent researchers questioned the firm's methodology. The No Surprises Act, which took effect in 2022, prohibits surprise billing for emergency services and certain out-of-network care in commercial insurance and self-funded plans. The law does not apply to Medicaid managed care, where state laws and contract provisions govern out-of-network emergency billing and member cost-sharing protections.
- Industry
Bipartisan House Bill Proposes $35 Monthly Insulin Cap for Private Insurance
House lawmakers introduced bipartisan legislation Thursday to cap monthly insulin costs at $35 for people with private health insurance. The bill includes support from two battleground Republicans, marking a shift from previous GOP resistance to government price-setting. If enacted, the cap would affect privately insured patients; Medicaid beneficiaries already benefit from rebate protections and state-specific cost-sharing limits that often result in lower out-of-pocket costs. The legislation has been discussed for years but has not previously advanced due to concerns about government price controls.
- Industry
59 Hospitals Close Departments or End Services Since January
Becker's Hospital Review reports that 59 healthcare organizations have closed medical departments or ended services at facilities since January 1. The closures are attributed to financial pressures, shifts toward higher-demand services, and staffing shortages. The report includes Catholic Health facilities in Buffalo, N.Y., among the affected organizations. The specific departments closed and effective dates vary by facility.
- Industry
UnitedHealth Group Eliminates Prior Authorization for 1,700 Service Codes Effective October 1
UnitedHealth Group will eliminate prior authorization requirements for approximately 1,700 service codes, including home healthcare services, effective October 1, 2026. The change builds on the company's May 2026 commitment to reduce prior authorization volume by 30% by year-end. The elimination affects services across UnitedHealth's commercial and Medicare Advantage lines. Providers delivering these services will no longer need to obtain advance approval from UnitedHealth plans, potentially reducing administrative burden and accelerating care delivery for affected members.
Wednesday, September 2 · 4 stories
- Industry
AHA Webinar on Medicare Advantage Electronic Prior Authorization Implementation
The American Hospital Association is hosting a webinar on preparing for Medicare Advantage's electronic prior authorization mandate effective January 1, 2027. The session will feature representatives from AHA, CMS, and Epic discussing workflow integration, implementation challenges, and readiness strategies for hospital and health system leaders. The webinar focuses on operational preparation for the new Medicare Advantage requirement.
- Industry · VT
UVM Medical Center Limits Patient Sitters Amid Budget Cuts, Unions File Cease and Desist
University of Vermont Medical Center in June changed its policy limiting licensed nursing assistants from serving as patient sitters, instead prioritizing remote video monitoring and a capped pool of 17 designated clinical patient safety attendants per shift across 14 inpatient units and the emergency department. Staff unions on August 20 sent a cease and desist letter arguing the change jeopardizes patient safety and interferes with ongoing contract negotiations. The policy shift is part of $140 million in systemwide expense cuts as UVM Health Network faces a projected $14 million loss for fiscal year 2027, driven by lower commercial reimbursement from BlueCross BlueShield and pharmaceutical markup restrictions.
- Industry · MN
Sanford Health Completes North Memorial Acquisition After Agreeing to State Oversight
Sanford Health has completed its acquisition of North Memorial Health, finalizing the deal after agreeing to 10 years of state oversight and committing $600 million in investments. The agreement allows South Dakota-based Sanford to expand into the Twin Cities market. The oversight agreement addresses state concerns about the consolidation's impact on healthcare access and costs. The deal represents significant market consolidation in Minnesota's Twin Cities region.