All stories
Jump to date
Monday, July 6 · 8 stories
- State Policy · AR
Arkansas Begins Pre-Enforcement Review of Medicaid Work Requirements
Arkansas has started verifying whether Medicaid expansion enrollees meet work requirements mandated by new federal law, though enforcement does not begin until January 1, 2027. The state is conducting a 'soft launch' to assess compliance among hundreds of thousands of enrollees before penalties take effect. Enrollees who do not currently meet work requirements will not lose coverage during this pre-enforcement period. This represents Arkansas implementing federal work requirement authority ahead of the mandatory compliance date.
- Federal Policy · CT
Connecticut Estimates Thousands Face Medicaid Loss Under New Federal Work Requirements
Connecticut officials project thousands of Medicaid beneficiaries could lose coverage when new federal work requirements take effect January 1, 2027. Congress and President Trump enacted the changes in an omnibus federal budget bill in July 2025. The requirements apply to able-bodied adults without dependents and mandate work, community service, or qualifying activities to maintain eligibility. Connecticut is preparing implementation plans and beneficiary outreach as the effective date approaches.
Friday, July 3 · 2 stories
- Federal Policy
CMS and VA Launch Data Match to Verify Marketplace Subsidy Eligibility
CMS is establishing a new Privacy Act computer matching program with the Department of Veterans Affairs to verify eligibility for insurance affordability programs under the Affordable Care Act. The data match will allow CMS to cross-check applicant information against VA records to confirm subsidy eligibility for Marketplace coverage. The matching program follows standard Privacy Act protocols requiring advance notice before implementation. This affects how eligibility is determined for individuals who may qualify for both VA benefits and Marketplace subsidies, though it does not directly alter Medicaid managed care operations.
- Legal
DOJ, CMS, OIG Detail Heightened Health Care Fraud Enforcement at AHLA Annual Meeting
Federal enforcement officials from the Department of Justice, Centers for Medicare & Medicaid Services, and the HHS Office of Inspector General outlined intensified fraud and abuse enforcement initiatives at the American Health Law Association's Annual Meeting in New York on July 3, 2026. The agencies described their coordinated approach to health care fraud investigations and prosecutions affecting providers and health plans. The remarks signal continued aggressive enforcement activity through 2026 and beyond. Medicaid managed care organizations should expect heightened scrutiny of billing practices, network arrangements, and compliance programs as federal agencies expand investigative resources and coordination.
Thursday, July 2 · 11 stories
- State Policy
State Legislatures Respond to H.R. 1 Medicaid Cuts in 2026 Sessions
State legislatures concluded 2026 sessions with varied responses to federal Medicaid cuts enacted under H.R. 1 approximately one year ago. States faced budget shortfalls and policy changes requiring legislative action to address coverage gaps, provider payment reductions, and program restructuring. The article follows up on earlier reporting from March 2026 that examined ten state responses to what are described as the largest Medicaid cuts in history. Implementation timelines and specific state actions vary by jurisdiction.
- Legal · CO
Federal Judge Blocks Colorado Drug Affordability Board Price Cap on Amgen's Enbrel
A federal judge has blocked Colorado's Drug Affordability Board from implementing a price cap on Amgen's Enbrel, a blockbuster rheumatoid arthritis medication. The ruling prevents the state board from enforcing its pricing limit on the drug. The decision affects Colorado's ability to use its drug affordability review process to control costs for high-priced medications. This represents a significant setback for state efforts to directly regulate pharmaceutical pricing through affordability boards, with implications for how states can address drug costs in Medicaid programs.
- Federal Policy
DEA Proposes Schedule I Classification for Synthetic Kratom Compound 7-OH
The Drug Enforcement Administration announced plans to temporarily classify 7-hydroxymitragynine (7-OH) and three related synthetic kratom compounds as Schedule I controlled substances, placing them in the same regulatory category as heroin and LSD. The classification applies to synthetic versions of the psychoactive compound found in kratom products. If finalized, the scheduling action would prohibit manufacture, distribution, and possession of these substances, with enforcement implications for entities handling these compounds. The timing of implementation and comment period was not specified in the available content.
- Legal
Federal Court Dismisses PBM Lawsuit Against FTC After Insulin Price Settlements
A federal court has dismissed a lawsuit filed by Express Scripts, CVS Caremark, and Optum Rx against the Federal Trade Commission. The three pharmacy benefit managers had sued the FTC after the agency accused them of inflating insulin costs, but the case is now closed following settlements between the PBMs and regulators. The settlements resolve the FTC's allegations regarding the PBMs' role in insulin pricing practices. The dismissal comes after the parties reached resolution on the underlying insulin pricing dispute.
- Federal Policy
Medicaid Coverage Reinstated for Non-Abortion Services at Planned Parenthood Clinics
Federal restrictions preventing Medicaid reimbursement for non-abortion services at Planned Parenthood have ended, restoring coverage for routine healthcare provided at these clinics. States now have discretion to determine whether Medicaid enrollees can access covered services at Planned Parenthood locations that remain operational. The change takes effect immediately, reversing a previous ban that prohibited Medicaid payment for any services delivered by Planned Parenthood providers, including primary care, family planning, STI testing, and cancer screenings. Medicaid managed care organizations must now determine network participation and reimbursement policies for these providers according to state guidance.
- Legal
DOJ Charges 455 Defendants in 2026 Health Care Fraud Takedown Targeting Medicaid
On June 23, 2026, the Department of Justice announced criminal charges against 455 defendants, including approximately 90 licensed medical professionals, connected to more than $6.5 billion in alleged false claims. DOJ characterized this as the largest coordinated health care fraud enforcement action in its history and emphasized a renewed focus on Medicaid fraud cases. The takedown included enforcement actions in Virginia and multiple other states. Charges took effect immediately upon announcement, with defendants facing federal prosecution.
- State Policy · NV
Nevada Medicaid Cuts Surface as 2026 Election Issue for GOP Governor
Federal cuts to Medicaid and SNAP programs are becoming a central issue in Nevada's 2026 gubernatorial race, potentially affecting Republican Governor Joe Lombardo's reelection bid. The state, a key battleground with significant Medicaid enrollment, faces voter concern over healthcare affordability as federal funding reductions take effect. The political dynamics may influence state policy decisions on Medicaid expansion, managed care contracts, and benefit design as the election approaches. Nevada's Medicaid managed care organizations should monitor how electoral pressure shapes state budget negotiations and program priorities.
- Federal Policy
CBO Projects Medicaid Enrollment and Spending Decline Through 2036 Under Reconciliation Law
The Congressional Budget Office's February 2026 projections show significant reductions in Medicaid enrollment and federal spending over the next decade following passage of the 2025 reconciliation law. The analysis compares current projections to pre-reconciliation baselines, quantifying the impact of policy changes including eligibility restrictions, state flexibility provisions, and federal funding modifications. CBO accounts for both legislative changes and updated economic assumptions in projecting enrollment trends and program costs through 2036. The projections provide the first comprehensive federal assessment of how reconciliation provisions will reshape Medicaid program size and federal financial participation.
- Federal Policy
GAO Reports $12 Billion in Federal Medicaid and Medicare Spending for Assisted Living in 2024
The Government Accountability Office reports that federal Medicaid and Medicare spending for services provided in assisted living facilities totaled at least $12 billion in 2024, including $3.5 billion in federal Medicaid spending and $8.5 billion in Medicare spending. Forty-four states cover assisted living services through their Medicaid programs, with 29 states using home- and community-based services (HCBS) waivers as of March 2025. GAO notes the $12 billion figure is likely an undercount due to data limitations, as assisted living facilities are not uniformly defined or consistently identified in program data. Medicare generally does not cover assisted living services but covers other health care such as hospice in these settings.
- State Policy
States Face Coverage Loss Risk as CMS Narrows Medically Frail Definition for Work Requirements
State Medicaid agencies report concerns that sick and disabled enrollees will lose coverage under a narrowed federal definition of "medically frail" used for work requirement exemptions. The change stems from legislation President Trump signed last year requiring states with Medicaid expansion to implement work requirements. State officials fear the tightened criteria will disqualify many enrollees who previously qualified for exemptions, forcing them into compliance or disenrollment. The policy directly affects how managed care organizations identify and retain vulnerable members.
- Federal Policy
OIG Finds Part D Plans Cover Most Drugs Used by Dual Eligibles in 2026
The HHS Office of Inspector General reviewed Part D plan formularies for 2026 and found that plans generally include drugs commonly prescribed to dual-eligible beneficiaries. The analysis examined formulary coverage patterns for medications frequently used by individuals enrolled in both Medicare and Medicaid. The report provides insight into whether dual eligibles have adequate access to needed medications through Part D coverage. This matters for Medicaid managed care organizations that coordinate benefits for dually eligible members and must ensure continuity of pharmacy coverage across programs.
Wednesday, July 1 · 12 stories
- Federal Policy
CMS Schedules Webinar on Interim Final Rule for Medicaid Community Engagement Requirements
The Centers for Medicare and Medicaid Services will host a webinar on July 9, 2026 from 12-1 p.m. ET to discuss an interim final rule on Medicaid community engagement requirements. The webinar follows CMS's issuance of new federal regulations governing work and community engagement provisions in state Medicaid programs. The session will provide technical guidance on the rule's implementation requirements and compliance expectations. Managed care organizations operating in states pursuing community engagement waivers will need to understand reporting, enrollment, and member communication obligations under the new federal framework.
- Legal · NY
HHS OIG Suspends Federal Funding to New York Medicaid Fraud Unit
The HHS Office of Inspector General notified New York on June 30 that federal grant funds to the state's Medicaid fraud control unit are suspended effective July 1, 2026. The unit receives approximately $60 million annually in federal funding. The suspension affects the state's capacity to investigate and prosecute Medicaid fraud, including cases involving managed care organizations. No end date for the suspension was specified in the OIG letter.
- Industry
Four Chemotherapy Drugs Remain in Shortage Until October
Cisplatin, carboplatin, oxaliplatin, and ifosfamide remain in active shortage, with full resupply of some formulations not expected until October 2026, according to the American Society of Health-System Pharmacists. These chemotherapy drugs are essential for treating breast, lung, ovarian, testicular, bladder, and head and neck cancers. Manufacturers have provided updated timelines for when supply will normalize. The shortages affect hospitals and health systems managing cancer treatment protocols.
- Managed Care
Hurricane Flooding Extends Home Health Treatment Times by Two Weeks
New research finds that hurricanes and related flooding cause significant disruptions to home health services, adding nearly two weeks to treatment times and reducing rates of successful discharge to the community. The decentralized structure of home health care makes both providers and payers particularly vulnerable to extreme weather events. The findings highlight operational and quality risks for managed care organizations that contract for home-based services, especially those serving dual-eligible populations and members with complex care needs who rely on consistent in-home support.
- State Policy · CA
California Schools Face Delays Implementing Newsom Mental Health Initiative Five Years After Launch
Five years after Governor Gavin Newsom launched an initiative to center mental health services in California public schools, many schools have struggled to implement the program and hundreds have not yet begun participation. The initiative aimed to transform schools into hubs for youth mental health services, but implementation challenges have delayed rollout across the state. The slow adoption affects access to behavioral health services for Medicaid-eligible children who rely on school-based care. No specific timeline for expanded implementation was reported.