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Wednesday, July 1 · 12 stories
- Federal Policy
Georgetown Hosts Webinar on Medicaid Federal-State Financing Basics
The Georgetown University Center for Children and Families held a webinar on June 30, 2026 covering foundational Medicaid financing concepts. The session explained the federal-state partnership structure, mandatory federal funding not subject to annual appropriations, and state financing mechanisms for their matching share. The webinar targeted audience members seeking to understand basic Medicaid funding mechanics. A recording will be made available on Georgetown's website.
- State Policy · WA
Washington State Launches WA Cares Long-Term Care Insurance Program July 1
Washington's WA Cares Fund, the nation's first publicly administered long-term care insurance program, begins providing coverage on July 1, 2026. The program offers eligible workers up to $36,500 in lifetime benefits for long-term services and supports, funded through a 0.58% payroll tax. Dozens of applications have already been submitted. The launch follows years of legislative debate and program delays since the payroll tax collection began in 2023.
- Federal Policy · WA
CMS Launches WISeR Gold Card Exemption Program July 6 in Washington State
CMS will launch the WISeR (Worthy of Individual Systematic Exemption and Review) gold-carding exemption program on July 6, 2026, in Washington state, with quarterly rollouts planned for five additional states. The program exempts certain high-performing providers from prior authorization requirements based on performance metrics. Medicaid managed care organizations operating in Washington and the subsequent rollout states will need to implement gold card criteria and modify prior authorization workflows. The initiative aims to reduce administrative burden for providers with strong approval track records while maintaining utilization management oversight for other providers.
- State Policy · NJ
New Jersey Legislature Passes Employer Fee Targeting Firms With 50+ Medicaid-Enrolled Workers
New Jersey lawmakers approved legislation imposing fees on employers with at least 50 workers enrolled in Medicaid, projected to generate $145 million in state revenue. The fee targets companies whose employees rely on public coverage, effectively shifting costs to employers for their workforce's health benefits. The measure now heads to the governor for signature. This represents a novel state financing mechanism that could affect Medicaid managed care enrollment patterns and employer benefit decisions.
- State Policy · MT
Montana Lacks Staff and Data Systems as Medicaid Work Requirements Near Implementation
Montana's health department has not hired the staff needed to review work requirement applications and lacks access to claims data required to verify medical exemptions as implementation approaches. The state only recently identified qualifying diagnoses for exemptions. These operational gaps raise questions about the state's readiness to administer work requirements without inappropriate coverage losses. The timing and specific effective date are not specified in the available content.
- State Policy · WI
Wisconsin Postpartum Medicaid Extension Takes Effect July 1, Covering 16,000 Mothers
Wisconsin's 12-month postpartum Medicaid coverage extension becomes effective July 1, 2026, extending coverage from the previous 60-day limit. The state became the 49th to adopt the extension when legislation was signed in March 2026. The Wisconsin Department of Health Services estimates the policy will provide continuous coverage to approximately 16,000 mothers annually. The extension addresses maternal health outcomes and coverage continuity for postpartum enrollees in Wisconsin's Medicaid program, including managed care plans.
- Federal Policy
AHA Opposes Bill Adding IRS Schedule H Reporting Requirements for Tax-Exempt Hospitals
The American Hospital Association submitted comments June 30 to the House Ways and Means Committee opposing H.R. 9504, the Tax-Exempt Hospital Transparency Act, ahead of a scheduled July 1 markup. The bill would add reporting requirements to hospitals' Schedule H IRS forms, affecting nearly two-thirds of all hospitals. While the AHA acknowledged improvements from an earlier draft — including removal of a parallel for-profit tax calculation and inclusion of standardized definitions — it maintains serious concerns about administrative and financial burdens, particularly requirements focused on financial assistance reporting that exclude Medicaid shortfall and other community benefit components. The bill includes carve-outs for small facilities but still requires eventual compliance.
Tuesday, June 30 · 12 stories
- Managed Care
Cityblock CEO: Most Health Care AI Invests in Billing, Not Care Delivery
Dr. Toyin Ajayi, CEO of Cityblock Health, argues that approximately 60 percent of health care AI investment focuses on billing, coding, and risk adjustment rather than care delivery. Cityblock serves over 100,000 Medicaid and dual-eligible members across ten states. Ajayi contends that redirecting AI investment toward care delivery for high-need populations can lower costs while improving outcomes. She discusses how Cityblock currently uses AI to enhance care and patient experience for Medicaid managed care enrollees.
- Federal Policy
GAO Adds Fourth Priority Recommendation for Social Security Administration
The Government Accountability Office identified one additional priority recommendation for the Social Security Administration in June 2026, bringing the total to four open priority recommendations. SSA has not implemented any of the three recommendations GAO identified in May 2025. The priority areas include preventing potential overpayments in Disability Insurance, improving online application access for Social Security benefits, and managing IT investments cost-effectively. GAO emphasizes these recommendations warrant urgent attention from SSA leadership to strengthen internal controls, improve service delivery, and identify opportunities for efficiency and cost savings.
- State Policy
NASHP Releases Five-State Behavioral Health Workforce Policy Academy Results
The National Academy for State Health Policy published findings from a multi-state policy academy focused on strengthening the behavioral health workforce. Five states participated in the initiative to develop and implement workforce development strategies. The report includes success stories and resources documenting state-level approaches to addressing provider shortages and building capacity. The findings are relevant to Medicaid managed care organizations operating in states that participated or considering similar workforce development partnerships with state agencies.
- Federal Policy
Trump Administration Obesity Drug Agreement Faces Implementation Issues
The Trump administration's negotiated agreement with Eli Lilly and Novo Nordisk regarding obesity medication pricing and coverage is encountering implementation problems. The deal, which was intended to expand access to GLP-1 medications while controlling costs, contains unspecified loopholes or structural issues affecting its execution. The problems impact how these high-cost medications are covered and reimbursed under federal health programs. Medicaid managed care organizations should monitor whether state programs adjust coverage policies or capitation rates in response to these federal-level complications.
- Legal · TX
AstraZeneca Pays $34 Million to Settle Texas Medicaid Kickback Claims
AstraZeneca agreed to pay $34 million to resolve allegations brought by the Texas Attorney General that the company paid kickbacks to improperly influence prescriptions reimbursed by Texas Medicaid. The settlement resolves claims that the pharmaceutical manufacturer violated anti-kickback statutes through payments that influenced prescribing behavior for drugs covered under the state's Medicaid program. The settlement does not include an admission of liability but ends the state's enforcement action against the company.
- Industry
PBM Trade Group Escalates Advocacy Against Drugmakers Following Congressional Overhaul
The leading pharmacy benefit manager lobbying organization is intensifying its advocacy campaign against pharmaceutical manufacturers after Congress enacted comprehensive PBM reform legislation earlier this year. The pharmaceutical industry has long blamed PBMs for high drug costs, culminating in legislative action this past winter. The lobbying escalation suggests ongoing tension between PBMs and drugmakers over responsibility for drug pricing and the implementation of new federal oversight provisions that affect both sectors.
- Managed Care · IL
Chicago Safety-Net Hospital Faces Closure Over Medicaid MCO Payment Delays
Roseland Community Hospital on Chicago's South Side is struggling to make payroll due to delayed payments from CountyCare, Cook County's largest Medicaid managed care organization. The facility barely met its June 30 payroll and CEO Tim Egan described the financial situation as critical. The hospital serves a predominantly Medicaid population in an underserved area. Payment delays from Medicaid MCOs threaten the facility's ability to remain operational.
- Federal Policy
ONC Awards New Contract to Oversee TEFCA Data Exchange Framework
The Office of the National Coordinator for Health Information Technology (ONC) has awarded a new contract to oversee the Trusted Exchange Framework and Common Agreement (TEFCA), the federal framework governing nationwide health information exchange. The move comes as the volume of health records exchanged through TEFCA increases significantly. The new oversight contractor will monitor compliance with TEFCA's technical and legal requirements for data sharing among qualified health information networks. This expansion of oversight signals federal emphasis on ensuring secure, standardized data exchange as TEFCA adoption accelerates.
- Legal · PA
Pennsylvania Joins Multi-State Lawsuit Challenging Federal Medicaid Work Requirement Rules
Pennsylvania has joined a multi-state lawsuit against the Trump administration over new Medicaid work requirement rules. The litigation challenges federal restrictions on how states can handle applicants deemed medically frail, a term that lacks a standardized definition in Medicaid policy. The lawsuit represents a coordinated state effort to block implementation of the work requirement framework. This legal action creates compliance uncertainty for managed care organizations operating in participating states as they await court resolution on exemption criteria and enrollment procedures.
- Legal · MS
Mississippi Judge Orders Emergency Medicaid Payment to Prevent Hospital Closure
A judge has ordered Mississippi Medicaid officials to make an emergency payment to Greenwood Leflore Hospital to prevent its imminent closure this week. The Delta hospital argued that without the payment, it would be forced to shut down, threatening a proposed agreement for the University of Mississippi Medical Center to assume operations. The court intervention ensures continued access to hospital services in the region while the UMMC takeover arrangement moves forward. The case highlights the acute financial pressures facing rural hospitals dependent on Medicaid reimbursement.
- State Policy · IN
Indiana Medicaid Enrollment Drops 174,000 Children in Three Months
Indiana lost 174,000 children from Medicaid between January and April 2025, a 20% decline that represents the steepest percentage drop in the nation, according to Georgetown University's Center for Children and Families. The state also recorded the third-highest absolute enrollment decline nationally during this period. This drop follows the end of continuous enrollment protections that were in place during the COVID-19 public health emergency. Indiana's redetermination process appears to be resulting in significantly higher disenrollment rates than most other states.
- Managed Care · CO
Denver Health CEO Discusses Housing Program for Medicaid, Uninsured Patients
Denver Health CEO Donna Lynne describes the health system's Housing Outreach, Partnerships and Engagement (HOPE) program, which provides 34 apartments to patients experiencing homelessness or housing insecurity. The program, which won the 2026 AHA Dick Davidson NOVA Award, includes 20 recuperative care units with average 2-3 day stays and 14 longer-term apartments for up to six months. Denver Health serves a patient population that is 47% Medicaid and 15% uninsured; the program reduces length of stay and readmissions for homeless patients, who typically stay 2.5 times longer than housed patients. The health system partners with Colorado Coalition for the Homeless and Denver Housing Authority to transition patients to permanent housing.
Monday, June 29 · 16 stories
- State Policy · TN
Tennessee Law Mandates Immigration Data Sharing for Children's Special Services Enrollees
Tennessee enacted legislation requiring state agencies to share data on public assistance program applicants and enrollees without qualified immigration status with federal immigration authorities. This requirement extends to the Children's Special Services program, which serves children with disabilities. The law affects eligibility and enrollment processes for state public assistance programs, including Medicaid-adjacent services. The policy creates operational challenges for managed care organizations and providers serving mixed-status families, potentially reducing program participation and complicating outreach and enrollment activities.