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Friday, September 4 · 10 stories
- Federal Policy
Medicare Pilot Expands GLP-1 Coverage for Weight Loss Through 2027
A new Medicare pilot program launched July 1, 2026, allows beneficiaries with Part D coverage to access GLP-1 weight loss drugs for $50 per month through December 2027. Eligibility includes patients with BMI 35 or above, or lower BMIs with heart failure, uncontrolled hypertension, chronic kidney disease, prediabetes, or cardiovascular disease. Previously, Medicare covered GLP-1s only for diabetes management, forcing patients to wait until conditions worsened to qualify. The pilot aims to test whether expanded access reduces hospitalizations and overall healthcare costs.
- Federal Policy · NY
CMS Awards New York $76 Million for Regional Health IT Modernization
CMS announced $76 million in federal funding to New York to strengthen regional healthcare coordination and modernize health information technology infrastructure. The funding supports interoperability improvements and care coordination initiatives across the state's Medicaid program. Implementation timelines and specific technology priorities were not detailed in the announcement. The investment targets infrastructure that underpins Medicaid managed care network integration and data exchange capabilities.
Thursday, September 3 · 1 story
- Federal Policy
CMS Permanently Waives Home Address Reporting for Telehealth Providers with Group Practice Enrollment
CMS has made permanent an enrollment flexibility allowing providers who furnish telehealth services from home to avoid reporting home addresses on Medicare enrollment applications, provided they maintain a separate physical practice location associated with a Medicare Part B-enrolled group practice. Affected providers can enroll and bill from their physical practice location as if services were furnished in person. The policy takes effect immediately and applies to both new enrollments and existing providers. The change reduces administrative burden and privacy concerns for clinicians providing telehealth from home while maintaining program integrity through group practice oversight.
Wednesday, September 2 · 8 stories
- Federal Policy
AHA Opposes CMS Home Health Payment Update and Enrollment Changes in CY 2027 Proposed Rule
The American Hospital Association submitted comments August 28, 2026 opposing CMS's proposed 2.4% payment update for home health services in calendar year 2027, calling it inadequate, and urging suspension of behavioral adjustments tied to the patient-driven grouping model. The proposed rule also includes Medicare provider enrollment changes affecting all Medicare-enrolled providers and suppliers. AHA warned the enrollment provisions would create significant reporting burdens and risk compliant providers' enrollment status. Comments urged CMS to finalize only narrowly tailored enrollment policies with objective standards and procedural safeguards protecting providers and beneficiary access.
- Federal Policy
CMS Durable Medical Equipment Enrollment Moratorium Expires
CMS's moratorium on new durable medical equipment supplier enrollment has expired. The moratorium had temporarily halted new DME supplier applications in certain geographic areas as a program integrity measure. With the expiration, CMS will resume processing new DME supplier enrollment applications. The change affects Medicaid programs in states where DME suppliers seek to enroll and bill Medicaid for equipment and supplies, potentially expanding the DME provider network.
- Federal Policy
SAMHSA Awards $77 Million for Substance Use and Mental Health Services
The Substance Abuse and Mental Health Services Administration (SAMHSA) awarded $77 million in grants to strengthen substance use prevention, treatment, crisis services, and mental health services. Over $22 million of the total supports substance use prevention programs, announced as National Substance Use Primary Prevention Month concludes. The funding supports expanded behavioral health infrastructure and service capacity. The awards matter for Medicaid managed care organizations and providers that coordinate with SAMHSA-funded programs and integrate federal grant-supported services into Medicaid-covered behavioral health networks.
- Federal Policy
Congress Blocks OMB Grant Rule Through Dec. 11, Averting Federal Shutdown
Congress passed a continuing resolution Sept. 1 funding the government through Dec. 11 and temporarily blocking an OMB proposal to revise federal grant regulations. The proposal would give agencies broader authority to modify, suspend, or terminate grant awards based on evolving priorities, raising concerns from the American Hospital Association about funding predictability for multiyear investments in workforce, research, and infrastructure. The AHA has sought clarity on whether the rule would affect Medicare rural programs, CMMI arrangements, supplemental Medicaid payments, and Medicaid managed care capitation. The temporary block expires Dec. 11, leaving hospitals facing renewed uncertainty unless OMB withdraws or revises the proposal.
- Federal Policy
Acting Attorney General Signals Federal Action to Restrict Abortion Access in All States
Acting Attorney General Todd Blanche told faith leaders on a private call hosted by the White House Faith Office that he plans to roll back abortion access nationwide, including in states with protective abortion laws. Blanche indicated the administration intends to reverse Biden-era protections for abortion access. The timeline and specific legal mechanisms for federal intervention were not detailed in available reporting. The development is significant for state Medicaid agencies and managed care organizations that cover abortion services under state law, potentially creating conflicts between federal directives and state coverage obligations.
- Federal Policy
Trump Executive Order Reduces Recommended Childhood Vaccine Schedule to 11 Core Immunizations
President Trump signed an executive order Monday advancing 'Make America Healthy Again' priorities by recommending 11 core childhood vaccinations instead of the current CDC schedule and directing agencies to split combined vaccines. The order takes effect immediately but applies only to federal recommendations, not state Medicaid EPSDT requirements, which mandate coverage of ACIP-recommended immunizations under federal law. The directive creates potential conflict between federal guidance and mandatory Medicaid Early and Periodic Screening, Diagnostic and Treatment benefits. State Medicaid agencies and managed care plans must continue covering all ACIP-recommended vaccines to maintain federal compliance and avoid audit findings.
- Federal Policy
Federal Rural Health Transformation Program Draws Criticism Over Lack of Transparency
The $50 billion federal Rural Health Transformation Program, created in summer 2025 as part of President Trump's One Big Beautiful Bill Act, faces criticism from policy groups for insufficient transparency one year into implementation. CMS will publish only an annual aggregate report, not proactively release individual state reports or funding recipient details, leaving transparency largely to states with widely varying disclosure practices. Multiple states have declined public records requests, held closed meetings, or sought to shield applications from public view. The five-year program was designed to offset anticipated Medicaid spending reductions of over $900 billion that disproportionately affect rural communities.
- Federal Policy
Federal Medicaid Work Requirements Exempt Indigenous Groups But Not Native Hawaiians
President Trump's One Big Beautiful Bill Act imposes Medicaid work requirements that exempt certain indigenous groups but not Native Hawaiians. Native Hawaiians will be required to comply with work requirements despite facing documented barriers to employment and healthcare access. The law takes effect as part of broader Medicaid eligibility changes under the legislation. This creates a disparity in how different indigenous populations are treated under federal Medicaid policy, potentially affecting coverage for Native Hawaiians who cannot meet work requirements.
Tuesday, September 1 · 4 stories
- Federal Policy
House to Vote on Stopgap Bill Blocking White House Control Over Federal Research Grants
The House is expected to vote Tuesday evening on a Senate-passed stopgap funding bill that temporarily blocks a White House proposal to give political appointees control over federal research grants, including NIH funding. The bill will use a fast-track process requiring two-thirds support, indicating House GOP leadership expects passage. If the vote fails, lawmakers must wait until September 14 when the Senate returns to reconcile differences between the chambers. The proposal affects federal research funding that supports Medicaid-related health services research and demonstration projects.
- Federal Policy
Opinion Argues Trump Administration Increases Administrative Burden on Federal Health Programs
An opinion piece argues the Trump administration has increased administrative requirements for federal health programs, including Medicaid, and biomedical research grants. The authors claim these changes worsen the existing "time tax" — the 10.5 billion hours Americans spent on federal paperwork in 2023 — which the government estimates causes $140 billion in unclaimed benefits annually. The commentary suggests increased bureaucracy at HHS affects scientists seeking grants and Medicaid beneficiaries navigating enrollment or benefits. No specific policy changes or dates are detailed in the excerpt provided.
- Federal Policy
SNAP Eligibility Changes Threaten Free School Meal Access for Low-Income Students
Over 1 million children lost SNAP benefits following implementation of the One Big Beautiful Bill Act, which imposed new work requirements and state cost-sharing provisions. Because many students qualify automatically for free school meals through household SNAP or Medicaid participation, reductions in those programs directly threaten school meal eligibility. Schools offering universal free meals under USDA's Community Eligibility Provision face potential loss of federal reimbursement, as funding formulas tie reimbursement rates to SNAP enrollment percentages. The 30-day grace period for previously qualified students is ending as the 2026-27 school year begins, with advocates warning of increased childhood hunger and academic impacts.
- Federal Policy
Trump Administration Announces Medicaid Drug Pricing Agreements with Nine Companies
The Trump administration announced new Medicaid drug pricing agreements with nine midsize biotechnology and pharmaceutical companies. Under the agreements, companies will charge state Medicaid programs prices equal to the lowest available globally. President Trump stated the deals will apply to every drug from participating firms. The announcement was made Monday in the Oval Office with company executives present.
Monday, August 31 · 15 stories
- Federal Policy
KFF Survey Finds LGBTQ+ Adults More Likely to Forgo Healthcare Due to Cost
A KFF survey of 2,640 LGBTQ+ adults found 60% missed needed healthcare in the past year due to cost or provider availability, compared to 38% of non-LGBTQ+ adults. Transgender adults, those under 30, and those with lower incomes or no insurance were most likely to forgo care. Among uninsured LGBTQ+ adults, over three-quarters reported missing needed healthcare. Nearly a third of LGBTQ+ adults said their health worsened as a result, with transgender adults and those on Medicaid or self-purchased plans experiencing higher rates of insurance denials and delays.
- Federal Policy
New Maternity Care Billing Codes Take Effect in 2027 for All Payers
New maternity care billing codes will be implemented across all insurance payers beginning in 2027. The coding changes are designed to improve transparency and payment accuracy across the continuum of maternity care services. State Medicaid agencies must adopt these codes alongside other major program changes scheduled for 2027, including work reporting requirements. The new codes are intended to provide better data on maternity care delivery and enable more precise reimbursement for services throughout the pregnancy and postpartum period.
- Federal Policy
NAMD Publishes Overview of Medicaid and Ryan White Program Coordination for HIV Care
The National Association of Medicaid Directors has published an explainer on how Medicaid and the Ryan White HIV/AIDS Program coordinate to provide comprehensive care for low-income people with HIV. The overview describes each program's distinct eligibility and coverage criteria and how they work together to ensure access to the full continuum of HIV care. The resource is available now on NAMD's website. It provides state Medicaid agencies with foundational information on program coordination and coverage responsibilities for this population.
- Federal Policy
CDC Reports 3,544 Drug-Resistant Candida Auris Cases Across 28 States in 2026
The CDC has reported 3,544 clinical cases of candida auris, a drug-resistant fungus, across 28 states as of August 1, 2026, along with 3,325 screening detections. California reported the most clinical cases at 887, followed by Texas (437) and Tennessee (293). The infection primarily affects hospitalized patients and long-term care residents with severe underlying conditions, breathing or feeding tubes, or catheters. While cases have declined slightly from 2024 levels, CDC continues to classify candida auris as an urgent threat due to its resistance to multiple antifungal drugs and its spread in healthcare facilities.
- Federal Policy · ND
Federal SNAP Restrictions Cut Refugee Eligibility, Expand Work Requirements Through Age 64
The 2025 One Big Beautiful Bill Act restricted noncitizen access to SNAP, eliminating benefits for refugees, and expanded work requirements for able-bodied adults without dependents from age 54 to 64. In North Dakota, approximately 1,000 noncitizens and 5,600 adults are losing benefits. Affected adults must now work, train, or volunteer at least 80 hours monthly to maintain eligibility or face a three-year lockout after three months. The maximum dependent age for exemptions dropped from 18 to 14. Refugee resettlement agencies report families losing nutrition support while seeking employment.
