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Wednesday, June 10 · 14 stories
- Industry
U.S. Drug Shortages Fell 23% in 2024 Despite Ongoing Systemic Supply Issues
Prescription drug shortages in the United States decreased by 23% in 2024 according to a new analysis, but systemic supply chain problems persist. The analysis identified ongoing structural vulnerabilities in pharmaceutical manufacturing and distribution that continue to affect medication availability. While the overall number of shortages declined, the duration and severity of certain shortages worsened. For Medicaid managed care organizations, drug shortages create formulary management challenges, increase member access barriers, and complicate pharmacy benefit administration when preferred products become unavailable.
- Federal Policy
CMS Administrator Oz Outlines Five-Point Affordability Strategy at HFMA Conference
CMS Administrator Dr. Mehmet Oz presented the agency's affordability strategy at the Healthcare Financial Management Association Annual Conference on Tuesday, addressing Medicare fraud, drug pricing, and nutrition initiatives. The presentation outlined CMS's policy priorities across multiple program areas. While the speech focused primarily on Medicare, any policy shifts at CMS have potential spillover effects on Medicaid managed care operations, particularly in areas like fraud prevention, pharmaceutical pricing strategies, and preventive health initiatives that may be adopted across programs.
Tuesday, June 9 · 3 stories
- Federal Policy
KFF Fact Sheet Details Women's Health Coverage Sources and ACA Impact in 2024
The Kaiser Family Foundation published a fact sheet examining women's health insurance coverage in the United States as of 2024. The analysis reviews major coverage sources for women, including employer-sponsored insurance, Medicaid, Marketplace plans, and Medicare. It assesses how the Affordable Care Act has affected women's access to coverage and identifies ongoing coverage gaps that persist despite ACA reforms. The fact sheet provides baseline data on coverage patterns relevant to understanding enrollment trends and coverage obligations.
- State Policy · IL
Illinois Awards Medicaid Managed Care Contracts to Six Insurers Including Humana
Illinois announced its intent to award new Medicaid managed care contracts to six health insurers: five incumbents and new entrant Humana. The contracts, each representing tens of billions of dollars in revenue over the contract period, will cover the state's Medicaid managed care program. The awards follow a procurement process and are subject to standard protest periods before final execution. This represents a significant market entry for Humana in Illinois Medicaid and continuation for existing plans in one of the nation's largest state programs.
- Federal Policy
HHS Escalates Medicaid Program Integrity Enforcement Across Multiple States
HHS has launched state-specific and nationwide actions targeting Medicaid program integrity, marking an escalation in federal oversight of state programs. The actions include audits, funding withholdings, and enhanced scrutiny of improper payments and eligibility determinations. States face increased federal review of their claims processing, provider enrollment, and payment accuracy systems. The brief identifies states likely to face heightened scrutiny and outlines enforcement priorities, though many details about timing and specific state selections remain unclear.
Monday, June 8 · 18 stories
- State Policy · CA
National Health Law Program Publishes Updated Medi-Cal Advocacy Guide for California
The National Health Law Program has released an updated advocate's guide to Medi-Cal services in California. The guide is designed to help advocates, beneficiaries, and legal professionals navigate California's Medicaid program, which covers 15 million low-income residents. The resource addresses current challenges including federal and state budget pressures and potential cuts to the program. It serves as a reference tool for understanding Medi-Cal eligibility, covered services, and beneficiary rights in California's managed care environment.
- Managed Care
UnitedHealthcare Changes Lactation Counseling Reimbursement Policy
UnitedHealthcare is revising its reimbursement methodology for lactation counseling services, a change that is expected to reduce payment rates for many providers. The policy modification affects how the nation's largest health insurer compensates lactation consultants and counselors who provide services to new mothers. The timing and specific payment methodology changes were not detailed in available reporting. The adjustment comes as maternal health services remain under scrutiny, particularly given federal emphasis on improving maternal health outcomes and access to postpartum care.
- Industry
Eli Lilly 340B Deadline Passes, Noncompliant Hospitals Lose Discounts
Eli Lilly's June 1 deadline for hospitals to submit claims data to maintain 340B drug discounts has passed without HRSA intervention. Hospitals that failed to comply with Lilly's data submission requirements will lose access to discounted pricing on covered drugs. HRSA has not responded to requests from hospital and pharmacy groups to intervene in the dispute. The action affects hospitals participating in the 340B program that purchase Lilly medications.
- Industry
Three Hospital Closures Reported in Early 2026, Down from 13 Year Prior
Three U.S. hospitals and emergency departments closed in early 2026, compared to 13 at the same point in 2025. Total closures in 2025 reached 23, nearly matching the 25 reported in 2024. The article suggests the early 2026 slowdown may not indicate structural improvement in hospital financial stability. The trend continues a multi-year pattern of hospital closures driven by financial pressures.
- State Policy
Survey: Most Medicaid Enrollees Unaware of Impending Work Requirements
A Health Management Academy survey found that over half of Medicaid enrollees are unaware of work requirements set to take effect in less than six months. Enrollees will be required to report work, education, or volunteer hours to maintain coverage. The findings suggest significant risk of coverage loss due to administrative non-compliance rather than actual ineligibility. States and managed care plans will need to intensify member outreach and education efforts to prevent disenrollment of otherwise eligible members.
- Federal Policy
HHS Affordability Czar Targets Provider Taxes and State-Directed Payments as Cost Drivers
Casey Mulligan, the Trump administration's healthcare affordability czar, identified provider taxes and state-directed payments as key drivers of healthcare cost inflation during a recent conference. He argued these mechanisms inflate spending beyond Medicaid and increase costs for employers and taxpayers. The remarks signal potential federal scrutiny of state financing arrangements commonly used in Medicaid managed care. No specific policy changes or timelines were announced.
- Legal
California Doctor Convicted in $45 Million Medicare Botox Fraud Scheme
A federal jury in the Central District of California convicted Dr. Violetta Mailyan for orchestrating a $45 million Medicare fraud scheme involving fraudulent Botox injection claims. The conviction reflects DOJ's increasing use of data analytics to identify and prosecute billing anomalies and fraud patterns in federal health programs. The case demonstrates heightened federal enforcement targeting suspicious billing practices, particularly for high-cost procedure codes and injectable medications. Medicaid managed care organizations face similar fraud detection scrutiny and should strengthen their claims review protocols and provider oversight mechanisms.
- Legal
DOJ Orders Fast-Track Review of Sealed Medicaid False Claims Act Cases
The Department of Justice announced May 27, 2026, that civil attorneys must prioritize and expedite sealed qui tam cases alleging fraud against Medicaid and other federally funded, state-administered benefit programs. Assistant Attorney General Brett Shumate directed DOJ Civil Division and U.S. Attorney's Office lawyers to fast-track these investigations. The directive applies immediately to pending sealed cases. This signals heightened federal enforcement scrutiny of Medicaid fraud allegations and may accelerate the timeline from complaint filing to government intervention decisions or unsealing.
- Federal Policy
HHS Autism Panel Endorses Controversial Communication Method Despite Scientific Criticism
Health Secretary Robert F. Kennedy Jr.'s newly formed autism panel is promoting a disputed communication method known as facilitated communication or spelling therapy, which has been widely rejected by mainstream medical and disability organizations. The technique involves a facilitator physically guiding an autistic person's hand to type or point at letters, with critics arguing it reflects the facilitator's thoughts rather than the individual's. Panel members include advocates of alternative treatments including camel's milk and stem cell injections. The panel's recommendations could influence federal autism research priorities and educational policies affecting Medicaid-funded services for children and adults with autism spectrum disorder.
- Federal Policy
Title X Funding Cuts and Policy Changes Drive Planned Parenthood Clinic Closures
Federal policy changes have led to decreased funding for Planned Parenthood, including provisions in the One Big Beautiful Bill Act and the withholding of Title X family planning funds from Planned Parenthood clinics. These funding cuts are resulting in clinic closures across multiple states. The changes affect access to family planning services, including contraception and STI screening, that many Medicaid managed care organizations rely on through network providers. The brief examines the scope of closures and the impact on the Title X program's provider network.
- Industry
NASHP Hosts Webinar on Rural Health Payment Reform Models
The National Academy for State Health Policy (NASHP) will hold a webinar on June 16, 2026, from 3–4 p.m. ET focusing on payment reform strategies for rural health settings. The session will explore collaborative learning opportunities around alternative payment models designed for rural providers. Rural health care delivery intersects with Medicaid managed care in states where MCOs serve rural populations or where rural providers participate in value-based payment arrangements.
- Industry
Health Economist Calls for New Payment Infrastructure for Gene Therapies
Health economist William Padula argues that high-cost gene therapies, including treatments costing $2 million or more, require new financing models to enable patient access. The commentary asserts that the barrier to deploying curative therapies is not scientific but financial and infrastructural. Padula contends that existing payment systems are ill-equipped to handle the upfront costs of one-time curative treatments. The piece calls for innovative financing mechanisms to bridge the gap between therapeutic breakthroughs and patient access.
- Industry
ADA Conference Highlights Obesity Drug Competition and Clinical Practice Gaps
The American Diabetes Association's annual conference featured industry discussions on the competitive landscape for GLP-1 obesity medications and identified clinical blind spots in diabetes care delivery. The conference addressed how pharmaceutical competition is shaping market access and pricing dynamics for widely-used medications including semaglutide and tirzepatide. For Medicaid managed care organizations, these developments directly affect formulary strategy, prior authorization protocols, and budget forecasting for one of the fastest-growing drug spending categories.
- Industry
Trump Administration Adds 160 Drugs to TrumpRx Direct-to-Consumer Platform
President Trump announced Friday that TrumpRx.gov will add 160 prescription medications to its direct-to-consumer platform, bringing the total to over 800 drugs available at discounted prices. This marks the second expansion of the initiative in two months. The platform sells drugs directly to consumers, bypassing traditional pharmacy channels. The announcement did not specify which drugs were added or provide details about pricing structures or manufacturer participation.
- Managed Care
Health Plans Miss Surgical Cost Savings by Focusing Only on Avoidance
Health plans are neglecting significant cost savings opportunities in surgical care by focusing primarily on avoidance rather than optimizing outcomes for necessary procedures. Plans that concentrate solely on reducing surgical volume miss larger savings from complications, readmissions, and poor outcomes when surgery does occur. The shift to value-based care and risk-based contracts makes surgical outcomes optimization financially critical for managed care organizations. Strategies include directing members to high-performing surgeons, implementing episode-based payments, and using decision support tools to ensure appropriate care pathways.