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Thursday, May 28 · 36 stories
- Industry
OIG Advisory Opinion Addresses Hospital Lease Arrangements; Construction Costs Stabilize
The HHS Office of Inspector General has issued a new advisory opinion on hospital lease arrangements, providing compliance guidance for healthcare real estate transactions. Separately, healthcare construction costs have leveled out after years of increases, potentially affecting facility expansion plans. These developments come as regional healthcare real estate markets show divergent growth patterns, with the Southeast and West Coast outperforming the Midwest and Northeast. For Medicaid managed care organizations with capital investments or provider network expansion plans, the OIG guidance clarifies Anti-Kickback Statute considerations in lease negotiations, while stabilizing construction costs may create opportunities for facility development.
- Federal Policy
CMS pauses Medicare enrollment for home health and hospice providers
CMS has temporarily halted new provider enrollment for home health and hospice services in Medicare, though specific details on duration and scope are not provided in the brief announcement. The enrollment pause likely reflects heightened scrutiny of fraud vulnerabilities in these sectors, which have been subjects of recent OIG investigations. Medicaid managed care organizations with delegated or integrated home health and hospice networks should monitor whether similar restrictions emerge in their contracts or state programs, particularly for dual-eligible populations where Medicare enrollment status affects network adequacy.
- Federal Policy
CMS Recharters Medicare Lab Test Advisory Panel, Announces July 2026 Meeting
CMS has rechartered the Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests and appointed five new members. The panel will meet July 14-15, 2026, to advise HHS and CMS on clinical diagnostic laboratory test issues under Medicare. While focused on Medicare, decisions on laboratory test coverage and payment often influence Medicaid managed care plan policies for diagnostic services, particularly for dual-eligible populations and carve-in lab benefits. State Medicaid programs frequently align lab fee schedules and coverage criteria with Medicare determinations.
- Managed Care · CA
Shasta County Measles Response Offers Community Engagement Model for Health Plans
Shasta County, California successfully contained a measles outbreak by partnering with teachers, church leaders, and other trusted community members to promote vaccination and public health measures in a vaccine-skeptical population. Infectious disease specialists say the approach demonstrates how health plans and public health agencies can engage non-traditional messengers to reach hesitant communities. The strategy is particularly relevant for Medicaid managed care organizations responsible for immunization rates and quality metrics in populations with low vaccine uptake. No immediate policy changes, but the model offers practical guidance as measles cases rise nationally.
- State Policy · KS
Kansas Legislature Permanently Fixes CHIP Eligibility Law After Multi-Year Waiver Workaround
Kansas enacted legislation in its 2026 session to permanently update state CHIP eligibility rules, ending reliance on temporary federal waivers that previously allowed eligible children to access coverage. The statutory change ensures continuous CHIP enrollment for qualifying Kansas children without recurring waiver renewals. The law codifies eligibility standards that had only been maintained through waiver authority, eliminating administrative uncertainty for families and the state Medicaid agency. This matters for managed care organizations administering Kansas CHIP because it stabilizes the enrolled population and removes the risk of coverage disruptions tied to waiver expiration.
- Industry
Big Five Medicaid Insurers Report Q1 2026 Financial and Enrollment Results
The five largest publicly-traded Medicaid managed care organizations—UnitedHealth Group, Elevance, CVS Health/Aetna, Centene, and Molina—have released first quarter 2026 financial and enrollment data. These companies collectively serve a majority of Medicaid managed care enrollees nationwide. Their quarterly results typically reveal trends in redetermination impacts, rate adequacy, medical loss ratios, and profitability that signal broader market conditions. State Medicaid directors and MCO executives monitor these earnings reports to benchmark performance, assess competitive positioning, and anticipate contract strategy shifts.
- State Policy
NASEM Report Highlights Maternal Mortality Gaps, Medicaid Coverage Extensions
The National Academies of Sciences, Engineering, and Medicine released a report on maternal mortality showing Black mothers face a maternal mortality rate of 44.8 deaths per 100,000 live births in 2024, significantly higher than other populations. The report emphasizes the importance of Medicaid postpartum coverage extensions, which 46 states and DC have now adopted to address pregnancy-related complications beyond 60 days. For Medicaid managed care organizations, this underscores the need for enhanced care coordination, cardiovascular screening protocols, and culturally competent care delivery for high-risk maternal populations through the extended 12-month postpartum period.
- Federal Policy · CA
CMS Defers Federal Medicaid Matching Funds to California, Second Such Action
CMS has announced a deferral of federal Medicaid matching funds to California, marking only the second time in Medicaid's 60-year history such action has been taken. Vice President J.D. Vance announced the deferral at a White House press conference, following a similar announcement on February 25. Federal financial participation deferrals represent CMS's most severe enforcement tool and typically indicate suspected fraud, waste, or abuse requiring state corrective action. The action creates immediate cash flow implications for California's Medicaid program and may signal broader federal enforcement priorities affecting managed care oversight.
- State Policy · TX
Texas Case Highlights Medicaid Gaps in Postpartum Mental Health Coverage for Black Mothers
A Lufkin, Texas mother charged after exhuming her stillborn daughter's remains illustrates systemic failures in Medicaid postpartum mental health coverage, particularly for Black women who face maternal mortality rates nearly three times higher than white women. The case underscores inadequate screening, follow-up, and culturally competent behavioral health services during the extended postpartum period when grief and mental health crises peak. Texas Medicaid managed care plans must assess whether their networks adequately address perinatal mental health needs and racial disparities in maternal outcomes, especially as federal Medicaid postpartum coverage extends to 12 months in participating states.
- Federal Policy · MN
CMS Threatens $515M Federal Funds Withhold from Minnesota Medicaid Over Fraud Concerns
CMS Administrator Dr. Mehmet Oz, with support from Vice President J.D. Vance, initiated a two-pronged action against Minnesota's Medicaid program on January 6, threatening to withhold $515 million in federal matching funds. The action centers on alleged fraud concerns within the state's Medicaid program. The article suggests this fiscal enforcement action may be reaching resolution. Minnesota managed care plans and state officials face potential significant federal funding disruptions pending CMS review of state compliance with program integrity requirements.
- State Policy · NE
Nebraska Launches H.R. 1 Medicaid Work Requirements May 1 Despite Implementation Gaps
Nebraska became the first state to implement work reporting requirements under H.R. 1 on May 1, 2026, despite noted implementation gaps. The state initiated a "soft start" approach, though specifics of enforcement and beneficiary communications remain unclear. Medicaid managed care plans operating in Nebraska should expect member eligibility disruptions as work reporting compliance becomes a redetermination criterion. Plans must prepare for enrollment volatility, potential member outreach responsibilities, and coordination with state agencies on verification processes as other states follow Nebraska's rollout timeline.
- Managed Care
Medicaid MCOs Deploy Community Health Workers to Close Pediatric Care Gaps
Community health workers (CHWs) are emerging as a strategic tool for Medicaid managed care organizations to address missed well-child visits, immunization delays, and undiagnosed chronic conditions in pediatric populations. CHWs connect families to care by addressing social determinants and system navigation barriers that fragment service delivery. For MCOs, CHW programs offer a mechanism to improve HEDIS measures, close pediatric quality gaps, and meet contractual performance targets while addressing upstream factors that drive preventable utilization. State Medicaid agencies are increasingly encouraging or requiring MCO investment in CHW models as part of value-based care strategies.
- State Policy · CA
California to Cut Medi-Cal Dental Benefits for 2 Million Immigrants in July 2026
California will eliminate full-scope dental coverage for approximately 2 million adult immigrants enrolled in state-only funded Medi-Cal effective July 1, 2026, limiting them to emergency dental services only. Pregnant individuals retain full dental benefits during pregnancy and for 12 months postpartum. This policy reversal affects immigrants in state-funded Medi-Cal programs who previously gained comprehensive dental coverage. Managed care organizations administering Medi-Cal dental benefits will need to adjust benefit packages, care coordination protocols, and provider network contracts to reflect the reduced scope of services for this population beginning mid-2026.
- State Policy
NHeLP Brief Analyzes ADA Challenge to State Vaccine Mandate Prohibitions
The National Health Law Program released an issue brief examining potential Americans with Disabilities Act challenges to state laws that prohibit or weaken vaccine mandates. The brief addresses a growing trend of state legislation expanding vaccine exemptions, with Florida poised to become the first state to ban public vaccine requirements. The analysis is relevant to Medicaid managed care organizations that serve immunocompromised enrollees and children with disabilities who face heightened risks when community vaccination rates decline. MCOs may need to assess how state vaccine policy changes affect care management protocols and member safety.
- Managed Care
TV Drama Highlights Medicaid Redetermination Barriers Affecting Coverage Continuity
The Max series 'The Pitt' depicts a common Medicaid coverage loss scenario: a redetermination notice sent to an outdated address, followed by prolonged re-enrollment struggles due to documentation requirements. The storyline reflects real-world challenges MCOs face during the unwinding period, where administrative barriers—including unforwarded mail and burdensome income verification for gig workers—disrupt continuity of care. Health plans should note this mirrors ongoing member retention issues and the need for robust outreach systems to prevent procedural terminations.
- Industry
NHeLP Executive Director Marks Medicaid Awareness Month, Cites Program's Reach to 70 Million
The National Health Law Program's new Executive Director released a reflection for Medicaid Awareness Month in April, highlighting the program's role in serving over 70 million enrollees. The statement emphasizes Medicaid's impact on health outcomes and economic security. This marks leadership commentary during a period of heightened attention to Medicaid coverage and access issues. The piece appears to be an advocacy blog post rather than a policy or regulatory announcement.
- State Policy · CA
California Budget Proposes Cutting Community-Based Mobile Crisis Response Services
California's Administration has proposed cutting funding for community-based mobile crisis response services, which provide 24/7 in-person behavioral health crisis intervention in homes, schools, and community settings. These services involve specially trained crisis response teams with specific composition and timeliness requirements. The National Health Law Program argues the proposed cuts will harm beneficiaries without generating real savings. The timing and effective date of potential cuts remain unclear, but managed care organizations with behavioral health responsibilities should monitor this budget proposal as it could affect crisis service availability and network adequacy requirements.
- State Policy · CA
California Proposes Applying Federal Work Requirements to State-Funded Immigrant Medicaid Coverage
California is considering extending work requirements from the 2025 Reconciliation Act (H.R. 1/OBBBA) to immigrants covered through state-only Medi-Cal funding, despite the Governor's Office previously calling OBBBA "not cost-saving" and "cruel." State stakeholders project the requirements will cause coverage losses through administrative churn rather than generate savings. The proposal would affect immigrants ineligible for federally-funded Medicaid who currently receive state-funded benefits. This marks a significant policy shift as California would voluntarily apply federal work requirement provisions to populations the federal mandate does not reach.
- State Policy · CA
Federal Marketplace Rule and H.R.1 Target California Exchange Coverage
The Trump Administration's Marketplace Final Rule and pending H.R.1 legislation contain provisions that could significantly reduce enrollment and affordability in Covered California and other state-based marketplaces. The changes affect eligibility, premium subsidies, and plan requirements that have expanded coverage since the ACA's implementation. California Medicaid managed care organizations may see enrollment shifts as marketplace enrollees lose coverage or face higher costs. Implementation timelines depend on final regulatory effective dates and congressional passage of H.R.1.
- Federal Policy
NHeLP Outlines State Strategies to Mitigate OBBBA Administrative Burdens on Medicaid Eligibility
The National Health Law Program published guidance for states on mitigating administrative challenges created by the One Big Beautiful Bill Act (OBBBA). The legislation imposes more frequent renewals, work requirements, and additional eligibility checks that will increase strain on state Medicaid agencies and enrollees, particularly individuals with disabilities. NHeLP recommends states prepare operational "landing pads" to prevent coverage disruptions as these changes take effect. The guidance is critical for managed care organizations whose enrollment stability and member outreach will be directly affected by states' administrative capacity during implementation.