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The Coming Medicaid Work Requirement

Among the many Medicaid-related aspects of the recently enacted FY 2026 budget reconciliation bill – the One Big Beautiful Bill Act – is a new requirement that much of the Medicaid population be employed or participate in some acceptable form of “community engagement.” But how will the work requirement work? How will it be implemented and enforced? KFF has taken an in-depth look at this matter, reporting on such issues as: What the new law requires. The timeline for the work requirement’s implementation. How much money the states and the [...]

August 6, 2025|Categories: Congress, Medicaid|Tags: FY 2026 budget reconciliation bill, Medicaid cuts, Medicaid eligibility, Medicaid work requirement, One Big Beautiful Bill Act|

Federal Health Policy Update for July 31

The following is the latest health policy news from the federal government for July 25-31. Some of the language used below is taken directly from government documents. Congress The House recessed last week and the Senate is still in session. When Congress returns in September its top priority will be funding the federal government before the fiscal year ends on September 30, likely requiring a continuing resolution to avoid a shutdown. Several major health care programs and extenders are set to expire at the end of the fiscal year, including [...]

July 31, 2025|Categories: 340b, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid regulations, Medicare reimbursement policy, Telehealth|Tags: 2024 National Survey on Drug Use and Health, 340B prescription drug program, approved Medicaid state plan amendments, HealthData.gov update, Hepatitis C pilot program, Living HHS Open Data Plan, MACPAC, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicare Acute Care at Home, Medicare dependent hospital program, Medicare low-volume hospital program, Medicare site-neutral payments for hospitals, next-generation digital health ecosystem, No Surprises Act, No Surprises Act independent dispute resolution process, patient harm events, Scientific Registry of Transplant Recipients, telehealth|

Providers Dominating No Surprise Act Dispute Resolution

Health care providers are winning the vast majority of payment disputes resolved under the No Surprises Act’s Independent Dispute Resolution process. Contrary to the expectation that the number of cases the process would adjudicate would decline once payers and providers got a better sense of what kinds of cases were being disputed and their outcome, the number of cases going into the process has only grown – considerably. And so has providers’ success rates. Providers won 70 percent of the disputes during the first quarter of 2023 and that rate [...]

July 30, 2025|Categories: Uncategorized|Tags: independent dispute resolution, No Surprises Act|

Federal Health Policy Update for July 24

The following is the latest health policy news from the federal government for July 18-24. Some of the language used below is taken directly from government documents. The White House The White House has released its AI action plan. Winning the Race: America’s AI Action Plan is a 28-page document that mentions health care only in passing but includes provisions that could potentially affect the health care industry. Find the plan here. Congress The House has adjourned for recess and will return to Washington after Labor Day. The Senate remains [...]

July 24, 2025|Categories: Centers for Medicare & Medicaid Services, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicare, Medicare post-acute care, Medicare reimbursement policy, post-acute care, Telehealth|Tags: approved Medicaid state plan amendments, approved state directed Medicaid payments, impact of One Big Beautiful Bill on uninsured rate, Medicaid 1115 waivers, Medicaid continuous enrollment, Medicaid disproportionate share, Medicaid DSH, Medicare Acute Care Hospital at Home program, Medicare dependent hospital program, Medicare long-term care hospital payment policy, Medicare low-volume hospital program, Medicare LTCH payment policy, Medicare Payment Advisory Commission, Medicare post-acute care payment policy, Medicare post-acute care reimbursement policy, MedPAC, misleading Medicare Advantage marketing practices, White House AI plan, White House artificial intelligence plan|

CMS Pulling the Plug on Continuous Medicaid Eligibility

Continuous eligibility for Medicaid is being phased out, the Centers for Medicare & Medicaid Services has announced. Characterizing its decision as one that follows more closely the statutory underpinnings of Medicaid and the Children’s Health Insurance Program, CMS explains that it “… is issuing guidance to states making clear it does not anticipate approving new or extending existing section 1115 demonstration authorities that have allowed some individuals to remain enrolled in Medicaid or CHIP for extended periods of time, even if they may not have otherwise been eligible.” At the [...]

July 24, 2025|Categories: Centers for Medicare & Medicaid Services, Medicaid|Tags: Centers for Medicare & Medicaid Services, continuous CHIP eligibility, continuous Medicaid eligibility, Medicaid section 1115 waivers, Medicaid workforce development programs|

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