Medicaid managed care

HHS Regulatory Agenda Revealed

The federal Office of Management and Budget has posted an updated version of the administration’s 2026 unified regulatory agenda and among the items posted are more than 180 for the Department of Health Services. Among the HHS items are 44 for the Centers for Medicare & Medicaid Services, which administers the Medicare and Medicaid programs. Most of the items are proposed rules, and among the issues CMS is expected to address through regulation during the rest of 2026 are the Medicare inpatient and outpatient prospective payment systems, the Medicare physician fee schedule, Medicaid managed care and state-directed payments, hospital price [...]

joe2026-07-09T14:19:30-04:00July 13, 2026|Alternative payment models, Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

Proposed Limits on Medicaid State-Directed Payments Explained

In late May, the Centers for Medicare & Medicaid Services proposed new restraints on state-directed Medicaid payments. In so doing, CMS was seeking to implement a mandate included in H.R. 1, last year’s federal budget reconciliation bill. Since 2016, states have been requiring Medicaid managed care plans to supplement their regular payments to selected Medicaid providers, especially hospitals, as a means of ensuring access to certain medical services in communities where such services are otherwise scarce. States, in turn, have been drawing down federal Medicaid matching funds for those additional payments, increasing federal Medicaid spending. Now, CMS is maintaining that [...]

joe2026-07-07T14:45:49-04:00July 8, 2026|hospitals, Medicaid, Medicaid managed care, Medicaid regulations|

Future Moms Face Challenge Finding Docs Who Accept Medicaid

The provider directories of Medicaid managed care plans often list maternal providers who do not accept Medicaid patients. At the same time, many of those provider directories list incorrect contact information for their participating maternal health providers. These are among the findings of the U.S. Department of Health and Human Services’ Office of the Inspector General. In two new audit reports, the OIG found that a review of several of the largest Medicaid managed care plans in the country found that anywhere from four to 22 percent of the maternal care providers listed in their provider networks were not actually [...]

joe2026-06-18T16:34:32-04:00June 22, 2026|Medicaid, Medicaid managed care|

Federal Health Policy Update for June 18

Don’t Miss: 340B Rebate Model pilot program – next steps Stricter rules on CMS’s reviews of new and existing section 1115 Medicaid demonstration programs Changes in health care institution accrediting practices HHS posts mental and behavioral health grant opportunities The following is the latest health policy news from the federal government for June 12-18. Some of the language used below is taken directly from government documents. Congress Both chambers of Congress will return to session on June 22. The House Energy and Commerce Committee’s Oversight and Investigations Subcommittee will hold a hearing titled “State Medicaid Program Integrity: Examining Fraud Risks [...]

joe2026-06-18T16:07:51-04:00June 18, 2026|340b, Affordable Care Act, Alternative payment models, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

MACPAC Issues Report to Congress

The Medicaid and CHIP Payment and Access Commission has sent its 2026 report to Congress. The report – mandated by Congress – includes recommendations for: overseeing community engagement/work requirements in Medicaid, including MedPAC’s recommendation that the Centers for Medicare & Medicaid Services develop a transparent plan through which it can monitor and evaluate community engagement requirements improving CMS’s oversight of the use of automation in Medicaid prior authorization decisions improving the accountability of states’ Medicaid managed care programs appropriate access to residential treatment services for Medicaid-enrolled youth with special behavioral health needs and disabilities facilitating the transition of children and [...]

joe2026-06-17T09:45:11-04:00June 17, 2026|Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations for long-term care|

Federal Health Policy Update for May 21

The following is the latest health policy news from the federal government for May 15-21. Some of the language used below is taken directly from government documents. Congress The House Ways and Means Committee marked up several health care bills addressing issues such as durable medical equipment (DME) and home health fraud. A discussion draft that would have required non-profit hospitals and health systems to provide additional reporting on community benefit spending was removed from the list of measures considered. See all the marked-up bills and a recording of the meeting on the committee’s website here. Ways & Means expects [...]

joe2026-05-21T16:10:09-04:00May 21, 2026|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicaid, Medicaid managed care, Medicaid regulations, Medicare reimbursement policy|

MACPAC Seeks Guardrails for AI Use in Medicaid Prior Authorization

While acknowledging the potential value of the use of AI in facilitating Medicaid prior authorization decisions, the agency that advises Congress on Medicaid and Children’s Health Insurance Program policy will recommend to Congress that the programs erect guardrails to protect those they serve. During a recent meeting of the Medicaid and CHIP Payment and Access Commission, members of that group discussed a staff report on the use of AI in Medicaid prior authorization decisions and endorsed the following principles for the use of AI in this manner: The Secretary of the U.S. Department of Health and Human Services should direct [...]

joe2026-05-13T12:04:25-04:00May 15, 2026|MACPAC, Medicaid, Medicaid managed care|

Federal Health Policy Update for May 14

The following is the latest health policy news from the federal government for May 8-14. Some of the language used below is taken directly from government documents. Congress The Ways and Means Committee has circulated a discussion draft of a bill that would require non-profit hospitals and health systems to report more of their community benefit-related spending activity. Under the draft bill, non-profit hospitals and health systems would be required to report on charity care spending, their process for patients to apply for financial assistance, and spending associated with community benefits. They also would be required to report on subsidized service lines, community health needs assessments, and more. Affected hospitals and health [...]

joe2026-05-14T15:39:30-04:00May 14, 2026|hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid and housing for the disabled, Medicaid managed care, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for April 16

The following is the latest health policy news from the federal government for April 11-16. Some of the language used below is taken directly from government documents. CMS – New Proposed Regulations FY 2027 Medicare Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Proposed Rule CMS has published its proposed FY 2027 Medicare hospital inpatient and long-term-care hospital prospective payment system rule. The highlights of the proposed rule are: A 2.4 percent rate increase for both acute-care hospital inpatient and long-term care hospital services. A $564 million reduction in Medicare disproportionate share hospital (Medicare DSH) and [...]

joe2026-04-16T16:21:07-04:00April 16, 2026|Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

MACPAC Meets

Members of the Medicaid and CHIP Payment and Access Commission met last week in Washington, D.C. During the course of the deliberations, MACPAC’s staff made the following presentations to the commissioners: Implementing Community Engagement Requirements in Medicaid State and Federal Tools for Ensuring Accountability of Medicaid Managed Care Plans: Draft Chapter Children and Youth with Special Health Care Needs (CYSHCN) Transitions to Adult Coverage: Draft Chapter and Recommendations Automation in the Prior Authorization Process: Draft Recommendations Exploring the Role of the State Medicaid Agency in the Program of All-Inclusive Care for the Elderly: Policy Options Health and Welfare in Self-Directed [...]

joe2026-04-15T12:51:27-04:00April 16, 2026|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care|