Medicaid managed care

Federal Health Policy Update for November 13

Don’t Miss: CMS proposes major downsizing of Medicare and Medicaid CoPs Providers face loss of hold-harmless protections in Medicaid managed care CMS awards 200 new medical residency slots The following is the latest health policy news from the federal government for November 6-13. Some of the language used below is taken directly from government documents. Congress Lawmakers returned to Washington, D.C. to conclude the 119th Congress. Government funding will be a top priority during the lame-duck session, with the current continuing resolution (CR) set to expire on December 11. Appropriators have discussed another short-term CR, although the duration of any [...]

joe2026-11-13T13:35:06-05:00November 13, 2026|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicare regulations|

Prior Authorization Remains a Challenge

Getting timely prior authorization for needed medical care continues to pose a problem for patients and providers. Despite federal government action to address prior authorization concerns associated with health care programs it oversees – Medicare Advantage, Medicaid and CHIP fee-for-service and managed care plans, and Affordable Care Act Marketplace plans – and the insistence of some insurers that they have been addressing the issue, problems persist. According to a recent analysis by KFF (quoted directly): Medicare Advantage insurers denied 12% of standard prior authorization requests, Medicaid managed care insurers denied 14%, and ACA Marketplace insurers denied 18%. Denial rates for [...]

joe2026-08-27T16:21:27-04:00September 1, 2026|Affordable Care Act, Medicaid, Medicaid managed care, Medicare|

CMS Proposes Medicaid Provider Tax Regulation

The Centers for Medicare & Medicaid Services has published a proposed rule that would implement a portion of H.R. 1, last year’s federal budget reconciliation bill, that called for establishing new indirect hold-harmless thresholds for health care-related taxes – primarily, provider taxes, which are currently employed in 49 states and the District of Columbia. Major changes include: Replacing the six percent safe harbor with state-specific thresholds based on July 4, 2025 structures. Prohibiting states from introducing new Medicaid provider taxes or increasing existing provider taxes that were in effect on that same date. Phasing down the provider tax ceiling [...]

joe2026-07-23T16:11:10-04:00July 24, 2026|Medicaid, Medicaid managed care, Medicaid regulations|

Federal Health Policy Update for July 23

Don’t Miss: Congress advances health care bills CMS proposes provider tax rule Courts act on ACA changes, 340B The following is the latest health policy news from the federal government for July 17-23. Some of the language used below is taken directly from government documents. Congress The House Energy and Commerce Committee held a markup for 29 bills, advancing the following health care transparency measures with bipartisan support: H.R. 9390, Prices on the Wall Act of 2026 H.R. 9393, Lower Costs, More Transparency Act of 2026, part of a package that also includes: H.R. 3514, Improving Seniors’ Timely Access [...]

joe2026-07-23T16:29:15-04:00July 23, 2026|340b, Affordable Care Act, MACPAC, Medicaid managed care, Medicaid regulations, Medicare regulations, Medicare reimbursement policy, MedPAC|

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|