Medicaid

Federal Health Policy Update for October 15

Don’t Miss: IRS proposes changes in rules governing ACA premium tax credits Lawsuit and legislation aim to block 340B Rebate Model Program CMS updates telehealth FAQ The following is the latest health policy news from the federal government for October 9-15. Some of the language used below is taken directly from government documents. Congress Both chambers of Congress will reconvene after the mid-term elections on November 9. Upon their return, one of their priorities will be advancing a government funding package because the current continuing resolution (CR) expires on December 11. Affordable Care Act Premium Tax Credits The IRS has [...]

joe2026-10-15T16:58:25-04:00October 15, 2026|340b, Affordable Care Act, Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

The Curious Case of Improper Medicaid Payments

While the Centers for Medicare & Medicaid Services continues its efforts to “crush” Medicaid fraud, a new report says that the biggest source of improper Medicaid payments is… Flawed paperwork. While improper payments generally are categorized as fraud, waste, and abuse, CMS’s focus has been squarely on fraud. At the same time, however, the Congressional Research Service recently reported that flawed paperwork, and not necessarily an attempt to inappropriately or illegally profit from Medicaid payments, is most of the problem. According to the report, CMS estimates that most improper payments (77% in FY2025) are the result of insufficient documentation (e.g., [...]

joe2026-10-14T11:32:26-04:00October 15, 2026|Medicaid|

Federal Health Policy Update for October 8

Don’t Miss: Latest 340B developments CMS penalizes majority of hospitals for failing to meet Readmissions Reduction Program standards FTC reminds hospitals of price transparency requirements The following is the latest health policy news from the federal government for October 2-8. Some of the language used below is taken directly from government documents. The White House The White House announced that the federal government will make one-time payments of $90 per person to more than 20 million Medicare enrollees – about one-third of Medicare participants – to help them pay their Medicare Part B premiums. Most eligible seniors will receive the [...]

joe2026-10-08T16:40:19-04:00October 8, 2026|340b, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, Medicaid, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for October 1

Don’t Miss: CMS partners with 37 states to launch Medicaid quality initiative CMS fleshes out GLOBE Model Medicare Part D Claims Data 340B Repository goes live The following is the latest health policy news from the federal government for September 25 - October 1. Some of the language used below is taken directly from government documents. The White House A statement issued by the White House titled “President Trump Takes Historic Action to Eliminate Wasteful and Harmful Spending” includes a series of cuts, or rescissions, of health-related federal expenditures, including $567 million for taxpayer-funded HHS services for non-citizens; $28 million [...]

joe2026-10-07T11:45:36-04:00October 1, 2026|340b, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, MACPAC, Medicaid, Medicaid and homelessness, Medicaid regulations, Medicare, Medicare reimbursement policy|

MACPAC Meets

Members of the Medicaid and CHIP Payment and Access Commission met last week in Washington, D.C. The following is MACPAC’s own summary of the meeting: MACPAC’s September 2026 meeting began with a discussion around community engagement (CE) requirements in Medicaid. The 2025 Budget Reconciliation Act established CE requirements and delegates to the Secretary the authority to set certain standards and procedures that the Centers for Medicare & Medicaid Services (CMS) addressed in the interim final rule with comment (IFC), issued on June 1, 2026. Staff summarized key IFC provisions, including individuals subject to CE, exceptions and exclusions from CE, state [...]

joe2026-09-30T11:58:20-04:00October 1, 2026|Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid long-term services and supports, Medicaid regulations|

Imminent Changes in Medicaid Eligibility for Immigrants

Come October 1, immigrants seeking Medicaid benefits – including lawful immigrants – will face a new array of eligibility criteria and requirements. KFF has presented a broad look at those new criteria, ushered in as a result of last year’s federal budget reconciliation bill – also known as H.R. 1 and the One Big Beautiful Act Bill – and how they are expected to be implemented. The major aspects of the coming changes are (all quoted directly from the KFF review): States must redetermine eligibility for all “potentially affected” existing Medicaid enrollees under the new rules by October 1, 2026, [...]

joe2026-09-30T08:25:08-04:00September 30, 2026|Medicaid|

Federal Health Policy Update for September 24

Don’t Miss: CMS plans major cuts in Medicare clinical lab payments Administration reconsiders shifting NIH grant decisions to White House All states enroll in CMS model to reduce prices of selected Medicaid-covered drugs The following is the latest health policy news from the federal government for September 18-24. Some of the language used below is taken directly from government documents. The White House The White House has issued the executive order “Enhancing Program Integrity and Interagency Coordination in the Administration of the H-1B Nonimmigrant Visa Program.” The order increases federal oversight of the H-1B visa program because “The abuse of [...]

joe2026-09-24T15:28:11-04:00September 24, 2026|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid and homelessness, Medicaid regulations, Medicare, Medicare reimbursement policy|

Immigrant Families Skipping Health Care for Kids

Immigrant families with children appear to be avoiding seeking health care over concern about their immigration status, according to a new survey of pediatricians. The survey, conducted on behalf of the American Academy of Pediatrics, found that: Forty percent of pediatricians reported that immigrant families with children are avoiding seeking care for their children because of concern about their immigration status. Thirty-one percent said those same families were avoiding applying for any government programs, including Medicaid, the Children’s Health Insurance Program (CHIP), and the Supplemental Nutrition Assistance Program (SNAP). More than 20 percent said they served immigrant families that were [...]

joe2026-09-17T15:36:28-04:00September 21, 2026|Medicaid|

Federal Health Policy Update for September 17

Don’t Miss: CMS advises on “medical frailty” as qualification for Medicaid eligibility CMS unveils long-anticipated IDR Gateway Medicare ACCESS Model to expand The following is the latest health policy news from the federal government for September 11-17. Some of the language used below is taken directly from government documents. Congress The House Energy & Commerce Committee’s Health Subcommittee held a hearing to discuss bills seeking to modify certain physician payments under Medicare, to address cybersecurity in the health care system, and to expand seniors’ access to care. See the chairman’s opening statement here and find a list of witnesses [...]

joe2026-09-17T16:23:30-04:00September 17, 2026|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

CMS Fleshes Out “Medical Frailty” Criterion for Medicaid Eligibility

When Congress included major reductions in Medicaid eligibility in last year’s budget reconciliation bill – H.R. 1, often referred to as the “One Big Beautiful Bill Act” – it included one criterion for Medicaid eligibility that immediately proved challenging. While the new law requires individuals to work or participate in “community engagement” activities such as attending school or performing volunteer work” as a condition of Medicaid eligibility, it offered an exception to this requirement: those found to be “medically frail.” The law, however, did little to define what constitutes medical frailty beyond defining as medically frail those who are blind [...]

joe2026-09-15T16:39:05-04:00September 16, 2026|Medicaid|