Medicaid

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|

Federal Health Policy Update for November 5

Don’t Miss: CMS releases final 2027 Medicare outpatient rule CMS releases final 2027 Medicare physician fee schedule rule New guidance for batching IDR claims The following is the latest health policy news from the federal government for October 30-November 5. Some of the language used below is taken directly from government documents. 2026 Midterm Elections Democrats regained control of the House and Senate in the 2026 midterm elections. As of 3:30 p.m. eastern time today, the House is 251-155 and the Senate 54-44, both in favor of Democrats, with the outcome of 29 House races and two Senate [...]

joe2026-11-05T17:13:24-05:00November 5, 2026|340b, Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations, Medicare, Medicare post-acute care, Medicare regulations, 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 two days of meetings. MACPAC’s October 2026 meeting began with a staff presentation on findings from a literature review on factors that drive hospital costs. MACPAC discussed the Medicaid payment methodologies used for inpatient and outpatient hospital services and clarified the distinction between hospital cost, defined as the resources that hospitals expend to provide care, and Medicaid hospital spending, defined as the payments Medicaid makes for those services. Next, staff provided background on the Medicaid [...]

joe2026-11-05T09:04:06-05:00November 5, 2026|hospitals, MACPAC, Medicaid, Medicaid regulations for long-term care|

What the Changing of the Guard May Bring for Health Care

Medicare for all? A reversal of 2025-enacted cuts in Medicaid eligibility. The restoration of some Affordable Care Act health premium subsidies? More drug price negotiations between the federal government and pharmaceutical companies? The restoration of some National Institutes of Health research funding? A closer look at No Surprises Act dispute adjudication? These are among the policy initiatives that may be undertaken next year in the wake of the outcome of the mid-term elections that saw Democrats gain majorities in both the House and Senate next years? Learn more about some of the policy possibilities for the 120th Congress from [...]

joe2026-11-04T11:01:33-05:00November 4, 2026|Affordable Care Act, Congress, Medicaid, Medicare|

Federal Health Policy Update for October 29

Don’t Miss: CMS charts new path for pursuing ACA premium tax credits CMS publishes timeline for implementation of Medicaid changes Court rejects narrow “medically frail” definition for exemption from Medicaid work requirement Inspector General elaborates on new CMS “power to exclude” The following is the latest health policy news from the federal government for October 23-29. Some of the language used below is taken directly from government documents. Congress The House Committee on Oversight and Government Reform announced an investigation into pharmacy benefit managers (PBMs). In letters to CVS Caremark, Express Scripts, and Optum Rx, Chairman James Comer (R-KY) [...]

joe2026-10-29T17:09:21-04:00October 29, 2026|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for October 22

Don’t Miss: Senate Finance Democrats release home care RFI New NIH Women’s Health Division Updated “Health Care Fraud Self-Disclosure” protocol The following is the latest health policy news from the federal government for October 16-22. Some of the language used below is taken directly from government documents. Congress Senate Finance Committee Ranking Member Ron Wyden (D-OR) released a Request for Information (RFI) titled “Delivering An Affordable Home Care Guarantee for American Families,” seeking feedback on policy proposals aimed at making home care affordable and accessible, especially for those with disabilities and seniors; improving the quality of care in nursing homes; [...]

sysadmin2026-10-25T16:53:19-04:00October 22, 2026|340b, Centers for Medicare & Medicaid Services, Congress, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare|

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|