Policy Updates

The Implications of New Limits on Medicaid Provider Taxes

Last year’s federal budget reconciliation law, in addition to introducing nearly a trillion dollars in federal health care spending cuts over the next decade, took aim at a tool state governments consider vital in financing their Medicaid programs: provider taxes. For years, states have used provider taxes, typically on some aspect of hospital activity, to help finance their share of their Medicaid programs; currently, 49 of the 50 states have such taxes. Among other benefits, using provider taxes in this manner has enabled states to avoid using more general fund money for this purpose. But the 2025 law imposes new [...]

joe2026-08-25T13:45:21-04:00August 26, 2026|Medicaid, Medicaid regulations|

Infants, Toddlers Increasingly Dependent on Public Health Insurance

A new study highlights the growing dependence of families on public health insurance programs – Medicaid and the Children’s Health Insurance Program – to pay for care for their infants and children. According to a new analysis by the Georgetown University McCourt School for Public Policy, Medicaid and the Children’s Health Insurance Program (CHIP) cover 4 in 10 (39.7%) children under age 3. For families earning less than 200% of the federal poverty level—about $54,640 for a family of three—Medicaid and CHIP are even more critical sources of coverage, insuring approximately three-quarters (74.6%) of infants and toddlers. Other major findings, [...]

joe2026-08-20T15:52:49-04:00August 24, 2026|Medicaid|

Federal Health Policy Update for August 20

Don’t Miss: Latest No Surprises Act/Independent Dispute Resolution news Dept of Homeland Security issues guidance on “public charge” The following is the latest health policy news from the federal government for August 14-20. Some of the language used below is taken directly from government documents. Congress Thirty Senate Democrats have written to HHS Secretary Kennedy seeking to reverse the cancellation of health research grants administered by the Agency for Healthcare Research and Quality (AHRQ). For more information, see the letter here. Congress remains in recess; the House is expected to return on August 31 and the Senate on September 14. [...]

joe2026-08-20T15:55:42-04:00August 20, 2026|Affordable Care Act, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

Non-Profit Hospitals Struggled in 2025, Moody’s Finds

The financial performance of non-profit hospitals weakened in 2025, according to Moody’s, the financial rating service company. According to Moody’s: Median operating margins fell from 1.3 percent in 2024 to 1.2 percent in 2025. Median operating income fell 13.3 percent. Revenue growth fell from 9.6 percent to 8.9 percent. Expenses continued to grow, driven by increased wages and rising costs for purchased services and prescription drugs. On the other hand, Moody’s also found that: Revenue growth outpaced rising expenses. Patient and pharmacy activity grew. Hospitals in some states benefited from expanded Medicaid supplemental payments. Commercial reimbursement improved. For a closer [...]

joe2026-08-18T14:42:20-04:00August 20, 2026|hospitals, Medicaid|

Analysis Puts Price Tag on Loss of Medicaid State Directed Payments

Thirty-seven states face the loss of significant federal Medicaid revenue depending on how the Centers for Medicare & Medicaid Services ultimately implements a provision in the 2025 reconciliation bill that called for new limits on so-called state directed payments – Medicaid money the states direct to their Medicaid managed care plans with instructions on how to use that money. The 2025 law calls for nearly a trillion dollars in reduced federal Medicaid spending and $60 billion of that cut could result from new limits on state directed Medicaid payments to managed care organizations. Providers in eight states, led by California, [...]

joe2026-08-18T16:49:35-04:00August 19, 2026|Congress, hospitals, Medicaid|

Mandatory Value-Based Programs Increase Hospital Costs

While policymakers continue to pursue mandatory Medicare value-based programs at least in part to help reduce taxpayers’ costs for Medicare, they may be robbing Peter to pay Paul. According to a new study, hospitals that participate in federally mandated Medicare value-based purchasing programs face increased administrative costs for doing so even while federal agencies maintain that the programs are saving taxpayer money. Brown University researchers examined 15 years of hospital cost reports and found that participation in Medicare’s Hospital Value-Based Purchasing Program, Hospital Readmissions Reduction Program, and Hospital-Acquired Condition Reduction Program cost hospitals about $650,000 a year in added administrative [...]

joe2026-08-13T16:41:29-04:00August 17, 2026|hospitals, Medicare|

Court Rejects No Surprises Act’s QPA Methodology

A federal appeals court has rejected how health care payers calculate their qualifying payment amount, or QPA, when addressing disputed payments under the No Surprises Act’s Independent Dispute Resolution process. The QPA is the central benchmark rate payers present to help settle out-of-network medical billing disagreements that for years led to surprise medical bills for many hospital patients. The court concluded that payers should not be permitted to include so-called ghost rates when calculating their QPA; a ghost rate is a rate for services that a given provider does not actually provide, leaving the provider no incentive to attempt to [...]

joe2026-08-13T15:13:04-04:00August 14, 2026|Uncategorized|

Federal Health Policy Update for August 13

Don’t Miss: Federal court vacates key aspect of No Surprises Act’s IDR process President calls for changes in childhood immunizations CMS seeks billing info so it can pay APM docs their bonuses The following is the latest health policy news from the federal government for August 7-13. Some of the language used below is taken directly from government documents. The White House The White House has issued an executive order calling for a change in recommended childhood vaccines. The order suggests reducing the number of recommended childhood vaccines from the current 17 to 11 revising the status of the remaining [...]

joe2026-08-13T14:39:23-04:00August 13, 2026|Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

CMS Clarifies Upcoming IDR Changes

Earlier this year, the departments of Health and Human Services, Labor, and the Treasury and the Office of Personnel Management published federal Independent Dispute Resolution operations final rules to improve the functioning of the No Surprises Act’s IDR process, which is part of a broader effort to eliminate surprise medical bills. The new rules seek to streamline communication between health care payers, providers, and certified IDR entities by establishing new timelines and processes. When the individual requirements in these final rules will take effect will vary depending on when the technical capacity to support them is ready within the not-yet-introduced [...]

joe2026-08-12T13:05:25-04:00August 13, 2026|Uncategorized|

Disagreement Over 340B’s Future

Almost immediately after the Department of Health and Human Services announced a pilot program to test using a rebate model in the 340B Drug Pricing Program, members of Congress responded with proposed legislation that would prevent HHS from implementing that pilot. Last week, HHS’s Health Resources and Services Administration announced its 340B Rebate Model Pilot Program, a refined version of a previous pilot program that a federal court rejected earlier this year. Under this new model, qualifying drug manufacturers will be able to provide the 340B ceiling price to eligible 340B providers through rebates, an approach manufacturers have increasingly sought, [...]

joe2026-08-11T15:58:28-04:00August 12, 2026|340b, hospitals|