Policy Updates

Search for Undocumented Medicaid Participants Not Yielding Major Results

An administration effort to identify undocumented U.S. residents illegally enrolled in Medicaid is not turning up many undocumented residents illegally enrolled in Medicaid. At least not so far. Last fall, the administration sent the names of hundreds of thousands of suspected illegal Medicaid participants to the states and directed them to review the eligibility of those individuals. Data from five states, however, has not turned up many such individuals. Between them, Colorado and Pennsylvania reviewed 79,000 names and found none illegally enrolled in their state Medicaid programs. Texas reviewed 28,000 records and terminated 77 people from the program. Ohio checked [...]

joe2026-04-07T16:53:00-04:00April 9, 2026|Medicaid|

States Looking to Swap Medicaid Taxes

With Medicaid provider taxes on the road to oblivion as a result of passage of last year’s H.R. 1, often referred to as “The One Big Beautiful Act Law,” a number of states are looking to Medicaid managed care plan taxes to replace at least some of the tax revenue they will lose from the demise of Medicaid provider taxes. Iowa has already adopted such a tax, more than tripling its Medicaid managed care plan tax in the middle of its fiscal year. The state even increased taxes on managed care plans that do not serve Medicaid patients. Elsewhere, lawmakers [...]

joe2026-04-07T14:42:09-04:00April 8, 2026|Medicaid|

Federal Health Policy Update for April 3

The following is the latest health policy news from the federal government for March 27 to April 3. Some of the language used below is taken directly from government documents. Proposed and Final CMS Medicare Regulations Proposed FY 2027 Medicare Inpatient Rehabilitation Facilities Payment Rule CMS has published a proposed rule updating Medicare payment policies and rates for inpatient rehabilitation facilities (IRF) under its IRF prospective payment system and updating the IRF quality reporting program for FY 2027. CMS proposes updating FY 2027 IRF rates by 2.4 percent based on a market basket update of 3.2 percent less a proposed [...]

joe2026-04-03T13:22:10-04:00April 3, 2026|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, Medicaid, Medicare regulations, Medicare reimbursement policy|

Hospitals Sue Over Medicare DSH Payments

More than 100 hospitals have sued the Department of Health and Human Services, arguing that the manner in which the Centers for Medicare & Medicaid Services calculates their Medicare disproportionate share payments shortchanges hospitals that care for especially large numbers of low-income patients – the very hospitals Medicare DSH payments were created to help. According to the hospitals, CMS’s Medicare DSH payment methodology undercounts the number of low-income patients hospitals serve, thereby reducing the Medicare DSH payments yielded under the Medicare DSH payment calculation formula adopted in 2023. Learn more about how the suing hospitals believe CMS is undercounting their [...]

joe2026-04-01T12:33:31-04:00April 3, 2026|hospitals, Medicare disproportionate share, Medicare DSH|

No More Hospital Jello?

The days of enjoying a heaping bowl of jello while stuck in a hospital bed may soon become a thing of the past. In a new directive to hospitals, the Centers for Medicare & Medicaid Services has told hospitals that they need to do a better job of meeting their patients’ nutrition needs and “…to align food service with the 2025–2030 Dietary Guidelines for Americans, which prioritize whole, nutrient-dense foods and adequate protein while limiting ultra-processed foods and added sugars.” The CMS memo to hospitals offers the following guidelines: Limiting ultra-processed food options for patients. Elimination of sugar-sweetened beverages unless [...]

joe2026-03-31T15:19:12-04:00April 2, 2026|Centers for Medicare & Medicaid Services, hospitals|

Medicare Increases Emphasis on Behavioral Health

Medicare policy is evolving to encourage providers to take a more active role in addressing the behavioral health needs of their patients. In traditional Medicare, new payment codes encourage practitioners to spend more time identifying and helping patients with their behavioral health challenges. Meanwhile, CMS and its Center for Medicare and Medicaid Innovation have introduced several new care and payment models that place a greater emphasis on beneficiaries’ behavioral health needs. Among them: The LEAD (Long-Term Enhanced ACO Design) Model, which seeks to include more behavioral health providers and encourages greater integration of behavioral health care. The ACCESS (Advancing Chronic [...]

joe2026-03-31T17:02:07-04:00April 1, 2026|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicare|

Hospitals Had a Rough January

Hospitals’ financial performance in January of 2026 suffered in comparison to that in January of 2025, according to a recent report. The report found that: Discharges fell two percent. Emergency department visits were off five percent. Average length of stay declined three percent. Expenses rose five percent. Labor costs increased five percent. Bad debt and charity care rose eight percent. Learn more about how the new year brought financial challenges to hospitals from the Healthcare Dive article Hospitals’ financial performance off to a shaky start in 2026: report.

joe2026-03-25T10:29:31-04:00March 27, 2026|hospitals|

Federal Health Policy Update for March 26

The following is the latest health policy news from the federal government for March 20-26. Some of the language used below is taken directly from government documents. Congress Republican leadership is exploring a reconciliation bill as a potential vehicle to fund Immigrations and Customs Enforcement (ICE) and pass the Safeguard American Voter Eligibility Act (SAVE) voting rights act. If pursued, this approach could increase the likelihood of additional health care cuts, including expanding site-neutral payment policies in both Medicare and Medicaid. It is not clear whether there will be sufficient support in either chamber for Republicans to pursue a party-line [...]

joe2026-03-26T15:09:34-04:00March 26, 2026|Alternative payment models, Center for Medicare and Medicaid Innovation, CMMI, Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicare, Medicare regulations, Medicare reimbursement policy|

FTC Creates Health Care Task Force

A new group will join the fight to protect Americans from their country’s health care system. The Federal Trade Commission has announced the creation of a health care task force “…that will engage in a coordinated, integrated approach to healthcare enforcement and advocacy to protect American patients, healthcare workers, and taxpayers.” According to the FTC, the task force will: Lead targeted enforcement and advocacy initiatives focused on key priorities; Devise coordinated agencywide strategies on investigations; Take a proactive and strategic approach to identifying amicus and statement of interest opportunities; and Identify emerging issues and new priority areas for enforcement and [...]

joe2026-03-24T14:29:41-04:00March 26, 2026|Uncategorized|

CMS Takes an Axe to the Fax

The days of sending health care claims forms and claims-related documents by fax and regular U.S. mail are fast drawing to a close. Last week the Centers for Medicare & Medicaid Services announced that it will adopt a new regulation – “The Administrative Simplification; Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures Final Rule” – that will establish HIPAA-compliant standards for sharing health care claims attachments, enabling the secure electronic exchange of health care claims-related supporting clinical documentation and attachments such as medical records, x-rays and imaging, clinical notes, telemedicine visit documentation, and laboratory results. The [...]

joe2026-03-24T13:44:33-04:00March 25, 2026|Uncategorized|