Medicaid

• CMS announced the Accelerating State Pediatric Innovation Readiness and Effectiveness Model (ASPIRE), a 10-year voluntary program for up to five states. • ASPIRE targets Medicaid and CHIP enrollees up to age 21 with complex medical and behavioral needs through early identification, care coordination, and quality accountability. • A Notice of Funding Opportunity will be released later this year to solicit state participation.

• The House Energy and Commerce Subcommittee held a March 17 hearing on CMS fraud prevention, with Deputy Administrator Kimberly Brandt detailing data analytics and real-time monitoring shifts. • Republicans highlighted improper payments in hospice, home health and Medicaid, calling for stronger oversight; Democrats urged balancing enforcement with patient access. • Lawmakers addressed fraud risks in durable medical equipment amid calls to end 'pay-and-chase' models.

• The Trump administration announced plans to halt billions in federal Medicaid payments to California, Florida, Maine, and New York, following similar actions against Minnesota involving over $2 billion in withheld funds and $260 million clawed back. • Officials cited alleged Medicaid fraud as the basis for these unprecedented measures, potentially creating a national playbook for pressuring states over program spending. • This escalation impacts public health insurance jointly funded by states and federal government, raising concerns about access for low-income Americans amid ongoing political tensions.

• The Medicaid and CHIP Payment and Access Commission (MACPAC) released its March 2026 Report to Congress on March 12, 2026, with primary recommendations focused on home and community-based services (HCBS) workforce challenges. • The report recommends that states be required to report hourly wages paid to HCBS workers to better align payment rates with frontline compensation and enable cross-state wage comparisons. • The report also examines behavioral health in Medicaid, the Medicaid Expansion Children's Health Insurance Program, Medicaid's role for justice-involved youth, and coverage for children in foster care.

The AMA submitted comments on March 13, 2026, recommending CMS actions to help states implement Medicaid community engagement requirements without causing unwarranted coverage losses for eligible enrollees. In separate marketplace plan comments, AMA stressed maintaining affordable, comprehensive coverage, warning proposed affordability boosts could destabilize risk pools and limit patient access. These advocacy efforts address national issues impacting physicians and patients amid ongoing health policy shifts. Senate HELP Committee bills from March 6 promote health care cybersecurity coordination and protections for living organ donors.