Medicaid

• The Trump administration will require all 50 states to explain their plans to revalidate Medicaid providers as part of a national escalation of anti-fraud efforts, announced by Dr. Mehmet Oz on Tuesday. • This marks a significant expansion from previous anti-fraud initiatives that have largely focused on specific states rather than a nationwide mandate. • The move aims to strengthen program integrity and reduce fraudulent claims across the Medicaid system.

Victory for abortion rights groups as court finds state’s constitution guarantees a right to abortionA Pennsylvania court on Monday said that the state’s constitution guarantees a right to abortion while striking down a decades-long law banning the use of state Medicaid funds to cover abortion costs.The ruling by a divided seven-judge panel of the appellate-level commonwealth court is a major victory for Planned Parenthood and abortion clinic operators who first sued Pennsylvania over its Medicaid funding restrictions in 2019. Continue reading...

Experts say any short-term financial benefit will be outweighed by long-term health costs related to obesityFaced with high demand for GLP-1 drugs, some American cities and states that previously covered the cost of the weight-loss medication for low-income residents and public employees have now started to restrict or eliminate coverage.The pullback stems from the dramatic increase in public spending on drugs such as Ozempic and Wegovy in recent years. Continue reading...

• Centers for Medicare and Medicaid Services published a proposed rule on Friday requiring health insurance companies and states to resolve non-urgent prior authorization requests for prescription drugs within 24 hours. • The regulation mandates Medicaid and CHIP insurers, plus state administrators, to publicly disclose denial rates and respond faster to improve patient access. • This addresses delays in medication approvals, potentially benefiting millions enrolled in these programs amid ongoing affordability challenges.

• HHS issued a final rule on April 7, 2026, permanently extending Medicare telehealth flexibilities introduced during COVID-19, covering 85 million Medicaid enrollees. • Audio-only visits now reimbursable at $18-$40 per session, with $37 billion allocated through 2030 to rural providers. • Addresses access gaps in 20% of US counties lacking specialists; 'This bridges urban-rural divides,' said HHS Secretary.

• Bluestem Health in Lincoln, Nebraska, serving 21,000 low-income and uninsured patients, has operated at a loss for two years and anticipates worsening conditions due to new Medicaid work rules under President Trump's One Big Beautiful Bill Act. • Nebraska becomes the first state to enforce work requirements for certain Medicaid enrollees, risking coverage loss and threatening clinic viability, as stated by CEO Brad Meyer. • The policy darkens the outlook for government-backed clinics nationwide by reducing patient access to care amid rising operational costs.

• A new report warns that hundreds of hospitals serving 6.6 million Americans in 44 states and Washington, D.C., face serious threats from potential Medicaid cuts. • The cuts could force hospitals to reduce services or close, severely impacting healthcare access for lower-income and underserved communities. • Medicaid remains a critical funding source for these facilities, highlighting the broad national implications for public health infrastructure.

• 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.

• Last August, the Trump administration ordered states to reverify immigration status of hundreds of thousands of Medicaid enrollees, but findings from five states show few immigrants without legal status improperly receiving benefits. • States paid Deloitte and other firms millions to comply with the law aimed at cutting Medicaid rolls, with federal officials mandating reverification of enrollee immigration data. • The reviews highlight limited evidence of widespread ineligibility, raising questions about the policy's effectiveness and costs to update systems amid ongoing crackdowns.

• 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.