In This Week’s Update:

• Healthcare Providers Raise Concerns About CMS’ Parameters
• Does Prior Authorization Drive Inequality in Healthcare?
• Democratizing Data: Putting Evidence into Action
• Medicaid Medical Directors’ Guidance on Medical Frailty Exemptions
• CMS Launches Nationwide Medicaid Fraud Audit
• State updates: AR, AZ, CA, DC, NC, ND, NH, OR, PA, WI & WV

Healthcare Providers Raise Concerns About CMS’ Parameters
This Center on Health Insurance Reforms blog examines the feedback provided by major healthcare provider organizations regarding the Centers for Medicare & Medicaid Services (CMS) proposed 2027 Notice of Benefit and Payment Parameters. The blog underscores the potential for significant Marketplace instability and a reduction in the quality of coverage for millions of enrollees.

Does Prior Authorization Drive Inequality in Healthcare?
An AcademyHealth report examines the disproportionate impact of prior authorization on historically marginalized patient populations and the widening of health disparities. The report highlights how these insurance protocols can exacerbate existing inequalities for low-income individuals and those with limited health literacy and hinder health equity.

Democratizing Data: Putting Evidence into Action
Children’s HealthWatch’s “Democratizing Our Data” project utilizes an interactive dashboard to share findings on social determinants of health, such as food security, housing stability, and health insurance coverage. By providing transparent access to research and data, the initiative aims to empower community leaders and policymakers to address health inequities and evaluate the impact of safety net programs like Medicaid and Supplemental Nutrition Assistance Program. 

Medicaid Medical Directors’ Guidance on Medical Frailty Exemptions
Medicaid medical directors from three states published an article focusing on clinical considerations for implementing medical frailty exemptions for work reporting requirements. The article highlights the need for flexibility to most effectively meet the requirements of H.R.1. 

Related resource: State Health & Value Strategies has a number of medical frailty resources on its H.R.1 Resources for States page.

CMS Launches Nationwide Medicaid Fraud Audit
CMS and federal officials held a press conference launching a multi-pronged effort to reduce Medicaid fraud, including a nationwide audit of state Medicaid Fraud Control Units and a moratorium on new hospice and home care provider enrollments. CMS also announced that $1.3 billion in federal Medicaid funds would be deferred from California as a result of ongoing program audits. 

State updates: AR, AZ, CA, DC, NC, ND, NH, OR, PA, WI & WV

• Arizona’s Health Care Cost Containment System will launch an AI tool to detect and prevent fraud before payment is made, directing human review resources to the highest-risk claims while minimizing delays for compliant providers.
• Arkansas submitted a request to renew the Arkansas Health and Opportunity for Me section 1115 Medicaid demonstration to expand the Life360 HOMEs program by updating provider and health plan requirements and introducing coaching services to help populations meet work requirements.
• California‘s Department of Health Care Services responded to CMS’ deferral of $1.1 billion to its In-Home Supportive Services program, calling for an immediate restoration of funds.
• District of Columbia‘s Department of Health Care Finance finalized regulations allowing Medicaid enrollees to submit claims for reimbursement of certain out-of-pocket expenses up to one year from the date of purchase.
• New Hampshire’s governor welcomed CMS officials to the state to highlight its approach to implementing the Rural Health Transformation (RHT) Program. 
• North Carolina’s Department of Health and Human Services selected organizations to serve as leads for the Rural Organizations Orchestrating Transformation for Sustainability Hub, which will work as regional networks connecting medical, behavioral health, and social supports.
• North Dakota’s Health and Human Services (HHS) posted information about the latest RHT Program funding opportunities and resources. HHS also expanded access to Parent-Child Interaction Therapy through telehealth to improve child behavior, strengthen parenting skills, and build healthier parent-child relationships.
• Oregon‘s overdose deaths decreased over the past two years, according to provisional federal data and an Oregon Health Authority (OHA) report. OHA also reported that the Opioid Settlement Prevention, Treatment, and Recovery Board allocated more than $90 million statewide for substance-use prevention, treatment, and recovery services throughout the last two years. 
• Pennsylvania‘s Department of Human Services secretary detailed the state’s commitment to stopping Medicaid fraud in an op-ed, highlighting the Commonwealth’s national leadership in monitoring Medicaid and other public assistance programs to stop fraud and misuse before it happens. 
• West Virginia’s governor launched the $29.5 million Provider Productivity Support Fund, a rural health initiative designed to reduce administrative burdens on healthcare providers and improve healthcare outcomes. The governor also invested nearly $4 million to strengthen healthcare workforce recruitment efforts and expand training and mentorship for rural providers.
• Wisconsin’s Department of Health Services and community partners developed a plan to eliminate viral hepatitis and released a public dashboard to track progress of the plan’s goals. Statewide efforts include improving testing, vaccination, and treatment to reduce death and illness from viral hepatitis.