Category: CMS News

Alternative Headline: Weiss Hospital Loses Medicaid

[MM Curator Summary]: Weiss Memorial Hospital — a staple for Medicaid and Medicare patients in the area — closed its ER after losing Medicaid and Medicare access due to care standard violations.

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Weiss Memorial Hospital in Chicago’s Uptown neighborhood has closed its emergency department as it was set to lose Medicaid access this weekend. 

The Department of Health and Human Services is removing Weiss from the federal health care programs, saying the hospital failed to meet its standards of care.

In addition, there have been multiple reports of mistreatment and unclean facilities at the Hospital. The Illinois Department of Public Health has investigated those claims seven times.

The news dealt a devastating hit to the community, finding the hospital’s removal from Medicaid and Medicare, and its potential closure, terrifying, saying it would be a catastrophe.

Marc Kapan, an organizer with Northside Action for Justice, said the hospital is an anchor of the community.

"Very much a hospital for seniors and elders in our community," he said. "Low-income elders that really don’t have any other options."

One man, who is originally from Vietnam, spoke to CBS News Chicago through an interpreter, saying, "My health fluctuates through time, but every single time that I’ve needed a hospital, it’s always been there for me."

He added that Weiss helped him overcome colon cancer; he’s now in remission.

"This hospital right now serves over 50% Medicare and 30% Medicaid, and that’s 80% of the revenue is from Medicare and Medicaid, and if they lose their funding from the federal CMS, they won’t be able to be sustainable long-term," said Illinois state Rep. Hoan Huynh (D-Chicago).

Huynh said he’s been in touch with hospital owner Manoj Prasad, who had promised to fix the issues after buying the hospital in 2022. That hasn’t happened.

"When leadership took over, we were working with them to make sure these changes happen, right, there’s infrastructure changes, there’s operational changes," Huynh said. "Obviously, they have not happened yet."

A nurse in the hospital’s Emergency Department told the Chicago Sun-Times they were informed of that decision by their supervisor, and also noted that no staff schedule has been set beyond Saturday.

ER nurse at Weiss Hospital says facility appears to be closed 02:52 

Daniel Maser, who is an ER nurse for the hospital, told CBS News Chicago the first thing he did this morning was ask his coworkers about what was happening in the facility. 

"This morning when I woke up, I just texted my coworkers just to get an update and see how things are playing out just to see what actually happened, and then it sound like we were just closed. Lights turned off, even security didn’t really know exactly what to do, so they just closed the doors," he said.

On Friday, doctors, nurses, and staff, along with elected officials, plan to rally the hospital’s closure at 1 p.m.    

Rep. Hoan Huynh on possible Weiss Memorial Hospital closure, rally Friday 05:17 

Huynh said he will be joining the group rallying to keep the hospital open. 

"This was a failure of epic proportions," Huynh said. 

CBS News Chicago has learned more about the exact reasons the hospital was deemed noncompliant with federal rules.

Notably, a July 12 report by the Centers for Medicare and Medicaid Services did not cite the hospital’s broken air conditioning as a reason. Rather, the report detailed multiple failures related to nursing care, along with a failure related to pharmaceutical record-keeping.

The owner of the hospital said their license was put on hold as of 7 a.m. Friday. However, they do plan to appeal, reapply, and reopen in the future. That process could take up to a year. 

All outpatient services will continue as they have not been impacted.

Ald. Angela Clay (46th Ward) commented on the closing, saying, "For now, I stand with community organizations, neighbors, and advocates who are calling on the State of Illinois and the Federal government to do everything in their power to save Weiss Hospital."

https://www.cbsnews.com/chicago/news/weiss-hospital-kicked-off-medicare-medicaid-closure/

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Alternative Headline: Medicaid Cuts Spark Fears

[MM Curator Summary]: Trump’s new budget law slashes Medicaid funding, imposing work requirements, and threatening millions’ access to health care.

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Over the past few months, Marcia Dinkins’ eldest child has been hospitalized frequently. A serious infection swept through her daughter’s body, affecting her pancreas, spleen, and gallbladder.

Fortunately, Dinkins’ daughter, Marshale Malone, was able to afford and receive life-saving surgery, thanks to Medicaid.

But without it, Dinkins said, the health emergency could have meant either “life or death” for Malone, who is 40.

The same can be said for her two other daughters, who also suffer from health-related issues, including seizures and blood clots in their lungs and legs, Dinkins told Capital B. In their cases, too, insurance, including Medicaid, has been vital in receiving the care they desperately need.

But because of the significant Medicaid cuts and provisions in the budget and reconciliation package, also known as the “One Big Beautiful Bill Act,” Dinkins now worries that these changes will impact the critical care her daughters and others could receive in the future. 

“That’s what made me so angry,” said Dinkins, founder of Black Appalachian Coalition, “because this one bad bill that they want to call beautiful is only going to make it harder for individuals like her and seniors and countless others in the region to be able to get access to health care, especially when the hospitals are already closing down.”

It’s been a month since President Donald Trump signed the act into law. The legislation requires able-bodied individuals on Medicaid to participate in a work program or community engagement for at least 80 hours a week. It also eliminates a 5% increase in federal matching funds for states, which means state governments must find a way to shoulder the costs. That additional expenditure, experts say, limits their ability to pay for Medicaid. 

This year marks the 60th anniversary of Medicaid, and currently 71 million people are enrolled, with children and women making up the majority. While Black people account for 20% of enrollees, white people represent the highest percentage at 40%, Pew Research Center reports. Children, adults and individuals with disabilities living in rural areas are most at risk, as they are more likely to rely on Medicaid. 

The Congressional Budget Office estimates the provisions in the new law will reduce federal Medicaid spending by $1 trillion over the next decade and increase the number of uninsured people by 10 million. Some estimates say $150 million of that funding will be removed from rural areas. 

Health care advocates, medical professionals, and doctors are concerned that nursing homes and rural hospitals may close, since the facilities already operate on low margins and rely heavily on Medicaid. An analysis by the Cecil G. Sheps Center for Health Services Research found that more than 300 rural hospitals could face closure or service reductions. 

But, health care professionals, along with advocates, say their biggest fear is that Black communities will be the hardest hit, and the lack of access could lead to death and chronic illnesses, and worsen economic disparities. 

Dr. Kristopher Stepps, a traveling physician in Arkansas and Texas, said, “Basic necessities are not so basic” for people in rural areas who are trying to decide whether to pay for extra medication or to travel to their specialist appointments, which Medicaid helps cover. 

“There is a fear that if those services are taken away, what happens to the members of this community?” Stepps said. “Regardless if you’re a Democrat [or] Republican, at the end of the day, we’re here to take care of people. 

“My biggest fear is that we start losing more lives due to preventable illnesses because of economic crises and folks couldn’t get access to health care.”

A crisis within a crisis

Marcia Dinkins, founder of Black Appalachian Coalition, said the federal spending bill will make it harder to get access to health care, “especially when the hospitals are already closing down.” (Courtesy of Marcia Dinkins)

In many rural areas, health care access has become a choice between “slow care or no care,” Dinkins said. 

Urgent care centers are no longer providing rapid services, and emergency rooms are becoming overcrowded with patients who are not experiencing a crisis, but need primary care. This often causes longer wait times, as many are unable to see a doctor due to shortages or lack of transportation, she added. Others already can’t afford the co-pay, which forces them to forgo care.

Cassandra Welchlin lives in Mississippi, where there are already high rates of maternal mortality, obesity, cancer, heart disease, and other illnesses. It is also one of the poorest places in the country. Although the state has not expanded Medicaid, the legislation will still affect those who are enrolled as well as those who make too much money to qualify for it, but don’t make enough to purchase their own insurance, she added. 

This isn’t just a health care issue, but an economic and workforce development problem, said Welchlin, who is the executive director of the Mississippi Black Women’s Roundtable. Welchlin’s organization focuses on economic security for women and girls. 

“This is going to not just devastate Black folks, but because we know there’s a disproportionate amount of Black folks that will be harmed, it’s going to be devastating to our communities,” Welchlin told Capital B.  

“It’s not just about health care, it’s about jobs,” she added. “And when you talk about the cuts to jobs, you talk about people now not having a paycheck to pay the basic necessities, such as rent, such as food, such as utilities. So it’s going to be devastating because it’s going to impact people’s kitchen tables like they haven’t seen it before.” 

In neighboring Louisiana, the state expanded Medicaid in 2016. Alma Stewart, the founder of the Louisiana Center for Health Equity, helped secure that expansion. As a result, it broadened access to primary care, and by 2020, the rate of uninsured adults dropped from 22.7% to 8.9%. Now, this new legislation threatens to undo that progress, Stewart said.

Approximately 1 in 5 Americans are enrolled in Medicaid. In certain districts represented by Republican congressional leaders — including Speaker of the House Mike Johnson and Reps. Julia Letlow, and Clay Higgins of Louisiana — more than 30% of residents are on Medicaid, according to The New York Times. Stewart said there’s no doubt it will devastate hospitals and the people they serve. 

Stewart expressed disappointment, but also concern for the youth and how the decisions made now will affect their future.

“I know that based on the data, based on the science of facts, they’re not faring well, anxiety, depression, suicide, suicidal ideation, it’s on the increase. What does that say about us as a society?” she said. 

“Those who have the responsibility on their backs should be concerned about what kind of world you are creating … and a society that is not conducive to the overall well-being of its own people to allow them the opportunity to live, to grow, to thrive.”

“Save our own souls”

Shelton Anthony is an administrator at a critical access hospital in Louisiana, where he said about 37% of the revenue the institution receives is from Medicaid payments. He projects the facility may experience up to $700,000 cuts in Medicaid over the next three years and says hospital officials refuse to cut services or lay people off.

Anthony is finding alternative ways, and options like grants, to help the majority Black community of Donaldsonville. In the city, nestled along the west bank of the Mississippi, many people suffer from limited wages and health care disparities. 

He said some of the hospital’s patients make $20,000 a year.

“Can you just stop and even imagine living on $20,000 a year? That’s what we’re faced with, so we have to bring clinics like this to the community so that we can continue to be healthy,” he said.

Anthony, who leads West Ascension Parish Hospital as the CEO, is partnering with community organizations like the health nonprofit Love Impact Coalition to host a free clinic in September. At the event, residents — regardless of insurance — can receive free dental, vision, and health care services. 

And many advocates, doctors, and patients are still uncertain on how Louisiana will respond to the cuts. Despite that, Stewart’s organization is preparing to educate communities. It will continue its mission to improve health outcomes over the next decade through its initiative, LA40by30. In September, she’s hosting the organization’s annual Health Summit, which includes a town hall to hear directly from residents who may be affected, while explaining to others what this law means. 

In Mississippi, Welchlin and her organization will push for improving health care outcomes, including Medicaid expansion and paid leave. They are also continuing their Strong Moms Healthy Babies campaign, which advocates for moms to have 12 months of postpartum under Medicaid.

Back in Ohio, Dinkins is working on education and training initiatives where she works with people in her state as well as in Pennsylvania, Kentucky, West Virginia, and Michigan. She is going to offer a virtual class on the implications of Medicaid cuts, and she’s building a Black doula network. She’s also calling on organizations in other states to work together to build coalitions.

“When we can come together for that, then we can get back to the place we used to be. Organized people became the organized power that we need,” she said. “Let’s learn about the impact that this is going to have on our communities.” 

Dinkins added: “We have to really have a strong vision in the reality of where we are, and being clear on what is our future vision, and how do we get to that point to save our own souls?” 

https://capitalbnews.org/medicaid-cuts-black-families-trump-bill/

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Alternative Headline: States Face Medicaid Work Crisis

[MM Curator Summary]:  New Medicaid work rules could strip coverage from millions as states scramble to build costly, complex verification systems by 2026.

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States must begin verifying millions of Medicaid enrollees’ monthly work status by the end of next year — a task some critics say states will have a hard time carrying out.

A provision in the tax and spending bill President Donald Trump signed into law July 4 will require the 40 states plus Washington, D.C., that have expanded Medicaid to check paperwork at least twice a year to ensure those enrollees are volunteering or working at least 80 hours a month or attending school at least half time.

The new law provides states $200 million for fiscal year 2026 to get their systems up and running. But some experts say states will have difficulty meeting the deadline with that funding and worry enrollees might lose their health benefits as a result.

A year and a half to comply is likely not going to be enough time for most states, especially since the federal government must craft guidance on how they should implement their programs, said Dr. Benjamin Sommers, a health economist at Harvard T.H. Chan School of Public Health. He predicted it will be difficult to create technology simple enough — such as a phone app — to streamline the process for all enrollees.

“Two hundred million [dollars] is not going to cover the 40 expansion states that we have,” he told Stateline. “There is not a silver bullet here, and there isn’t a single app out there that’s going to keep people who should be in Medicaid from losing coverage. That’s just not realistic.”

A spokesperson for the North Carolina Department of Health and Human Services, Hannah Jones, told Stateline that “it will take a significant amount of time and investment in order to implement work requirements.”

Jones said an estimated 255,000 people in North Carolina could lose coverage because of these requirements and their “administrative burden.”

“More automation reduces manual work on beneficiaries and eligibility case workers, but it requires more time, funding, and staff resources to implement,” Jones wrote in an email.

Emma Herrock, a spokesperson for the Louisiana Department of Health, wrote in an email that the vast majority of the state’s Medicaid enrollees already work, and the agency expects few people to be disenrolled. Herrock said the department will establish work verification systems by the end of 2026.

“The department is taking a thoughtful approach to implementation,” Herrock wrote. “We are already working with several Louisiana agencies … in order to receive data on recipients who are working.”

She added that the department views work requirements “as a means to grow our economy, while reinforcing the value of work and self-sufficiency.”

In New York, it could cost the state $500 million to administer the new requirements, New York Department of Health spokesperson Danielle De Souza wrote in an email.

Between 600,000 and 1.1 million individuals who are eligible for and enrolled in Medicaid could potentially lose coverage because of work reporting requirements, she wrote, based on what happened when states were required to resume checking eligibility after the COVID-19 health emergency ended.

“The department will remain steadfast in its commitment to protecting the health of all New Yorkers and will work to mitigate the impacts of this law,” De Souza wrote.

The new rules apply to states that expanded Medicaid to adults between the ages of 19 and 64 with incomes below 138 percent of the federal poverty line (about $22,000 for an individual), an option that was made available under the 2010 Affordable Care Act. More than 20 million people were enrolled through Medicaid expansion as of June 2024 — those are the patients who will face work requirements.

Reapplying for Medicaid, which typically has been required once a year, already is burdensome for some patients, said Dr. Bobby Mukkamala, president of the American Medical Association.

“On top of that, now we’re going to be challenging so many people who were at least able to deal with it financially with things like … proving that they got a job,” Mukkamala said in an interview.

Previous attempts at implementing work requirements have ended up costing states millions in administrative and consulting fees. And in some cases, people who were eligible for Medicaid lost their coverage due to paperwork issues.

Arkansas’ Example

Several states wanted to implement work requirements during the first Trump administration. But only Arkansas fully did so, in 2018, before a federal judge halted the requirements. More than 18,000 Arkansas residents lost Medicaid coverage during the 10 months the requirements were in effect.

Sommers, of Harvard, noted that most people were disenrolled because they didn’t know about the policy or made paperwork errors, not because they weren’t working.

“Red tape led to people losing their coverage,” he said. “They had more trouble affording their medications. They were putting off needed care.”

Brian Blase, president of the Paragon Health Institute, a conservative policy group that advises congressional Republicans, said he thinks concerns about the new requirements are overblown because there’s more advanced technology now.

“Lots of government programs have initial implementation challenges,” Blase told Stateline. “Arkansas was seven years ago, and if you just think about the change in the technological advancements over the past seven years … we didn’t have artificial intelligence and just the ability of modern tech.”

As it stands, each state has varying technological capabilities, and will have a different timeline and budget, said Michael Heifetz, a managing director at consulting firm Alvarez & Marsal and a former Medicaid director in Wisconsin. His team contracts with states to implement Medicaid, including work requirements, and other programs.

He also noted that the Trump administration can give states a deadline extension on implementing work requirements to Dec. 31, 2028, if they show they are making a “good faith effort.” States will need to share data across agencies in new ways, he said.

“It will require some form of data sharing and communications with educational agencies, workforce training agencies and some other agencies that typically aren’t in the Medicaid ecosystem,” Heifetz said.

State governments may resist hiring full-time positions for those tasks, he said, but “artificial intelligence and other tools can help work through these processes in a smoother fashion.”

Other State Efforts

Efforts in other states to implement work requirements have had mixed results.

In Georgia, for example, an experimental work requirement program cost taxpayers more than $86 million in its first 18 months but enrolled just 6,500 people during that time, according to an investigation by ProPublica and The Current published in February. That’s 75 percent fewer participants than the state had estimated for the program’s first year.

The nonpartisan U.S. Government Accountability Office in 2019 looked at five states that tested systems to track Medicaid work requirements under the first Trump administration. Those demonstration projects were rescinded during the Biden administration.

The states estimated their projected administrative costs for implementing work requirements for one to three years, and the total far surpassed the $200 million Congress has provided in the new law. Kentucky alone estimated $270 million, Wisconsin $70 million, Indiana $35 million, Arkansas $26 million and New Hampshire $6 million.

Susan Barnidge, an assistant director on the GAO health care team and an author of the report, said the agency found that across states there wasn’t much federal oversight of administrative costs on test programs. Oversight will be key as states roll out their work requirement systems, she said.

“We found some weaknesses in [federal] Centers for Medicare & Medicaid oversight of certain federal funding for certain administrative activities. So we found examples of things that states sought federal funding for that didn’t appear to be allowable,” Barnidge said in an interview. “I think that will remain relevant.”

Mukkamala, of the American Medical Association, said the burden will in some ways fall to doctors’ offices to help keep patients enrolled, as they work with patients to check eligibility and possibly help get them on Medicaid. He works in Flint, Michigan, as an otolaryngologist, or ear, nose and throat doctor, and said a third of his patients are on Medicaid.

“As if it’s easy to take care of their health care issue, given things like prior authorization,” Mukkamala told Stateline. “Now to add to the challenge, we have to figure out how to get them covered.”

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

https://www.governing.com/policy/states-may-have-trouble-tracking-medicaid-patients-work-status

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Alternative Headline: Albertsons Joins CMS Pledge

[MM Curator Summary]: Albertsons became the only grocer to sign CMS’s digital health pledge, expanding its Sincerely Health platform to support interoperability and patient wellness.

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Dive Brief:

• Albertsons announced Thursday that it’s the only grocer out of the more than 60 companies that signed the Trump administration’s Make Health Technology Great Again pledge.
• The pledge, which the White House announced Wednesday during an event with the Centers for Medicare & Medicaid Services (CMS), aims to modernize the digital health infrastructure and boost health data sharing through partnerships with major healthcare and technology firms.
• As part of the pledge, Albertsons said it will explore how its Sincerely Health platform can provide more personalized assistance to users as well as better connect to the CMS’s initiative to promote a more patient-centric healthcare ecosystem and enhance health data interoperability.

Dive Insight:

Albertsons’ participation in the pledge is part of its goal to allow its consumers to share and access their personal health information in ways that will help them make more informed healthcare decisions, the grocer said in a press release. 

As part of the pledge, Albertsons said its Sincerely Health platform’s diabetes and obesity tools will use participating customers’ histories to give them “more tailored guidance, offering direct assistance when appropriate and directing them to a healthcare professional when needed.”

Albertsons noted that 2.3 million loyalty members have access to Sincerely Health, which launched in 2023 and was built in collaboration with healthcare providers, insurance companies and technology organizations. Through the lifestyle and wellness digital platform, users can track their fitness, receive personalized nutrition insights, search shoppable recipes, manage prescriptions, schedule vaccines and access personal health records. The platform also allows users to earn rewards that they can redeem for grocery coupons.

So far, Albertsons said it has gained insights from over 10,000 customers and associates who have used the platform. 

“We are thrilled to collaborate alongside the White House, HHS, CMS and the many great partners across the digital health ecosystem to see how technology like Sincerely Health can empower Americans to more easily manage their health and wellness,” Albertsons CEO Susan Morris said in a statement. “We’re eager to explore how Sincerely Health can make health and wellness management more accessible and rewarding for communities across America.”

The Trump administration’s initiative focuses on two areas: encouraging adoption of a voluntary data sharing blueprint called the CMS Interoperability Framework and increasing the availability of personalized digital health tools, the CMS said in a press release. 

Other companies that signed onto the pledge include UnitedHealth Group, Apple, Google, Samsung, Zocdoc, CVS Health, Anthropic, OpenAI and Google.

• Albertsons accepting supplemental health benefits with new partnership By Catherine Douglas Moran • Updated April 26, 2024
• Albertsons adds nutrition guidance tool to digital health system By Peyton Bigora • Aug. 16, 2023
• Albertsons launches digital health platform By Sam Silverstein • Feb. 7, 2023

https://www.grocerydive.com/news/albertsons-signs-pledge-make-health-technology-great-again/756531/

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Alternative Headline: Sun Life warns on dental profits

[MM Curator Summary]: Sun Life shares dropped 8.5% after it warned its U.S. dental unit will miss 2025 profit goals due to Medicaid funding uncertainty.

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TORONTO  – Sun Life Financial’s shares plunged as much as 8.5% on Friday, a day after the Canadian insurer said it would miss a 2025 profit target for its dental business in the U.S. due to uncertainty over Medicaid funding.

Sun Life, which bulked up its dental business through the $2.5 billion acquisition of DentaQuest in 2022, said underlying net income for the dental business, which has struggled in past quarters, is expected to be below $100 million in 2025.

The forecast revision was driven by uncertain Medicaid funding resulting in slower negotiations with states on coverage rates and higher Medicaid claims, the company said.

Sun Life works with U.S. states to administer Medicaid and Medicare Advantage dental benefits through the DentaQuest business and is dependent on government funding.

"The claims are also increasing at a faster pace, which I partially think is because people are seeing that they may lose their Medicaid benefits. So they’re going to the dentist more quickly," CEO Kevin Strain said in an interview on Friday.

Strain noted that the states have been reluctant to pass on the increased claims costs, something he expects to sort itself out over the next few years.

"If we’re struggling, you can imagine that the smaller players are really struggling with it … We’ll work our way through it," he said.

The U.S. remained one of the company’s fastest growing and least capital-intensive regions, Strain added.

Sun Life expects over 12% underlying net income growth for Sun Life U.S. in the long term, with the dental business expected to contribute at least a third of overall earnings in the region.

The stock has lost about 8% of its value, including Thursday’s losses, while peer Manulife which also reported weakness in its U.S. business, is down 6.5%.

"We believe that a reversal in the (Sun Life’s) U.S. dental business that caused the company to retract its 2025 profit target for this business has implications beyond the quarter," National Bank analyst Gabriel Dechaine said.

Analysts have said Sun Life’s dental business could be vulnerable to provisions in U.S. President Donald Trump’s recent tax-cut and spending legislation, known as the One Big Beautiful Bill Act, which aims to cut Medicaid spending. That could weigh on the future growth of the business as tighter eligibility requirements could shrink Medicaid enrollment over time.

Underlying net income fell 4% in the U.S., which accounts for about a fifth of the company’s underlying earnings.

Its underlying earnings of C$1.79 in the second quarter were above analysts’ average estimate of C$1.78 per share, according to LSEG data.

Reporting by Nivedita Balu in Toronto and Prakhar Srivastava in Bengaluru; Editing by Nia Williams and Joe Bavier

Our Standards: The Thomson Reuters Trust Principles., opens new tab

Nivedita Balu is a correspondent for Reuters based in Toronto, where she reports on Canadian banks and financial services. She previously covered U.S. tech, media and telecom companies, and consumer and retail companies in Bengaluru.

https://www.reuters.com/business/healthcare-pharmaceuticals/sun-life-shares-plunge-medicaid-uncertainty-prompts-us-dental-forecast-revision-2025-08-08/

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Alternative Headline: $50B rural hospital fund

[MM Curator Summary]: A new $50 billion rural hospital fund will launch in September to offset Medicaid cuts from President Trump’s recent legislation

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Washington — Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz said Sunday that applications for a fund for rural hospitals will go out in "early September" in the wake of Medicaid cuts in President Trump’s signature piece of legislation passed by Congress last month.

"We’re putting $50 billion. The president wants this, the Congress wants this," Oz said on "Face the Nation with Margaret Brennan."

Mr. Trump signed the so-called "big, beautiful bill" into law last month, which included a number of his second-term priorities from tax cuts to increased spending on border security, defense and energy production. The legislation was paid for in part by significant cuts to health care programs, like Medicaid, which provides government-sponsored health care for low-income and disabled Americans.

Among the cuts to Medicaid, the new law will lower provider taxes, which states use to help fund their portion of Medicaid costs. Lawmakers sought to supplement the cuts with a rural hospital stabilization fund after some GOP senators expressed concern over how rural hospitals could be impacted by the Medicaid restrictions, allocating $50 billion for rural hospitals.

Oz said the applications for the fund will start going out in early September. He said the money is designed to help with "workforce development, right-sizing the system and using technology to provide things like telehealth that can change the world."

"Imagine if we can change the way we think about the delivery of health and make it more about getting people healthy who can thrive and flourish and be fully present in their own lives and as Americans," Oz said. 

The new law will also make changes to Medicaid work requirements for some able-bodied adults, along with more frequent eligibility checks. The Congressional Budget Office estimated that the legislation would result in 10 million Americans losing health coverage under Medicaid over the next decade.

Oz touted the work requirements, saying "every Democratic president and Republican president has said that the foundation of a healthy welfare system, a social system of support, is work." 

He outlined that the requirements can also be met through community engagement, education and in caretaking roles, and that the administration began pursuing pilot programs when the bill was signed to demonstrate how technology can support the changes. But Brennan noted that according to KFF Health Policy, 92% of adult Medicaid recipients already are working or are caregivers or qualify for other exceptions. Oz said "they’re fine."

"We want to help connect you to the job market and get you into work," Oz said of people who are considered able-bodied. "The goal of health care insurance is to catalyze action in the right direction, to get you healthier, to give you agency over the future, so you recognize you matter, and you should have a job, therefore, to go out and change the world."

https://www.cbsnews.com/news/dr-oz-cms-administrator-rural-hospital-fund-applications-medicaid/

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Alternative Headline: Georgia Medicaid Work Program Faces Cost, Access Criticism

[MM Curator Summary]: Georgia’s Medicaid work requirement program has high costs, low enrollment, and mounting criticism over accessibility and efficiency.

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Every time Ashton Alexander sees an ad for Georgia Pathways to Coverage, it feels like a “kick in the face.” Alexander tried signing up for Pathways, the state’s limited Medicaid expansion, multiple times and got denied each time, he said, even though he met the qualifying terms because he’s a full-time student.

Georgia is one of 10 states that haven’t expanded Medicaid health coverage to a broader pool of low-income adults. Instead, it offers coverage to those who can prove they’re working or completing 80 hours a month of other qualifying activities, like going to school or volunteering. It is the only state currently doing so.

“Why is this marketing out here?” said the 20-year-old, who lives in Conyers. “It’s truly not accessible.”

Each denial used the same boilerplate language, Alexander said, and his calls to caseworkers were not returned. State offices couldn’t connect him with caseworkers assigned to him from the same state agency. And when he requested contact information for a supervisor to appeal his denial, he said, the number rang to a fax machine. “It’s impenetrable,” Alexander said. “I’ve literally tried everything, and there’s no way.”

Millions of Americans trying to access Medicaid benefits could soon find themselves navigating similar byzantine state systems and work rules. Legislation signed into law by President Donald Trump on July 4 allocates $200 million to help states that expanded Medicaid create systems by the end of next year to verify whether some enrollees are meeting the requirements.

Conservative lawmakers have long argued that public benefits should go only to those actively working to get off of government assistance. But the nation’s only Medicaid work requirement program shows they can be costly for states to run, frustrating for enrollees to navigate and disruptive to other public benefit systems.Georgia’s budget for marketing is nearly as much as it has spent on health benefits. Meanwhile, most enrollees under the age of 65 are already working or have a barrier that prevents them from doing so. What Georgia shows is “just how costly setting up these administrative systems of red tape can be,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families.

Over the past two years, KFF Health News has documented the issues riddling Georgia’s Pathways program, launched in July 2023. More than 100,000 Georgians have applied to the program through March. Just over 8,000 were enrolled at the end of June, though about 300,000 would be eligible if the state fully expanded Medicaid under the terms of the Affordable Care Act.

The program has cost more than $100 million, with only $26 million spent on health benefits and more than $20 million allocated to marketing contracts, according to a KFF Health News analysis of state reports. “That was truly a pretty shocking waste of taxpayer dollars,” Alker said.

The Government Accountability Office is investigating the costs of the program after a group of Democratic senators—including both members of the Georgia delegation—asked the government watchdog to look into the program. Findings are expected this fall.

A state report to the federal government from March said Georgia couldn’t effectively determine if applicants meet the qualifying activities criteria. The report also said the state hadn’t suspended anyone for failing to work, a key philosophical pillar of the program. Meanwhile, as of March, more than 5,000 people were waiting to have their eligibility verified for Pathways.

The Pathways program has strained Georgia’s eligibility system for other public benefits, such as food stamps and cash assistance.

In April, the state applied to the federal government to renew Pathways. In its application, officials scaled back key elements, such as the requirement that enrollees document work every month. Critics of the program also say the red tape doesn’t help enrollees find jobs.

“Georgia’s experience shows that administrative complexity is the primary outcome, not job readiness,” said Natalie Crawford, executive director of Georgia First, which advocates for fiscal responsibility and access to affordable health care.

Despite the struggles, Garrison Douglas, a spokesperson for Gov. Brian Kemp, defended the program. “Georgia Pathways is doing what it was designed to do: provide free healthcare coverage to low-income, able-bodied Georgians who are willing to engage in one of our many qualifying activities,” he said in an emailed statement.

New federal requirements in the tax and spending legislation mean that the 40 states (plus Washington, D.C.) that expanded Medicaid will need to prepare technology to process the documentation some Medicaid recipients will now have to regularly file. The federal law includes exemptions for people with disabilities, in addiction treatment or caring for kids under 14, among others.

The Trump administration said other states won’t face a bumpy rollout like Georgia’s.

“We are fully confident that technology already exists that could enable all parties involved to implement work and community engagement requirements,” said Mehmet Oz, head of the Centers for Medicare & Medicaid Services, in an emailed statement.

In a written public comment on Georgia’s application to extend the program, Yvonne Taylor of Austell detailed the difficulties she faced trying to enroll. She said she tried to sign up several times but that her application was not accepted. “Not once, not twice, but three times. With no response from customer service,” she wrote in February. “So now I am without coverage.”

Victoria Helmly of Marietta wrote in a January comment that she and her family members take care of their dad, but the state law doesn’t exempt caregivers of older adults. “Georgia should recognize their sacrifices by supporting them with health insurance,” she wrote. “Let’s simplify this system and in the end, save money and lives.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling and journalism. Learn more at kff.org.

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https://flagpole.com/news/news-features/2025/08/06/national-medicaid-changes-copy-georgias-failed-pathways-program/

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Alternative Headline: $51.5M Boost for Autism Care Innovator

[MM Curator Summary]: Positive Development raised $51.5M to expand its lower-cost, relationship-based autism therapy model and strengthen Medicaid partnerships.

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Positive Development, a leader in developmental therapy for autistic children and their families, has secured $51.5 million in Series C funding, co-led by new investor aMoon and existing investors B Capital and Flare Capital Partners.

As the only provider delivering developmental therapy at scale, Positive Development addresses the crisis in the autism care sector, where traditional Applied Behavior Analysis (ABA) interventions can cost $50,000 to $70,000 per child per year.

The organization utilizes Developmental Relationship-Based Interventions (DRBI), combining speech, occupational, and mental health therapies with technology and real-time data. These therapies are designed to be lower in intensity, achieving measurable outcomes at an average cost that is 50% less than traditional ABA programs.

How the funding will be used: Positive Development will utilize the funds to expand its DRBI-based care model, targeting new and existing markets, and investing in new health plans and state Medicaid partnerships. Additionally, the organization will advance its proprietary technology and AI platform, enhancing the efficiency, experience, and quality of care.

New board member: As part of the Series C round, Dr. Tomer Berkovitz of aMoon has joined Positive Development’s Board of Directors.

KEY QUOTES:

“Positive Development’s ability to improve outcomes and reduce the total cost of care is directly aligned with aMoon’s mission to partner with exceptional companies who are advancing solutions that will transform healthcare and help people live healthier, better lives. Their unique developmental therapy model brings accessibility and affordability to systems in desperate need of change, and their extensive partnerships with payers and Medicaid programs showcase their success. We look forward to partnering with the team to help the company expand and scale to serve more families.”

Dr. Tomer Berkovitz, Managing Partner at aMoon

“This funding allows us to continue expanding a model that’s working for families, providers and payers. As the nation’s leading provider of developmental autism care, we’re focused on making high-quality, relationship-based support more accessible and affordable. We’re grateful to aMoon, B Capital, and all our investors for helping us move this important work forward.”

Mike Suiters, Co-founder and CEO of Positive Development

“Autistic children and families deserve affordable options that are tailored to their unique strengths and challenges, and our healthcare system needs options that don’t break the bank. Positive Development’s relationship-based, developmental therapy approach and alternative payment model are the future of autism care, and we’re excited to help the company continue to build out these important services to make care more accessible and affordable.”

B Capital Partner Adam Seabrook

https://pulse2.com/positive-development-51-5-million-raised-for-expanding-therapy-model-for-autism/

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Alternative Headline: Medicaid Cuts to Cost Dosher $1.6M Annually

[MM Curator Summary]: Dosher Hospital projects a $1.6M annual loss from Medicaid cuts but is financially positioned to weather the impact better than many rural hospitals.

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Dosher Memorial Hospital is projected to lose $1.6 million annually as a result of Medicaid cuts recently approved in President Donald Trump’s “One Big Beautiful Bill.”

Dosher CEO and President Lynda Stanley briefed hospital trustees last week on the impact of cutting Medicaid enrollment as a result of the federal legislation. The hospital would receive around $2.8 million from Medicaid annually, but that amount will be cut.

However, Dosher is in better shape to weather the storm than many rural hospitals because it has a lower Medicaid patient ratio. It is estimated that 26% of Medicaid recipients in North Carolina may be impacted by the legislation. For Dosher’s population, the number appears to be closer to just 7% in the hospital’s preliminary assessments, Stanley said.

“It is not just the dollars that we are concerned about, we are concerned about the patients that may be impacted,” said Stanley.

Stanley said it will not alter Dosher’s treatment of patients, with or without Medicaid.

“We know these patients need care,” said Stanley. “That’s the bottom line.”

Because Dosher is in a retirement community, it relies more on Medicare coverage for seniors and private insurance. Dosher is also supplemented by a special four-cent Smithville Township property tax used to help pay for capital needs at the hospital.

After Dec. 31, 2026, many Medicaid recipients ages 19-64 will be required to engage in qualifying activities for at least 80 hours per month to maintain coverage. These activities include work, community service or educational programs. The bill is expected to cut $930 billion in Medicaid over the next decade.

These work requirements are expected to lead to a decrease in Medicaid enrollment, with the Congressional Budget Office estimating 4.8 million people could lose coverage. Hospitals and counties are trying to prepare now for the future by asking who or what agency will certify such Medicaid work requirements.

“I don’t have the answer to that,” Stanley told trustees.

The bill also establishes a $50-billion Rural Health Transformation Program over five years, providing grants to states to support rural hospitals and health centers. The goal of the program, said Stanley, is to soften the blow to hospitals financially but it likely won’t be enough to close the gap.

“Across the country, (Medicaid cuts) could have major implications,” said Stanley. “We’re in a pretty good position financially.”

While it will affect Dosher, and the hospital must prepare for the impact, Dosher’s lower volume of Medicaid patients and its overall 2.4% operating margin place it in a greater position to overcome the cuts. The 2.4% margin represents a strong measure of profitability while the hospital industry standard is at just 0.0%.

“In the words of our chairman, ‘We are less worse than some people,’” said Stanley, referring to previous comments by Trustee Chairman Robert Howard. “It’s unfortunate, but that is where we are.”

June finances

Chief Financial Officer Ed Tusa told trustees Dosher’s patient volume in June was very strong. A main reason is operating room procedures were up 52% over last June’s volume.

Dosher finished June with a net operating income of $194,043 when it was budgeted to close with a $274,000 loss. For the year-to-date, the hospital is operating with a positive $1,212,527 in net income. When factoring in all sources of revenue, the hospital finished the month with a positive $781,729 and for the year stands at a positive $6,374,148.

The fiscal year ends September 30.

“To see it come in the black, we’re very pleased,” said Tusa. “Financially, the organization is on a trending basis. We’ve picked up some positive momentum this fiscal year. I don’t believe July will be nearly as strong as June.”

Net operating revenue for June was $5,872,545 while expenses were $5,678,502.

Monthly reports

• Chief Nursing Officer Jill Ward reported the hospital is still awaiting an inspection from DNV’s hospital accreditation team. Dosher also continues to recruit full-time nurses to cut back on its reliance on traveling nurses.

• Trustee Randy Jones, chair of the Building and Grounds Committee, reported moving medical records to the Dosher Wellness Center is complete and the office opens its doors Aug. 4.

“If someone comes to the hospital and wants their records, they can still get them here,” said Jones.

Jones reported work on the new emergency department building remains on schedule and on budget.

• Trustees voted unanimously to accept a recommendation presented by Finance Committee Chairman Linda Pukenas to hire Forvis Mazars LLP of Charlotte to conduct the 2024-25 financial audit for the fiscal year that ends Sept. 30. The contract includes a 2.5% increase over last year. This is the third year Dosher has contracted with the firm.

Credentials

Trustees unanimously approved the following credentials:

Initial appointments – Kathleen Wild, MD, anesthesiology; Hatim Attar, MD, tele-neurology; William Marin, MD, radiology; Ameer Al Wafai, MD, tele-neurology; Brennan Russell, CRNA, nurse anesthetist; Barry Amerson ,CRNA, nurse anesthetist.

Reappointments – Deborah Cobb, FNP-C, family medicine; Patrick Ellis, MD, cardiology; Joshua Felix, PA-C, radiology; Catlin Jo Ferguson, DDM, pediatric dentistry; Zachary Garrett, MD, cardiology; John Geis, PA-C, radiology; Arnold Hite Jr., MD, cardiology; Justin Vandermolen, MD, cardiology; Robert Wilson, MD, radiology; Sara Ward, MD, family medicine; George McLeod, MD, cardiology; Ricardo Maribona, DPM, podiatry; Vishavpreet Singh, MD, orthopedic surgery.

Voluntary relinquishment of privileges – Sugaree Ganzman, NP-C, tele-psychiatry; Robert Delozier, NP-C, tele-psychiatry.

https://stateportpilot.com/news/article_165f2524-2ac4-480b-8fc1-242c06a7976c.html

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Alternative Headline: New Law Targets Medicaid Waste

[MM Curator Summary]: Section 71103 of OBBBA mandates a national database to eliminate costly duplicate Medicaid and CHIP enrollments across states.

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Section 71103 of the recently passed reconciliation bill presents a rare opportunity to improve Medicaid’s efficiency without sacrificing access to care. The provision directs the Centers for Medicare & Medicaid Services (CMS) to build a national database that allows states to detect when someone is enrolled in Medicaid or Children’s Health Insurance Program (CHIP) in more than one state at the same time—a situation that occurs far more often than people realize.

This isn’t a speculative problem. States currently lack a consistent mechanism to detect overlapping enrollments, leading to duplicate payments, administrative confusion, and billions in wasted taxpayer dollars.

Section 71103 offers a smart, targeted fix. It addresses real inefficiencies without reducing benefits, strengthens the technical backbone of Medicaid, and sets the stage for broader improvements to how government delivers services. It is the kind of reform conservatives and state-capacity-minded policymakers should champion.

The Real Problem: Administrative Waste, Not Fraud

When Medicaid enrollees move between states, their previous enrollment often remains active—because there’s no reliable mechanism for states to know they’ve left. Medicaid and CHIP are administered at the state level but funded jointly with the federal government. That means when someone is enrolled in more than one state at the same time, two states (and the federal government) may pay premiums or managed care fees for the same person.

The scale of the problem is significant. A 2024 Wall Street Journal investigation found that insurers were paid $4.3 billion over three years for patients who were enrolled, and paid for, in more than one state. In managed care states, where roughly 70 percent of Medicaid beneficiaries are enrolled, this translates directly into double monthly payments to insurance companies, despite the fact that care is only used in one state.

A 2022 Health and Human Services (HHS) IG report found that 47 states had this problem and called for a solution that involved “CMS provid[ing] States with matched […] enrollment data that identify Medicaid beneficiaries who were concurrently enrolled in a Medicaid managed care program in two States.” A 2025 “expert perspective” from the Robert Wood Johnson Foundation also notes that “[s]tates are eager to work in partnership with CMS.” That’s what this provision does.

Critically, this is not about fraud by beneficiaries. Most people don’t know they are still enrolled in their old state’s program. Instead, this is an IT and administrative gap, with states relying on returned mail or labor-intensive paperwork to update residency information.

The Congressional Budget Office score projected a $17 billion savings in the 10-year budget window.

A (Partially) Proven Model: Learning from the National Accuracy Clearinghouse

A better way already exists: the National Accuracy Clearinghouse (NAC) for the Supplemental Nutrition Assistance Program (SNAP). Similar to Medicaid, SNAP had a problem catching duplicate SNAP enrollments. NAC was created to address this, reducing improper payments while avoiding new burdens for recipients.

Between 2013 and 2015, the Office of Management and Budget supported a pilot project in five states—Alabama, Florida, Georgia, Louisiana, and Mississippi—which began submitting recipient data daily to NAC to cross-check for overlapping enrollments. That program was evaluated as a success in 2015. This program was incorporated into the 2018 Farm Bill, and in 2022 the Biden administration issued a final rule to implement it. States and the Department of Agriculture (USDA) have until 2027 to comply. Although the extended timeline highlights the challenges of coordinating 50 state-level systems, NAC’s experience proves that secure, privacy-preserving interstate data-sharing can reduce waste while protecting access to critical benefits.

Section 71103 essentially brings NAC’s proven approach to Medicaid. By January 2028, all states will submit identifying Medicaid and CHIP enrollee data at least monthly to a new federal system run by HHS. The database will match records, flag potential duplicates, and prompt states to verify residency and disenroll individuals from the incorrect state program when necessary. Compared to SNAP, CMS already operates a more centralized eligibility infrastructure, which could allow Medicaid’s duplicate enrollment system to be built and deployed faster and more effectively than NAC’s multi-year rollout.

These savings are not abstract: they can fund additional services, support program solvency, or reduce budget pressures on both federal and state governments. And they do so without restricting eligibility or limiting access to health care services.

So all that we have to do is implement a big government IT program, right? But if anyone can do it in government, CMS can.

As Jennifer Pahlka has noted, CMS has been relatively successful in large scale IT implementation under the leadership of Yadira Sánchez. Pahlka describes the IT successes at CMS as “the single biggest source of hope for me in the past ten years.” CMS’s experience with large-scale data systems such as the Transformed Medicaid Statistical Information System (T-MSIS) shows it can manage complex, secure IT projects across all 50 states. For example, since 2015, CMS has increased the number of states fully submitting T-MSIS data from fewer than half to nearly 100 percent today, improving the quality of Medicaid data for audits and program management.

While CMS has faced challenges in the past (notably the early Healthcare.gov rollout), it has also demonstrated the capacity to adapt and build effective systems. This gives reason for cautious optimism that it can implement the Section 71103 database successfully—especially with the modest federal investment of $10 million for development and $20 million for ongoing operations authorized by Congress.

The Key to Success: Engaging States Early and Fully

While building a national Medicaid duplicate enrollment system is technically feasible, the clearest path to real savings and program integrity lies in ensuring every state actively participates—and does so consistently. The experience of NAC shows that even well-designed federal systems can face long delays and hurdles if states are unprepared.

Despite the NAC pilot beginning in 2013, it took nearly a decade for USDA to finalize implementation rules, largely because of states’ varying IT readiness and concerns about administrative burdens on under-resourced counties. Smaller counties, in particular, often lack the staff or technology to keep up with new reporting requirements, which can cause uneven participation and undermine the effectiveness of a nationwide system.

For Section 71103 to succeed, CMS should take a proactive approach:

• Invest early in technical assistance for states and counties, providing onboarding toolkits, training materials, and pre-implementation checklists that help them integrate new reporting processes into existing systems.
• Offer financial support for IT upgrades in jurisdictions with outdated eligibility systems, ensuring all states—regardless of size or resources—can comply with the database’s requirements.
• Set clear federal standards and timelines for timely data submission and resolution of duplicate enrollments, with mechanisms to monitor state compliance and provide targeted support when needed.
• Maintain privacy protections by designing the system to securely flag duplicate enrollments without exposing unnecessary personal data at the federal level, similar to NAC’s privacy-focused architecture.

CMS also has an advantage over USDA: Medicaid’s federal-state funding relationship gives CMS powerful tools to align incentives, since states rely on federal funds to operate their Medicaid programs. By combining technical and financial support with clear expectations and oversight, CMS can help states avoid the pitfalls NAC encountered, accelerating implementation and ensuring the new system reduces improper payments while preserving access to care.

A Model for Smarter Government IT

Section 71103 exemplifies the kind of modernization conservatives should support: it improves efficiency, reduces waste, and does so without adding burdens on beneficiaries or sacrificing benefits. Medicaid enrollees will simply see smoother transitions between states, while taxpayers benefit from significant savings. And it relies on talented government employees with a record of successful implementation.

This approach also reflects a broader trend toward data-driven governance. By updating eligibility systems and integrating modern data-matching practices, government can deliver services more effectively without expanding bureaucracy.

Beyond Medicaid, the new federal database could eventually share technical infrastructure with other programs like SNAP’s NAC or HHS’s Public Assistance Reporting Information System (PARIS), which today suffers from fragmented participation and outdated technology. Integrating or aligning these systems could lower development and maintenance costs, improve accuracy across programs, and reduce administrative overhead.

The potential applications extend beyond social services. The Institute for Responsive Government has highlighted how secure, interstate data-sharing systems such as NAC or the non-profit driven Electronic Registration Information Center can offer models for modernizing both benefits programs and voter registration systems, emphasizing the potential to improve accuracy without creating new burdens.More generally, integrated systems could become a backbone for programs that depend on verifying where people live, from education funding formulas to housing assistance.

Section 71103 represents an opportunity to make Medicaid more efficient and effective, delivering real savings and a better experience for beneficiaries. By learning from NAC and investing in modern, interoperable IT, policymakers can strengthen state capacity and show that government can solve real problems without sacrificing care or adding red tape.

This is the kind of pragmatic, thoughtful reform that conservatives, moderates, and anyone who wants government to work better should support.

https://www.thefai.org/posts/fixing-duplicate-medicaid-enrollments-through-smart-government-it

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