HMA Weekly Roundup

Trends in Health Policy

April 2, 2025

This week's roundup:

In Focus: HHS Begins Reorganization: Actions Focus on Efficiency, Establishment of Administration for a Healthy America
What to Watch: Medicare Payment Rules
Arkansas Submits Section 1115 Demonstration Medicaid Work Requirement Amendment
Florida Releases MMIS Modernization RFI
Idaho Submits Behavioral Health Transformation Section 1115 Demonstration Extension Request
Montana Governor Signs Medicaid Expansion Renewal Bill with Work Requirements
Oregon Releases CCO Procurement RFI
States File Lawsuit Over Federal Funding Cuts for Public Health Programs
Point32Health to Exit MassHealth Managed Care, Cuts 110 Jobs Amid Financial Losses

In Focus

HHS Begins Reorganization: Actions Focus on Efficiency, Establishment of Administration for a Healthy America

On March 27, 2025, the US Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. announced significant changes in the department with respect to staffing and organizational restructuring. This reorganization is consistent with President Trump’s February 11, 2025, Executive Order (EO) 14210, “Implementing the President’s Department of Government Efficiency Workforce Optimization Initiative.”

HHS is moving rapidly to implement its plans. On April 1, 2025, HHS initiated actions to reduce the federal workforce across the agencies and remake the department. In addition, the Senate is expected to vote on a budget resolution this week, which could have significant impacts on federal healthcare spending, including for the Medicaid and Medicare programs.

In the coming weeks and months, HHS intends to make additional announcements about how the department will be restructured. It will be critical that healthcare organizations and stakeholders track these developments closely. Organizations seeking to participate in the development of new federal policies and initiatives must know which offices within HHS will maintain authority over key policy areas. Further, to adapt to changes in funding and policies, it is vital that healthcare leaders remain informed.

Because many changes have already begun, the remainder of this article explains what is known to date about the HHS restructuring and other developments and actions relevant to providers, life sciences firms, insurers, safety net clinics, state and local agencies, and other interested stakeholders. This information can help stakeholders consider how best to proceed.

The Reorganization Plan

EO 14210 required agencies to develop reorganization plans and submit them to the Director of the Office of Management and Budget within 30 days and to “promptly undertake preparations to initiate large-scale reductions in force.” The broader HHS reorganization plan seeks to implement a new departmental focus on “ending America’s epidemic of chronic illness by focusing on safe, wholesome food, clean water, and the elimination of environmental toxins.”

The reorganization calls for the following:

Consolidating the 28 HHS divisions into 15
Reducing the HHS regional offices from 10 to five
Centralizing the human resources, information technology, procurement, external affairs, and policy functions of the department
Reducing the full-time staff at HHS by 10,000

When combined with other efforts, including early retirement and pre-reduction in force (RIF), HHS’s staffing levels of 82,000 full-time will be reduced to 62,000. The announcement listed specific workforce reduction plans for the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), the National Institutes of Health, and the Centers for Medicare & Medicaid Services (CMS).

Following the March 27 announcement, additional details regarding the restructuring have continued to emerge, including:

The Biomedical Advanced Research and Development Authority (BARDA) reportedly will be combined with Advanced Research Projects Agency for Health (ARPA-H) under a new Office of Healthy Futures.
The Administration for Strategic Preparedness and Response (ASPR) will be reorganized as a part of CDC.
Programs currently under the Administration for Community Living (ACL) are slated to be reassigned to other agencies; for example, programs that support older adults and people with disabilities will move to the Administration for Children and Families (ACF), Assistant Secretary for Planning and Evaluation (ASPE), and CMS.

HHS Plans for New Agencies that Mirror Policy Priorities

The reorganization includes the establishment of a new Administration for a Healthy America (AHA), which will combine the following offices and agencies:

Office of the Assistant Secretary for Health, which includes the Office of the Surgeon General, the Office of Women’s Health, and several programs focused on health promotion, chronic disease prevention, and vaccines
Health Resources and Services Administration (HRSA)
Substance Abuse and Mental Health Services Administration (SAMHSA)
Agency for Toxic Substances and Disease Registry (ATSDR)
National Institute for Occupational Safety and Health (NIOSH)

According to HHS, the changes are intended to “improve coordination of health resources for low-income Americans and will focus on areas including, Primary Care, Maternal and Child Health, Mental Health, Environmental Health, HIV/AIDS, and Workforce development.” The department also noted that transfer of SAMHSA to the new AHA will “break down artificial divisions between similar programs” and improve operational efficiency.

HHS also intends to establish a new Assistant Secretary for Enforcement position, which will be responsible for leading efforts to address waste, fraud, and abuse at the Departmental Appeals Board, Office of Medicare Hearings and Appeal, and the Office for Civil Rights.

HHS will merge the ASPE and Agency for Healthcare Research and Quality (AHRQ) to establish a new Office of Strategy. The new office will support research “that informs the Secretary’s policies and evaluates the effectiveness of federal health programs.” This office will also include some of the “critical programs that support older adults and people with disabilities” that are currently within the Administration for Community Living.

Developments on Workforce Reduction Plans

On April 1, 2025, HHS began issuing formal termination notices to a significant number of federal employees across several agencies, including the FDA, SAMHSA, and CDC. The workforce actions reportedly include a full dissolution of some offices, for example, SAMHSA’s Office of the Director for Centers for Mental Health Services, Office of Behavioral Health Equity, The Policy Lab, among others, and CMS’s Medicare Medicaid Coordination Office.

What’s Next

In the coming weeks HHS will put in place a structure for the new AHA and other planned new entities. Many questions remain about the impact on specific agencies and authorities as well as reassignment of responsibilities for programs and functions that were carried about by affected federal employees and offices.

Congressional committees are seeking additional information about the HHS restructuring. The US Senate Committee on Health, Education, Labor, and Pensions (HELP) requested that Secretary Kennedy testify at a hearing on April 10, 2025, to discuss the proposed reorganization plan. Providers, health centers, life sciences firms, insurers, health systems, state and local agencies and other healthcare stakeholders and partners should take steps to work through challenges and avail themselves of opportunities to strengthen healthcare systems and improve health. Examples include:

Identify the HHS agencies and offices that are now responsible for policies and procedures that impact your business.
Establish a plan for tracking developments—including litigation—and processes to brief key organizational leaders and act on information, when needed. Healthcare providers, insurers, community groups, and state and local governments will benefit from information as it becomes available regarding changes to agencies and their portfolios and decision makers for policies governing Medicare, Medicaid, child-specific programs, aging and disability programs, mental health and substance use programs, among many others.
Immediately assess current federal discretionary funding and reimbursement policies that may be at risk for your organization, your key partners, and collaborators. Consider potential impact of the policy changes that Congress is separately negotiating, which would significantly affect Medicare and Medicaid. Identify changes that may minimize risk for your organization and position it to engage in new initiatives.
Familiarize your organization with federal oversight and enforcement priorities and incorporate flexibility into compliance plans. Identify opportunities to mitigate vulnerabilities going forward.
Engage now—with your community, your peers, and other experts—to identify opportunities for improvement and plan to build out the strategy, infrastructure and funding to support this work. Think creatively, act decisively.

Connect with Us

Health Management Associates, Inc., experts know the federal landscape and have an intimate knowledge of the dynamics in states and communities. Our policy team is working with clients to help them understand what is happening within HHS and Congress that is ushering in significant policy and funding changes. Our teams are advising stakeholders on the implications for Medicare, Medicaid, and other public programs; strategies to advance their objectives in this new environment; and working with healthcare organizations and state and local government to understand immediate impacts on local financing.

For details about these federal level developments contact one of our featured federal policy experts: Monica Johnson, Andrea Maresca, and Laura Pence.

What to Watch: Medicare Payment Rules

Medicare stakeholders are awaiting the imminent release of the Centers for Medicare & Medicaid Services (CMS) final Medicare Advantage and Part D rate notice and technical updates, as well as a final policy rule that establishes a significantly new direction for Medicare Advantage (MA) stakeholders. These final rules typically are released in April of each year.

In addition, the agency kicks off the annual cycle of payment rules for traditional fee-for-service Medicare, including the first wave of proposed rules that typically are released in April for the forthcoming payment year. These proposed rules for 2026 pertain to the following: Hospital Inpatient Prospective Payment System for Acute Care Hospitals, the Inpatient Rehabilitation Facility Payment System, the Home Health Payment System, and the Inpatient Psychiatric Facility Payment System. A second wave of 2026 proposed rules are typically released in July, including the Medicare Physician Fee Schedule and the Hospital Outpatient Prospective Payment System.

The MA rules and the first wave of Medicare Part A and Part B rules are highly anticipated regulations and now under review at the Office of Management and Budget. These rules are expected to be released in the coming days and weeks.

Why These Rules Matter

The rules set the rates for MA and reimbursement for a significant number of healthcare providers and facilities that serve Medicare beneficiaries. The rules also contain important information about CMS’s quality reporting programs and bonus payments and other changes required for Medicare stakeholders to ensure compliance.

What’s Different About 2025 Proposals

In the first year of a new presidential administration, CMS leaders have a limited window to include their policy priorities in the MA and Part D Final Rate Notice. CMS may, however, decline to finalize some or all of the prior administration’s proposals. Key issues that Health Management Associates (HMA), experts are watching for in the final rules include:

Whether CMS chooses to delay or not finalize significant policy changes proposed by the Biden Administration, including new requirements and guardrails around the use of prior authorization
Potential finalization of improvements to the Medicare plan finder
Direction on oversight of MA plan marketing activities
CMS decision and response to the proposal to expand coverage of anti-obesity medications under Medicare Part D and Medicaid

Stakeholders can access HMA’s review of the contract year (CY) 2026 MA and Part D proposed rule and key considerations here and our review of the 2026 Advance Notice for the Medicare Advantage and Medicare Part D programs here.

Similarly, in the first year of a presidential transition, CMS has a narrower opportunity to shape Medicare’s first set of proposed payment and policy rules. The agency may, however, begin to signal important policy direction on a global level and technical issues that can have an impact on Medicare stakeholders. HMA experts are watching in particular for requests for information and other signals of CMS’s Medicare priorities, including reforms in quality reporting, value-based contracting, pricing and contract transparency, among others.

Connect with Us

HMA’s expert consultants provide the advanced policy, tailored analysis, and operational skills you need to navigate today’s rapidly evolving regulatory landscape and to support implementation of final policies. Don’t let the uncertainty of future policies derail your strategic plans or burden your teams.

For details about the forthcoming Medicare Advantage and traditional Medicare regulations, contact one of our featured experts, Amy Bassano, Zach Gaumer, and Greg Gierer.

HMA Roundup

Arkansas

Arkansas Submits Section 1115 Demonstration Medicaid Work Requirement Amendment. The Arkansas Department of Human Services (DHS) submitted on March 27, 2025, an amendment request titled “Pathway to Prosperity” to its Section 1115 Arkansas Health and Opportunity for ME (ARHOME) demonstration to implement work and community engagement requirements for Medicaid expansion adults aged 19–64 enrolled in Qualified Health Plans (QHPs), targeting over 220,000 beneficiaries. The state plans to use data matching to identify individuals “not on track” for economic and health self-sufficiency and provide them with Success Coaching—a form of focused care coordination that includes developing a Personal Development Plan (PDP). Medicaid coverage would be suspended—but not terminated—for individuals who fail to engage, with coverage reinstated upon re-engagement. The new requirements are proposed to begin on January 1, 2026.

Colorado

Colorado Budget Committee Finalizes Fiscal 2026 Budget with Medicaid Rate Increase. The Denver Post reported on March 28, 2025, that Colorado’s Joint Budget Committee finalized the state’s $16 billion fiscal 2026 budget without enacting major cuts to Medicaid, despite facing a $1.2 billion shortfall. The budget also raises Medicaid provider rates. Medicaid, which covers about 1 in 5 Coloradans, remains one of the largest drivers of state spending. The spending package will be introduced in the Senate next.

Florida

Florida Releases MMIS Modernization RFI. The Florida Agency for Health Care Administration (AHCA) released on April 1, 2025, a request for information (RFI) regarding the Florida Medicaid Management Information System (FMMIS) within the Florida Medicaid Enterprise. Florida is in the process of modernizing the current Medicaid technology using a modular approach. The RFI seeks feedback from stakeholders and potential vendors with MMIS/Medicaid fiscal agent experience on transitioning the operations and maintenance of the FMMIS. AHCA plans to develop MMIS and associated standalone fiscal agent business processes into a standalone module. Responses are due June 2, 2025. Florida’s current MMIS contract with Gainwell Technologies expires December 31, 2027.

GuideWell, Florida Blue Chief Executive to Retire. GuideWell and Florida Blue announced on March 31, 2025, that president and chief executive Pat Geraghty will retire on December 31, 2025. Geraghty has served in his role since 2011. GuideWell has initiated a search for his replacement.

Idaho

Idaho Senate Approves Medicaid Supplemental Budget. Fox 26 reported on March 31, 2025, that the Idaho Senate voted 22-13 to approve the state’s Medicaid budget, which includes $674 million of additional funds to go toward federally required contracts, population forecast adjustments, and implementation of Medicaid managed care. The legislature had already approved a $4.5 billion baseline budget. Idaho’s Medicaid budget totals $5.2 billion. The supplemental budget now heads to the House for consideration.

Idaho Submits Behavioral Health Transformation Section 1115 Demonstration Extension Request. The Centers for Medicare & Medicaid Services (CMS) announced on March 27, 2025, that Idaho has submitted a request to extend its Behavioral Health Transformation Section 1115 demonstration for five years. The request also seeks to add expenditure authority for the Youth Empowerment Services (YES) Group. Idaho’s amendment specifies that it is not requesting to extend personal care services; the state had previously submitted an amendment to CMS seeking to end the program early. CMS will accept public comments on the application through April 25, 2025.

Iowa

Iowa House Approves Amended Medicaid Work Requirements Bill. The Iowa Capital Dispatch reported on March 26, 2025, that the Iowa House passed an amended version of Senate File 615, which would require most able-bodied adults enrolled in the state’s Medicaid expansion program to work at least 80 hours per month to maintain coverage. The House added clarifying language to ensure the program would only end if federal approval for work requirements is granted and later revoked. The bill also directs a review of Medicaid for employed people with disabilities and raises the asset limit for married enrollees. The bill now returns to the Senate for approval.

Kentucky

Kentucky Governor Vetoes Medicaid Work Requirements Bill. Health Payer Specialist reported on March 31, 2025, that Kentucky Governor Andy Beshear vetoed House Bill 695, which would impose Medicaid work requirements and prior authorization for behavioral health services, arguing it would delay care. However, the Republican supermajority in the legislature is likely to override the veto.

Kentucky Enacts Immediate Ban on Medicaid-Funded Gender-Affirming Care. The Lexington Herald Leader reported on March 28, 2025, that Kentucky Republicans voted to override Governor Andy Beshear’s veto of House Bill 495, which immediately bans the use of Medicaid funds for gender-affirming care for transgender adults and overturns an executive order banning public funding for conversion therapy. The law went into effect immediately due to an emergency clause included in the legislation. Separately, Beshear allowed Senate Bill 2 to become law without his signature, which bars incarcerated transgender individuals from receiving gender-affirming care.

Louisiana

Louisiana Governor’s Fiscal 2026 Budget Proposes $1.5 Billion Increase for Healthcare Spending. The Louisiana Illuminator reported on March 26, 2025, that Louisiana Governor Jeff Landry’s proposed fiscal 2026 budget recommends increasing the healthcare budget by nearly $1.5 billion. Medicaid accounts for $19 billion of the governor’s total proposed $21.4 billion healthcare budget. Louisiana is currently facing a possible $100 million Medicaid budget deficit for fiscal 2025.

Massachusetts

Point32Health to Exit MassHealth Managed Care, Cuts 110 Jobs Amid Financial Losses. The Boston Globe reported on March 31, 2025, that Point32Health, owner of Harvard Pilgrim Health Care and Tufts Health Plan, announced it will exit the MassHealth traditional Medicaid managed care program, affecting approximately 30,000 Medicaid members who must transition to new insurers by January 2026. Point32Health will remain in the Accountable Care Organization program, the Senior Care Options program, and the One Care program. The insurer laid off 110 employees to reduce costs, following significant financial losses. Rising healthcare spending, particularly on weight-loss drugs, and ongoing provider contract disputes contributed to the company’s financial challenges.

Michigan

Michigan Announces $8 Million in Funding for Healthy Community Zones. The Michigan Department of Health and Human Services announced on April 1, 2025, that it has awarded approximately $8 million to 20 organizations to build Healthy Community Zones in the City of Detroit and Chippewa and Saginaw counties. Healthy Community Zones aim to reduce racial disparities in chronic disease through community-led solutions. The initial funding period will last 18 months.

Mississippi

Mississippi Enacts Presumptive Pregnancy Eligibility Bill. Mississippi enacted on March 25, 2025, House Bill 662, which removes the requirement that women show proof of income for presumptive Medicaid eligibility. The bill, sponsored by House Medicaid Committee Chairwoman Missy McGee (R-Hattiesburg), was made law without Governor Tate Reeves’ signature.

Mississippi Governor Vetoes Medicaid Reform Bill. The Magnolia Tribune reported on March 28, 2025, that Mississippi Governor Tate Reeves vetoed Senate Bill 2867, which would extend Medicaid coverage for former foster youth to age 26, reduce eligibility redetermination frequency for children with chronic conditions, and broaden reimbursement for perinatal and behavioral health services. The governor estimated the bill would add $40 million in recurring costs to the annual Medicaid budget, with the state responsible for covering 24 percent of that amount. The bill has been referred back to the Senate Medicaid Committee for further consideration and potential revisions before the end of the legislative session.

Montana

Montana Governor Signs Medicaid Expansion Renewal Bill with Work Requirements. The Montana Public Radio reported on March 28, 2025, that Montana Governor Greg Gianforte signed into law House Bill 245, which would renew Medicaid expansion and remove the Medicaid expansion sunset provision, ensuring ongoing coverage for approximately 75,000 enrollees. The expansion also includes a work requirement that the state would need a federal approval to implement.

Nevada

Nevada Faces $66 Million Medicaid Budget Shortfall. The Nevada Independent reported on April 2, 2025, that Nevada is facing a $66 million Medicaid budget shortfall due to miscalculations of cost inflation among managed care organizations. The Nevada Medicaid agency is recommending the state address the shortfall by strengthening oversight of Medicaid enrollees who moved out of state, and pulling from a previous budget surplus. The state may also find approximately $38 million in savings due to federal immigration policy changes to the “public charge rule,” which could result in the federal government denying legal status to people on public benefits. Nevada’s Medicaid department estimates a 15 percent reduction in Medicaid caseloads in families that have mixed immigration status.

New York

New York Federal Judge Temporarily Delays CDPAP Overhaul Until April 4 Amid Legal Challenge. Crain’s New York Business reported on March 31, 2025, that a federal judge has issued a temporary restraining order delaying New York’s planned April 1 consolidation of its Consumer Directed Personal Assistance Program (CDPAP) until April 4, postponing the transition to a single vendor, Public Partnerships LLC (PPL). The lawsuit argues that system delays and access barriers prevented many from registering with PPL on time, risking disruptions to care and worker pay. The court order allows current intermediaries to pay aides for unregistered consumers, while PPL continues paying those already enrolled. A follow-up hearing is scheduled for April 4 to consider a longer delay.

Oregon

Oregon Releases CCO Procurement RFI. The Oregon Health Authority released on March 27, 2025, a request for information (RFI) regarding the upcoming procurement of Coordinated Care Organizations (CCO) for the Oregon Health Plan (OHP). The state is seeking feedback from stakeholders on what services and accountability will be required, including regarding health equity, behavioral health, dental care, provider networks, community partnerships, and service area considerations to inform the procurement process. Responses are due April 16, 2025. New CCO contracts are scheduled to begin in 2027. There are currently 16 CCOs in the state.

South Carolina

South Carolina Medicaid Funding Block on Planned Parenthood Heads to U.S. Supreme Court. The Associated Press reported on April 1, 2025, that the U.S. Supreme Court has agreed to review a case involving South Carolina’s decision to block Medicaid funding to Planned Parenthood. Governor Henry McMaster’s administration aims to stop the organization from receiving any public health funds. The move could impact general healthcare services provided by Planned Parenthood, such as cancer screenings and contraception.

Texas

Centene Dismisses Superior HealthPlan CEO. The Dallas Morning News reported on March 27, 2025, that Centene has dismissed the chief executive of Superior HealthPlan, Mark Sanders. No replacement has been named.

Utah

Utah Expands Adult Medicaid Dental Coverage Through University of Utah Partnership. KSL News Radio announced on April 1, 2025, that Utah has expanded dental services to all Medicaid beneficiaries aged 21 and over. Previously, coverage was limited to specific groups like children, pregnant women, and seniors. The expansion, approved through a section 1115 Utah Medicaid Reform demonstration in January 2025, is in partnership with the University of Utah School of Dentistry and is expected to provide access to dental care for an additional 120,000 adults.

West Virginia

West Virginia Seeks to Expand SNAP Work Requirements, Ban Certain Foods. The Weirton Daily Times reported on March 31, 2025, that West Virginia Governor Patrick Morrisey signed a letter of intent to seek a federal waiver to expand work, training, and educational requirements for Supplemental Nutrition Assistance Program (SNAP) recipients. The governor also intends to seek a waiver banning certain foods from being SNAP-eligible benefits, including subsidized soda. Health and Human Services Secretary Robert F. Kennedy Jr. stated that West Virginia would lead the Make America Healthy Again federal initiative.

West Virginia Lawmakers Shelve Medicaid Expansion Trigger Bill. West Virginia Watch reported on March 31, 2025, that state legislators have placed a Medicaid expansion trigger bill on an inactive calendar. House Bill 3518, sponsored by Delegate Stanley Adkins (R-Summersville), sought to repeal Medicaid expansion if the federal government reduced its federal medical assistance percentage (FMAP). Approximately 166,000 people would lose healthcare coverage if expansion was repealed. House delegates indicated that the federal government has confirmed the state will continue to receive the same level of funding.

National

HHS Initiates Layoffs Affecting 10,000 Employees. Health Payer Specialist announced on April 1, 2025, that the Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. has initiated layoffs affecting up to 10,000 employees as part of a plan to reduce the agency’s workforce by approximately 25 percent. In total, 20,000 positions will be eliminated—10,000 through the new layoffs and another 10,000 from prior probationary cuts or voluntary departures. The Centers for Medicare & Medicaid Services (CMS) will lose about 300 employees. Additionally, HHS will consolidate 28 divisions into 15 and reduce its regional offices from 10 to five. A new agency, the Administration for a Healthy America, will also merge several offices to focus on chronic disease prevention and health resources for low-income Americans. HHS maintains that essential health services will remain unaffected.

HHS Layoffs Include Transfer Offers to Fill Vacancies at Indian Health Service. STAT News announced on April 1, 2025, that amid ongoing layoffs at the Department of Health and Human Services (HHS), some employees, including high-ranking officials from agencies like the NIH and CDC, were offered transfers to the Indian Health Service (IHS), which currently has a vacancy rate of about 30 percent. The email offer listed IHS regions such as Alaska, New Mexico, Oklahoma, and the Navajo Nation, and required employees to submit their relocation preferences within 24 hours.

States File Lawsuit Over Federal Funding Cuts for Public Health Programs. The Associated Press announced on April 1, 2025, that a coalition of 23 states filed a lawsuit against the Trump administration over its decision to cut $11 billion in federal funding for COVID-19 and public health programs. The suit, filed in Rhode Island, argues the cuts are unlawful, lack justification, and would cause serious harm by disrupting vaccination, mental health, and addiction services. States warn the move could lead to thousands of job losses and weaken defenses against infectious diseases.

State Medicaid Programs Overpaid $4.3 Billion for Multi-State Enrollees, WSJ Finds. The Wall Street Journal reported on March 26, 2025, that state Medicaid programs paid health plans at least $4.3 billion in duplicate payments between 2019 and 2021 for an average of about 660,000 beneficiaries per year who were enrolled in multiple states simultaneously. Partly due to continuous coverage requirements during the pandemic, managed care organizations (MCOs)—such as Centene, Elevance Health, and UnitedHealth Group—received overpayments, with Centene alone collecting an estimated $620 million. Georgia paid $92 million, Florida $218 million, and Indiana $106 million to MCOs for beneficiaries enrolled in multiple states.

Medicaid, CHIP Enrollment Drops 340,000 in November 2024, CMS Reports. The Centers for Medicare & Medicaid Services (CMS) reported on March 28, 2025, that enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) was 79 million in November 2024, reflecting a decrease of 340,000 from October 2024. Over the year from November 2023 to November 2024, Medicaid enrollment fell by 7.1 million individuals, while CHIP enrollment saw an increase of 27,000.

MACPAC Releases Issue Brief on SBHCs, Behavioral Healthcare for Medicaid-covered Students. The Medicaid and CHIP Payment Access Commission (MACPAC) released in March 2025, an issue brief highlighting school-based health centers (SBHCs) and their role in providing behavioral healthcare for students covered by Medicaid. The report discusses SBHC funding and sponsorships, service sites, and compliance with state policy. Additionally, the issue brief discusses the challenges in providing care through SBHCs, including payment, consent, and workforces issues.

Industry News

RFP Calendar

The Actuaries' Corner

Sale of Ozempic Knockoffs Are Supposed to End Soon. Telehealth Companies Aren’t Happy. March 19th was supposed to mark the beginning of the end for cheaper, knockoff versions of hot weight-loss drugs. The Food and Drug Administration wants bulk production of the copycats to stop for pharmacy-prepared versions of Zepbound and later in the spring for knockoffs of Ozempic and Wegovy.

Discover other developments in the Wakely Wire here.

Company Announcements

MCG Press Release

MCG Recognizes Regence with the 2024 Richard L. Doyle Award for Innovation and Leadership in Healthcare: MCG Health has named Regence Health Plans a recipient of its 2024 Richard L. Doyle Award for Innovation and Leadership in Healthcare. The nonprofit health insurer was recognized for its innovative use of HL7® Da Vinci Project’s FHIR® standards to help automate clinical authorization processes and reduce administrative burdens. Read More

HMA News & Events

HMA Webinar

Survey Readiness: Prepare, Respond, Succeed, a 5-part Virtual Series. Every Wednesday in April 1:00 PM to 2:30 PM ET.

In today’s complex healthcare environment, navigating the scrutiny of regulatory and accreditation bodies like The Centers for Medicare & Medicaid Services (CMS), Department of Health (DOH), The Joint Commission, and Det Norske Veritas (DNV) Healthcare is critical for the success of every hospital and health system. Unexpected surveys, triggered by recertification, validations or even complaints, can occur at any time.

HMA has partnered with the Healthcare Association of New York State (HANYS) to develop the content for Survey Readiness: Prepare, Respond, Succeed, a 5-part virtual series on Wednesdays in April from 1- 2:30pm ET. HMA’s expert faculty will also co-teach the sessions. Attendees will dive deep into organizational strategies and tactics to prepare, manage and respond to surveyors effectively – and get the essential skills to excel in survey readiness.

While some examples in the program will address issues from the New York state perspective, attendees from organizations nationwide should attend. Hospital and long-term care executive team and leaders in quality and compliance, survey coordinators, and risk management will benefit from attending.

Survey Readiness: Prepare, Respond, Succeed

Virtual Series | April 2 – 30

April 2: Survey readiness 101: Overview and getting started
April 9: Preparation: How to mitigate risk and prepare for upcoming surveys
April 16: They’re here: Establishing a survey response and management protocol
April 23: Responding to survey findings: How to develop a strong correction plan and knowing your options
April 30: What’s next: Leveraging survey findings and strengthening organizational quality and compliance

The cost to attend this series is $475.

State hospital associations and their members can enjoy $50 off when using this code when registering: SHADISCOUNT25

To learn more and to register, visit http://hanys.org/events/survey-readiness.

NEW THIS WEEK ON HMA INFORMATION SERVICES
(Exclusive Access for HMAIS Subscribers):

HMAIS Reports

New HMA Medicaid Databook
New Nevada Medicaid Managed Care Award Analysis
Updated Section 1115 Medicaid Demonstration Inventory
Updated Virginia and Wisconsin State Overviews

Medicaid Data

Medicaid Enrollment and Financial data from Arkansas, Georgia, Idaho, Maryland, New Jersey, North Dakota, Rhode Island, Virginia, Washington, and West Virginia.

Public Documents:

Medicaid RFP documents from Delaware, Florida, Hawaii, Nevada, and Oregon.

Medicaid Quality Strategy Reports, Medicaid Expenditure Reports, HEDIS Reports, Strategic Plans, Budget Documents, Section 1115 Waivers, and other key documents from the following states: Arkansas, Idaho, Oregon, South Dakota, Tennessee, Texas, Vermont, and Washington.

A subscription to HMA Information Services puts a world of Medicaid information at your fingertips, dramatically simplifying market research for strategic planning in healthcare services. An HMAIS subscription includes:

State-by-state overviews and analysis of latest data for enrollment, market share, financial performance, utilization metrics and RFPs
Downloadable ready-to-use charts and graphs
Excel data packages
RFP calendar

If you’re interested in becoming an HMAIS subscriber, contact Andrea Maresca at amaresca@healthmanagement.com.

Edited by:

Alona Nenko
Andrea Maresca
Gabby Palmieri
Maddie McCarthy

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