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The Record

The week on the record

54 records · 13 issues

Analysis

By issue

Medicaid work-requirement implementation

On November 9, DC's Department of Health Care Finance said that on January 1, 2027, work requirements start and retroactive coverage drops from three months to one for childless adults and two for others. The October 29 ruling in Massachusetts v. Oz widened the medically frail exemption and struck CMS's work impairment test in every state. The CMS administrator announced an appeal on November 3. The 26 plaintiff states, including DC, have six months of protection from CMS enforcement. On November 5, Washington, Oregon, Minnesota and New Mexico sued HHS in Oregon over the work requirement itself. The rule stays in effect, and states must apply it by January 1, 2027. Indiana estimates nearly 140,000 people will qualify as medically frail. In Taylor v. Kennedy, the government's final reply is due December 2. Iowa's rule starts December 1. (as of )

Arizona Health Care Cost Containment System

Arizona's five-year Medicaid lifetime limit is NOT approved

Correction to tracked context, based on AHCCCS's own federal-waiver page. Our records carried a pending AHCCCS Works 1115 amendment imposing a five-year Medicaid coverage lifetime limit as though it were an approaching reality.

AZSource
5 more records

The $50 billion Rural Health Transformation Program

On November 9, CMS announced $10 billion in second-year Rural Health Transformation awards to all 50 states. Each state gets a $100 million base, and CMS says the rest partly reflected state progress on plans. Texas gets the most, $281,976,026. Pennsylvania gets $190,730,492 and Maryland $168,410,112. New Jersey gets the least, $142,338,224. The CMS release names no health center. KFF Health News reported on November 5 that six states listed more than $60 million in consultant contracts, and Montana voided a potential $25 million consulting award. States are spending first-year money. Louisiana obligated about $208 million and Vermont allocated all $195 million. Oklahoma funds 25 community health workers at 18 federally qualified health centers. Ohio listed its health center association at $10,406,623, plus $1,836,462 for maternal care. Applications close in Kansas on November 13 and North Carolina on November 16. (as of )

4 more records

AI in care: law, oversight and adoption

The HTI-5 final rule, published October 28, takes effect December 28, 2026. It removes the AI model card duties from the decision support criterion for certified EHRs and cuts 14 of 60 certification criteria. On October 19 ATA Action told the FDA not to shift monitoring of generative AI medical devices to practices, since many small, rural and safety-net practices lack the staff. In California, SB 503 and AB 1979, signed September 30, take effect January 1, 2027. Clinics using clinical decision support AI must monitor it for bias, and licensed clinicians must keep independent judgment. SB 947 requires written notice when an employer relies mainly on an automated system to discipline or fire a worker, starting July 1, 2027. AAAHC's v45 standards add AI governance expectations for surveys on or after December 15. (as of )

Morgan Lewis

California's AI Transparency Act went operative August 2

This entry exists to close a gap in our own coverage with a negative answer rather than a manufactured obligation. Our internal notes flagged that California SB 942 took effect August 2, 2026 and appeared nowhere in our data.

Source

Medicaid financing and eligibility operations

Maryland's Health Care Commission took FQHC applications through November 9 for 2027 grants from a $25 million fund, paying $150 to $250 a month per eligible uninsured patient. Maryland's hospital rate commission put possible fiscal 2027 uncompensated care at $128 million. On November 5, the Massachusetts Senate passed a supplemental budget without the House version's 340B section. Texas lawmakers filed House and Senate bills on November 9 to expand Medicaid. Republicans still hold the Texas Senate 19 to 12. Georgetown counts 2.56 million fewer children in Medicaid and CHIP through August 2026 than in January 2025. On November 2, Colorado's governor proposed cutting more than $600 million in projected Medicaid spending. CMS deferred another $1.2 billion in California Medicaid payments. Pennsylvania and Indiana shorten retroactive coverage for applications from January 1, 2027, and Georgia has proposed the same. (as of )

Safety-net workforce and capacity shifts

Health care added 42,000 jobs in October, above its 12-month average of 31,000, the Bureau of Labor Statistics reported on November 6. Hospitals added 16,000 and outpatient care centers 5,000. Shortages persist. In North Carolina's annual survey, 12% of RN positions and 16% of LPN and nursing assistant positions were unfilled. In Arizona, Valle del Sol, a primary and behavioral health provider, says it would hire 20 physicians and 100 therapists if it could. Training money is arriving. New York awarded $32.5 million to 34 facilities, including Sun River Health and The Chautauqua Center, and West Virginia awarded Charleston Area Medical Center more than $3.9 million in Rural Health Transformation funds. California's AB 1811 keeps areas on the January 1, 2025 federal shortage list counted in state programs until 2035. (as of )

Community Health Center Fund and federal appropriations

Democrats won the House and Senate in the November election, and Jeffries named reversing Medicaid cuts and extending ACA credits as priorities. The stopgap P.L. 119-103 runs out December 11, and the mandatory Community Health Center Fund and NHSC still end December 31, 2026, 20 days later. No enacted bill extends the fund. The House Labor-HHS bill approved June 9 leaves it out, and the $750 million health center package the Energy and Commerce Committee advanced 45-0 on July 21 has not passed. (as of )

The White House

Stopgap sets December 11 deadline, 20 days before the CHC Fund expires

The President signed H.R. 6500, now Public Law 119-103, funding the government through December 11. It does not mention health centers or the Community Health Center Fund, which still expires December 31.

Corrected Oct 16, 2026: Earlier text said the law's only health provision was a Medicare Improvement Fund offset. Section 2006 also adds $21.4 million to the Northern Mariana Islands' fiscal 2026 Medicaid allotment.

Source

Enforcement: privacy, fraud and audits

Brockton Neighborhood Health Center agreed to an $850,000 fund to settle a class action over a 2024 ransomware attack that affected 97,488 people, with claims due December 8, 2026. NorthShore Health Centers in Indiana warned patients of a cyber incident detected August 10, and the Insomnia ransomware group claimed the attack. The Justice Department charged 15 defendants in Los Angeles cases citing over $1.8 billion in fraudulent claims, and its False Claims Act self-disclosure pilot with HHS accepts submissions through April 22, 2027. Texas HHSC proposed Medicaid recovery audits of managed care claims, and it may make some Medicaid providers revalidate before CMS's June 5, 2028 deadline. (as of )

HRSA Health Center Program rules

HRSA's FY2027 Service Area Competition for 63 awards has Phase 2 due in EHBs by 5 p.m. ET on November 18. Phase 1 closed October 19, and the awards start April 1, 2027. HRSA extended funding for 272 health centers that must re-compete, through June 30 or July 31, 2027, and each must still apply. A correction added Sayre Health Center of Philadelphia, with an estimated $900,374 award. On October 20 HRSA sent revised Health Center Program forms to OMB, with comments due November 19. A proposed Grants.gov form would collect applicants' NPIs and CMS certification numbers, with comments due November 9. HRSA moves scope data to new Forms 5A and 5B on November 20. (as of )

Immigration enforcement, public charge and immigrant eligibility

Under USCIS public charge guidance issued August 18, officers may weigh any means-tested benefit, including Medicaid and CHIP, received on or after September 18, 2026. Before that date only cash assistance and long-term institutional care count. KFF estimates 1.4 to 4.1 million people could drop Medicaid or CHIP, up to 1.7 million of them citizen children. Federal agents blocked the emergency entrance at White Memorial hospital in Boyle Heights, diverting ambulances for about two hours. A La Clínica nurse practitioner in Oakland said about half of her patients missed appointments while ICE agents were at Highland Hospital. A Nashville court extended its block on Tennessee immigration checks in the Ryan White program. In the states' public charge suit, the states move for summary judgment by December 11. (as of )

340B drug pricing

On November 18 a Maine federal court hears the hospitals' bid to block HRSA's 340B rebate pilot, starting January 1, 2027. The government and four drugmakers oppose it. NACHC and the National PCA Hub back it. West Virginia's Cabin Creek Health Systems says its drug purchasing costs in the pilot could rise from $100,000 to about $750,000. A bipartisan House bill would end the pilot. CMS's final 2027 Physician Fee Schedule requires Medicare-enrolled covered entities to report Part D 340B claims, first by September 30, 2027. On November 9 the Illinois Primary Health Care Association, representing 55 health centers, said it asked to help defend the state's 340B law. The Massachusetts Senate passed a supplemental budget without the House's 340B section. Mississippi's Supreme Court response to Novartis is due November 27. The Ninth Circuit hears Washington's case December 1. (as of )

ACA marketplace coverage and uninsured demand

Open enrollment for 2027 began November 1 with higher prices. KFF reported on November 6 that average benchmark silver premiums rise 13% and 11 insurers announced exits from at least one state. Mississippi's benchmark rises 23% as Cigna and Molina leave, and on November 9 Stateline reported UnitedHealthcare will sell short-term plans through the state's portal by early 2027. Michigan approved individual increases averaging 14.2%. Effectuated enrollment fell 12% to 19.2 million by February 2026. Covered California raised state subsidies from $190 million to $300 million, which cannot replace nearly $2.5 billion a year in expired federal credits. Florida's navigator grant is 90% below 2024. Comments are due November 27 on a CMS rule to verify income and status before subsidies start, and November 30 on IRS premium tax credit rules. Covered California enrollment runs to January 31, 2027. (as of )

Behavioral-health integration and capacity

On November 6 the Nevada Health Authority posted a draft request to extend its substance use disorder waiver from 2028 through 2032, with comments due December 16. Santa Clara County's $470 million Behavioral Health Pavilion, with 35 youth beds and 42 adult beds, was set to open for service November 3. On October 26 the Governor announced $115.2 million in Homekey+ awards for 329 homes, and Proposition 1 bonds are estimated to fund 6,800 residential treatment beds when fully awarded. Payment is a weak point. Insurers rejected $4.1 million in mobile crisis bills from 11 counties since 2024. On October 6 CMS told states how to cover Certified Community Behavioral Health Clinic services in Medicaid state plans. States need not pay a PPS rate and get no enhanced federal match, and clinics must keep care coordination agreements with FQHCs. (as of )

State health elections and ballot measures

The Associated Press reported November 9 that California voters rejected Proposition 40, 52.8% no to 47.2% yes. SEIU-UHW said the 5% billionaire tax would have raised $100 billion for health care and education, and vows a 2028 retry unless lawmakers deliver a real solution. Texas lawmakers filed House and Senate bills to expand Medicaid. Republicans hold the Texas Senate, the Legislature convenes January 12, 2027, and it is unclear whether the governor-elect can order an expansion plan. Proposition 44 also failed, and certification is December 11. California Governor-elect Xavier Becerra takes office January 4, 2027. On November 6, San Diego's Measure B had 52.00% yes, and Imperial County's Measure N had 54.97% but needs two-thirds. Colorado approved Amendment 87, estimated to raise $2 billion a year for health care, schools and child care. South Dakota kept Medicaid expansion. (as of )

The next two weeks

Public dates in the 14 days after Sep 6, 2026.

Other records

6 records with no linked issue