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The Record

The week on the record

37 records · 14 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 )

CourtListener docket, Taylor v. Kennedy, Jr., No. 1:26-cv-03705

Enrollees and physician groups sue HHS over work-requirement frailty rules

Five Medicaid enrollees, physician groups and the City of Columbus, Ohio sued HHS in federal court in Maryland on September 18, 2026 (Taylor v. Kennedy). They ask the court to pause, cancel and block the work-requirement rule's medical-frailty provisions.

Source

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 )

Centers for Medicare & Medicaid Services

Delaware's three health centers get nearly $23M in rural health funds

CMS announced nearly $23 million in Rural Health Transformation Program funding for Delaware's three health centers.

Corrected Sep 28, 2026: The Governor's release names Delaware's three health centers and their shares; Mississippi's and South Carolina's rounds also fund health centers.

DESource

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 )

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 )

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 )

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 )

CourtListener docket, State of New York v. DHS, No. 1:26-cv-07978

Public charge rule stays in effect as court sets October 9 conference

A federal judge in New York signed an order on September 16, 2026 setting an initial conference for October 9 in the 21-state suit against the new public charge rule. The states have not asked the court to block the rule while the case proceeds.

Source

California's state-only Medi-Cal coverage

Xavier Becerra won the race for governor and will seek to reverse the Medi-Cal limits that pushed tens of thousands of undocumented immigrants off the program, CalMatters reported on November 4. He takes office January 4, 2027. Full-scope enrollment among undocumented immigrants fell 19% through June, against 5.5% overall. The current rules still apply. On January 1, 2027, members with unsatisfactory immigration status (UIS) move to fee-for-service and keep coverage, but ECM and Community Supports end for them. Providers that bill only through managed care cannot care for UIS members after December 31, 2026. Refugees, asylees and other affected immigrants keep full-scope Medi-Cal but must update immigration information by December 1. CMSP staff asked its board to approve cuts starting January 1, 2027, including emergency-only coverage for undocumented adults. No vote is recorded. (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 )

California EDD Detailed WARN Report

SAC Health, 51 positions

SAC Health filed two California WARN notices on September 22, 2026 (processed September 24), typed "Layoff Permanent" and effective September 28, 2026: 42 employees at 1003 East Brier Drive and 9 at 250 South G St. In San Bernardino.

CASAC HealthSource

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 )

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 )

Health center openings, closures and mergers

Partnership Health Center closed its Seeley Lake clinic in Montana on October 16, before the October 31 lease end it had announced. Community Health Alliance planned to close its North Valleys center in Reno on October 30. Penobscot Community Health Care is no longer pursuing an imminent Chapter 11 filing after Maine's $2.8 million award, but it is closing Adult Wellness Center as a separate practice, eliminated its outreach and enrollment team and keeps Seaport Dental Center closed. Services are also growing. Iliuliuk Family and Health Services opened Unalaska's first full-service pharmacy with a $400,282 Rural Health Transformation award. Waianae Coast Comprehensive Health Center added OB/GYN care in Nānākuli, and Guam's Northern Region center in Dededo reopened by appointment after Typhoon Champi. (as of )

Healthcare access, language, and civil-rights implementation

HHS published a final rule on November 3 that reads the Section 504 disability exclusion to cover gender dysphoria not resulting from a physical impairment. It takes effect January 4, 2027. CMS's rule ending federal Medicaid and CHIP payment for gender-dysphoria care for youth has been in effect since October 13, and on October 30 a federal court in New Hampshire heard four families' request to pause it. Illinois Medicaid will cover the care with state-only funds through state fiscal year 2027. In the states' Title X case in Maryland, HHS asked for summary judgment on October 23 and opposed the states' motion. Healthy Texas Women providers must recertify by December 31 or lose payment. (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 )

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 27, 2026.

Other records

2 records with no linked issue