Weekly Roundup -
September 23, 2026
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VA Community Care Program: Richard Topping to Discuss NextGen VA at HMA 2026 Conference
Health Management Associates (HMA) is pleased to welcome The Honorable Richard F. Topping, Assistant Secretary for Management and Chief Financial Officer at the US Department of Veterans Affairs (VA), to HMA’s US Healthcare 2026: Signals, Signs & Flashing Lights conference, October 5-7, 2026, in New Orleans, LA. His participation will give health plans, providers, technology companies, and other organizations interested in working with the VA Community Care program a timely opportunity to hear directly from senior VA leadership about the priorities shaping the program’s next phase.
VA Community Care Priorities and Opportunities for Collaboration
HMA’s Jean Glossa, MD, MBA, FACP, will join Mr. Topping during Community Care for Veterans—NextGen VA to discuss priority healthcare issues for the VA. They will examine the VA care delivery system, Mr. Topping’s areas of oversight, and opportunities to better integrate care delivered by VA providers with services furnished by contracted community providers.
In addition to its direct care system, the VA operates six national payer programs, including VA Community Care—now the fourth-largest health insurer in the United States. Mr. Topping will describe how the VA is shifting Community Care from a network administration model toward a true healthcare purchasing and performance‑management model. CCN NextGen is the VA’s first major modernization of Community Care contracting since the MISSION Act, which took effect in 2019. This 10‑year, multiple‑award IDIQ structure will increase competition, enable regional adaptability, and support iterative improvements through sequential task orders opening up new opportunities for industry to partner with the VA.
Explore Best Practices for Working with the VA
Mr. Topping also will participate in one of HMA’s Coffee Conversations and Collaborations, a highly interactive format, which fosters practical discussion. Participants will have an opportunity deepen their knowledge about effective approaches to working with the VA, ask questions, and share experiences. This combination of senior-level perspective and smaller group dialogue makes Mr. Topping’s participation especially relevant for managed care plans, provider organizations, technology firms, and other partners monitoring the direction of VA Community Care.
Join VA and Healthcare Leaders at HMA’s 2026 Conference
HMA is honored to host Mr. Topping and create space for a substantive discussion about the future of VA Community Care. Register for HMA’s US Healthcare 2026 conference to hear directly from leaders who are shaping public healthcare and connect with peers working to turn policy priorities into stronger systems of care.
Pennsylvania Health Policy Conference 2026: What’s Next for Medicaid Enrollees, Rural Hospitals, and the Workforce
State of Reform (SOR), an HMA Company, hosted its inaugural Pennsylvania Health Policy Conference in Harrisburg on September 16, 2026, bringing together more than 170 interest-holders, including state health and human services departments leaders, policymakers, providers, health plans, community‑based organizations (CBOs), and others to discuss the most pressing health-related issues in the commonwealth.
The conference focused on how federal Medicaid policy changes, managed care challenges, and workforce shortages, are reshaping Pennsylvania’s healthcare landscape while highlighting prevention and cross-sector collaboration as essential to building a more sustainable system. Key discussions are highlighted below.
Central Discussions: Federal Medicaid Policy, Managed Care, and the Workforce
Pennsylvania Medicaid
Valerie Arkoosh, MD, Secretary of the Pennsylvania Department of Human Services (DHS) opened the conference by examining how federal policy and fiscal pressures are likely to affect Pennsylvania’s health and human services system. She discussed the anticipated loss of Medicaid coverage for approximately 310,000 enrollees due to the 2025 budget reconciliation act (P.L 119-21, now known as the Working Families Tax Cut Act [WFTCA]) and the resulting strain on individuals, providers, and the broader healthcare system.
WFTCA and broader financial pressures also raise concerns about the sustainability of hospitals, with closures threatening access to care, especially in rural and underserved communities. Hospitals and safety-net facilities are consistently working against staffing shortages, capacity constraints, and shifting payer dynamics. Pennsylvania is using funds from the Rural Health Transformation Program (RHTP) to support struggling rural hospitals as best it can. DHS has awarded $42 million in RHTP grant fund awards so far to support various rural facilities.
Medicaid managed care
Community HealthChoices (CHC), Pennsylvania’s Medicaid managed long-term services and supports (MLTSS) program, has been at the forefront of the healthcare conversation in the state as a result of the cancellation of its 2024 contract awards for the program. In June 2026, DHS released a request for information seeking responses on several topics that could shape a new CHC re-procurement, including the number of Medicaid managed care organizations (MCOs) within CHC, regional versus statewide coverage, length of contract terms, strategies to align coordination of Medicare and Medicaid, artificial intelligence (AI), and other program recommendations.
During the managed care discussion, Sally Kozak, Deputy Secretary of the Office of Medical Assistance Programs, and Emily Katz, Executive Director of Pennsylvania Medicaid MCOs, joined health plan leaders in assessing how well the physical health managed care program is improving access, quality, and cost management.
The conversation centered on persistent challenges involving provider participation, care coordination, the complexity of administering the programs, and the variation in performance by region. There are opportunities to reform or refine managed care to better align incentives with patient needs and system sustainability.
Workforce shortages
Like all states, Pennsylvania is facing a health professional shortage across all sectors. Jennifer Hale, Director of the Bureau of Policy and Regulatory Management in the Office of Long-Term Living, and Garry Pezzano, President and Chief Executive Officer of LeadingAge PA, highlighted how this issue is affecting people who need long-term care. Speakers emphasized that Pennsylvania’s ability to meet the needs of an aging population will depend largely on strengthening the workforce that delivers these services. They explained several of the strategies underway and being discussed to achieve this goal, for example by improving wages and benefits for direct care workers, strengthening education and training pipelines, expanding loan repayment programs, prioritizing recruitment, and investing in technology for telehealth services and AI-assisted workflows.
Advancing Change: Upstream Interventions and Collaboration
Paying for care continues to be a chief concern. While many of the financial pressures come from within the healthcare system as the result of policy and budgetary challenges, throughout the conference speakers emphasized that many of Pennsylvania’s most pressing healthcare challenges begin outside the healthcare system. Food insecurity, unstable housing, transportation barriers, limited caregiver support, and lack of social and community supports worsen health outcomes and lead to increased healthcare expenditures.
Panelists called for greater investment in upstream prevention services that help people remain healthy and independent before their needs become more acute to contain costs over time. Speakers recommended approaches such as expanding housing supports, food as medicine initiatives, community health worker investments, caregiver supports, reentry services, and technology that allows people to receive care at home, as well as other initiatives to ensure people can remain healthy and independent.
Pennsylvania has already begun investing in several of these areas. The fiscal 2027 budget allocated $1.9 million to the Investments in Health pilot program for housing stability services and reentry supports for incarcerated individuals. Federal matching dollars for the first year of this program total $5.2 million. Another tool, PA Navigate, connects people with CBOs, state agencies, and providers that can help people access basic necessities.
Speakers also stressed that these efforts will have limited reach if organizations operate separately. Better coordination among healthcare providers, MCOs, CBOs, hospital systems, and state agencies can reduce the fragmentation, make services easier to navigate, and help funding and data systems support common goals. That message was consistently expressed throughout the conference: Pennsylvania’s healthcare challenges cannot be addressed by one sector alone, and progress will depend on sustained collaboration among the organizations that serve individuals and communities.
Looking Ahead
If you are looking for strategies and solutions to address urgent healthcare policy and operational challenges, Health Management Associates (HMA) experts are available to help you navigate these complex changes and identify practical paths forward.
Through the HMA National Conference, State of Reform partnership events, and other HMA meetings across the country, we connect state leaders, providers, health plans, and community stakeholders to share insights, elevate lessons, and advance solutions. Join us at an upcoming event—including our next HMA National Conference in New Orleans, LA, October 5–7, 2026—or explore additional opportunities to engage with HMA and access the full schedule of conferences and resources.
State of Reform develops its conference agendas through collaboration with HMA subject matter experts/market leads and stakeholders across the public and private sectors, including state officials, community-based organizations, providers, payers, and more.
Federal Policy News
Fueled By Leavitt Partners Weekly Health Intelligence
HHS Nominations Move Forward as NIH Debate Grows
This week, the Senate HELP Committee will vote on the nominations for several key leadership positions within HHS, including SAMHSA Administrator, Assistant Secretary for Aging, and U.S. Surgeon General. This follows last week’s hearing to review the nominations of Dr. Timothy Westlake to be SAMHSA Administrator and Dr. Nicole Saphier to be Surgeon General. Ms. Mary Lazare is nominated for Assistant Secretary of Aging and will proceed without a hearing, but she did meet with committee staff ahead of this week’s markup. Immediately following this Thursday’s executive session, the HELP Committee will hear testimony from Dr. Heidi Overton, who is nominated to serve as FDA Commissioner. Dr. Overton currently serves as Deputy Director of the White House Domestic Policy Council.
Last week, Senators Ashley Moody (R-FL) and Roger Marshall (R-KS) announced support for Dr. Overton after meeting with her. She also reportedly met with Senate HELP Committee Chair Bill Cassidy (R-LA) earlier this month, but he has not publicly commented on the meeting.
After her nomination was first announced in August, Chair Cassidy posted on social media that Dr. Overton’s role in President Trump’s Executive Order on a revised childhood vaccine schedule (EO 14420) “is almost disqualifying.” In an interview this Sunday, Chair Cassidy stated that to support Dr. Overton, he “need[s] to hear that she understands that calling the measles vaccine lethal is absurd,” in reference to comments made by the President during the signing of the EO. During the interview, Senator Cassidy also indicated that he plans to support the nomination of Dr. Saphier following her responses during her confirmation hearing in support of vaccines.
Though the HELP Committee is likely to advance the three health nominations it will vote on this week, they likely will not receive a vote by the full Senate until after midterm elections, as the Senate is reportedly likely to recess earlier than initially scheduled, possibly as soon as the end of this week. Mr. Sean Kaufman, whose nomination to serve as Assistant Secretary for Preparedness and Response was advanced by the HELP Committee in July, also awaits confirmation by the Senate. Mr. Chris Klomp’s nomination for HHS Deputy Secretary is awaiting a vote in the Senate Finance Committee before it can move to the full Senate for a vote.
Consideration of these nominations comes as news outlets report that the President directed the Office of Management and Budget (OMB) director, Russ Vought, to draft an order to create a board to determine which grant applications receive National Institutes of Health (NIH) research funding. The reports elicited bipartisan concerns from the Hill, including appropriators who have until December 11 to negotiate the rest of FY 2027 funding for the federal government. Senator Susan Collins, Chair of the Senate Appropriations Committee, issued a statement that, “Any attempt to politicize grantmaking at the NIH, or any other agency, by another means—whether an Executive Order or guidance—is contrary to congressional intent. Imposing a political review on awards that have already been selected through a vigorous scientific and merit-based process undermines the long-standing principle that the government funds awards based on scientific need and merit, rather than political ideology.” Senate Appropriations Vice Chair Patty Murray also issued a statement strongly opposing the move, noting, “Under this scheme, a single political appointee could kill a cancer study or an Alzheimer’s trial with no scientific reason at all.”
FDA Opens the Door to More Non-Animal Testing Methods
On September 21, the US Food and Drug Administration (FDA) issued a direct final rule updating its regulations to clarify that non-animal testing methods can be used where appropriate to support the development of drugs and biologics intended for human use. The rule updates regulatory language by replacing references to “animal tests” and “animal studies” with broader terms such as “nonclinical tests” and “nonclinical studies,” reflecting advances in technologies including human cell-based models, organs-on-chips, and computer-based modeling. FDA emphasized that the change does not eliminate animal testing or alter existing evidence standards, but instead provides sponsors with more flexibility to use innovative scientifically appropriate approaches for gathering safety data.
The agency also launched a database highlighting examples of accepted New Approach Methodologies (NAMs), underscoring broader federal efforts to promote innovative, human-relevant alternatives in drug development while maintaining established safety protections. Stakeholders are invited to comment on the rule and comments must be submitted by December 7, 2026. The rule will go into effect on February 4, 2027.
FDA Charts a Path for Interchangeable Biosimilars
On September 18, FDA published a draft strategy document, “Biosimilar User Fee Act III Future Needs in the Development of Interchangeable Products Post-Workshop,” as part of its commitments under the Biosimilar User Fee Act III (BsUFA III). The document summarizes stakeholder feedback from a 2025 FDA workshop on interchangeable biosimilars and outlines FDA’s planned actions to support future product development. Key priorities include advancing the scientific framework for interchangeability, improving communication of emerging scientific and policy developments, addressing challenges related to user interface design and human factors studies, and ensuring regulatory approaches keep pace with evolving biosimilar science. FDA also highlighted plans to expand educational resources for healthcare providers and patients to strengthen confidence in the safety and effectiveness of interchangeable biosimilar products. Public comments on the draft strategy are due by November 17, 2026.
CMS Removes 760,000 Individuals from ACA Marketplace Coverage and Halts New Broker Enrollment
The Centers for Medicare & Medicaid Services (CMS) announced on September 22, 2026, that it has cancelled approximately 315,000 unauthorized enrollments covering 760,000 individuals from the federal health insurance Marketplace as part of the anti-fraud efforts of the White House Task Force to Eliminate Fraud. CMS also released an Interim Final Rule announcing a temporary moratorium on new Exchange broker registration for the 2027 plan year for agents and brokers without an active Exchange agreement for 2026. The IFR took effect on September 22, 2026, and will remain in effect until February 1, 2027. CMS has established an anti-fraud coordination group for the federal Marketplace which brings together leadership from across CMS and the US Department of Health and Human Services that will regularly meet to coordinate program integrity enforcement.
HHS Names New Members to the Preventive Services Task Force
On September 17, Secretary Kennedy announced eight new appointments to the U.S. Preventive Services Task Force (USPSTF), including designation of a new chair. The eight new appointees will join eight existing members of the panel. The USPSTF makes evidence-based recommendations about clinical preventive services, such as cancer screenings and preventive medications, that determine Affordable Care Act coverage requirements for the service. While traditionally heavily composed of primary care physicians, the new appointments include an increased number of physicians practicing in specialties such as cardiology, oncology, and radiology, as well as a health economist. The appointments come after statements from Secretary Kennedy before the House Ways and Means Committee that the panel has been “lackadaisical and negligent for 20 years,” more than a year of cancelled USPSTF meetings, and the dismissal of vice chairs Dr. John Wong and Dr. Esa Davis.
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State Policy News
Colorado Faces $443 Million Medicaid Budget Deficit in Fiscal 2027
The Colorado Commission on Medicaid met on September 17, 2026, to present finding that the state went over its Medicaid budget by $213 million in fiscal 2026, and the Department of Health Care Policy and Financing, the state’s Medicaid agency, expects that increasing costs will result in going over the budget by $443 million in the current fiscal year 2027, bringing the total HCPF deficit to $918 million. Medicaid costs are up 92 percent since 2023 while enrollment decreased 31 percent during the same period. In addition, Colorado expects to lose $105 million starting in fiscal 2028 due to new provider tax limits approved under the 2025 budget reconciliation act (P.L 119-21, OBBBA).
Louisiana Releases Medicaid MCO Contract Extensions for 2027
The Louisiana Department of Health has proposed contract extensions with four of its Medicaid managed care organizations (MCOs), AmeriHealth Caritas, CVS/Aetna, Centene/LA Healthcare Connections, and Humana. The contracts are valued at $16.1 billion total, down from the $16.7 billion contract extensions in 2026, with each individual agreement ranging from $3.2 billion to $5.8 billion. While the total of the contracts has decreased, the individual contract amounts are all significantly larger as the Louisiana Medicaid market shrinks with the departure of UnitedHealthcare in April 2026 and the upcoming exit of Elevance in January 2027.
Nebraska to Update Medicaid Work Requirements to Align with Recent Federal Guidance After Early Implementation
Modern Healthcare reported on September 22, 2026, that nearly five months after Nebraska implemented the Medicaid work requirements for its 70,000 Medicaid expansion enrollees, the state Department of Health and Human Services (DHHS) is having to make some adjustments to align with new federal requirements. The Centers for Medicare & Medicaid Services (CMS) notified DHHS that some of the aspects of its program do not meet federal requirements, mainly new medical frailty requirements, and gave the state 30 days to explain how it will align with the federal government. Between July 1 and August 30, 643 enrollees lost coverage due to not meeting the work requirements, according to the state. From May to July, DHHS processed 6,985 new Medicaid applications, denying more than half overall, but just 336 due to work requirements. Some providers and advocates in Nebraska have reported confusion surrounding the work requirements, as well as long call center wait times for enrollees trying to reach the state.
Nevada Releases Amended 2025-27 Medicaid Quality Strategy for Public Comment
The Nevada Health Authority released on September 18, 2026, a draft of its amended Medicaid 2025-2027 Quality Strategy for public comment. The 2027 goals of the amended quality strategy include improving health and wellness of Nevada Medicaid members, increasing the use of evidence-based practices for those with chronic conditions, reducing opioid and other medication misuse, improving the health and wellness of pregnant women and infants, increasing the use of evidence-based practices for members with behavioral health conditions, increasing dental service utilization, reducing or eliminating health disparities, and improving outcomes for individuals receiving long-term services and supports. Nevada will accept feedback for 30 days after the posting of the notice.
Private Market News
Fueled By Wakely Consulting Group
OURA and Counsel Health Join CMS ACCESS Model to Advance Wearable-Enabled Value-Based Care
Counsel Health has partnered with OURA to incorporate wearable health data into its participation in CMS’ ACCESS model, a value-based care initiative focused on improving care coordination and outcomes. The collaboration reflects the growing role of remote monitoring and consumer health technology in Medicare-focused care delivery. It is also an early example of how the CMS chronic care initiative could become a proving ground for AI-powered, wearable-enabled care delivery.
NCQA 2026 Health Plan Ratings: Nonprofits Leading 5-Star Performance
The National Committee for Quality Assurance released its Health Plan Ratings 2026. Eighteen plans attained the standards organization’s highest 5-star rating, up from 11 last year. All of top-rated plans are non-profits. Plans’ average score rating ticked up slightly, from 3.483 last year to 3.493 in 2026 thanks to improvements in commercial and Medicaid plans, though Medicare insurers’ average rating slipped.
Read the latest Wakely Wire for actuarial insights into the trends shaping payer strategy and financial performance.
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Health Management Associates
Webinar: The Value of Home-Based Personal Care Services - October 22
This webinar, supported by TEAM Services Group, will provide an overview of home-based care, including the populations served, key service types, and delivery models. Experts will discuss findings from a review of the value of home-based care, highlighting its potential to stabilize health, improve the care experience, reduce unnecessary healthcare utilization, and enhance safety and satisfaction for both individuals receiving care and their family caregivers. The webinar will also examine opportunities to expand access to high-quality home-based care, including policy and system-level strategies that can strengthen the structural components needed to make these services more widely available to those who could benefit.
North Carolina, Illinois State of Reform Health Policy Conferences Slated for November
Managing constant change in healthcare takes more than just hard work. It takes a solid understanding of the legislative process and knowledge about intricacies of the healthcare system. That’s where State of Reform comes in. State of Reform pulls together practitioners, thought leaders, and policymakers – each working to improve the healthcare system in their own way – into a unified conversation in a single place.
- The 2026 North Carolina State of Reform Health Policy Conference will be taking place in-person on November 10th, 2026 at the Raleigh Marriott Crabtree Valley. Join the Conversation!
- The 2026 Illinois State of Reform Health Policy Conference will be taking place in-person on November 17th, 2026 at the Hyatt Centric Chicago Magnificent Mile. Join the Conversation!
Wakely
CY 2027 Medicare Physician Fee Schedule Proposed Rule Could Reduce Average Reimbursement by 2.2%
The Centers for Medicare & Medicaid Services (CMS) Calendar Year 2027 Medicare Physician Fee Schedule (MPFS) Proposed Rule includes proposed changes to payment rates, practice expense methodology, evaluation and management coding, and geographic payment factors. Using national Medicare fee-for-service data and the Wakely Medicare Repricing Analysis Tool, Wakely estimates that the proposed changes would reduce average MPFS reimbursement by approximately 2.2% for non-qualifying participants. The impact would vary substantially by provider specialty and Medicare locality.
Why Medicare Part D Oncology Spending Is Rising Even as Prescription Volume Stays Flat
Medicare Part D oncology spending is being shaped by a widening gap between prescription volume and allowed cost. Therapy mix, precision medicines, and portfolio diversification are reshaping oncology trend forecasting.
RFP Calendar
RFP Calendar
| Date | State/Program | Event | Beneficiaries |
|---|---|---|---|
| Date: Summer 2026 | State/Program: Illinois Foster Care | Event: RFP Release | Beneficiaries: 33,000 |
| Date: July 28, 2026 (Delayed) | State/Program: Nevada Children's Specialty | Event: Awards | Beneficiaries: NA |
| Date: November 6, 2026 | State/Program: Indiana | Event: Proposals Due | Beneficiaries: 1,400,000 |
| Date: January 1, 2027 | State/Program: Illinois | Event: Implementation | Beneficiaries: 2,400,000 |
| Date: January 1, 2027 | State/Program: Nevada CO D-SNP | Event: Implementation | Beneficiaries: 88,000 |
| Date: January 1, 2027 | State/Program: Wisconsin LTC GSR 3 | Event: Implementation | Beneficiaries: 56,000 (all GSR) |
| Date: January 1, 2027 | State/Program: Illinois Tailored Care Management Program | Event: Implementation | Beneficiaries: 22,400 |
| Date: July 2027 | State/Program: Indiana | Event: Awards | Beneficiaries: 1,400,000 |
| Date: July 1, 2027 | State/Program: Nevada Children's Specialty | Event: Implementation | Beneficiaries: NA |
| Date: Fall 2027 | State/Program: Oregon | Event: RFP Release | Beneficiaries: 1,200,000 |
| Date: January 1, 2028 | State/Program: Wisconsin LTC GSR 4,6 | Event: Implementation | Beneficiaries: 56,000 (all GSR) |
| Date: 2028 | State/Program: North Carolina | Event: RFP Release | Beneficiaries: 2,200,000 |
| Date: 2029 | State/Program: California | Event: RFP Release | Beneficiaries: NA |
| Date: January 1, 2029 | State/Program: Indiana | Event: Implementation | Beneficiaries: 1,400,000 |