14. Department of Health and Human Services · Minor
Conduct oversight and reform of Medicaid managed care
Printed page 467 14. Department of Health and Human Services
“Conduct oversight and reform of managed care.”
What has happened
- Attempted
CMS proposed to rewrite the limits on State directed payments in Medicaid managed care — the mechanism by which States route supplemental money to providers through managed care plans — and to cap certain targeted fee-for-service practitioner payments. A proposal; no final rule. Alongside it CMS ran the CRUSH request for information (2026-02-27) canvassing managed care program-integrity changes, and the 2026 Unified Agenda carries RIN 0938-AV70, "Strengthening the Integrity of Medicaid and CHIP Managed Care, Financing, and Access to Care", at proposed-rule stage with an NPRM scheduled for July 2026 and not yet published. Oversight activity, no reform in force.
Research log
What was searched, and what didn’t count as evidence
Research notes
- Queries: every Medicaid final and proposed rule of the window among the federal records we keep and search (30 records); Federal Register “Medicaid managed care” → 37 documents; the Unified Agenda entry for RIN 0938-AV70 read at https://www.govinfo.gov/content/pkg/FR-2026-08-14/html/2026-16603.htm, which states CMS is developing a rule “including rescinding or revising provisions finalized in the 2024 final rules” (the Managed Care Access, Finance and Quality rule and the Ensuring Access rule).
- OIG continued to publish State-level managed care audits through the window (Arizona, New York, Kansas, Health Share of Oregon), which is routine oversight rather than the reform the Quote asks for; oig.hhs.gov can be read, but its report search could not be used.
- Action
- other
- Object
- Medicaid managed care
- ID
- 1279