CMS Administrator Mehmet Oz stated this week that his agency is exploring IT solutions to support states in implementing Medicaid work requirements. Specifically, CMS is aiming to create an IT infrastructure that will pull a hodgepodge of data related to work requirements and eligibility in a “central place.”

CMS aims to release the minimum requirements for the ambitious system “within a year.” Dr. Oz also noted that CMS’ IT modernization effort is receiving help from the DOGE, and its acting administrator, Amy Gleason. Patient advocates pointed out that the House-passed reconciliation bill would give states barely 18 months to implement work requirements, so CMS’ new IT system could not possibly be ready by then.

Daniel Tsai, former CMS Medicaid Director under Pres. Biden, stated: “Those systems do not work…. They’ve led to people not being to navigate through that, and they’ve led to immense amounts of costs from any of the IT vendors that have tried to build this app. So, I think any realistic state or person on the ground or IT vendor thinking about this will understand that it is impossible — not only under the timelines — but in any sort of way that does not lead to incredible challenges of people navigating the system.”

The Medicaid consulting firm Sellers-Dorsey has published a free “playbook” to assist states, health plans, and other stakeholders in operationalizing the new requirements. The document “offers a high-level framework to guide states, health plans, and solution partners to design, implement, and evaluate” work requirements, and offers “key considerations, emerging best practices, and lessons learned” from officials who have worked on these types of programs in the past.

The Pennsylvania Insurance Department (PID) announced insurers are taking steps to expand coverage for medications used to treat postpartum depression and related maternal mental health conditions. Health insurers in the individual and small group insurance markets will cover an FDA-approved fast-acting postpartum medication for plan year 2026. Gov Shapiro’s proposed 2025-2026 Budget includes $5 million to fund maternal health initiatives and is working to implement universal depression screenings for all Pennsylvania mothers during and after pregnancy.

Devon Trolley, Pennie’s Executive Director, provided a deep dive into the impact of the reconciliation bill for the public on Pennsylvania’s Health Insurance Marketplace. For the 2025 Enrollment Period, Pennie enrolled nearly 500,000 people. The Reconciliation Bill passed by the House and under consideration in the Senate includes significant impacts to Pennsylvanians and could result in 270,000 people losing coverage. The bill increases costs and imposes unnecessary barriers. The Reconciliation Bill does not extend the current Enhanced Premium Tax Credits, which thousands rely on to lower costs. Without Congressional action, costs will go up by 82% and double the cost for most enrollees.

Some barriers to enrollment include pre-enrollment verification for enrollees who have already been verified using trusted resources like the IRS and state data sources, prohibiting auto-enrollment and removing conditional eligibility for enrollees, such as newborns, without documentation at the time of enrollment thus requiring full cost premium payment without the benefit of tax credits.

Listen to a recording of the briefing. For more data, check out Pennie’s webpage on Cost and Affordability.

The new HPSA score requirements for the National Health Service Corps’ 2026 scholars have been published. As typically seen in the past, the minimum scores for the class of 2026 (scholars whose training end dates between Oct. 1, 2025 and Sept. 30, 2026) have increased, in some cases dramatically.

HRSA’s Pediatric Specialty loan repayment program is now accepting applications. Eligible clinicians who provide pediatric medical subspecialty, pediatric surgical specialty, or child and adolescent behavioral health care, including substance use disorder prevention and treatment, can apply for up to $100,000 to pay off student loans in exchange for three years of full-time service at an approved facility. The application deadline is July 17 at 7:30 pm.

The Serious Mental Illness Training and Technical Assistance Center is now accepting requests for free technical assistance and clinical consultation to improve the effectiveness of treatment, recovery services, and supports for people with serious mental illness and first episode psychosis. It only takes three minutes to submit a request for these confidential services. Request technical assistance support today!

The Pennsylvania Department of Health has updated the public standing order for naloxone based on recent data and stakeholder feedback. The standing order for first responders will also be updated shortly to match the public one. Updated instructions for the use of naloxone are also available.

Since the start of 2025, 340B providers have experienced reduced 340B savings on Januvia, Janumet, Janumet XR, Atrovent HFA and Spiriva Handihaler. 340B savings on these drugs will drop even further starting on July, 1, 2025. These reductions are the result of manufacturers’ decision to drop the Wholesale Acquisition Cost (WAC) for these drugs effective Jan. 1, 2025. Lower WAC prices lead to lower 340B savings, by causing:

• Lower reimbursement from insurers, starting almost immediately (aka in January).
• Higher 340B prices starting on July 1, when the new quarterly 340B discount (which lags six months behind changes in a drug’s WAC) will no longer include an “inflationary penalty.” Instead, the only discount will be the standard 340B discount of 23.1% for brand-name drugs.

This two-step reduction in 340B savings follows the same pattern that CHCs saw in 2024 with many diabetes drugs and inhalers, when a change in how state Medicaid rebates are calculated, led manufacturers to reduce WAC levels for many insulins and inhalers.

On June 5, CMS issued an informational bulletin (CIB) notifying states that it has rescinded a previous informational bulletin from Nov. 9, 2023. The rescinded CIB was titled Guidance on Adding Sexual Orientation and Gender Identity Questions to State Medicaid and CHIP Applications for Health Coverage. CMS stated that it no longer intends to collect this information as a part of T-MSIS data submissions.