State Action and Federal Policy: What’s Shaping Healthcare Today
This week’s HMA Weekly Roundup highlights key federal and state developments across Medicare, Medicaid, and the ACA Marketplace, including a growing emphasis on program integrity and accountability. This edition also provides a first look at HMA’s 2026 conference Oct. 5-7 and early bird registration—offering an opportunity to engage with the policy and market trends shaping healthcare today.
Join us at HMA’s 2026 National Conference: Signals, Signs & Flashing Lights
Registration is now open for the Health Management Associates (HMA) 2026 National Conference, US Healthcare 2026: Signals, Signs & Flashing Lights, October 5–7 in New Orleans, LA. HMA’s conference is intentionally structured to bring together leaders who are shaping decisions across sectors to engage in candid conversations about what is working, what is not, and what is changing in Medicare, Medicaid, Marketplace and adjacent programs. In an environment defined by new challenges and “flashing lights,” even the most seasoned healthcare leaders will find value in stepping out of their day‑to‑day roles to compare strategies, test assumptions, and learn from peers facing similar pressures.
Signals and Strain in Federal Health Leadership Decisions
On April 30, President Trump announced that he was withdrawing the nomination of Dr. Casey Means to serve as U.S. Surgeon General and instead nominating Dr. Nicole B. Saphier. Dr. Saphier is a radiologist and the director of breast imaging at Memorial Sloan Kettering in Monmouth, New Jersey. She is a Fox News contributor and the author of Panic Attack: Playing Politics with Science in the Fight Against COVID-19 and Make America Healthy Again: How Bad Behavior and Big Government Caused a Trillion-Dollar Crisis.
Federal Contracting Overhaul Advances with New Performance Mandates
On April 30, the White House issued an Executive Order (EO) on “Promoting Efficiency, Accountability, and Performance in Federal Contracting.” The EO directs that, consistent with law, agencies should utilize fixed-price contracts, as defined in Part 16 of the Federal Acquisition Regulation (FAR), Title 48 CFR, with performance-based considerations as the default and preferred method of procurement.
FDA Proposes Removing Key GLP-1 Ingredients from Compounding List
On April 30, FDA published a notice proposing to exclude several active ingredients used in GLP-1 drugs, including semaglutide, tirzepatide, and liraglutide, from its 503B bulk drug substances list, which enumerates drugs that can be compounded using bulk ingredients. In the press release, FDA states that it has determined there is not a specific clinical need for these drugs to be compounded by outsourcing facilities, which is required for drugs that are not in shortage to appear on the 503B list.
Audit Finds Gaps in Medicare Safeguards for Virtual Check-ins and E-Visits
On April 28, HHS OIG released a report titled, “CMS Could Strengthen Medicare Program Safeguards To Prevent and Detect Potentially Improper Payments for Virtual Check-in and E-visit Services,” finding that CMS made up to $2.3 million in potentially improper payments for communication technology-based services from 2019 through 2022.
ACA Enrollment Declines: Implications and Options for State and Federal Policymakers
Recent and future policy changes are reshaping the Affordable Care Act (ACA) market. A recent Wakely report finds that only 86% of ACA enrollees nationwide paid their first premium at the start of the year, raising important questions about affordability, access, and market stability. Additionally, the 2027 Notice of Benefits and Payment Parameters (NBPP) is expected to be finalized this Spring which will have additional implications for consumers, issuers, and other stakeholders. On May 20, join HMA’s ACA team for a policy-focused conversation on what these projected changes mean for marketplace dynamics, including impacts to risk pools, premiums, and issuer participation. The session will explore emerging federal and state policy responses and offer insight into how today’s decisions may shape 2027 rates, plan offerings, and long-term market sustainability.
Saving Lives with Compassion: Overdose Response Training with RiVive®
This webinar will present findings from the 2025 RiVive Community Engagement Report and best practices in Compassionate Overdose Response™, with a focus on the community use of RiVive naloxone nasal spray 3 mg. A panel of expert speakers will present their protocols for effective overdose intervention, guidance on the training of others, and strategies for integrating trauma-informed approaches into post-overdose care. Designed for program teams, medical professionals, and harm reduction leaders, anyone who attends will leave with research and experience-backed methods for improving outcomes in opioid overdose emergencies. A recording of this webinar will be available after this session, with a link to the 2025 report.
On May 4, 2026, CommonSpirit Health announced it has signed a definitive agreement to transfer ownership of Trinity Health System to the University of Pittsburgh Medical Center (UPMC).
On Capitol Hill, Health System CEOs Agree to 'Rational Reworking' of Site-Neutral Payments
Hospital consolidation has contributed to rising costs. The willingness of major health system CEOs to come to the table on site-neutral reform suggests the industry recognizes that some recalibration is inevitable.
HMA is an independent, national research and consulting firm specializing in publicly funded healthcare and human services policy, programs, financing, and evaluation. We serve government, public and private providers, health systems, health plans, community-based organizations, institutional investors, foundations, and associations. Every client matters. Every client gets our best. With multidisciplinary consultants coast to coast, HMA's expertise, services, and team are always within client reach.
HMA is an independent, national research and consulting firm specializing in publicly funded healthcare and human services policy, programs, financing, and evaluation. We serve government, public and private providers, health systems, health plans, community-based organizations, institutional investors, foundations, and associations. Every client matters. Every client gets our best. With multidisciplinary consultants coast to coast, HMA's expertise, services, and team are always within client reach.
