The Regulator

$64.3 billion: that is how much the Centers for Medicare and Medicaid Services (CMS) says its new Medicaid drug pricing deal will save over the next decade, and the holdout states have until this Wednesday to lock in. CMS announced September 18, 2026 that all 50 states, the District of Columbia and Puerto Rico applied to the GENEROUS Model, a voluntary five-year program under which drug manufacturers agree to sell covered outpatient drugs to participating state Medicaid programs at prices closer to what other wealthy countries pay, topped up by manufacturer-paid supplemental rebates that CMS audits for accuracy. Forty states plus Puerto Rico had already signed binding participation agreements as of that announcement; the rest have until September 30, 2026 to sign or opt out entirely, after CMS already pushed the original August 31 deadline back once. Confidence: High. This run reviewed CMS’s own press release directly. Sources: CMS Announces Participants in Landmark Medicaid Drug Payment Model, Centers for Medicare and Medicaid Services.

CMS canceled roughly 315,000 Affordable Care Act marketplace enrollments this month, covering more than 760,000 people it says never should have been signed up, and expects to recover about $2.2 billion in taxpayer-funded subsidies. CMS announced the action September 22, 2026 as part of the White House Task Force to Eliminate Fraud’s ongoing marketplace crackdown; since January, CMS says it has issued termination notices to more than 200 non-compliant insurance agents and brokers and sent 569 notices of intent to terminate to agents and brokers whose 2026 applications were missing information such as Social Security numbers. CMS is also releasing an interim final rule imposing a temporary moratorium on new 2027 plan-year Exchange registrations for agents and brokers who lack an active 2026 Exchange agreement. People whose coverage is canceled get little advance notice and may not learn they lost insurance until they try to use it. Confidence: High. This run reviewed CMS’s own press release directly. Sources: CMS Cracks Down on Fraud, Waste, and Abuse in the Federal Health Insurance Marketplace, Centers for Medicare and Medicaid Services.

Twenty-four state attorneys general told CMS this week that its proposed rewrite of Medicaid provider-tax rules breaks the law Congress wrote, days before part of that same law takes effect on its own. California Attorney General Rob Bonta led the coalition in a September 22, 2026 comment letter opposing a proposed rule, published in the Federal Register July 23, 2026, that would replace the longstanding uniform 6 percent “hold harmless” threshold for state health care-related taxes with new state-specific thresholds tied to taxes in place as of July 4, 2025; the attorneys general argue CMS’s version goes further than last year’s reconciliation law authorized, would force states to reconstruct financial records back to mid-2025, and would require costly new state reporting systems. CMS projects the underlying policy will cut federal Medicaid spending $246 billion over 10 years; the Congressional Budget Office has estimated it could leave 1.2 million more people uninsured by 2034. Part of the same statute takes effect October 1, 2026, regardless of how the rulemaking fight resolves. Confidence: High. This run reviewed the attorney general’s own press release and the Federal Register filing directly. Sources: Attorney General Bonta Opposes Trump Administration Proposed Rule That Would Unlawfully Disrupt How Medicaid Is Currently Funded, California Department of Justice, Medicaid Program; Amending the Indirect Hold Harmless Threshold of Health Care-Related Taxes, Federal Register.

A federal audit found New York kept paying private Medicaid managed care plans to cover more than 1,300 people who were actually sitting in prison, and now owes the federal government $6.2 million back. The HHS Office of Inspector General (OIG) reported September 21, 2026 that New York made $7,551,670 in unallowable managed care capitation payments, including $6,164,734 in federal share, on behalf of 1,375 incarcerated Medicaid enrollees between January 2021 and December 2024; OIG found New York’s own systems for matching incarceration records against Medicaid enrollment did not consistently catch discrepancies in names, dates of birth and other identifying information. OIG recommended New York refund the federal share and strengthen its identification procedures; the state’s written response described steps it says it has already taken without stating whether it agrees with the findings. Confidence: High. This run reviewed the OIG report directly. Sources: New York Made Unallowable Managed Care Capitation Payments on Behalf of Incarcerated Medicaid Enrollees, HHS Office of Inspector General.

The rule that sets how much Medicare pays every doctor in 2027 is legally due before November 1, and as of today it still has not reached the White House office that must review it first. Federal law requires CMS to publish the calendar year 2027 Medicare Physician Fee Schedule final rule “before November 1”; a direct check of the Office of Information and Regulatory Affairs’ (OIRA) public pending-review list on September 28, 2026 found no entry for the rule (RIN 0938-AV82), even though three companion CY2027 rules, covering hospital outpatient payment, end-stage renal disease and home health, are already under OIRA review. The proposed version drew more than 40,000 public comments and would cut the physician conversion factor 1.68 percent for clinicians outside alternative payment models and 1.19 percent for those inside them; for comparison, the CY2024 edition of this same annual rule missed its own November 1 statutory deadline and was not published until November 2, 2023. A further slip squeezes physician practices and Medicare Shared Savings Program accountable care organizations that need the final numbers to plan 2027 budgets and risk-track elections. Confidence: High. This run reviewed OIRA’s public review-tracking database directly. Sources: Regulatory Review search, Office of Information and Regulatory Affairs, CMS Issues CY 2024 Physician Fee Schedule Final Rule, American Hospital Association.

Doctors’ groups and five Medicaid enrollees sued the federal government this month, arguing CMS made it too hard to prove someone is too medically frail to meet Medicaid’s incoming work requirements. The American College of Physicians, the American Academy of Pediatrics and five individual Medicaid enrollees filed suit September 18, 2026 challenging a June 2026 CMS interim final rule that implements the work-requirement provisions of last year’s reconciliation law; the complaint alleges CMS defined “medically frail,” the exemption from the law’s 80-hour-a-month work, education or volunteering requirement, more narrowly than the statute permits, requires enrollees to see a provider repeatedly to document their frailty, and uses a 12-month claims lookback the plaintiffs call too short to catch people with intermittent conditions. The work requirements take effect nationally in 2027; a separate lawsuit brought by 25 states over the same medical-frailty definition was dismissed earlier this year. Confidence: Medium-High. The complaint itself could not be independently retrieved this run; this run relied on direct reporting that reviewed the filing. Sources: New lawsuit targets Medicaid work requirements’ medical frailty rules, Healthcare Dive.