The Regulator

CMS will let states keep Medicaid coverage in place for people who miss the new work requirement, through June 30, 2027. The Centers for Medicare & Medicaid Services (CMS) announced an optional “hold harmless” period yesterday. States that use it must still check whether people meet the work requirement or qualify for an exclusion, but they may not deny an application or disenroll an otherwise eligible person solely for failing it. The requirement itself starts January 1, 2027 for certain applicants and enrollees ages 19 to 64, and CMS’s June interim final rule sets the test at 80 hours a month of work, community service or a work program, half-time schooling, or a qualifying income. Who it hits: state Medicaid agencies, which get roughly six months to fix eligibility systems, and enrollees, who keep coverage through the first half of 2027 even if the systems misfire. CMS published no cost or enrollment figure and no opt-in deadline in the release. Confidence: High on the terms, which are in the release; Low on how many states will opt in, since CMS has not said. Sources: CMS press release.

CDC says about one in 10 U.S. adults used a GLP-1 drug in 2025, and 44% of them changed how they took it. The Centers for Disease Control and Prevention (CDC) published the finding November 12 in its Morbidity and Mortality Weekly Report. GLP-1 drugs are the semaglutide and tirzepatide class used for diabetes and weight loss. The survey of 8,118 adults found 9.8% used one in the past year, 22.6% of users took a compounded version, and 28% of users skipped doses. Among those who altered their use, 38% cited cost and 36% cited availability, and use among uninsured adults was 2.7% versus 10.6% for privately and publicly insured adults. Who it hits: employers, insurers and Medicare planners sizing GLP-1 coverage, and compounding pharmacies. Confidence: Med, because the data are self-reported from online panels with response rates of 13.3% and 3.8%, which the authors flag. Sources: CDC MMWR report.

CMS says fewer than 10,000 of an estimated 16 million eligible Medicare beneficiaries use its diabetes prevention program, and it just launched a digital push to change that. The CMS Innovation Center said November 12 that the Medicare Diabetes Prevention Program, a yearlong lifestyle program aimed at a 5% weight loss, now has a digital collaborative of suppliers. Participating suppliers pledged to enroll “hundreds of new beneficiaries” each between January 2026 and May 2027, with monthly technical assistance from CMS. Who it hits: Medicare beneficiaries with prediabetes and the digital health suppliers that win those enrollments. CMS posted no dollar figure. Confidence: High on the figures, which are CMS’s own estimates. Sources: CMS Innovation Center update.

Minnesota’s attorney general settled with Hendricks Community Hospital over $171,800 in discount errors for uninsured patients. The settlement, announced Monday, alleges the Hendricks, Minnesota hospital miscalculated the discount owed to uninsured patients earning under $125,000, billing some up to 32.63% more than state law allows, and used a charity care application requiring tax returns, pay stubs, bank statements and 53 questions. Hendricks must pay refunds or reduce medical debt for 323 eligible patients served from January 1, 2020 through June 30, 2026, notify them directly and simplify the application. Who it hits: Minnesota nonprofit hospitals, whose uninsured pricing the attorney general is auditing one by one. These are allegations resolved by agreement, not findings. Confidence: High. Sources: Minnesota Attorney General press release.

Quiet note: no Federal Register issue publishes on Saturday, and the Food and Drug Administration (FDA) decision on Summit Therapeutics’ lung cancer drug ivonescimab, due today, had not been announced when we went to press.