CMS Names Dan Brillman as New Medicaid and CHIP Director Amid Policy Shift

The Centers for Medicare & Medicaid Services (CMS) has appointed Dan Brillman, former CEO of the health technology company Unite Us, as Deputy Administrator and Director of the Center for Medicaid and CHIP Services. In this role, Brillman will oversee the implementation of major Medicaid provisions included in H.R.1, including work requirements and more frequent eligibility redeterminations. The selection follows major staffing reductions and restructuring within CMS, and HHS. Caprice Knapp, who had been serving as Acting Director, will become Principal Deputy Director (Fierce Healthcare, October 28).

Louisiana Work Requirements Verification Pilot Suffers from Low Participation

Ahead of the effective date for states to implement Medicaid work requirements, Louisiana was part of a pilot program to test the Trump Administration’s digital tool that is intended to aid enrollees in confirming their incomes through a quarterly wage check. Of the 13,000 enrollees who were sent the text message, only 894 people completed the process. Another pilot program was carried out in Arizona for the Supplemental Nutrition Assistance Program (SNAP), but officials were unable to share how many people participated or the outcome. CMS Administrator Mehmet Oz has stated that the verification system makes income verification seamless and can be done within seven minutes. Many officials worry about those living in rural areas without reliable access to the internet and cell service, and how they will be able to access vital information regarding their eligibility status (Modern Healthcare, October 24).

Home Health Stakeholders Ask Congress to Stop Proposed CMS Pay Cuts

On October 23, more than 100 stakeholders led by LeadingAge and the National Alliance for Care at Home sent a letter to Congress asking that lawmakers stop CMS from cutting Medicare rates for home health services. Earlier this year, CMS released its proposed 2026 home health payment rule, which would result in a 6.4% reduction, or $1B, in Medicare reimbursements for home health services. The proposed rule is expected to be finalized by November 1. Stakeholders remain wary, arguing that any reduction would result in new coverage losses and exacerbate existing gaps from previous budget cuts. The final home health payment rule was posted for review by the White House Office of Management and Budget on October 24 (Inside Health Policy, October 23).

Largest Federal Employee Union Calls for an End to the Shutdown

The American Federation of Government Employees (AFGE) called for the immediate end to the government shutdown on October 27. The union, representing more than 800,000 federal workers, called the shutdown an “avoidable crisis” and demanded that lawmakers pass a short-term funding bill. The AFGE has brought several lawsuits against the Trump Administration, most recently regarding the layoffs that occurred during the government shutdown. In previous shutdowns, back pay was guaranteed, but the current administration has cast doubt on that policy (Politico, October 27).

Senators Ask CMS for More Details on Biden-Era Medicaid Rules

Democratic Senators Wyden and Merkley of Oregon sent a letter to CMS Administrator Dr. Oz on October 21 requesting that the agency provide states with clarification on which parts of the Medicaid eligibility and enrollment and nursing home staffing rules are still in effect. While H.R. 1 created a moratorium on the implementation of these rules, the lawmakers are asking CMS to identify which policies could still be implemented as a state option. In June, the Senate parliamentarian ruled that several provisions that were already in effect could not be reversed by the bill, as well as the mandate that all items in the budget reconciliation process have an impact on the federal budget. Nearly all of the provisions related to the Children’s Health Insurance Program were left out of the moratorium, meaning that states are no longer able to impose annual or lifetime benefit limits, lockout periods, or waiting periods. Other policies related to Medicaid enrollment for adults remain in effect as well, like automatic enrollment for individuals with Supplemental Security Income and preventing states from requiring enrollees to apply for other benefits as a condition of eligibility. Notably, in the nursing home staffing final rule, the provision for states to report on the staffing levels of nursing homes and intermediate care facilities, and the amount of Medicaid funding spent on salaries and benefits is still required, beginning May 2028. Many other provisions remain in place as well, with the Senators requesting CMS to provide additional details about implementation and enforcement (Inside Health Policy, October 22).

AHA Calls for Delay of CMS WISeR Model

The American Hospital Association (AHA) is urging the Centers for Medicare & Medicaid Services (CMS) to delay implementation of its new Wasteful and Inappropriate Service Reduction (WISeR) Model, set to begin January 1, 2026. In a letter, the AHA outlined numerous concerns about the demonstration, which expands prior authorization requirements in traditional Medicare. The association argues that the model’s payment structure, rewarding vendors with 10% to 20% of the savings from denied claims, creates a perverse incentive to reject appropriate care. Hospitals also object to excluding patients from the appeals process, saying it undermines Medicare beneficiaries’ rights and could delay or prevent necessary treatment, especially when denials are based on artificial intelligence. The AHA recommends delaying the program by at least six months and establishing a testing period while systems are refined during which claims cannot be denied. Additional requests include requiring physician oversight of AI-based denials, implementing flat-fee payments for vendors to avoid denial bias, ensuring transparency in performance metrics, and postponing expansion beyond the six pilot states until the model’s effects on patient outcomes and care quality are properly evaluated (Inside Health Policy, October 24).

• From Our Viewpoint:

CMS announced the WISeR model in June of this year, touting the program as a way to enhance prior authorization processes and lower healthcare spending in Original Medicare utilizing artificial intelligence. According to data released by the Medicare Payment Advisory Committee in 2022, CMS spent $5.8B on “minimal benefit” services for Medicare enrollees. In August, Democratic lawmakers sent a letter to the CMS Innovation Center detailing their concerns about the model. The lawmakers argued that the WISeR model would add more administrative burden on providers and potentially contradict ongoing efforts to reduce prior authorization in Medicare Advantage.

17 Million Americans Expected to See Spikes in ACA Marketplace Costs

Based on documents reviewed by the Washington Post, up to 17 million Americans who purchase health coverage on Healthcare.gov can expect to see their insurance premiums increase, with some expected to double or even triple in 2026. Enrollees can expect to see an average increase of approximately 30% on their premiums upon open enrollment on November 1, 2025. This is largely due to the looming expiration of enhanced subsidies for ACA insurance premiums at the end of 2025, unless Congress moves to intervene and extend them (The Washington Post, October 24).

Democratic Governors, AGs File Suit Against Administration to Sustain SNAP Benefits

On October 28, Democratic governors and attorneys general across 25 states filed a lawsuit against the Trump Administration. Earlier this month, the administration determined that it does not have the authority to use emergency funds to sustain Supplemental Nutrition Assistance Program (SNAP) benefits ahead of the funding cliff on November 1. However, the plaintiffs argue that the U.S. Department of Agriculture (USDA) has violated federal law with its intent to withhold food assistance, as the $5B in emergency funding has been appropriated by Congress. The $5B figure still falls short of the more than $8B needed to fully fund SNAP for November, but the plaintiffs argue that the USDA could leverage Section 32 dollars to bridge the funding gap. The lawsuit was filed in federal court in Massachusetts where the plaintiffs are requesting that the judge overturn the USDA’s decision and require the agency to use all available funds to maintain SNAP benefits for nearly 42 million individuals (Politico, October 28).