HHS Publishes Bulk Medicaid Provider Claim Data

A large Medicaid claims dataset has been made publicly available through the Department of Health and Human Services (HHS) open data portal. The Department of Government Efficiency’s (DOGE) HHS team said the provider level billing data is intended to strengthen transparency and fraud detection efforts, pointing to alleged autism diagnosis fraud in Minnesota as an example of how the information could be used.  The data includes provider-level Medicaid spending data from January 2018 to December 2024, aggregated to the provider-procedure-month level, and includes fee-for-service, managed care, and CHIP claims.  HHS DOGE is seeking public research into the dataset, requesting that the “open-source community” assist in efforts to identify potential fraud, waste, and abuse. The release comes amid continued Republican scrutiny of Medicaid spending and oversight in certain states. HHS stated that privacy safeguards are in place and noted that the effort follows earlier federal initiatives to obtain and analyze state Medicaid claims data for oversight and utilization review (Inside Health Policy, February 13).

CMS Expands ACCESS Model Across Insurance Markets

The Center for Medicaid and Medicare (CMS) announced that its 10-year Medicare Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model, originally designed for traditional Medicare beneficiaries, is expanding across Medicare Advantage, Medicaid, and commercial insurance markets, potentially reaching 165 million additional Americans by 2028. The voluntary model supports the use of health technologies such as telehealth tools, wearables, and digital applications to manage common chronic conditions including hypertension, diabetes, musculoskeletal pain, and depression. It introduces outcome-aligned payments that reward providers based on results rather than service volume. Several major commercial insurers have pledged to adopt aligned payment approaches and collaborate with primary care providers. The reporting period begins July 5, and organizations must notify CMS by April 1, 2026, to participate. CMS is also developing standardized billing codes and reporting infrastructure to facilitate consistent implementation across payers (Fierce Healthcare, February 13).

HRSA Releases 340B Pilot Program RFI, Following HHS’ Decision to Withdraw Lawsuit Appeal

On February 13, the Health Resources and Services Administration (HRSA) released a public request for information (RFI) on the implementation of a 340B rebate pilot program. The RFI came shortly after the HHS’ statement earlier this month that it would withdraw its court appeal and revise its pilot to align with objectives laid out by the American Hospital Association, the lawsuit’s plaintiffs. The agency’s new pilot program was approved by the Office of Budget and Management on February 11. Included within the RFI are questions relating to expected workforce impacts, costs and impacts on rural safety-net hospitals or a community health center, and how entities collect, maintain and retain related data. Public comments are due on March 19 (Inside Health Policy, February 12; Inside Health Policy, February 13).

CDC Proposes $600M in Public Health Grant Cuts, Temporarily Stopped by Federal Judge

The Centers for Disease Control (CDC) last week announced over $600M in cuts to public health grants in California, Illinois, Colorado, and Minnesota. The Trump administration stated that the grants were being cut to better align with the CDC’s priorities. According to a webpage on the CDC, the agency’s new priorities include updating public health infrastructure, rebuilding trust in the institution, and aligning with the goals and priorities of the Trump administration. The webpage also explicitly calls out diversity, equity, and inclusion initiatives as well as any programs that promote medical services for transgender children as items that will be deprioritized. These grants that were set to be cut last week were included in the bipartisan HHS funding bill that was signed into law by President Trump on February 3. The grants fund a variety of public health issues including health equity, workforce initiatives and training, and sexually transmitted infection prevention efforts. However, the attorneys general in the impacted states filed suit against the administration in a federal district court in Illinois on Wednesday, February 11. The plaintiffs sought and were awarded a temporary restraining order late Thursday, February 12. According to the attorneys general, the cuts seemed to originate from the Office of Management and Budget before being proposed by the CDC on February 11 (Healthcare Dive, February 11; NPR, February 13).

Secretary Kennedy Makes Several Senior Advisor Changes Within HHS

The Department of Health and Human Services has made several shifts in high-level staff positions within the Food and Drug Administration (FDA) and other agencies. Grace Graham, FDA policy chief, and Kyle Diamantas, senior FDA food official, will serve Secretary Kennedy Jr. as joint senior FDA counselors while retaining their original roles. Notably, Graham brings with her deep expertise in congressional policy. She spent time in both chambers of Congress, working with the House Energy and Commerce Committee and, prior to that, the Senate Health Committee on health policy. According to Inside Health Policy, observers in the industry feel that Graham’s appointment in particular could improve and stabilize the agency’s actions. Currently, FDA Commissioner Marty Makary and his associate Vinay Prasad have found themselves at odds with the pharmaceutical industry over their intense scrutiny of vaccines, or in the case of Moderna’s mRNA influenza vaccine, refusal to review entirely. Graham and Diamantas’ new dual positions come as Deputy Secretary of HHS Jim O’Neill prepares to depart the agency. O’Neill also serves as acting director of the CDC and will step down from that position as well. Other shifts in staffing include CMS Deputy Director Chris Klomp taking on the role of chief counselor at HHS and CMS Deputy Administrator and chief policy and regulatory officer John Brooks as senior counselor of CMS. According to intel from FDA staff, federal employees are also preparing for staff restructuring (Inside Health Policy, February 13).