Todd Blanche Sworn in as U.S. Attorney General
On August 10, Todd Blanche was sworn in as attorney general (AG), following a 50-49 Senate confirmation vote. As AG, Blanche will lead the Department of Justice and efforts relating to vaccine policy, Medicaid fraud, waste, and abuse, and abortion. Blanche confirmed that he would pursue legal action in the prevention of abortion access, including telehealth care that facilitates the prescription and mailing of abortion pills. At his confirmation hearing last month, the new AG said he would not defend the previous administration’s expansion of access to mifepristone, an abortion medication (Inside Health Policy, August 10).
American Hospital Association Calls for RHTP Funding Cap Removals
On August 5, the American Hospital Association (AHA) sent a letter to CMS Administrator Mehmet Oz calling for the removal of Rural Health Transformation Program (RHTP) funding caps, arguing that the 15% provider payment funding cap and 20% infrastructure and capital improvement caps restrict states’ ability to sustain and modernize rural hospitals. The AHA also requests that CMS allow states to revise their initial applications and allow for a longer period to spend dispensed funds, given the short timeline of 2 months that states were given for their application (Inside Health Policy, August 10).
ACA Enrollment Declines as CMS Tightens Enrollment Oversight
ACA Marketplace enrollment declined by nearly 3 million to about 19.2 million in 2026. The Trump administration has linked the decline to efforts to identify and remove improper enrollments, citing an HHS report that estimated 5.6 million people were improperly enrolled in 2025 and that 2.9 million have since been removed. Other health policy experts have pointed to higher consumer costs as another factor, with average monthly premiums increasing 58% from 2025 to $178 and deductibles rising 37% to nearly $3,800, according to KFF. Since 2025, regulators have also removed about 1.5 million people for other reasons, including unmet tax-filing requirements and concurrent enrollment in programs such as Medicaid. Alongside these enrollment removals, CMS is implementing additional identity verification requirements for brokers and reviewing accounts identified as potentially unauthorized (Modern Healthcare, August 7).
Eight States Plan Stricter Medicaid Work Requirement Verification
At least eight states are planning to implement Medicaid work requirement policies in January 2027 that are stricter than the federal minimum, including Arkansas, Idaho, Indiana, Iowa, North Carolina, North Dakota, Ohio, and Utah. Under federal policy, states may accept self-attestation of medical frailty throughout 2027, with verification of those exemptions beginning in 2028. Rather than using that one-year self-attestation period, the eight states will require documentation earlier. The requirements are part of the federal Medicaid work requirement policy enacted under H.R. 1, which generally requires adults eligible under Medicaid expansion to work, volunteer, or participate in education for at least 80 hours per month. The policy applies to about 21 million Medicaid expansion enrollees, and nonpartisan analysts have estimated it could result in at least 5 million people losing Medicaid coverage over 10 years. As states prepare for implementation, those adopting earlier verification requirements have cited program integrity and administrative consistency, while health policy experts and advocates have raised concerns that documentation requirements could create additional barriers for medically frail enrollees, particularly in areas with provider shortages (Politico, August 10).
CMS Ends Medicaid, CHIP Funding for Gender-Related Care for Minors
On August 11, CMS finalized a rule ending federal Medicaid and CHIP funding for certain gender-related medical interventions for children and youth, including puberty blockers, cross-sex hormones, and surgical procedures. CMS said the policy follows an HHS review that identified evidence of gaps and safety concerns related to these treatments. As part of the transition, federal funding will remain available for up to six months after its effective date for children currently receiving hormone therapy to taper-off treatment and does not affect Medicaid EPSDT or CHIP coverage of mental health services. The restriction applies only to federal Medicaid and CHIP funding and is scheduled to take effect October 13, 2026 (CMS, August 11).
