Democratic Doctors Caucus Urges CMS to Reconsider Medical Frailty Provisions

The Democratic Doctors Caucus, led by Oregon Rep. Maxine Dexter, wrote to CMS Administrator Dr. Mehmet Oz expressing significant concerns about the administrative burden the Interim Final Rule (IFR) implementing community engagement requirements will place on physicians. Under the IFR, providers will be responsible for determining whether an individual is medically frail, wherein an individual’s condition impairs their ability to comply with community engagement requirements. In addition to creating a burdensome documentation requirement for medically frail patients, the letter argues that most physicians are not trained to conduct individual assessments of their patients’ ability to work or engage in other qualifying activities. The letter urges CMS to revise the IFR in a manner more consistent with the underlying statute (Inside Health Policy, September 3).

States in Lawsuit Over Medicaid Community Engagement Requirements Narrow Scope

According to a motion for summary judgment filed on September 1, the 25 states suing the administration over CMS’ Community Engagement Interim Final Rule have narrowed their challenge to allegations that the agency violated the Administrative Procedure Act. The plaintiffs have dropped their challenge against CMS’ limit on short-term hardship exemptions. The lawsuit, Commonwealth of Massachusetts, et al. v Mehmet Oz, still contends that the Trump administration exceeded the statute by mandating the functional eligibility condition of medically frail Medicaid beneficiaries, requiring that those eligible for the exemption are not able to work, study, or otherwise comply with community engagement requirements due to their condition. The lawsuit maintains its request that the court prohibit CMS’ limitation of self-attestation and ensure that states are not penalized for errors or delays in implementing the interim final rule. The U.S. District Court for the District of Massachusetts has set a hearing for the case on October 20 (Inside Health Policy, September 2).

Congress Passes CR to Fund Government Through November Midterms

On September 1, the House of Representatives passed the Senate’s continuing resolution, funding the federal government largely at current levels through December 11. The spending bill also prevents a proposed rule from the Office of Management and Budget from being promulgated. The proposed rule would shift federal grant approvals, including those for scientific grants, under political appointees and make existing grants more accessible for modification or cancellation. The legislation also prevents any equivalent actions from the executive branch to achieve the goals of the proposed rule. President Trump signed the bill into law on September 2 (Fierce Healthcare, September 2; The White House, September 2).

Coalition of Health Providers Calls On CMS to Reconsider Home Health Rule Provisions

On August 31, a coalition of hospitals and aging service providers sent a letter to CMS Administrator Dr. Mehmet Oz, urging the agency to reconsider the proposed changes for Medicare provider enrollment provisions within the CY 2027 Home Health Prospective Payment System (PPS) Rule, as it risks penalizing providers and could lead to barriers to care access for vulnerable beneficiaries. In the letter, the coalition makes recommendations related to the issuance of standalone rulemaking for provider enrollment following engagement with stakeholders, distinguishing intentional misconduct from good-faith errors, establishing due-diligence protections for third-party relationships, and the preservation of meaningful due-diligence processes and response periods (Inside Health Policy, September 4).

New Study Reveals Continued Drop in Enrollment in ACA Marketplace

A recent study from the State Marketplace Network found that, within 18 state-based marketplaces (SBM), as of May 2026, enrollment has dropped by 8.5% from the previous year, from 5 million enrollees to 4.92 million. Disenrollment varies widely among states, with rates jumping to over 60% for some, such as New Jersey with 140,000 disenrollments and Massachusetts with 91,000 disenrollments. The SBMs anticipate coverage losses to continue through 2027 and 2028, along with increased premiums. The study also discusses varying trends among state-based marketplaces, with disproportionate disenrollments among young adults and the lowest- and highest-income households (Health Payer Specialist, September 2).