RISE summarizes recent regulatory-related headlines and reports.
Fed crackdown on Medicaid funding expands to other states
The Centers for Medicare & Medicaid Services’ new tactics to address alleged Medicaid fraud in Minnesota are now being expanded to other states, according to KFF Health News. This year CMS declared it could withhold from Minnesota over $2 billion in payments slated for the state and claw back nearly $260 million from last year. Critics say the move is unprecedented and unlikely to reduce fraud effectively. But California, Florida, Maine, and New York are now being targeted for fraud through audits and public allegations, KFF Health News reports. Advocates fear funding cuts will destabilize home‑ and community‑based services, leaving vulnerable patients at risk.
OIG investigations focus on inappropriate use of antipsychotic drug use in nursing homes
The Department of Health and Human Services Office of Inspector General (HHS OIG) has released two reports that address the use of antipsychotic drug use in nursing homes. The first report found that some nursing homes falsely diagnosed residents with schizophrenia to justify antipsychotic drug use and inflate Star ratings. These diagnoses allowed facilities to bypass safeguards meant to protect residents from the risks of antipsychotic medications, which are particularly dangerous for people with dementia. The OIG recommends that the Centers for Medicare & Medicaid Services (CMS) strengthen its oversight, improve transparency, and increase efforts to ensure patients and their families are fully informed when drugs are given.
A second OIG review found widespread misuse of antipsychotic drugs in nursing homes, including giving them to dementia patients to manage behavior despite Food and Drug Administration warnings of increased mortality risk. Many facilities failed to follow required safety protocols; medical directors and pharmacists often did not intervene. The report urges CMS to improve resources, oversight responsibilities, and nursing home policies.
KFF: 1 in 10 consumers dropped marketplace coverage and are now uninsured
New findings from a follow‑up KFF survey reveal that marketplace enrollees are feeling significant financial strain following the expiration of enhanced Affordable Care Act (ACA) premium tax credits.
KFF interviewed more than 80 percent of the original sample of 1, 117 U.S. adults who had ACA marketplace coverage in 2025 to learn how they are navigating changes to the ACA marketplace.
According to the survey:
- Fifty-one percent of returning enrollees report their health care costs are now “a lot higher” than last year, with four in 10 specifically citing sharply higher premiums.
- Eighty percent say their overall costs, including deductibles and other out‑of‑pocket expenses, have increased.
- One in 10 enrollees has dropped marketplace coverage and is now uninsured, while three in 10 have switched to different ACA plans, most attributing their decisions to rising costs.
The data suggests continued instability in marketplace enrollment patterns as consumers navigate higher premiums and affordability concerns.
Meanwhile, to address rising health care costs, Senate Democrats this week released a new framework to counter increased premiums and reduced coverage in ACA plans. Their plan aims to “put patients over profits” through three goals: reversing GOP‑driven cost increases, simplifying health care processes, and cracking down on corporate greed in insurance and drug pricing.