Medicare & Medicaid Updates (June 2026)

Recent federal and CMS updates introduce significant changes to Medicaid eligibility, Medicare billing practices, and hospital reimbursement policies.

Medicaid (HUSKY D) Changes – Connecticut

• Eligibility restrictions (Oct. 1, 2026): Coverage will be limited to U.S. citizens, lawful permanent residents, and select eligible groups, impacting some non‑citizen populations.
• Work requirements (Jan. 1, 2027): Adults ages 19–64 must meet income thresholds or complete 80 hours/month of work, training, or volunteering (with defined exemptions).
• More frequent renewals (Jan. 1, 2027): Eligibility redeterminations will shift from annually to every 6 months, increasing risk of coverage gaps and uninsured patients.

Medicare Compliance & Billing Focus

• Improper payments: Hip and knee replacements continue to have the highest improper payment rates, largely due to lack of documented medical necessity and incorrect inpatient billing.
• Documentation requirements: Complete, accurate, and legible medical records are critical to support inpatient admissions and reimbursement.
• Modifier 25 use: Providers should only bill separately identifiable E/M services with procedures when clearly justified to avoid improper billing.

Payment & Coverage Updates

• Proposed FY2027 payment rule: Hospital inpatient payments are expected to increase by ~2.4% (approximately $1.4B), with some supplemental payment programs expiring at the end of 2026.
• GLP-1 coverage expansion: Beginning July 1, 2026, Medicare Part D will temporarily expand access to certain GLP-1 medications for eligible beneficiaries under a demonstration program.

As these changes are implemented, there may be some adjustments to administrative processes and patient coverage.  Please reach out to the OHCP with any questions you may have.