Analysis: FY2027 Hospice Wage Index Final Rule
LeadingAge recaps in this article for members critical pieces of the Fiscal Year 2027 Hospice Wage Index final rule and offers analysis of the Centers for Medicare and Medicaid Services’ decisions to move forward with the Services and Spending Variation Index and the addendum requirement for all patients.
CMS Releases Toolkit Signaling Targeted Medicaid HCBS Fraud Focus
On August 4, The Centers for Medicare and Medicaid Services (CMS) released a toolkit for states to support person centered services, safeguard program integrity, and protect individuals from inappropriate treatment. The toolkit is specifically targeted for states for use in their youth autism spectrum disorder programs, though LeadingAge takes notice because CMS’s approach speaks to a broader undermining of confidence in Medicaid home and community-based services (HCBS). The toolkit’s press release cites rapid utilization growth in Applied Behavioral Analysis (ABA) service provision, relating that the growth “raises important questions about whether Medicaid resources are consistently supporting medically appropriate care. It also signals that rapid program growth requires stronger oversight to ensure children receive services based on medical need rather than financial incentives.” Though there are distinct differences between ABA and other HCBS, the focus and overt mention that the attention is a result of program growth is reflective of the concerning trend in messaging that undermines the credibility and necessity of HCBS in providing life sustaining services. That said, the toolkit could be a useful model for states and may be a model for policy efforts bolstering internal controls for HCBS access, utilization, and provider oversight.
Senate Budget Hearing Slams Medicaid Payment Policies and Program Integrity
On August 4, Senator Ron Johnson (R-WI) held his first hearing as the new chair of the Senate Budget Committee, a position he took on after the passing of Senator Lindsay Graham (R-SC). While the Budget Committee does not have jurisdiction over the Medicaid program, LeadingAge is very interested in its discussion of Medicaid because this Committee is in a position to direct cuts to the Medicaid program through a budget reconciliation process, as occurred in 2025 when HR 1 cut federal Medicaid funding to states by about $911 billion over the next 10 years. During the hearing, “Medicaid: The Reality,” the Committee heard testimony from three witnesses: Brian Blase, Paragon Health Institute, Mr. Jonathan Ingram, Foundation for Government Accountability, and Andy Schneider, Center for Children and Families McCourt School of Public Policy at Georgetown University. Mr. Blase and Mr. Ingram both discussed Medicaid’s federal fiscal matching policy, with particular attention to the enhanced federal match for expenses incurred by states for Medicaid expansion enrollees. Both witnesses focused on the need for reforms to shift what they described as current financial “incentives” for states so as to better align Medicaid payment policy with a focus on the ideals and populations Medicaid was originally designed for – older adults, people with disabilities, children, and moms. Mr. Schneider focused on the loss of healthcare coverage as policies from HR 1 are implemented and the impact of rural healthcare provider closures. Chair Johnson urged a fact-based approach to understand what he described as “out of control Medicaid spending growth.” Though remaining moderately civil, the two parties clashed over messaging. Democrats focused on the administration’s firing of Inspectors General and pardoning of convicted fraudsters, while Republicans attacked state credibility in administration of state eligibility categorization and fraud control efforts. Early in the hearing, Senators John Kennedy (R-LA) and Bernie Moreno (R-OH) questioned Mr. Schneider over their assumptions that states improperly drive up Medicaid enrollment through the expansion pathway to cheat the federal government out of funding. The narrative continued as Mr. Blase described Medicaid financing in a way that implied it generates revenues for states through federal matching dollars, instead of the federal government sharing with states in the total cost of eligible services. We will continue to monitor congressional interest in Medicaid financing and program integrity. The full hearing can be watched here.
Weekly Recaps: August 5, 2026
- Affordable Housing Weekly Recap. Here is your Affordable Housing Weekly Recap.
- Home Health Weekly Recap. Here is your Home Health Weekly Recap.
- Hospice Weekly Recap. Here is your Hospice Weekly Recap.
- Life Plan Community Weekly Recap. Here is your Life Plan Community Weekly Recap.
- Medicaid, HCBS, and PACE Weekly Recap. Here is your Medicaid, HCBS, and PACE Weekly Recap.
- Nursing Home Weekly Recap. Here is your Nursing Home Weekly Recap.
- Workforce Policy Weekly Recap. Here is your Workforce Policy Weekly Recap.
