Samwise Healthcare IT Newsletter
Tuesday, June 2, 2026
CMS Releases Medicaid Work Requirements Guidance for States
The CMS released an interim final rule Monday detailing guidance for states implementing Medicaid work requirements, which take effect January 1, 2027, under the Big Beautiful Bill passed last summer. The rule defines exempt populations, including a broad medical frailty exemption that leaves discretion to states. Individuals may self-attest to exemptions once, but must provide supporting documentation at subsequent eligibility checks. CMS Administrator Dr. Mehmet Oz warned states must modernize data and eligibility systems to prevent improper disenrollments. Critics, including patient advocates and Democratic lawmakers, argue the rule creates burdensome documentation requirements that risk stripping vulnerable patients of coverage.
Sources: Healthcare Dive
Massachusetts Sues UnitedHealthcare Over Alleged Medicaid Fraud
Massachusetts filed suit against UnitedHealthcare on Monday, alleging the insurer manipulated health condition data for seniors in MassHealth managed care plans to collect at least $100 million in improper government payments. The lawsuit, filed in Suffolk Superior Court by Attorney General Andrea Joy Campbell, claims UnitedHealthcare classified members as higher-acuity tiers including Level 2 for behavioral health despite the absence of relevant diagnoses. The insurer denied the allegations as meritless. UnitedHealth has faced mounting scrutiny over upcoding practices, including a Senate investigation in January 2026 finding the company was aggressively gaming Medicare Advantage and a Department of Justice probe.
Sources: Healthcare Dive
Elevance Again Avoids Medicare Advantage Sanctions, but Deadline Looms
The CMS said Monday it will not impose Medicare Advantage sanctions on Elevance Health for now, after the insurer resubmitted seven years of faulty risk adjustment data and paid estimated overpayments to the government. Elevance's estimated liability ranges from $350 million to $1.5 billion. Sanctions including a ban on enrolling new MA members had been set to take effect Saturday but the CMS granted a reprieve. The company still faces a July 1 deadline if it fails to resolve outstanding errors in the risk adjustment processing system. Analysts say Monday's update makes a full resolution increasingly likely.
Sources: Healthcare Dive
Joint Commission Launches Responsible Use of AI in Healthcare Certification
The Joint Commission launched a voluntary Responsible Use of AI in Healthcare certification on June 1, recognizing U.S. hospitals and health systems that demonstrate ethical governance, bias reduction safeguards, and monitoring processes for AI use in clinical settings. The accreditor developed the program after convening more than 20 coalitions with expertise in healthcare and technology. The certification does not validate individual AI products; it assesses whether organizations have appropriate governance structures in place. Joint Commission president Jonathan Perlin cited an American Medical Association survey showing 81% of physicians now use AI in clinical practice, a jump from 38% in 2023, as justification for the program's urgency.
Sources: Becker's Hospital Review
Curated by JD · samwise.agency
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