Health Equity blog

The One Big Beautiful Bill Act (OBBBA), establishes work and community engagement requirements for most Medicaid beneficiaries, requiring participation in work, volunteer service, or other work-related activities for a minimum of 80 hours per month, subject to certain exceptions. California estimates that about 1 to 2 million of its 14 million Medi-Cal recipients will lose coverage, either because they will fail to meet the work requirements or due to challenges associated with navigating the administrative process to comply. Individuals experiencing homelessness may be particularly affected, given the practical difficulties associated with meeting work verification, documentation, and periodic eligibility confirmation requirements.

The Rural Health Transformation Program (RHTP), administered by the Centers for Medicare & Medicaid Services (CMS), is a $50 billion 5-year program (2026-2030) that aims to strengthen, modernize, and improve health care access and outcomes in rural U.S. communities. In December 2025, CMS awarded each state an average of $200 million. However, before rural hospitals can apply for funding, states must open applications, which many have failed to do, condensing the timeline for organizations to submit applications by the September 2026 deadline. Additionally, rural hospitals, many of which do not have experience in grant writing or have limited administrative resources, are reportedly concerned they will miss this significant funding opportunity.

Hospitals and community health centers participating in the 340B Drug Pricing Program (also known as covered entities) are objecting to new data‑reporting requirements imposed by several drug manufacturers. On March 6, Novo Nordisk issued a notice that, effective April 1, covered entities must submit comprehensive claims-level data in order to continue receiving 340B discounts. Eli Lilly issued a similar notice in January 2026. Although these drug manufacturers claim their objective is to ensure appropriate discounts go to the correct providers and are not duplicated, covered entities contend that that the requirements are unlawful and will limit access to lower-priced drugs. In response to Eli Lilly’s actions, the American Hospital Association (AHA) sent a letter to the Health Resources Services Administration (HRSA), which oversees this 340B program, urging HRSA to take action to halt the new reporting mandates, which they consider to be onerous administrative burdens.

A study by the West Health-Gallup Center on Healthcare in America released on March 12 found that as many as one-third of U.S. citizens – including many with six-figure incomes – are facing growing financial challenges with continuing to afford vital health care services. Rapid inflation in recent years, as well as looming loss of coverage due to Affordable Care Act (ACA) subsidies sunsetting and cuts in Medicaid, are all combining to create a cauldron of economic woes. A third of the individuals surveyed reported making at least one trade-off with daily living expenses, such as skipping meals and reducing utility usage, to pay for their health care.

A new JAMA Internal Medicine study found that a national policy correcting race-based kidney function estimates was associated with higher kidney transplant rates for Black patients. After implementation of Organ Procurement and Transplantation Network (OPTN) wait time modifications in 2023, transplant rates among Black candidates increased by 5.3 transplants per 1,000 listings—without reducing access for other racial or ethnic groups. The authors suggest these findings that targeted policy changes to remedy harms from race-based medicine can meaningfully reduce inequities in kidney transplantation.

Health systems and physicians are reporting concerns that crackdowns by Immigration and Customs Enforcement (ICE), particularly in metropolitan areas, such as Minneapolis, are making immigrants afraid to leave their home. This fear has led to a significant increase in missed medical appointments and fewer vaccines administered to immigrant populations. Some providers are turning to telehealth and even in-home visits to provide necessary care. In a recent press conference held in Minnesota, physicians described instances of adults and children foregoing care, which can result in worse and costlier health outcomes. The American Medical Association (AMA) expressed serious concerns with ICE enforcement activities in and around hospitals, saying these actions are preventing immigrants from seeking vital medical care.

A new Fitch Ratings report foreshadows that many hospitals in states that did not expand Medicaid under the Affordable Care Act (ACA) will likely see a surge of uninsured patients. This is because, starting Jan. 1, 2026, enhanced premium tax credits expired, making Marketplace plans no longer financially feasible for such individuals. Limited Medicaid eligibility and lack of safety-net and other government subsidized backstop programs in many of these states is expected to exacerbate the problem.

A study published in Health Affairs found that a significant number of physicians enrolled in Medicaid never see a Medicaid patient – so-called “ghost” physicians. The research indicated participation in Medicaid varied widely by specialty. For example, more than 40% of psychiatrists were “ghost” physicians who saw no Medicaid enrollees in a given year, in contrast to primary care physicians, who were most likely to be high-volume “core” Medicaid participants. Other research has noted that Medicaid enrollees have a disproportionately higher need for mental health services compared to the overall patient population, which makes this statistic even more daunting.

Entering into the third year of a 5-year cooperative agreement executed by the Centers for Disease Control and Prevention (CDC), American Indian and Alaska Native (AI/AN) tribes across the country have received $82.5 million in funding to strengthen the performance, quality, and infrastructure of their tribal public health systems. The funds enable recipient tribes to improve their capacity to implement, develop, and evaluate public health programs and services for their communities.

On Feb. 3, the President signed into law a funding bill that largely left intact the Department of Health and Human Services’ (HHS) FY 2025 budget heading into FY 2026. Notably, the bill also included extensions for several expiring health care provisions including telehealth waivers, delay of Medicaid Disproportionate Share Hospital (DSH) cuts, extension of community health center funding, and the hospital at home program.