Weekly Health Care Policy Update – July 25, 2025

August 1, 2025

In this update: 

  • Administration Updates
    • White House Releases AI Action Plan
    • 20 States Sue CMS over ACA Final Rule
  • Federal Agencies
    • CMS Gives ICE Access to Data 
    • CMS Finds Possible Dual Enrollment in Medicaid and ACA Plans
    • New Director of FDA Center for Drug Evaluation and Research Named
    • HHS Announces Effort to Reform Organ Transplant System
  • Other Federal Updates
    • CBO Releases Final Score on OBBBA
    • KFF Report Shows Spike in ACA Premiums for 2026
  • New York State Updates
    • DOH Issues Proposed Regulatory Framework for the SNALR Voucher Program
    • OPWDD Issues Final Regulations for Emergency Management and Preparedness Plan
    • OPWDD Issues Revised Guidance on Individual Eligibility and Enrollment for the HCBS Waiver
    • OMH Hosts Town Hall on Impact of OBBBA and other Federal Actions

Administration Updates

White House Releases AI Action Plan
On July 23rd, the White House released its AI Action Plan to accelerate the adoption of AI across sectors with potential breakthroughs for the practice of medicine and drug discovery. The Plan is broken into three pillars – AI Innovation, AI Infrastructure, and International Diplomacy & Security – and centers on opportunities to deregulate AI technologies, create environments (AI Centers of Excellence) to test innovation, and develop infrastructure. The White House is proposing over 90 policy actions, including rescinding Biden-era regulations and withholding federal funds to states enacting AI restrictions. While the Plan only mentions health care in passing, initiatives including the production of the “largest and highest quality AI-ready scientific datasets” could have cascading impacts on medicine.
 
The plan is available here.
 
20 States Sue CMS Over ACA Final Rule
On July 17th, 20 states filed a suit over the recent Centers for Medicare & Medicaid Services (CMS) Marketplace Integrity rule. The plaintiffs claim that the rule included illegal changes to regulations governing state and federal marketplaces, causing up to 1.8 million people to lose coverage next year. The lawsuit claims that the rule imposes burdensome and expensive paperwork and is arbitrary and capricious. The plaintiffs filed their suit in the U.S. District Court for the District of Massachusetts and also filed a motion for a preliminary injunction and stay to keep the final rule from taking effect while the legal process continues. The legal arguments mirror a case brought by Baltimore, Chicago, and Columbus, along with Doctors for America and the Main Street Alliance.
 
The suit is available here.

Federal Agencies

CMS Gives ICE Access to Data
On July 17th, the Associated Press (AP) reported that a recent agreement between the Centers for Medicare & Medicaid Services and the Department of Homeland Security will transmit the personal data of 79 million Medicaid enrollees to Immigration and Customs Enforcement (ICE) officials. The data includes home addresses, birth dates, Social Security numbers, and ethnicities, and will facilitate “the location of aliens” for arrest and potential deportation. This marks an escalation of efforts; last month the Trump Administration sought data from the seven states that allow immigrants without citizenship to enroll in their Medicaid programs. Twenty states sued the Administration over this move, alleging it violated federal health privacy laws.
 
The original story is available here.
 
CMS Finds Possible Dual Enrollment in Medicaid and ACA Plans
On July 17th, the Centers for Medicare & Medicaid Services (CMS) announced that a recent analysis of 2024 enrollment data found 2.8 million Americans possibly enrolled in multiple federal health programs. The analysis found an average of 1.2 million Americans each month enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) in multiple states and found an average of 1.6 million Americans each month simultaneously enrolled in Medicaid/CHIP and a subsidized Affordable Care Act (ACA) plan. CMS Administrator Oz stated that CMS is working with states to identify these individuals and fix the duplicate enrollment problem. Requirements for Exchanges to examine data for dual enrollment were paused to ensure continuous coverage during the public health emergency (PHE), though these checks have resumed. CMS indicates several ways it will work with states, including providing state-based Exchanges with a list of individuals potentially simultaneously enrolled in Medicaid or CHIP and a subsidized ACA plan, asking them to determine the individuals’ enrollment status, and asking them to implement a process to recheck eligibility.
 
The announcement is available here.
 
Dr. George Tidmarsh Named Director of FDA Center for Drug Evaluation and Research 
On July 21st, the Food and Drug Administration (FDA) announced the appointment of Dr. George Tidmarsh to serve as the Director of the Center for Drug Evaluation and Research (CDER). Dr. Tidmarsh received his M.D. and Ph.D. in cancer biology from Stanford University, where he remains as faculty, specializing in pediatrics and neonatology. Outside academia, Dr. Tidmarsh has served in numerous industry posts, including founding and leading several biopharmaceutical companies and overseeing the clinical development of seven FDA-approved drugs. Dr. Tidmarsh is joining the FDA at a time of considerable staff turnover and leadership vacancies.
 
The announcement is available here.
 
HHS Announces Effort to Reform Organ Transplant System 
On July 21st, the Department of Health and Human Services (HHS) announced new efforts to reform the organ transplant system following an investigation led by the Health Resources and Services Administration (HRSA) concerning reports from one Appalachian organ procurement organization (OPO). HRSA found a pattern of cases where the procurement process began “when patients showed signs of life.” The investigation pointed to poor neurologic assessments, lacking consent practices and coordination, and a misclassification of causes of death as exacerbating circumstances. These systemic vulnerabilities are most common in small and rural hospitals. HHS is mandating strict corrective action for the OPO in question and directing the Organ Procurement and Transplantation Network (OPTN) to update data collection policies related to organ donation stoppages.
 
The announcement is available here.

Other Federal Updates

CBO Releases Final Score on OBBBA
On July 21st, the Congressional Budget Office (CBO) released its final estimate of the budgetary and other effects of the One Big Beautiful Bill Act (OBBBA) as signed into law by President Trump. Overall, CBO estimates the bill will increase the federal budget deficit by $3.4 trillion, reduce health sector spending by $1.1 trillion, and cause ten million people to lose health insurance coverage over the ten-year budget window. The deficit estimate is slightly higher than CBO’s previous estimate ($3.3 trillion), with most of the cost coming from the law’s permanent extension of the 2017 Trump tax cuts (which would reduce revenues by $4.5 trillion). The health spending reductions were driven by a roughly $950 billion reduction in Medicaid spending and nearly $200 billion reduction in spending for plans created by the Affordable Care Act (including the health insurance marketplaces and New York’s Essential Plan). Medicare spending was projected to have a small increase. The uninsured estimate is slightly lower than the previous estimate of 11.8 million people, due in part to the removal of a policy in the final bill that would have led to an estimated 1.4 million undocumented immigrants losing coverage.
 
The estimate is available here.
 
KFF Report Shows ACA Premiums to Spike for 2026
On July 18th, the Peterson-Kaiser Family Foundation Health System Tracker released an analysis of rate filings for the 2026 plan year. Researchers found that rates in the Affordable Care Act’s (ACA’s) individual market will increase by a median of 15%, the highest increase since 2018. Premium increases are driven by rising health care costs (impact of 8% on average), expiration of the enhanced premium tax credits (impact of 4% on average), and potential tariffs on pharmaceuticals (impact of 3% on average). The premium impact from the expiring tax credits is the result of a deteriorating risk pool, as the out-of-pocket portion of the premium paid by enrollees is expected to jump by an average of 75%. The analysis included preliminary filings from 105 ACA Marketplace insurers in 19 states and the District of Columbia (including both federally facilitated and state-based marketplaces).
 
The report is available here.

New York State Updates

DOH Issues Proposed Regulatory Framework for the Special Needs Assisted Living Residence (SNALR) Voucher Program
On July 23rd, the New York State (NYS) Department of Health (DOH) issued proposed regulations to establish a Special Needs Assisted Living Residence (SNALR) Voucher Program for Persons with Dementia, introducing Section 1001.17 to Title 10 of the New York Codes, Rules, and Regulations (NYCRR). The proposed program would provide financial assistance to help residents with Alzheimer’s disease or other dementias remain in appropriate care settings and avoid discharge or transfer due to an inability to pay privately. The program is designed to reduce unnecessary transitions to skilled nursing facilities and delay or avoid Medicaid enrollment.

To participate, facilities must be certified SNALRs and must submit an attestation agreeing to accept the voucher payment as part of the resident’s cost of care. To qualify, residents must: 

  • Have a diagnosis of Alzheimer’s disease or other dementia;
  • Have lived in a participating facility for at least one year;
  • Meet income, asset, and resource thresholds; and
  • Not currently be receiving (or approved to receive) Medicaid-funded services.

 Voucher amounts will be tiered based on the resident’s ability to pay, covering up to 75% of the average regional SNALR cost. Applications will be reviewed on a rolling basis and may be subject to regional funding limits and waitlists.

The proposed regulations are available here. Comments may be submitted to regsqna@health.ny.gov through September 21, 2025.

OPWDD Issues Final Regulations for Required Emergency Management and Preparedness Plans 
On July 23rd, the NYS Office for People with Developmental Disabilities (OPWDD) issued final regulations that require OPWDD providers (except for Family Care Providers) to develop and review annually: 

  • An agencywide Emergency Management Plan; and
  • An Emergency Preparedness Plan for each facility certified or operated by OPWDD.

 Each provider is required to engage in a documented risk assessment to develop the plans that considers public health emergencies, natural hazards/disasters, and human-made hazards. All staff and volunteers must receive training on the plans on an annual basis, with new staff/volunteers receiving training within three months of employment. OPWDD has developed a toolkit and educational program to support providers with development of the facility emergency plan.

The development of these regulations are in direct response to an Office of the State Comptroller (OSC) audit of OPWDD’s Covid-19 pandemic response (here), which recommended that OPWDD review and update its emergency management protocol and ensure that facility-level emergency plans are adequate.

The final regulations are available in the State Register here.

OPWDD Issues Revised Guidance on Individual Eligibility and Enrollment for the HCBS Waiver
On July 14th, OPWDD issued revised guidance for providers to align with the most recent CMS-approved renewal of the OPWDD Home and Community-Based Services (HCBS) 1915(c) Waiver. The updated guidance: 

  • Clarifies the new classification of Individually Directed Goods and Services (IDGS) from a support to a service;
  • Highlights the time-limited services that do not meet the monthly need requirements (e.g., environmental modifications, assistive technology); and
  • Specifies that the required monthly HCBS must be provided by an OPWDD-certified service practitioner.

The updated guidance is available here.

OMH Hosts Town Hall on Impact of OBBBA and Other Federal Actions
On July 22nd, the NYS Office of Mental Health (OMH) convened a Town Hall to brief providers and other stakeholders on the impacts of recent federal actions and their implications for New York’s behavioral health and social safety net systems.

In addition to reviewing the projected impacts on the State’s Essential Plan/Medicaid enrollees, SNAP and nutrition assistance programs, and student loan borrowing, the webinar also addressed new restrictions on the provision of care to immigrants within certain mental health programs (e.g., PATH, grant-funded initiatives) and potential structural and funding changes to the Substance Abuse and Mental Health Services Administration (SAMHSA) and existing block grant programs. OMH continues to monitor these changes and will provide further guidance to providers as more details become available. However, OMH emphasized that several ongoing State initiatives will proceed as planned, including the submission of a State Plan Amendment (SPA) to continue the Certified Community Behavioral Health Clinic (CCBHC) program and enforcement of the commercial reimbursement mandate.

Moving forward, OMH will continue to provide updates and intends to host regional planning meetings with counties, providers, advocacy groups, and service recipients to develop mitigation strategies. OMH also encourages providers to submit questions and suggestions for appropriate State response to planning@omh.ny.gov. Specific questions regarding federal funding distributed through counties may be sent to CBFM-Contracts@omh.ny.gov.

The slides are available here.