Federal Focus: Q1 2026

Please note: The following updates are current as of March 31, 2026 and are subject to change given the fluid nature of the legislative process. For any questions, please email admin@caresourcemission.com. 

It’s been a busy first quarter of 2026 for Congress. We’re closely monitoring the decisions and policies that will shape the healthcare landscape in the months ahead.

Congress Acts on Funding

After a brief partial government shutdown, Congress passed a government spending bill that funds the Department of Health and Human Services (HHS) at $116 billion for the remainder of the fiscal year.

The bill included several bipartisan healthcare priorities, such as:

• Extensions for Medicare telehealth services and hospital-at-home programs
• Increased funding for community health centers and rural hospitals
• New pharmacy benefit manager (PBM) reforms aimed at lowering drug costs and boosting transparency

However, Congress did not extend the enhanced Advanced Premium Tax Credits (eAPTCs), which expired at the beginning of the year. At this time, lawmakers are not expected to revisit this policy in 2026, a decision expected to leave millions of Americans at risk of significant premium increases.

Updates from HHS

Due to delays caused by the 2025 government shutdown, the Department of Health and Human Services (HHS) entered 2026 with a backlog of major payment and program rules to release, as well as requests for information from health care stakeholders.

Several key proposals and initiatives include:

• Calendar Year (CY) 2027 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and MA and Part D Payment Policies
  
  Top Takeaway: If finalized as proposed, payments to MA plans would average a payment increase of .09% in CY 2027.

• The Plan Year (PY) Notice of Benefit and Payment Parameters for 2027 (NBPP) proposed rule.
  
  Top Takeaway: Released later than usual, this rule includes a number of new proposals, including broadening catastrophic plans and non-network plans.
  
• Request for Information: Comprehensive Regulations to Undercover Suspicious Healthcare (CRUSH)
  
  Top Takeaway: Opportunity for health care stakeholders to identify fraud, waste and abuse. Information from RFI will likely inform future rulemaking.
  
• Request for Applications: Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model
  
  Top Takeaway: This voluntary model would allow CMS to negotiate drug pricing and coverage terms with manufacturers of GLP-1 medications on behalf of state Medicaid agencies and Medicare Part D plan sponsors.

Looking Ahead

As 2026 progresses, we continue to track the latest developments shaping coverage, affordability and care delivery for the members we serve.

• Legislative Slowdown: Due to the election year, Congressional activity is expected to slow by late July.
• Fraud, Waste & Abuse Focus: Health care leaders on key committees are prioritizing legislation in this area, with hopes to have a bill ready for passage by July or September.
• Medicaid Work Requirements: CMS is expected to release guidance for states on Medicaid work requirements by June.
• Ongoing Rulemaking: Additional program rules and regulatory updates are expected throughout the year

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