WHITE HOUSE:

Over the last few weeks, the White House continued their efforts to reform education with a series of Executive Orders focusing on college accreditation, transparency on foreign funding for colleges, and modifying public school disciplinary policies. They also continued their goal of remaking the federal workforce with new Executive Orders changing how federal employees are protected both during their initial probationaryperiod and throughout their career. Finally, they are modernizing government procurement regulations and contracts, as well as rescinding a pair of past Executive Orders that limited where federal government facilities could be located. Three items of interest for us:

• • Continuing on efforts from his first Administration, they issued an Executive Order to continue the effort to lower drug prices, with a specific focus on importation and looking ever more closely at PBM’s. The full text of the order can be found here.

• • Following in the general efforts to tackle deregulation, the President signed an Executive Order that directs agencies to identify regulations that conflict with recent Supreme Court decisions, including the case that overturned the Chevron deference, which served as the underlying authority for agency action over the last 40 years. Once identified, the regulations that conflict will be prioritized to be rescinded.

• • Working to prioritize strong growth areas for the workforce, the Administration is creating a new task force to modernize the American workforce, as well as a new task force to create early training for students in the use and development of AI. Both of these programs are designed to create a more robust American workforce in skilled areas that have shortages.

CONGRESS:

Even as both the House & Senate passed budget resolutions before Congress went on recess, Congress remains stuck in pretty much the same spot we left off: with the target goals for how much to cut from federal spending at least $1.5 trillion apart in each chamber, there’s no simple way to get there. Adding to Speaker Mike Johnson’s headaches is a letter (PDF) that went out from 12 House Republicans that said they would not vote for a final bill that cuts Medicaid. It came as little surprise, therefore, that GOP leadership is pushing back the timeline on the bill and now hope to have a bill on the floor by May 19^th (the final week before the Memorial Day recess). The Energy & Commerce committee, which oversees Medicare/Medicaid and where the biggest fight lies, is currently planning on taking up the bill on May 7^th. As Congress heads back to town this week, the schedule is jam-packed. Elsewhere in the political world:

• • In addition to signing the Medicaid letter, Congressman Mike Lawler issued an op-ed reiterating his commitment to protect Medicaid. He also did an interview where he specifically said that he’s opposed to any changes to the structure of how Medicaid is funded.

• • With two high profile Democratic lawmakers leaving Congress, as Senator Dick Durbin and Congresswoman Jan Schakowsky are both retiring, Illinois politics are about to undergo a seismic shift. Democrats in general remain a party in chaos, with Colorado Senator Michael Bennett announcing a run for Governor and more left-progressive primary challengers looking to unseat incumbents.

• • Sometimes it’s easy to get numbed by the massive numbers that are used to discuss the federal budget. This is a useful, relatively simple way to understand how every dollar spent by the government is split up.

• • As more House members look for an exit strategy, it’s clear that It’s not just members of the public that are disillusioned by the chamber.

• • An entertaining read on the most socially ambitious members of Congress.

• • Looks like DOGE is gonna need a new leader as Elon Musk announced that he’s planning on taking a step back from the agency.

AGENCIES:

CMS officially announced the delay of the revalidation process till August 1^st.

CMS released the 2026 SNF payment rule. The rule is scheduled to be published to the Federal Register on April 30^th, but if you can’t wait to read it, you can access a pre-publication copy of the relatively tame 105-page rule here (PDF).

Nothing official yet, but Fierce Healthcare reports that CMS submitted a regulation to OMB (usually the final stage before a proposed rule is issued) that would change how states use the bed tax to fund Medicaid. The link to the regulatory page is here. It could end up being nothing, but with provider taxes under attack, it’s something to monitor.

A federal judge overturned the minimum staffing rule for nursing homes.

CMS announced that they’re ending programs that allow states to use federal funding for state programs that aren’t part of their “core” mission, such as housekeeping programs or internet for rural providers. The letter to states can be found here (PDF).

DOGE is starting in on healthcare spending.

FROM THE NOTEBOOK:

• • Pennsylvania lawmakers introduced a bill to fight the state’s “budget adjustment factor” that limits how much the state actually pays to Medicaid providers. With a recent report (PDF) showing just how damaging the state’s minimum staffing standards are, it’s a good first step in fixing the antiquated payment system.

• • Both Arkansas and Alabama passed new bills aimed at regulating PBM’s.

• • Louisiana is looking at implementing the use of AI to uncover potential fraud in their Medicaid programs.

• • A Connecticut hospital is suing United Healthcare’s for underpaying their MA claims.

• • The Vermont Legislature passed a bill that will eliminate medical debt for many in the state.

• • In a sign of just how passionate folks are about the development of AI, more than 10,000 public comments were submitted to the White House on how to develop an AI action plan.

• • Texas inched closer to finalizing their budget, but there’s still more to come.

• • Several states have “trigger” laws that would automatically end their Medicaid expansion programs if federal funding drops.

• • It’s from last month, but NCSL looked at how state legislatures are aiming to tackle workforce shortages.

• • California approved $2.8 billion dollars for their Medi-Cal program to close a funding gap.

• • McKnight’s reports that Maine is looking at emergency funding for their SNF’s.

• • A deep dive on the state of laws allowing the usage of cameras in elder care facilities.