Nebraska will start Medicaid work requirements in May, making it the first expansion state to implement the new HR 1 community engagement rules. Expansion states must comply by the start of 2027, but Becker's reported some can move earlier through a waiver or state law. KFF Health News said some states already lack staff to process applications and answer enrollee calls, and researchers expect coverage losses under the new rules. The first wave looks less like an employment policy than administrative churn, with disenrollment risk for MCOs and uncompensated-care exposure for providers.

AbbVie sued HHS and HRSA on April 8, challenging HRSA's 1996 340B patient guidance and asking the court to narrow who qualifies for discounted drugs. AbbVie argues covered entities can claim 340B pricing after minimal or unrelated contact and wants eligibility limited to provider-managed care within 12 months. HRSA's 1996 notice requires a covered-entity relationship, records, and care responsibility, but it does not impose AbbVie's recency test. If the court accepts that rewrite, hospitals could lose 340B script volume and spread revenue.

DOJ said on March 11 that Aetna will pay $117.7 million to resolve False Claims Act allegations tied to Medicare Advantage diagnosis coding. The government alleged Aetna used 2015 chart reviews to add codes without withdrawing unsupported diagnoses and, from 2018 through 2023, kept morbid obesity codes unsupported by BMI. Because CMS pays MA plans based on submitted diagnoses, unsupported codes are not clerical noise; they are revenue. For actuarial and finance teams, retrospective coding, deletion logic, and obesity edits just became cash-risk management.