Health Equity & Access Weekly Roundup: May 1, 2026

“Fraud Pays”: Congressional Hearing Exposes Deep Cracks in Medicare’s Defenses

A House Ways and Means Committee hearing on Medicare fraud highlighted concerns that the current system rewards criminals while burdening legitimate providers and accountable care organizations (ACOs). Witnesses described how fraudulent hospice agencies and other sham providers can easily obtain Medicare billing privileges, sometimes operating from vacant storefronts or unrelated businesses, while stolen physician identities and revoked licenses continue to be used for billing. Industry leaders criticized the CMS “pay-and-chase” model, in which claims are paid before fraud is investigated, contrasting it with private insurers’ use of artificial (AI) and clinical review teams to stop suspicious payments in real time. Testimony also emphasized the human toll, including patients unknowingly enrolled in fraudulent hospice programs and denied needed care. Lawmakers discussed reforms such as stricter provider verification and monthly Medicare claim statements for beneficiaries. ACO leaders warned that fraud schemes quickly shift to new billing targets, including recent spikes in skin substitute spending. Although the hearing included partisan debate over health care fraud pardons and Medicaid oversight, members on both sides agreed that Medicare needs stronger provider screening, better fraud-detection tools, and improved interagency coordination to combat increasingly sophisticated fraud networks.

Potential Expiration of Tax Credits and Medicaid Unwinding Threaten Progress in Health Equity

The Commonwealth Fund’s 2026 State Health Disparities Report found that racial and ethnic inequities remain deeply embedded across the US health care system, with Black, Hispanic, and American Indian and Alaska Native (AIAN) populations consistently facing worse access, quality, and health outcomes even when income and insurance status are similar. Using 24 indicators across all states, the report showed wide disparities in avoidable mortality, insurance coverage, preventive care, and chronic disease outcomes, with states like Massachusetts performing well overall yet still showing major gaps between White residents and communities of color. Researchers highlighted especially severe inequities for AIAN populations, including avoidable death rates exceeding 1000 per 100,000 people in South Dakota, while Hispanic adults in many states were most likely to forgo care due to costs or remain uninsured. The report also identified persistent “quality disconnects,” such as Black women experiencing higher breast cancer mortality despite higher screening rates. Commonwealth Fund leaders argued these disparities stem from policy decisions rather than inevitability, emphasizing the need for expanded insurance coverage, stronger primary care systems, protection of preventive services, investment in social determinants of health, and equitable use of AI and data collection. The report concluded that no state has eliminated racial or ethnic health gaps and warned that Medicaid unwinding and expiring Affordable Care Act subsidies could further worsen disparities without sustained policy action.

Patients Treated for Common Cancers in Community Settings Live Longer, COA Study Finds

New real-world evidence presented at the Community Oncology Alliance’s annual conference found that patients with metastatic breast cancer and metastatic non–small cell lung cancer (NSCLC) treated in community oncology practices experienced longer overall survival than national benchmarks from the SEER database. The study, conducted with Flatiron Health using data from nearly 98,000 patients treated between 2013 and 2022, showed median survival of 48 months for patients with metastatic breast cancer in community practices compared with 40 months in SEER, and 15 months vs 13 months for metastatic NSCLC. Researchers said the survival advantage persisted across multiple analyses and became even more pronounced after adjusting for demographic differences. Community oncology leaders attributed the findings to factors such as personalized, high-touch care, improved access to treatment close to home, patient navigation services, and rapid adoption of newer therapies. The study’s authors argued the results provide long-sought evidence that community oncology practices can deliver not only lower-cost and more convenient care, but also strong survival outcomes for patients with advanced cancers.

How Specialty Pharmacies Navigate Charitable Patient Assistance Programs

At Asembia’s AXS26 Summit, leaders from specialty pharmacies, charitable foundations, and patient advocacy organizations discussed the growing role of specialty pharmacies in helping patients navigate rising medication costs and access financial assistance programs. Panelists explained that pharmacies are often the first point of contact when patients experience “co-pay shock,” with some facing thousands of dollars in out-of-pocket costs for lifesaving therapies. Speakers highlighted the extensive coordination required to determine eligibility for manufacturer co-pay cards, charitable grants, or other support programs, while operating within strict regulatory requirements. The discussion also focused on concerns surrounding accumulator and maximizer programs, as well as alternative funding programs, which panelists said can delay treatment access, increase financial strain, and worsen patient stress and health outcomes. Despite changes under the Inflation Reduction Act, organizations such as HealthWell Foundation and the Patient Advocate Foundation reported rapidly increasing demand for assistance, driven by high deductibles, coinsurance, and persistent underinsurance. Panelists emphasized that specialty pharmacies now serve not only as medication dispensers, but also as financial navigators and patient advocates, helping individuals overcome affordability barriers to treatment.

Survey Reveals State Plans for Work Requirement Implementation in Medicaid

A new KFF survey found that states are taking varied approaches to implementing Medicaid work requirements mandated under the One Big Beautiful Bill Act, which are set to take effect in January 2027. Based on responses from 43 states and focus groups with Medicaid officials, the survey showed that most states do not plan to enforce work requirements before the federal deadline, although Iowa, Montana, and Nebraska intend to begin earlier and disenroll noncompliant enrollees, while Arkansas plans a soft launch without disenrollments until 2027. Most states expect to verify compliance every 6 months and use look-back periods for applications and renewals, though some plan stricter requirements and fewer hardship exceptions. States are also considering technological solutions, including AI and outside vendors, to manage implementation, but many remain undecided about staffing increases or system changes. A recurring theme was the need for more detailed guidance from CMS on exemptions and qualifying activities, with officials warning that unclear federal direction could increase administrative costs and lead to inconsistent implementation across states.