CMS under Dr. Oz – Administrator Mehmet Oz, MD, is charting an ambitious path to reshape federal healthcare policy in line with President Donald Trump’s “Make America Healthy Again” agenda. His vision comes as President Trump on July 4 signed The One Big Beautiful Bill Act, a sweeping package of reforms targeting Medicaid, Medicare, and the ACA marketplace.

1. CMS plans to add prior authorization for some traditional fee-for-service Medicare services as part of its newly launched Wasteful and Inappropriate Service Reduction model.
2. CMS is enacting a final rule that will shorten the open enrollment period on the ACA exchange and create stricter eligibility verifications for enrollees.
3. CMS proposed a rule to close what it describes as a Medicaid tax “loophole” that some states have used to increase federal payments while limiting their own financial contributions.
4. CMS is ramping up federal oversight to prevent states from “misusing” Medicaid funds to cover care for undocumented immigrants.
5. CMS proposed a 2.4% payment increase in 2026 for hospitals and ambulatory surgery centers that meet quality reporting requirements. In a major shift, the agency plans to phase out the inpatient-only list over three years, beginning with 285 mostly musculoskeletal procedures.
6.  CMS unveiled its 2026 Medicare Physician Fee Schedule proposal, which includes two separate conversion factors — 3.83% for qualifying alternative payment model participants and 3.62% for others.
7. The agency has proposed key changes to the Medicare Shared Savings Program aimed at encouraging accountable care organizations to transition more quickly to two-sided risk models. The updates, which take effect for agreement periods beginning Jan. 1, 2027, would shorten the time ACOs can participate in one-sided risk from seven to five years.
8. CMS on June 3 withdrew a 2022 guidance issued under the Biden administration that reinforced hospitals’ obligations to provide emergency abortion care under the Emergency Medical Treatment and Labor Act. The move effectively removes federal protections for clinicians who offer such care in states where abortion is restricted or banned.
9. CMS is investigating an undisclosed number of hospitals that provide gender-confirming care to minors.
10. On May 22, CMS issued updated price transparency requiring hospitals to publicly post actual prices for items and services — not estimates.
11. On April 4, CMS published its final rule for Medicare Advantage and Part D in 2026. While the final rule solidifies several changes — including measures to streamline prior authorization, tighten oversight of supplemental benefits and codify provisions from the Inflation Reduction Act — CMS stopped short of addressing two of the most closely watched issues: expanding coverage for GLP-1s under Medicare and Medicaid, and regulating the use of AI in prior authorization. Those decisions have been deferred to future rulemaking.
12. CMS plans to increase payments to MA plans by more than $25 billion in 2026. MA plans can expect a payment increase of 5.03% in 2026, more than double what the Biden administration proposed.
13. CMS plans to audit every MA plan annually as part of what it calls an “aggressive” effort to strengthen oversight and address potential overpayments. The agency currently audits about 60 plans each year but intends to expand that to all 500-plus MA plans moving forward.
14. On April 10, CMS said it is halting federal matching funds for state expenditures on designated state health programs and designated state investment programs “to preserve the core mission of the Medicaid program.”
15. In early April, CMS proposed a series of payment updates across multiple care settings for fiscal 2026, including a 2.4% payment increase for inpatient hospitals, equating to a $4 billion funding increase.