CMS Administrator Mehmet Oz, MD, said April 10 that his vision for the agency includes a commitment to President Trump’s “Make America Healthy Again” agenda and modernizing Medicare, Medicaid and the ACA marketplace.
Eight notes:
1. As a first step, CMS will implement President Trump’s executive order from February aimed at boosting healthcare price transparency. The order directs HHS, and the Labor and Treasury departments to “rapidly implement and enforce” healthcare price transparency enforcement regulations that the president introduced during his first term.
2. CMS will work to streamline access to life-saving treatments by “equipping providers with better patient information versus unnecessary paperwork.” The agency did not elaborate further on how it would streamline care access.
3. Identifying and eliminating fraud, waste and abuse is a top priority for the agency. During his confirmation hearing process, Dr. Oz promised scrutiny of the Medicare Advantage program amid allegations of widespread fraud, and expressed concerns about MA sales and brokers encouraging seniors to switch to MA policies for financial gain.
4. CMS will focus on prevention, wellness and chronic disease management. HHS Secretary Robert F. Kennedy Jr. has identified chronic disease as a key priority under his leadership. He has criticized the influence of the pharmaceutical and food industries, linking issues like obesity and diabetes to ultra-processed foods, federal subsidies and dietary guidelines. He has called for reforms targeting food additives, pesticides and environmental health risks, alongside overhauls of agencies like the CDC and FDA. Mr. Kennedy has also called on states to ban fluoridated drinking water. Effective May 7, Utah will become the first state to enact a fluoride ban.
5. Dr. Oz promoted the use of artificial intelligence avatars during his first all-staff CMS meeting, WIRED reported April 9. Sources told the publication that during the April 7 meeting, Dr. Oz discussed potentially prioritizing AI avatars over front-line healthcare workers. He added that technologies such as machine learning and AI can help scale “good ideas” quickly and affordably.
6. On April 10, House Republicans approved the Senate’s fiscal 2025 budget blueprint, paving the way for key portions of President Trump’s domestic policy agenda, including potential sweeping changes to Medicaid. The House Energy and Commerce Committee must identify at least $880 billion in federal healthcare spending cuts, a figure many healthcare stakeholders expect will fall disproportionately on Medicaid.
Among the GOP’s proposed changes are Medicaid work requirements, which are projected to achieve an estimated $130 billion in federal savings over 10 years. Some lawmakers are also eyeing cuts to the enhanced Federal Medical Assistance Percentage to curb federal spending. Under the ACA, expansion states receive up to a 90% federal match, far above the standard 50%.
On April 10, CMS said it is halting federal matching funds for state expenditures on designated state health programs (DSHP) and designated state investment programs (DSIP) “to preserve the core mission of the Medicaid program.”
7. On April 4, CMS published its final rule for MA 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.
On April 9, Mr. Kennedy told CBS News that HHS is considering a “regulatory framework” for public coverage of GLP-1s.
8. On April 7, CMS said it would 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. The agency will continue the final year of the phase-in of risk-adjustment changes, shifting MA’s diagnosing coding from ICD-9 to ICD-10 and remove certain codes from the hierarchical condition categories model.
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