CMS Administrator Mehmet Oz, MD, is pushing an ambitious agenda of reform for the agency, including sweeping changes to federal healthcare programs and goals to align policies with President Donald Trump’s “Make America Healthy Again” agenda.
Here are eight policies from CMS under Dr. Oz’s leadership for physicians to know:
1. 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. The proposed rule aims to ensure that federal Medicaid dollars are used to support vulnerable populations rather than being redirected to fund other state programs, including healthcare coverage for undocumented immigrants.
“States are gaming the system — creating complex tax schemes that shift their responsibility to invest in Medicaid and rob federal taxpayers,” Dr. Oz said. “This proposed rule stops the shell game and ensures federal Medicaid dollars go where they’re needed most — to pay for health care for vulnerable Americans who rely on this program, not to plug state budget holes or bankroll benefits for noncitizens.”
2. CMS is escalating federal oversight to prevent states from “misusing” Medicaid funds to cover care for undocumented immigrants. While federal Medicaid dollars are generally limited to emergency services for “noncitizens with unsatisfactory immigration status” who meet specific eligibility criteria, CMS claims that some states have expanded benefits beyond what is permitted — shifting additional costs to federal taxpayers.
“Medicaid is not, and cannot be, a backdoor pathway to subsidize open borders,” Dr. Oz said. “States have a duty to uphold the law and protect taxpayer funds. We are putting them on notice — CMS will not allow federal dollars to be diverted to cover those who are not lawfully eligible.”
3. On June 3, CMS 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.
The original guidance, issued in July 2022 shortly after the Supreme Court overturned Roe v. Wade, clarified that clinicians treating pregnant patients in emergency departments — including providing abortions — were protected under the Emergency Medical Treatment and Active Labor Act, regardless of conflicting state laws. Enacted in 1986, EMTALA requires Medicare-participating hospitals to provide appropriate emergency care to all patients .The guidance has since been withdrawn, but CMS affirmed it will continue to enforce EMTALA in cases where the health of a pregnant woman or her unborn child is at risk.
4. CMS is investigating an undisclosed number of hospitals that provide gender-confirming care to minors. In a letter sent May 28 to “select hospitals,” Dr. Oz voiced concerns about clinical standards and potential financial incentives associated with gender-affirming treatments. CMS is requesting that hospitals respond within 30 days with detailed information on informed consent practices for pediatric patients, updates to clinical guidelines, documentation of adverse outcomes, and financial data — including facility- and provider-level revenue and profit related to such care.
5. On May 22, CMS issued updated price transparency requiring hospitals to publicly post actual prices for items and services — not estimates. The update follows an executive order from President Trump aimed at increasing transparency in healthcare pricing.
6. On April 4, CMS published its final rule for Medicare Advantage and Part D in 2026. 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.
However, CMS did not address two closely watched issues: the expansion of coverage for GLP-1s under Medicare and Medicaid, and the regulation of the use of AI in prior authorization. Those decisions have been deferred to future rulemaking.
7. On April 10, CMS said it is stopping 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.”
8. In 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.
