Insights

Washington – September 24, 2025: Crowell & Moring today announced the arrival of two seasoned attorneys, Rachel Park and Jill Abrams, to its nationally recognized Health Care Group. Both join Crowell after more than two decades at the Department of Health and Human Services (HHS), where they served in various senior level positions across the department. The addition of Park and Abrams further strengthens the firm’s ability to advise sophisticated health care clients on complex regulatory, compliance, enforcement, and litigation matters. They join the firm as senior counsel in Washington, D.C.

On Wednesday, June 3, 2026, the Department of Health and Human Services (HHS) published an interim final rule with comment (IFC) instructing all state Medicaid agencies to incorporate “community engagement” as an eligibility condition for program participation by no later than January 1, 2027. The rule (Medicaid Program; Community Engagement Requirement for Certain Individuals) does not impose affirmative operational obligations for Medicaid managed care plans, as it focuses primarily on equipping the states to administer the community engagement requirement. However, it does establish a few specific guardrails to govern the role managed care organizations, prepaid inpatient health plans, and prepaid ambulatory health plans may — and may not — play in that administration.

With the Centers for Medicare & Medicaid Services (CMS) poised to determine which organ procurement organizations (OPO) will retain their Medicare certification and service territories under a controversial new performance framework, a coalition of OPOs is fighting to have its day in court — but first, it must convince a federal judge that the courthouse doors are open to it at all. The U.S. District Court for the Middle District of Florida is actively weighing whether it has jurisdiction to hear a pre-enforcement challenge to a 2020 Final Rule, which introduced a competitive three-tier performance model that threatens lower-performing OPOs with the loss of their designated service areas (DSA) and, potentially, their Medicare certifications. The resolution of this threshold question will determine whether the plaintiff OPOs can seek judicial relief ahead of decertification proceedings, which CMS has signaled will occur after it finalizes its 2026 Proposed Rule at the end of the year.

On May 27, 2026, the U.S. District Court for the Southern District of Georgia issued a sweeping decision in Clover Insurance Company v. HHS that could ultimately lead to the invalidation of nearly half of all Star Ratings measures and, potentially, lead the Centers for Medicare & Medicaid Services (CMS) to seek statutory changes to Medicare law.

This podcast episode features the following speakers: