May 7, 2026

This issue of The Rheum Advocate highlights key policy developments affecting student loans, Medicaid protections, insurance access, and quality reporting in rheumatology.

ACR Warns DOE Student Loan Rule Could Deepen Health Workforce Shortages

The Department of Education (DOE) has finalized a rule redefining which programs qualify as “professional degrees” for federal student loan purposes—despite strong opposition from the ACR. Effective July 1, only 11-degree programs will retain access to expanded federal loan limits of up to $200,000. The programs are:

• Medicine
• Pharmacy
• Osteopathic medicine
• Chiropractic
• Optometry
• Podiatry
• Clinical psychology
• Dentistry
• Veterinary medicine
• Law
• Theology

Critically, advanced training pathways that support the rheumatology workforce—such as nurse practitioners (MSN, DNP), physician assistants, physical and occupational therapists, and audiologists—will now be classified as “non-professional.” Students in these programs will face significantly lower borrowing caps of $20,500 annually and $100,000 total.

This policy change risks exacerbating existing workforce shortages across rheumatology and related specialties. Rheumatology care teams rely heavily on advanced practice providers and allied health professionals to meet growing patient demand, particularly as the prevalence of rheumatic disease rises and physician shortages persist. Limiting access to federal student loans may deter prospective students from entering these fields or increase financial barriers for those already pursuing training.

ACR raised concerns that this rule undermines team-based care and threatens patient access, especially in underserved areas where non-physician professionals play a critical role. The College will continue advocating for policies that support a robust, multidisciplinary workforce and ensure patients with rheumatic disease can access timely, high-quality care.

Also, be on the lookout for a special edition of The Rheum Advocate in the coming weeks, focused on federal student loan changes and what that means for borrowers.

Rheumatology Groups Call for Patient Protections in Medicaid Work Requirements

The American College of Rheumatology (ACR), Arthritis Foundation, Coalition of State Rheumatology Organizations (CSRO), North Carolina Rheumatology Association (NCRA), and the Association of Women in Rheumatology (AWIR) are calling on North Carolina policymakers to put patients first as they consider adding work reporting requirements to the state’s Medicaid program. The legislation, advancing under the One Big Beautiful Bill Act (OBBBA) signed in July 2025, could establish a precedent other states may follow when shaping Medicaid eligibility and access to care.

The coalition is particularly concerned about how rigid work rules could affect people living with chronic, fluctuating conditions such as arthritis, lupus, and other rheumatic diseases. Many of these patients rely on Medicaid to afford medications, specialist visits, and ongoing monitoring that allow them to remain as active and independent as possible.

Why work requirements can be risky for rheumatology patients

Rheumatic diseases are often characterized by periods of relative stability interrupted by unpredictable flares of pain, fatigue, and disability that can make regular work activities difficult or impossible. When policies fail to reflect this reality, patients may be penalized for missed work hours or reporting gaps that stem directly from their disease, not from lack of effort.

“For patients with rheumatic diseases, stable access to care is not optional, it’s essential,” said William F. Harvey, MD, MSc, FACR, president of the American College of Rheumatology. “Work reporting requirements that do not account for fluctuating disease activity risk disrupting treatment and jeopardizing patients’ ability to remain functional and independent.”

What the rheumatology community is asking for

In their statement, the organizations underscore several key protections that must be embedded in any Medicaid work requirement policy:

• Clear exemptions for individuals with serious, debilitating, or fluctuating chronic conditions, including many forms of arthritis and rheumatic disease.
• Medical frailty definitions that reflect the lived experience of chronic illness, recognizing that functional ability and work capacity can vary over time.
• Simplified, accessible reporting processes that do not create administrative barriers or confusion for people already managing complex health needs.
• Strong safeguards to prevent inappropriate coverage loss due to documentation challenges, temporary changes in health status, or disability-related work limitations.
• A core focus on continuous coverage so patients can maintain stable treatment plans and avoid preventable disease flares or complications.

The ACR and its partners have pledged to continue working with policymakers in North Carolina and across the country to ensure Medicaid policies center patients and do not erect new barriers to care for people living with complex, lifelong rheumatic diseases. They stress that protecting access to consistent treatment is essential for helping patients remain functional, independent, and, when possible, active in the workforce.

ACR Insurance Subcommittee Supports Members by Safeguarding Patient Access to Care

Insurance-related challenges continue to shape how rheumatologic care is delivered, often delaying or limiting patient access to essential therapies. ACR’s Insurance Subcommittee (ISC) is working to address these barriers while supporting rheumatologists and rheumatology professionals on the front lines.

“Rheumatology practices are increasingly facing issues created by insurance policies which affect patient access to care and specific therapies,” says Michael Feely, MD, chair of the ISC. He points to growing concerns such as prior authorization requirements, step therapy protocols, formulary restrictions, and reimbursement pressures. Additional hurdles—including “white bagging” and insurer down-coding programs—can place significant strain on practices already operating on thin margins.

At the core of the subcommittee’s advocacy is a clear principle: “The decision on which therapy is appropriate should be made by the treating rheumatologist… not dictated by third-party payors,” Dr. Feely emphasizes. While guidelines are important, he notes that rigid insurance policies often delay necessary treatment and interfere with individualized patient care.

The ISC collaborates closely with other ACR committees and relies on both advocacy staff and practicing clinicians to track emerging payer trends. “We rely greatly on rheumatology practices keeping us apprised of issues as they arise,” Dr. Feely explains.

To support these efforts, ACR members are encouraged to report insurance-related challenges through the ACR website. “The most important thing members can do is notify us of issues that impact the ability to deliver the high-quality care our patients deserve,” he says.

Through continued advocacy and member engagement, the ISC remains committed to reducing administrative burden and ensuring patients receive timely, evidence-based rheumatologic care. You can reach out to the committee at practice@rheumatology.org.

UHC Extends Grace Period on Medicare Advantage Referral Requirements, ACR Advocates for Rheumatology Exemption

UnitedHealthcare (UHC) has updated its provider guidance to confirm that, while referral requirements for most Medicare Advantage HMO plans remain in place, the implementation of adverse payment decisions tied to those requirements will continue to be deferred beyond the previously announced April 30, 2026 deadline. This policy applies to services delivered on or after January 1, 2026. This extension effectively continues the current grace period.

During this time, clinicians are still expected to submit referrals in accordance with plan requirements, even though payment penalties related to missing referrals are not currently being enforced. While the extended grace period offers temporary relief from financial penalties, practices should continue to follow referral protocols to avoid future disruptions once enforcement resumes.

The ACR is actively advocating on behalf of its members and their patients. The College is preparing a formal letter to UHC requesting that rheumatology services be excluded from these referral requirements, citing concerns about patient access, continuity of care, and the specialized nature of rheumatologic treatment.

Members with questions or who are experiencing challenges related to referral requirements are encouraged to share their experiences to help inform ongoing advocacy efforts at practice@rheumatology.org.

Level Up Your Lupus Quality Reporting with RISE

Join us during Lupus Awareness Month on May 15 for a free, fast, focused education opportunity on how to implement new lupus quality measures in the ACR’s RISE registry, reportable for the 2026 MIPS performance year. This 30-minute session is ideal for clinicians and practice staff looking to optimize lupus care while meeting federal reporting requirements.

You will hear directly from the volunteer leaders who developed these measures as they walk through:

• Appropriate hydroxychloroquine use
• Strategies to reduce prolonged glucocorticoid exposure
• Capturing patient reported physical function in routine care

We will also demonstrate how to use RISE data to identify care gaps, track performance, and drive better outcomes for people living with lupus. By the end of the webinar, you will have practical tips you can apply immediately in your practice.