State Policy
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- State Policy · ME
Maine Cuts Medicaid Coverage for Over 1,000 Immigrants Oct. 1
More than 1,000 immigrants in Maine lost MaineCare coverage starting October 1 under eligibility changes from the 2025 federal budget law (H.R. 1), which excludes refugees, asylum seekers, trafficking and abuse victims, and noncitizen veterans from Medicaid. Children under 21, pregnant people, and green card holders are unaffected. Maine DHHS has notified affected households since June, and state officials say many losing coverage are high-needs individuals with disproportionate use of home and community-based services and high rates of serious mental illness. Unlike California, New York, and Pennsylvania, Maine has no state-funded backstop program to cover the gap, though a $250 million legislative proposal to offset federal cuts failed to pass last session.
- State Policy · IL
Illinois Releases Multisector Plan for Aging Population
Illinois released EngAging Illinois in January 2026, a statewide multisector plan for aging built through years of cross-agency organizing and community partnership. This CHCS-authored blog post, published via ASA Generations, describes how the plan coordinates priorities across state agencies and community organizations to serve a growing population of older adults. The post highlights the relationship-building process behind the plan rather than announcing new regulatory or funding action.
- State Policy · MO
Missouri Releases Master Plan on Aging After Three-Year Process
Missouri published its "Aging with Dignity" Master Plan on Aging in February 2026, the result of a nearly three-year planning effort that gathered input from more than 10,000 residents. The plan is intended to coordinate policies and services for older adults across state agencies and community partners as Missouri's aging population grows. A Center for Health Care Strategies piece describes the plan's development and goals as a model of multisector coordination for aging services. The write-up does not specify an implementation timeline or funding mechanism.
- State Policy · AR
Sanders' Medicaid Work Requirements Ad Sparks Bipartisan Backlash
Arkansas Gov. Sarah Huckabee Sanders released a campaign ad depicting a Medicaid recipient playing video games and eating junk food instead of working, aimed at promoting the state's upcoming Medicaid work requirements. The ad drew criticism from both the NAACP, which called it stigmatizing and racially coded, and from some right-wing commentators who objected on different grounds. Arkansas's work requirements are set to take effect soon, requiring certain beneficiaries to document employment or qualifying activities to maintain coverage. The controversy highlights how politically charged messaging around Medicaid work requirements has become as states move to implement them.
- State Policy · IN
Indiana Law Shifts Long-Stay Nursing Home Residents to Fee-for-Service
Indiana enacted House Enrolled Act 1277, a Medicaid reform law altering the state's PathWays for Aging managed care program and other long-term services and supports. Most provisions took effect July 1, 2026, but the law also directs a transition of certain long-stay nursing facility residents out of managed care and into fee-for-service Medicaid, with that transition beginning on a later timeline described in the update. Long-term care and HCBS providers, along with PathWays managed care plans, must adjust billing, care coordination, and enrollment processes to align with the new structure. The change affects how nursing facilities and HCBS providers interact with payers for affected residents going forward.
- State Policy · PA
PA 7th District Rivals Split Sharply on Medicaid, ACA Cuts
Spotlight PA compares economic platforms of Rep. Ryan Mackenzie (R) and challenger Bob Brooks (D) in Pennsylvania's competitive 7th Congressional District ahead of the Nov. 3 election. Mackenzie backed the One Big Beautiful Bill Act, which includes roughly $1 trillion in Medicaid cuts over a decade plus new work requirements, more frequent eligibility checks, and higher cost-sharing; he says he continues working across the aisle on affordability measures and voted for a bill to extend enhanced ACA subsidies for three years. Brooks calls the law "God-awful" and wants to restore cuts to Medicaid, SNAP, and ACA subsidies, and supports moving toward universal coverage. The race is rated a toss-up, and the outcome could influence future congressional action on Medicaid financing and eligibility rules.
- State Policy
Four States, Indiana Health System Erase $1.1B Medical Debt
Four states and an Indiana health system partnered with the nonprofit Undue Medical Debt in 2026 to erase more than $1.1 billion in residents' medical debt. The organization works by purchasing bundled medical debt at reduced rates and canceling it for qualifying individuals. Undue Medical Debt states it has eliminated more than $40 billion in medical debt nationwide since it was founded in 2014. The initiative affects residents carrying unpaid medical bills, many of whom may also be Medicaid-eligible or uninsured populations facing collections and credit impacts.
- State Policy · VT
Swenson: Vermont's Physician Exodus Threatens Care Access
In a VTDigger commentary, Matt Swenson, founder of Omnidex Solutions, argues that Vermont's healthcare debate focuses too narrowly on prices while ignoring a worsening access crisis. He cites recent layoffs at the University of Vermont Health network (199 positions affected) and Dartmouth Health (124 cuts plus eliminated vacant positions), alongside state data showing primary care physicians fell from 634 in 2004 to 529 in 2024. Swenson argues the Green Mountain Care Board's price regulation and movement toward reference-based pricing, while worthwhile, must be paired with an access-to-care dashboard tracking wait times, ER boarding, and practices' new-patient capacity. He also criticizes Gov. Phil Scott's conciliatory approach and argues single-payer financing reforms alone won't solve a shrinking physician pipeline.
- State Policy · VA
Virginia Democrats Warn of Medicaid, ACA Cost Strains Before Election
Virginia Democratic lawmakers and a nonprofit leader held a press call warning that healthcare affordability will worsen as more federal policy changes take effect, five weeks before the state's Nov. 3 elections. Expired enhanced ACA premium tax credits have already driven steep premium increases, with one Charlottesville resident's monthly premium rising from $235 to $1,336; Virginia's marketplace enrollment fell by 94,000 to 295,000 as of late August. Starting January 1, new Medicaid work and community engagement requirements (generally 80 hours monthly, with exemptions for pregnancy, medical frailty, and some caregivers) will apply to more than 500,000 Virginia enrollees, raising concerns about coverage loss from paperwork burdens. Gov. Spanberger has directed agencies to improve outreach, and the state legislature approved a $150 million premium assistance program for households between 138%-250% of the federal poverty level, though lawmakers say the state cannot fully offset federal cuts.
- State Policy · AR
Arkansas Governor Candidates Split on Medicaid Expansion, Postpartum Coverage
Arkansas's three gubernatorial candidates, Republican Gov. Sarah Huckabee Sanders, Democratic state Sen. Fred Love, and Libertarian Colt Shelby, offered differing views on the state's Medicaid expansion program ahead of the 2026 election. Sanders said conversations are underway on "the best path forward" after the Trump administration rejected the state's renewal request this summer because the program doesn't meet a new federal cost-neutrality provision; Arkansas has since requested a two-year extension. Love called for increased Medicaid enrollment and investment, citing rural hospital closures tied to low reimbursement rates, while Shelby said he hopes the extension request is granted and supports extending postpartum coverage to 12 months, calling it a "no-brainer." Arkansas remains the only state limiting postpartum Medicaid coverage to 60 days; Sanders opposes extending it, citing other insurance options for low-income residents.
- State Policy · WV
WV Advocates Press State to Fix Autism Therapy Workforce Shortage
Advocates for children with autism in West Virginia are urging state officials to address a shortage of workers who provide applied behavior analysis and other therapy services covered by Medicaid. Families report long waitlists and difficulty accessing care due to insufficient numbers of trained providers, particularly in rural areas. The advocates are calling on state leaders to take action on reimbursement rates, provider recruitment, or other policy levers to expand the workforce. No specific legislative or regulatory proposal has yet been detailed in this report.
- State Policy · MO
Missouri Lacks Mandatory Mental Health Screening for Pregnant Patients
Missouri's latest Pregnancy-Associated Mortality Review found mental health conditions and substance use disorder contributed to nearly a quarter of pregnancy-related deaths from 2019 to 2023, with 24 of 108 reviewed deaths attributed to these causes. Providers failed to complete mental health or other key screenings in 38 of the deaths reviewed, and nearly 80% of pregnancy-related deaths were deemed preventable, including all mental health and substance use deaths. Screenings for perinatal mental health conditions remain voluntary in Missouri rather than mandatory, and the state received a "C" grade in 2026 from the Policy Center for Maternal Mental Health, up from a D-minus in 2023. The mortality rate was 2.9 times higher for women on Medicaid than those with private insurance, and rural areas, especially northeast Missouri, saw the highest death rates and face acute shortages of mental health providers.
- State Policy · SD
South Dakota Ballot Measure Opponents Warn of Medicaid Expansion Repeal Risks
Opponents of South Dakota's Amendment I, on the Nov. 3 ballot, said Monday the measure would reduce health care access and shift costs to privately insured residents. Amendment I would automatically repeal Medicaid expansion if federal funding for the expansion population is reduced below current levels. South Dakota's Republican attorney general and other opponents oppose the measure, arguing it threatens coverage gained through expansion. The vote takes place November 3, and its outcome will determine whether the state's expansion population retains coverage if federal funding changes.
- State Policy · NE
Nebraska Early Data Shows Medicaid Work Requirement Verification Outcomes
A policy brief examines Nebraska's process for verifying compliance with Medicaid work requirements and reports early data on how enrollees subject to the requirement have fared. The brief details how the state confirms work, education, or other qualifying activities, and what share of affected enrollees have successfully verified compliance versus those at risk of losing coverage. Findings are relevant as more states implement or plan similar requirements following federal changes expanding work requirement mandates. The brief highlights administrative and verification challenges that could inform other states' implementation strategies.
- State Policy · CO
Colorado Warns Proposed Federal Rules Would Cut Medicaid Funding
Colorado officials say newly proposed federal rules would have a "disastrous" effect on Medicaid and other insurance funding streams, further straining an already stressed state budget. The state warns that lost federal funding under the proposal would force difficult tradeoffs in coverage and spending. Details on the specific federal rule's scope, comment deadline, and mechanism are not fully specified in the source report. State officials are raising alarms as the proposal moves through the federal rulemaking process.
- State Policy
CHCS Outlines Strategies to Link Primary Care, Food Is Medicine
In a blog post, the Center for Health Care Strategies presents three strategies for state Medicaid agencies to strengthen primary care's role in connecting members to Food Is Medicine (FIM) interventions, such as medically tailored meals and produce prescriptions. The piece targets state Medicaid officials seeking to embed nutrition-related screening, referral, and care coordination into primary care workflows. It frames primary care providers as a key entry point for identifying food insecurity and directing members to FIM services. No specific regulatory or funding action is announced; the post offers programmatic guidance for states designing or scaling these efforts.
- State Policy · KS
Kansas Builds Sustained Medicaid-Public Health Coordination Model
In a NAMD snapshot, the association profiles Kansas's approach to bridging Medicaid and public health agencies through sustained, structured collaboration rather than one-off, crisis-driven coordination. The model relies on monthly cross-agency meetings, shared data governance arrangements, and joint initiatives covering newborn screening, infectious disease response, and rural maternal and infant health. State Medicaid agencies and public health departments are the primary audience, as the profile is meant to offer a replicable framework for other states seeking to formalize interagency coordination. No specific effective date or regulatory action is described; the piece functions as a case study of institutional practice.
- State Policy · PA
Allegheny County Kindergarten MMR Rate Falls Below Herd Immunity Threshold
Pennsylvania has confirmed 835 measles cases across 39 counties in 2026, including 164 hospitalizations and four deaths among unvaccinated residents, compared to just 16 cases statewide in 2025. Allegheny County's kindergarten MMR vaccination rate stood at 91.8% for the 2025-26 school year, below the 95% threshold needed to prevent community spread, continuing a decade-long decline. The MMR vaccine is available at no cost to Medicaid-enrolled, uninsured, and underinsured children at Pennsylvania's 59 state health centers. The outbreak underscores how declining childhood vaccination coverage is driving disease resurgence in a state where Medicaid covers a large share of pediatric immunizations.
- State Policy · RI
Rhode Island AG Rejects Turnaround Plan for Safety-Net Hospitals
Rhode Island Attorney General Peter Neronha's office rejected a financial turnaround plan submitted by CharterCARE Health of Rhode Island, the new owner of Roger Williams Medical Center and Our Lady of Fatima Hospital, saying it relied on unrealistic assumptions. The plan was required under conditions imposed when the hospitals' sale to nonprofit owner The Centurion Foundation closed in March. Neronha gave the owners until October 2 to submit a revised plan, warning the hospitals could be at risk of closing by year's end despite an $85 million cash infusion required at sale closing. Both hospitals serve large shares of Medicaid and Medicare patients and face pressure from new federal Medicaid eligibility requirements and funding cuts expected to increase uncompensated care.
- State Policy · CA
Newsom Signs Limited CARE Court Fixes, Bigger Overhaul Bills Die
California Gov. Gavin Newsom signed two bills making incremental changes to CARE Court, the state's mental health court program launched in 2023 to connect severely mentally ill residents with treatment. One law lets more first responders refer people into the program; another allows family members to share treatment-relevant information with care teams. Two more sweeping bills that would have created pathways from CARE Court into involuntary conservatorship died in the Assembly Appropriations Committee in August over cost concerns and insufficient data on program performance. State data through June 2025 show CARE Court has reached far fewer people than projected, with only 517 of 2,216 petitions resulting in care agreements.
