State Policy
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- State Policy · IA
Iowa Cites Four Nursing Homes Over Resident Death, Medication Errors
Iowa state inspectors cited four nursing homes for resident injuries or abuse, including one case where a resident died after staff allegedly failed to perform proper CPR. At Laurens Care Center, body camera footage reviewed by inspectors contradicted medical records, showing staff standing around a dying resident rather than administering chest compressions or rescue breaths; inspectors proposed a $10,000 fine, currently suspended pending a federal CMS penalty determination. Separately, Luther Manor at Hillcrest in Dubuque was fined after a medication aide gave a resident six drugs intended for another resident sharing the same first name, causing a dangerous overdose; that facility has been cited for repeated violations over the past 16 months. State fines at both homes remain in suspension while CMS decides whether to impose federal penalties, a process relevant to facilities' Medicaid certification standing.
- State Policy · PA
Perry Touts Medicaid Cuts at Pennsylvania Campaign Rally With Johnson
At a Dauphin County campaign rally days before the election, Rep. Scott Perry (R-PA) cited cutting Medicaid spending among the Trump administration's achievements while framing his tight reelection race against Democrat Janelle Stelson in religious "good vs. evil" terms. House Speaker Mike Johnson joined Perry to warn against Democratic control of Congress and dismissed polling showing a close race. The piece is primarily campaign-trail political coverage, with Medicaid spending cuts mentioned only briefly as one of several policy talking points Perry highlighted. No new Medicaid policy, rule, or legislative action is reported.
- State Policy · OR
Oregon Relaunches State-Run ACA Marketplace After 2013 Failure
Oregon's ExploreHealthOR.gov marketplace launches Nov. 1 for open enrollment, moving the state off the federal healthcare.gov platform and ending a decade-plus reliance on it following the failed 2013 Cover Oregon rollout. The Oregon Health Authority contracted with vendor Vimo for over $90 million, less than half the cost of the earlier Oracle-built system, and cites the vendor's experience in at least eight other states as a key difference. The marketplace serves roughly 120,000 Oregonians who buy coverage individually rather than through an employer, and officials say state control will allow easier auto-renewal when insurers like Providence and PacificSource exit the market and better routing of enrollees to state programs such as Healthier Oregon and Oregon Health Plan Bridge. The launch comes as enhanced ACA subsidies lapse for higher earners and premiums rise double digits for 2027.
- State Policy · MI
Michigan Approves 14.2% ACA Rate Hike, Enrollment Falls 27%
Michigan regulators approved 2027 rate increases of 14.2% for individual health plans, including ACA marketplace plans, and 9.6% for small group plans, ahead of the Nov. 1 open enrollment start. Individual market enrollment has dropped more than 130,000 in a year, with marketplace enrollment down 27%, more than double the national 12% decline. The University of Michigan's Center for Health and Research Transformation attributes the trend to the expiration of enhanced premium subsidies, federal rules changes, and provisions tied to the One Big Beautiful Bill Act that narrow eligibility and add paperwork requirements. The number of marketplace insurers has fallen to seven, down from 15 in 2016, and Meridian Health Plan of Michigan's individual enrollment dropped from over 156,000 to under 19,000 after exiting Metro Detroit.
- State Policy · AR
Arkansas Advocacy Report Urges Lawmakers to Pass Paid Family Leave
Arkansas Advocates for Children and Families published a report based on five focus groups of 35 Arkansans, finding that existing paid family and medical leave policies are difficult to access due to confusing deadlines, paperwork and institutional barriers. Nurses and teachers in the groups said they routinely delayed care, exhausted paid time off, or returned to work before recovering from illness or childbirth. Arkansas has no statewide paid leave requirement, though it covers maternity leave for state workers and public school employees; the report calls on lawmakers to expand coverage to fathers, adoptive and foster parents when the legislative session begins in January. The report also links the issue to Arkansas's healthcare workforce stability and notes that rural Medicaid spending is expected to drop by $15.5 billion annually starting in 2026 under federal budget changes, affecting the more than 800,000 Arkansans who rely on Medicaid.
- State Policy · CA
Catalyst California CEO Argues to Close Prop 13 Tax Loopholes
In a guest commentary, Catalyst California president and CEO John Kim argues that California should close Proposition 13's commercial and industrial property tax loopholes, citing USC research estimating up to $25.1 billion in additional annual revenue if such properties were reassessed at current market value. Kim contends the state needs this revenue because federal budget legislation will push roughly 2 million Californians off Medi-Cal by 2028 and shift nearly half a million off CalFresh, while the state faces a deficit exceeding $20 billion a year. He calls on the Legislature and the next governor to use new tax revenue to offset these federal cuts to health and food assistance programs. The piece frames tax reform as a way to rebuild public trust in government amid rising safety-net losses.
- State Policy · OH
Ohio Capital Journal Roundup: Voters Fret Over Costs, Medicaid Work Rules
In its Catching Our Eye news roundup, the Ohio Capital Journal compiles reporting on rising healthcare and caregiving costs ahead of Ohio's midterms, alongside a separate item on local data-center ballot fights. Ideastream reporting cited in the roundup notes that new Ohio Medicaid work requirements take effect at the start of 2027, and one study estimates up to 356,000 Ohioans could lose Medicaid coverage as a result. The roundup also cites an AARP study finding family caregiver out-of-pocket costs have risen 60% in five years, and separate reporting on Ohio's data-center moratorium movement appearing on dozens of local ballots this November. No new policy action is reported; the roundup aggregates existing coverage.
- State Policy · CA
California Governor Candidates Offer Vague Plans on Healthcare Costs
KFF Health News reports that California's gubernatorial candidates have offered few concrete proposals to address rising healthcare costs, even as 4 in 10 adults in the state report carrying medical debt and employer family premiums have climbed 24% since 2022. Democrat Xavier Becerra, the frontrunner, has pledged to negotiate lower drug prices, pursue antitrust action against hospital consolidation, and has called for Congress to restore an estimated $900 billion in federal Medicaid cuts and reinstate expired enhanced ACA tax credits, though both are federal rather than gubernatorial matters. Republican Steve Hilton wants to build on state price-transparency and PBM laws and proposes partially replacing Medi-Cal with personal healthcare accounts of up to $10,000 a year, an idea unlikely to advance in the Democrat-controlled legislature. Neither candidate agreed to interviews on their health policies, leaving voters without detailed funding or implementation plans ahead of the election.
- State Policy
Study: 12-Month Postpartum Medicaid Boosted Care for Complications
A study published Oct. 14 by Columbia University's Mailman School of Public Health found that extending Medicaid coverage to 12 months postpartum increased use of postpartum care among mothers with pregnancy complications like diabetes and hypertension. Analyzing Medicaid claims data on births from 2019-2023 in New York and Texas, researchers found postpartum outpatient visits rose 28% for those with diabetes and 19% for those with hypertension in New York, with larger increases of 58% and 51% respectively in Texas, where baseline care rates were lower. Diabetes screening rose 5 percentage points in New York and 12 points in Texas, but screening rates later declined in Texas after coverage lapsed during the unwinding of COVID-era continuous enrollment protections. The findings point to coverage duration as a key driver of postpartum care utilization for high-risk mothers.
- State Policy · RI
Outgoing RI AG Neronha Proposes Public Option, Health Agency Overhaul
Rhode Island Attorney General Peter Neronha, who leaves office in January, unveiled two proposals requiring legislative approval: a state-run public insurance option and a restructuring of the state's health and human services agencies. The public option, developed with Brown University researchers, would let individuals and employers buy state-administered plans comparable to state employee benefits, competing with private insurers while leaving Medicare and Medicaid intact; it is projected to cost about $398 million annually in subsidies and enroll roughly 134,000 people by 2028 if approved quickly. Neronha framed the plan partly as a hedge against anticipated Medicaid coverage losses, citing an estimated 33,600 Rhode Islanders who could lose Medicaid coverage under new federal work requirements and immigrant restrictions from H.R.1. His separate agency proposal would eliminate the Executive Office of Health and Human Services, replacing it with two cabinet-level agencies and a new independent long-term planning office.
- State Policy · ME
Maine GOP Leaders Demand Independent Review After MaineCare Fraud Arrests
Following the arrest of six individuals and an agency indicted for healthcare fraud conspiracy, Maine's Republican legislative leaders Trey Stewart and Billy Bob Faulkingham held a press conference demanding greater oversight of MaineCare. They called for an independent third-party review of waste, fraud and abuse in the program, a full public accounting from the state health department of what officials knew and did, and a status report on providers under payment suspension or investigation. The arrests stem from an indictment alleging Community Home Health Care and its owner submitted false claims to MaineCare, including over $600,000 for services to a single client never rendered. Republicans argue recovered funds could help raise Medicaid reimbursement rates and address the state's projected $1 billion budget gap.
- State Policy
Kansas, New York, Massachusetts Deploy Surveys to Map BH Workforce
NASHP describes how Kansas, New York, and Massachusetts are using behavioral health workforce surveys to fill gaps left by licensing data, which cannot show whether licensed professionals are actively practicing, what insurance they accept, or which populations they serve. Kansas's Behavioral Sciences Regulatory Board built a 2025 survey spanning seven behavioral health professions, using profession-specific advisory committees and about 60 engaged stakeholders to standardize topics for cross-profession comparison. States are pairing survey data with licensure, claims, and labor market information to target training investments, modernize licensure rules, and build funding cases. The piece outlines design principles, including collecting practice-setting and retention data and structuring surveys around specific policy questions states need answered.
- State Policy
States Diverge on Verifying Medicaid Work Requirement Compliance
States are developing differing approaches to verifying whether Medicaid applicants and enrollees meet, or are exempt from, new work reporting requirements (WRRs). The analysis examines the policy choices states face in confirming compliance or exclusion status, including how they will document exemptions and check work activity. These verification methods directly affect how many eligible people retain coverage, since procedural errors or administrative mismatches can trigger wrongful terminations. The piece highlights ongoing variation across states as they implement these requirements.
- State Policy · MN
Minnesota Author Argues Deportation Spending Crowds Out Medicaid Funding
In a Minnesota Reformer commentary, a parent of a child with Type 1 diabetes argues that federal mass deportation spending diverts taxpayer money that could instead fund healthcare and other needs. The author cites an Economic Policy Institute calculator estimating Minnesota taxpayers are contributing $4.4 billion, or $2,050 per taxpayer, toward national deportation enforcement costs, and argues that sum could instead cover Medicaid for 130,000 Minnesotans, rural hospital funding, or veterans' care. The piece also cites the recently enacted federal reconciliation law as having cut funding for Medicaid, the ACA, and SNAP. The author draws on her own experience losing health coverage for her daughter's diabetes treatment before Minnesota adopted insulin price caps, and calls on elected officials to oppose using tax dollars for deportation operations.
- State Policy · MN
Minnesota Reformer Argues Gubernatorial Candidates' Tax Pledges Ignore Medicaid Cut Fallout
In a Minnesota Reformer commentary, the author argues that Sen. Amy Klobuchar and House Speaker Lisa Demuth's debate pledges to rule out tax increases as governor are unrealistic given a looming $2 billion state deficit and the fiscal pressures created by federal policy. The piece cites the federal tax and spending law's roughly $900 billion in Medicaid spending reductions, which it says could cause up to 140,000 Minnesotans to lose coverage and push financially distressed rural hospitals toward closure. The author contends that anti-tax promises from both candidates would make it harder for Minnesota to offset these federal cuts or fund affordability initiatives like reinsurance expansion or child care investment. No new policy action has occurred; this is an opinion piece ahead of the 2026 Minnesota governor's race.
- State Policy · CA
California Homelessness Falls Again, Still Above Newsom's 2019 Level
California's unsheltered homelessness dropped 6.5% in January 2026 versus January 2025, and total homelessness fell 3.4% to an estimated 175,836 people, according to preliminary point-in-time count data cited by Gov. Gavin Newsom's office. Since 2024, unsheltered homelessness is down nearly 13% and overall homelessness down 6%, which Newsom attributes to state investments including a $900 million program funneling homeless funds to cities and counties. Despite the gains, about 24,600 more Californians are homeless today than when Newsom took office in 2019. Advocates caution the count may undercount people displaced by increased encampment enforcement, and note recent federal cuts to Medi-Cal and social services could make further progress harder.
- State Policy · NC
NC Workforce Report Finds Easing but Persistent Health Staffing Shortages
The NC Center on the Workforce for Health released its third annual health workforce analysis on Oct. 26, finding that vacancy and turnover rates for registered nurses, licensed practical nurses, nursing assistants and medical assistants improved from 2025 to 2026 but remain above national and recommended levels. Rural communities and western North Carolina, still recovering from Hurricane Helene, face the worst shortages, with behavioral health and long-term care settings seeing higher turnover than other care types. The state projects shortfalls of 12,500 RNs and 5,000 LPNs over the next decade, and paramedic and EMT positions sit vacant for over 100 days on average. Education and training programs are not producing enough graduates to meet annual demand in several professions, including registered nursing.
- State Policy · MA
Massachusetts Launches Home Care Agency Licensing Law Nov. 4
Massachusetts' "Act to Improve Massachusetts Home Care" takes effect Nov. 4, requiring non-medical home care agencies to conduct background checks on employees and owners with at least a 5% stake, implement annual caregiver training on topics like dementia and abuse prevention, maintain workers' compensation and liability insurance, and disclose ownership and financial information. Temporary licenses are due by May 3, 2027, with permanent licensure required by Nov. 4, 2027. Industry attorneys note the law's broad definition of "home care agency" may sweep in referral, registry and matching arrangements beyond traditional providers. Industry leaders told Home Health Care News the law creates a consistent statewide safety baseline but will raise overhead costs, potentially squeezing margins for private-pay providers already constrained by what families can afford.
- State Policy · NY
New York Focus Explains How County Legislatures Administer Medicaid
In an explainer, New York Focus describes how New York's 62 county governments function, including their role as the local administrative arm for Medicaid and SNAP. County legislatures pass budgets, conduct oversight, and in many cases share power with an elected county executive; social services, public safety, and health typically make up the largest budget shares. The piece notes that over half of the state's 939 county legislative seats are on the ballot in next week's midterm elections, with results potentially shifting control of these bodies. Outside New York City, counties collectively raise about $37 billion in revenue and will need to absorb roughly $1 billion in added costs next year due to federal SNAP cuts.
- State Policy · VA
Author Beth Macy Challenges Rep. Cline, Vows to Reverse Medicaid Cuts
Beth Macy, author of "Dopesick" and a longtime journalist covering the opioid epidemic, is the Democratic nominee challenging Republican Rep. Ben Cline in Virginia's 6th Congressional District. Macy says Cline's vote for the federal tax and spending law, which included Medicaid changes, motivated her to enter the race, arguing the cuts would make addiction treatment harder to obtain. Her platform includes reversing the law's Medicaid provisions, restoring enhanced ACA premium subsidies, expanding addiction treatment access in prisons, and improving care for people leaving incarceration. The general election will determine whether she unseats the four-term incumbent in a traditionally Republican-leaning district that national Democrats have recently targeted as competitive.
