State Policy
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- State Policy
1.4 Million Uninsured in Ten Non-Expansion States Remain in Medicaid Coverage Gap
An analysis estimates 1.4 million uninsured individuals in the ten states that have not adopted Medicaid expansion remain in the coverage gap — earning too much for traditional Medicaid but too little to qualify for Marketplace premium tax credits. This population includes working adults, people of color, and individuals with disabilities. These individuals are ineligible for Medicaid because their states have not adopted the ACA's expansion to adults up to 138% of the federal poverty level and ineligible for Marketplace subsidies, which begin at 100% FPL. The analysis highlights the continued state-by-state variation in Medicaid eligibility and access to affordable coverage.
- State Policy
National Association of Medicaid Directors Elects New Board Leadership
State Medicaid directors have elected a new board of directors for the National Association of Medicaid Directors (NAMD). The organization represents state Medicaid agencies in policy discussions with CMS and serves as the primary vehicle for state-to-state coordination on Medicaid program operations. The new board will guide NAMD's advocacy priorities and engagement with federal policymakers during a period of ongoing program changes. State agencies should monitor NAMD communications for shifts in organizational priorities or focus areas under the new leadership.
- State Policy
KFF Tracker Compiles State Rural Health Transformation Plans
KFF Health News is maintaining an ongoing database of state rural health transformation plans as they become available through state responses and public records requests. The tracker aims to compile approved plans across states. This is a standing resource updated as new state plans are obtained, not a report of a specific policy development or deadline.
- State Policy · ID
Idaho to Implement Medicaid Expansion Work Requirements in 2027
Idaho will begin enforcing work requirements for Medicaid expansion enrollees in 2027, following state adoption of provisions from the federal One Big Beautiful Bill Act in April 2026. The Idaho Department of Health and Welfare will administer the requirements. State officials indicate most current expansion enrollees already meet the work requirement criteria, though specific exemption categories and compliance verification procedures have not been detailed.
- State Policy · NC
North Carolina AG Says Federal Medicaid Work Requirement Rule Shifts Millions to Counties
North Carolina's attorney general says a last-minute federal rule change regarding Medicaid work requirements will impose significant costs on counties. Congress included a medically frail exemption in last year's federal Medicaid work requirement law for individuals with serious or complex conditions like cancer, Parkinson's disease, and cystic fibrosis. The state AG contends recent federal regulatory changes will shift financial responsibility for administering or monitoring these exemptions to county governments, resulting in millions of dollars in unexpected local costs. The timing and specific implementation details of the rule change are causing concern about counties' ability to absorb these new expenses.
- State Policy · WI
Wisconsin Medicaid Functional Screen Determines Long-Term Care Program Eligibility
Wisconsin Medicaid requires applicants for long-term care programs to pass a functional screen test in addition to meeting financial eligibility criteria. The functional screen assessment evaluates an individual's ability to perform activities of daily living and need for assistance to determine whether they meet the level of care required for program enrollment. The screen applies to programs including Family Care, IRIS, and institutional care. For applicants and providers, understanding functional screening requirements is critical to navigating Wisconsin's long-term care access and ensuring appropriate program placement.
- State Policy
KFF Tracker Compiles State Abortion Coverage Policies Across Medicaid and Exchange Plans
This interactive resource tracks state-level abortion coverage policies across Medicaid, private insurance, and ACA exchange plans as of 2025. The tracker shows the number of states with laws restricting abortion coverage in Medicaid and private insurance has increased since 2010. It provides a state-by-state breakdown of coverage restrictions, exceptions for life endangerment or other circumstances, and differences between Medicaid fee-for-service and managed care plan coverage. The tool allows Medicaid agencies, health plans, and advocates to compare abortion coverage rules across states and insurance types.
- State Policy · CA
California Medi-Cal Enrollment Drops 5% as 730,000 Disenroll Between June 2025 and March 2026
California's Medi-Cal program lost 730,000 enrollees—a 5% decline—between June 2025 and March 2026, according to California Health Care Foundation data analysis. Undocumented children and young adults experienced disproportionate coverage losses during this period. The enrollment decline follows the end of Medicaid continuous coverage requirements that had kept enrollment elevated during the public health emergency. State agencies and managed care plans should anticipate continued membership volatility and assess impacts on network capacity, risk adjustment, and community-based provider networks serving populations with higher disenrollment rates.
- State Policy
NASHP Examines State Use of Community Health Workers for Oral Health Access
The National Academy for State Health Policy published an analysis of how states are deploying community health workers to expand oral health access in rural areas. The publication explores state-level strategies for integrating these workers into care delivery models where dental provider shortages limit access. The approach is particularly relevant for states addressing dental health disparities through Medicaid program design, as community health workers can connect beneficiaries to preventive services and coordinate care in underserved regions.
- State Policy
Political Dispute Over Medicaid Payment Deferrals Threatens Home Care Provider Stability
Political tensions are escalating around states' use of Medicaid payment deferrals, with home care providers caught in the crossfire. The dispute centers on whether states can delay payments to manage budget cycles, a practice that disproportionately affects home- and community-based services providers operating on thin margins. Home care advocates warn that payment timing conflicts threaten provider solvency and beneficiary access to HCBS. The controversy reflects broader partisan divisions over Medicaid financing and state flexibility in program administration.
- State Policy
Rhode Island and Hawaii Enact Healthcare AI Laws; Arizona Governor Vetoes Chatbot Bill
Rhode Island and Hawaii enacted healthcare AI legislation in June and July 2026, while Arizona's governor vetoed a similar chatbot disclosure bill. Rhode Island Governor Dan McKee signed two AI-related healthcare bills into law. The measures reflect divergent state approaches to regulating artificial intelligence in healthcare settings. These laws may affect how Medicaid managed care organizations deploy AI tools for utilization management, care coordination, or member services in these states.
- State Policy · KY
Kentucky Governor Reverses 4% Medicaid Provider Rate Cuts
Kentucky Governor Andy Beshear announced a reversal of the state's previously enacted 4% Medicaid provider rate cuts. The move follows criticism of the original cuts' impact on disability services and other providers. Beshear cautioned that the reversal would not immediately resolve all provider concerns, saying the change is not "a magic wand" or "a magic bullet." Managed care organizations operating in Kentucky should expect updated rate schedules reflecting the restored funding levels.
- State Policy · CO
Colorado Medicaid Owes $8 Million in Federal Funds for HCBS Claims
An Office of Inspector General audit found Colorado Medicaid improperly claimed at least $8 million in federal funds for in-home disability care services. The OIG identified an additional $45 million in federal payments requiring further review. State officials acknowledged billing errors but stated no fraud occurred. The audit examined home and community-based services claims, a program area where improper billing has drawn increased federal scrutiny. Colorado must repay the federal share of identified improper payments.
- State Policy · NM
New Mexico Lawmakers Criticize Slow Rollout of Behavioral Health System Reforms
Bipartisan New Mexico legislators voiced frustration over delays in implementing the state's behavioral health system overhaul during a Monday legislative session. The criticism focuses on the pace of program deployment intended to rebuild behavioral health infrastructure and service delivery. The concerns come amid ongoing challenges in the state's behavioral health network, which affects Medicaid managed care organizations responsible for coordinating behavioral health services for enrollees. The delays may impact MCO network adequacy requirements and care coordination for members with behavioral health needs.
- State Policy · DE
Delaware Enacts Hospital Price Caps, Charity Care Expansion, PE Acquisition Moratorium
Delaware Governor Matt Meyer signed three healthcare bills on July 20, 2026, that will phase in hospital price caps, expand charity care eligibility, and temporarily block private equity acquisitions of nonprofit hospitals. The legislation aims to improve healthcare affordability and access in Delaware. The price cap implementation will be delayed to allow a phased approach. These changes affect hospital reimbursement structures and access requirements that impact Medicaid managed care organizations contracting with Delaware hospitals.
- State Policy · NY
New York Struggles to Establish Oversight for Opioid Settlement Spending
New York state agencies face challenges establishing clear oversight for multibillion-dollar opioid settlement funds, which come with loose spending guidelines rather than strict requirements. Advocates for individuals affected by the opioid crisis are calling for stronger fiscal guardrails and accountability mechanisms. The situation in New York reflects broader challenges states face in managing settlement dollars intended for substance use disorder treatment and prevention. The lack of centralized oversight raises concerns about whether funds will reach evidence-based programs that serve Medicaid populations most affected by opioid use disorder.
- State Policy · OH
Ohio Legislature Debates Bill to End Medicaid Managed Care for 3 Million Enrollees
Ohio lawmakers are considering Senate Bill 386 and a House companion bill, the Medicaid Savings Act, which would dismantle the state's Medicaid managed care system currently serving approximately three million enrollees. The bipartisan legislation would shift Ohio away from its managed care delivery model. The bill is under active debate in Statehouse committee rooms. If enacted, this would represent one of the largest managed care program terminations in recent state Medicaid history, affecting every MCO operating in Ohio.
- State Policy
Georgia and Maine Evaluate Respite Care Programs to Improve Caregiver Outcomes
Georgia and Maine conducted evaluations of their respite care programs to assess effectiveness in supporting family caregivers and inform future state investments. The evaluations examined how respite services affect caregiver burden, health outcomes, and care continuity for individuals receiving long-term services and supports. Results are being used to guide state policy decisions on respite service design, reimbursement levels, and eligibility criteria. This work reflects growing state focus on caregiver support as a cost-effective strategy to maintain community-based care and reduce institutional placement.
- State Policy · MS
Mississippi Exchange Premiums Rise as State Remains Without Medicaid Expansion
Health insurance premiums on Mississippi's federally-facilitated marketplace continue to increase while the state has not expanded Medicaid eligibility under the Affordable Care Act. Low-income workers above the poverty line face higher out-of-pocket costs for exchange coverage, while those below 100% of the federal poverty level remain ineligible for both exchange subsidies and Medicaid. The coverage gap affects Mississippi residents who would qualify for Medicaid in expansion states but have no affordable coverage option in Mississippi. Mississippi is one of ten states that have not adopted Medicaid expansion as of 2026.
- State Policy · FL
Florida Counties Face $420M Medicaid Bill as Property Tax Revenue Declines
Florida's 67 counties will pay nearly $420 million toward state Medicaid spending this fiscal year, according to state economists. Miami-Dade County faces the largest share at $69.4 million, followed by Broward at $34.7 million and Hillsborough County. The county obligation comes as Florida counties anticipate declining property tax revenue. This county-level Medicaid cost-sharing arrangement represents mandatory local government contributions to the state's Medicaid program budget.