State Policy
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- State Policy · MN
Minnesota Terminates 3,000 Medicaid Providers in Federal Fraud Crackdown
Minnesota's Department of Human Services terminated funding to more than 3,000 care providers across 13 Medicaid service categories following a four-month revalidation screening of approximately 5,500 providers. The action represents a 60% termination rate and responds to heightened federal scrutiny over fraud in Minnesota's social services programs. The revalidation effort targeted providers across multiple service lines, requiring rapid compliance with new screening requirements. The mass terminations create immediate network adequacy concerns for Medicaid managed care organizations operating in Minnesota and signal potential federal enforcement pressure on other states with similar fraud vulnerabilities.
- State Policy · NE
Nebraska Reviews Federal Medicaid Work Rule, Continues May Implementation
Nebraska became the first state to implement federally mandated Medicaid work requirements in May 2026. CMS released an interim final rule this week outlining requirements all states must follow by January 1, 2027. Nebraska DHHS is reviewing the federal rule but declined to pause its current implementation. The state's approach will serve as an early test case for other states preparing to comply with the federal mandate.
- State Policy · OK
Oklahoma Extends Foster Care Services to Age 21 with Medicaid Coverage
Oklahoma enacted legislation allowing foster youth to voluntarily remain in state care until age 21, retaining stipend payments, Medicaid coverage, and caseworker support. The law, which passed unanimously this session, enables eligible young adults to continue services beyond their 18th birthday. Implementation timing was not specified in the report. The policy affects Medicaid managed care organizations serving foster care populations in Oklahoma, who will need to ensure continuous coverage and coordinate care for this extended eligibility group.
- State Policy · NE
Nebraska Seeks Federal Waiver to Exempt Dawson County from Medicaid Work Requirements
Nebraska Governor Jim Pillen has directed the state's Department of Health and Human Services to request federal approval for a temporary high-unemployment exemption from Medicaid work requirements in Dawson County. The county recorded the state's highest unemployment rate in April. The waiver request would suspend work requirement enforcement in the county while the broader state policy remains in effect. Federal approval from CMS is required before the exemption can take effect.
- State Policy · WI
Wisconsin Launches Webpage on Federal Medicaid Work Requirement Implementation
The Wisconsin Department of Health Services has created a webpage to inform BadgerCare recipients about new federal work requirements taking effect in 2027. The state is currently reviewing the federal rule issued June 1, 2026, which governs state implementation of the requirements. The webpage marks Wisconsin's initial public communication on compliance with the federal mandate, though specific implementation details remain under review.
- State Policy · NH
CMS Approves New Hampshire $205M Rural Health Transformation Spending Plan
CMS approved New Hampshire's spending plan for approximately $205 million in federal Rural Health Transformation Program funding awarded in late 2025. The GO-NORTH initiative will fund rural health infrastructure and service delivery improvements across the state. The approval allows New Hampshire to begin deploying federal dollars for rural provider support and access expansion. Medicaid managed care organizations operating in rural New Hampshire counties should anticipate changes in provider networks and potential care delivery model shifts as these federal investments take effect.
- State Policy · NM
New Mexico Spent $844M on Behavioral Health Since 2022 Despite Access Gaps
New Mexico invested $843.5 million in behavioral health system infrastructure since 2022, yet a new state report shows persistent access barriers for residents seeking appointments and rising overdose deaths. New Mexico was among only seven states where overdose deaths increased last year. The report suggests outcomes have not kept pace with financial investment. The findings have implications for Medicaid managed care organizations responsible for behavioral health service delivery and network adequacy in the state.
- State Policy
First 1115 SUD IMD Waiver Evaluations Show Mixed Progress on State Milestones
Early summative evaluations of Section 1115 waivers allowing Medicaid payment for substance use disorder treatment in institutions for mental disease reveal uneven state performance on required milestones. The brief analyzes evaluation findings as states navigate waiver renewals amid evolving federal Medicaid policy. States must demonstrate progress on access to evidence-based treatment, use of opioid use disorder medications, and improved care transitions. The findings come as CMS continues to refine expectations for SUD IMD waiver demonstrations and states prepare renewal applications.
- State Policy · MI
Michigan Prepares for Federal Medicaid Changes as 400-Page Guidance Released
Federal officials released nearly 400 pages of guidance on upcoming Medicaid changes affecting Michigan's program. The guidance clarified some implementation details but left unresolved questions as the state prepares for program modifications. Michigan Medicaid officials are reviewing the guidance to determine operational and compliance requirements. The changes will affect how the state administers its Medicaid program and contracts with managed care organizations.
- State Policy · WA
Washington State Launches First Public Long-Term Care Benefit Program
Washington state has implemented the nation's first public long-term care insurance program, providing benefits to help cover home care and other long-term services and supports. The program offers a benefit to eligible residents who need assistance with activities of daily living. Several other states are monitoring Washington's implementation as they consider similar programs. This represents a significant shift in how long-term care services may be financed outside of traditional Medicaid LTSS programs.
- State Policy · VA
Virginia Budgets $15M for Medicaid Sickle Cell Gene Therapy Coverage
Virginia lawmakers allocated nearly $15 million over two years to help the state Medicaid program cover gene therapy treatments for sickle cell disease patients. The funding connects to a federal payment model designed to help Medicaid programs manage the high cost of cell and gene therapies. The initiative aims to improve patient access to these treatments, which can cost over $2 million per patient. Providers indicated the funding could reduce barriers to obtaining complex gene therapy services through Medicaid.
- State Policy · OK
Oklahoma Shifts State Behavioral Health Services to Four Private Providers
The Oklahoma Department of Mental Health and Substance Abuse Services has awarded one-year contracts to four private providers to deliver behavioral and mental health services in portions of the state, transitioning from direct state operations to a privatized model. The shift affects regional service delivery and represents a structural change in how Oklahoma delivers public behavioral health care. Contract terms and implementation timelines were not specified in the announcement. This change may create new network and coordination requirements for Medicaid managed care organizations operating behavioral health programs in Oklahoma.
- State Policy
CHCS Report Outlines State Medicaid Strategies to Expand CGM Coverage
The Center for Health Care Strategies published a report examining how state Medicaid programs can expand access to continuous glucose monitors for beneficiaries with diabetes. The report addresses coverage policies, prior authorization requirements, and reimbursement strategies that states can implement to improve glucose management technology access. It highlights disparities in diabetes outcomes among Medicaid populations and presents policy options for removing barriers to CGM adoption. The recommendations are relevant for managed care organizations responsible for implementing durable medical equipment benefits and managing diabetes care quality metrics.
- State Policy · WA
Washington State Receives Recognition for Medicaid Reentry Program
Washington State has been recognized for its Medicaid reentry program serving justice-involved individuals. The program represents state-level implementation of policies enabling Medicaid coverage for incarcerated individuals in the period before release. This recognition highlights Washington's approach to establishing pre-release Medicaid enrollment and services. The program is part of broader state efforts to implement Section 1115 waiver authority or state plan amendments that allow Medicaid coverage for certain services during incarceration, particularly for individuals with behavioral health and substance use disorder needs.
- State Policy · GU
Guam Receives National Award for Medicaid IT System Modernization
Guam's Medicaid program received a national award for its innovative collaboration to modernize its IT systems and operations. The recognition highlights the territory's approach to upgrading its Medicaid infrastructure. The award comes from the National Association of Medicaid Directors.
- State Policy
State Medicaid Directors Report Section 1115 Waiver Approval Delays at CMS
The National Association of Medicaid Directors (NAMD) has raised concerns about delays and challenges in the Section 1115 waiver approval process at CMS. Section 1115 waivers allow states to test innovative approaches in their Medicaid programs, including managed care delivery system reforms, coverage expansions, and payment models. The delays affect states' ability to implement planned program changes and innovations. This matters for Medicaid managed care organizations because Section 1115 waivers frequently authorize new managed care authorities, quality initiatives, value-based payment arrangements, and coverage requirements that MCOs must operationalize.
- State Policy
NAMD Calls for Congressional Action to Improve Section 1115 Waiver Process
The National Association of Medicaid Directors is urging Congress to reform the Section 1115 waiver system to better support state innovation in Medicaid programs. NAMD argues the current waiver process limits states' ability to pursue program improvements aligned with health and wellness goals. The commentary does not specify particular legislative proposals or timelines. For Medicaid managed care organizations, waiver reforms could expand opportunities for state-MCO partnerships on value-based care, social determinants of health interventions, and delivery system innovations.
- State Policy
NAMD Reports State Medicaid Budget Pressures in 2024
The National Association of Medicaid Directors released a discussion on budget challenges facing state Medicaid programs. States are confronting fiscal pressures as Medicaid enrollment stabilizes post-unwinding and healthcare costs rise. The document addresses how budget constraints affect program design, benefits, and provider rates. State Medicaid directors are navigating these fiscal realities while maintaining program coverage and quality requirements.
- State Policy · MN
Minnesota Counties Report Administrative Strain from Medicaid Renewal Processing
Minnesota counties are experiencing significant administrative burden processing Medicaid renewals following the end of the continuous enrollment period. Dual-eligible beneficiaries and tribal members report receiving inappropriate redetermination notices despite categorical eligibility protections. Counties cite inadequate state support and staffing shortages as renewal volumes exceed capacity. The processing delays affect timely coverage determinations for beneficiaries who should maintain continuous eligibility under federal and state rules.
- State Policy · AZ
Arizona Democrats Report Coverage Losses One Year After Federal Budget Reconciliation
Democrats in Arizona are reporting increased coverage losses among state residents one year after enactment of the "One Big Beautiful Bill Act," federal budget reconciliation legislation that reduced federal spending on healthcare programs including Medicaid. The officials indicate families in Arizona have experienced difficulty accessing public coverage. The law, signed by President Trump in 2025, included cuts to programs serving lower-income populations. State leaders are documenting the legislation's effects on Arizona's Medicaid program and beneficiary enrollment.