State Policy
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- State Policy · TN
Tennessee Law Mandates Immigration Data Sharing for Children's Special Services Enrollees
Tennessee enacted legislation requiring state agencies to share data on public assistance program applicants and enrollees without qualified immigration status with federal immigration authorities. This requirement extends to the Children's Special Services program, which serves children with disabilities. The law affects eligibility and enrollment processes for state public assistance programs, including Medicaid-adjacent services. The policy creates operational challenges for managed care organizations and providers serving mixed-status families, potentially reducing program participation and complicating outreach and enrollment activities.
- State Policy
NASHP Releases Model Legislation Tying State Drug Pricing to Medicare Negotiated Rates
The National Academy for State Health Policy published revised model legislation allowing states to reference Medicare Maximum Fair Prices negotiated under the Inflation Reduction Act when setting prescription drug payment rates for state programs. The model act would apply to state-funded programs including Medicaid fee-for-service and potentially managed care pharmacy benefits. States can adapt the model to tie reimbursement rates to Medicare's negotiated prices for high-cost drugs, creating potential benchmark pricing constraints. The legislation offers states a mechanism to leverage federal negotiating power for prescription drug cost containment.
- State Policy · CA
California Grants Staffing Waivers to 23 Psychiatric Hospitals After New Nurse Ratio Rules
California's Department of Public Health approved temporary waivers for 23 of 35 psychiatric hospitals required to comply with new nurse-to-patient ratios that took effect June 1, 2026. The regulations mandate one nurse per six adult patients and one nurse per five youth patients in psychiatric units. The waivers allow non-compliant facilities to continue operating while they work toward meeting staffing requirements. This affects Medicaid managed care organizations with behavioral health carve-ins or delegated inpatient psychiatric contracts, as network adequacy and access standards depend on participating hospitals maintaining operational capacity.
- State Policy · ID
Idaho Behavioral Health Council Recommends Rural Opioid Funding Priority
Idaho's Behavioral Health Council is recommending that the state legislature direct opioid settlement funds toward rural communities in upcoming funding decisions. The council, which includes representatives from all three branches of state government, will present project proposals prioritizing rural areas. This recommendation comes as Idaho determines allocation of settlement funds received from opioid litigation. The focus on rural communities reflects ongoing challenges in accessing behavioral health services in non-urban areas of the state.
- State Policy · CA
California Report Examines Undocumented Residents' Medi-Cal Access Under Enforcement Climate
A California Health Care Foundation report based on interviews with 39 undocumented Californians analyzes how recent Medi-Cal eligibility expansions interact with heightened immigration enforcement concerns. The qualitative research explores coverage enrollment decisions, trust barriers, and healthcare access patterns among undocumented individuals now eligible for Medi-Cal under California's eligibility expansions. The report documents how immigration policy uncertainty affects enrollment behavior and continuity of coverage even when individuals are legally eligible for benefits. Findings inform outreach strategies and enrollment retention efforts for managed care plans serving this population in California.
- State Policy
Young Children's Uninsurance Rises Faster Than School-Age Peers Pre-2025
Analysis shows young children experienced faster uninsurance growth compared to school-aged children prior to 2025 Medicaid enrollment declines. The trend emerged before recent federal policy changes including Trump administration actions and H.R. 1 proposals. The data suggests underlying coverage gaps for young children independent of current redeterminations. States may need targeted outreach and enrollment strategies for families with young children to reverse the trend.
- State Policy · CT
Connecticut Medicaid Spending Rose in 2024 but Remained Lowest Per-Member Cost
Connecticut's Medicaid program experienced spending increases in 2024 while maintaining the lowest per-enrollee costs compared to commercial insurance markets in the state. The data shows Medicaid's cost efficiency persisted despite upward spending pressure. The comparison encompasses all insurance market segments operating in Connecticut. Medicaid managed care organizations in the state continue to deliver care at lower per-member costs than commercial carriers, though absolute spending grew year-over-year.
- State Policy · IL
Illinois Law Restricts Out-of-State Access to Abortion, Gender Dysphoria Records
Illinois Governor J.B. Pritzker signed the Reproductive Health Records Privacy Act on June 24, 2025, requiring abortion services and gender dysphoria diagnoses to be separated from patients' electronic medical records and limiting disclosure to out-of-state entities. The law takes effect July 1, 2027. Healthcare providers, including Medicaid managed care organizations, must implement new record-keeping protocols to segregate these specific health information categories and establish controls preventing out-of-state disclosure.
- State Policy · CA
California Replaces Mental Health Services Act with New Behavioral Health Services Act
California has replaced the Mental Health Services Act (MHSA) with the Behavioral Health Services Act (BHSA), changing how counties allocate mental health funding. The BHSA modifies funding allocation requirements and county spending priorities for mental health and substance use disorder services. The change affects how counties structure behavioral health programs and redirect existing MHSA revenues. California Health Care Foundation has published resources detailing the differences between the two funding frameworks.
- State Policy · KY
Kentucky Directs Opioid Settlement Funds to Rural Substance Use Services
Eastern Kentucky is using opioid settlement funding to support programs addressing substance use disorders, housing instability, and food insecurity in rural communities. The initiative targets regions heavily affected by the opioid crisis with integrated support services. No specific implementation timeline or funding amount is provided in the reporting. This represents Kentucky's approach to deploying settlement resources for behavioral health infrastructure in underserved areas.
- State Policy · FL
Florida AG Opens Antitrust Investigation Into CVS Pharmacy Practices
Florida Attorney General Ashley Moody has launched an investigation into CVS Health for alleged anticompetitive pharmacy practices. The probe examines whether CVS is using its integrated pharmacy benefit manager and retail pharmacy operations to disadvantage competitors and increase drug costs. This investigation follows similar state-level actions targeting PBM practices and comes amid broader scrutiny of vertical integration in the pharmacy supply chain. The inquiry could result in enforcement actions, consent agreements, or legislation affecting how PBMs operate in Florida's commercial and Medicaid markets.
- State Policy · NM
New Mexico Behavioral Health Restructuring Causes Regional Implementation Conflicts
New Mexico is experiencing confusion and conflicts as it implements a new regional structure to rebuild its behavioral health infrastructure. State officials are working to repair the system, but the restructuring has created challenges at the community level. The article does not specify implementation timelines or affected populations. This matters for Medicaid managed care organizations because behavioral health network adequacy and provider coordination are core contractual requirements, and state infrastructure changes can disrupt existing MCO networks and referral pathways.
- State Policy · MI
Michigan Erases $74M in Medical Debt Through Nonprofit Partnership
Michigan has eliminated over $74 million in medical debt for 71,871 residents through a partnership with nonprofit Undue Medical Debt, bringing the state's total debt relief to more than $200 million. Governor Gretchen Whitmer's office announced the initiative on June 22. The program targets qualifying residents with medical debt, though specific eligibility criteria and coverage periods were not detailed in the announcement. This marks Michigan's continued expansion of its medical debt relief efforts using state budget allocations to purchase and forgive outstanding hospital and provider balances.
- State Policy · WV
West Virginia Prepares for Federal Medicaid Work Requirements with New Website
West Virginia's Department of Human Services launched an information website and is requesting Medicaid recipients update their contact information ahead of new federal Medicaid work requirements taking effect in 2026. The state is preparing to implement work requirements that will affect certain Medicaid enrollees, though specific eligibility criteria and exemptions have not been detailed. The initiative signals active state-level preparation for federal policy changes that will require states to verify work activity for non-exempt adult Medicaid recipients.
- State Policy · PA
Pennsylvania Projects $5.6 Billion Budget Deficit, May Tap $8 Billion Rainy Day Fund
Pennsylvania faces a $5.6 billion budget deficit for fiscal year 2026-27, according to the Independent Fiscal Office. Governor Shapiro's budget proposal projects using $4 billion from the state's rainy day fund, assuming new revenue from legalizing marijuana and taxing skill games. Without new revenue sources, the state will need to drain reserve funds, implement spending cuts, or use accounting maneuvers to balance the budget by the June 30 deadline. Senate Republicans have discussed cutting Medicaid and SNAP spending, though specifics have not been provided. The state has already drawn down $6.6 billion from reserves over the past two fiscal years.
- State Policy · LA
Planned Parenthood to Reopen Louisiana Clinic After Medicaid Funding Cut Closures
Planned Parenthood plans to open a New Orleans clinic later this year and begin telehealth services this summer, following the closure of its two Louisiana clinics last fall. The closures resulted from Trump administration Medicaid funding cuts. The reopening represents a return of Planned Parenthood services to Louisiana after a multi-month gap in availability. The organization will phase in brick-and-mortar and virtual care access.
- State Policy · ME
Maine GOP Group Petitions DHHS for Stricter MaineCare Anti-Fraud Rules
Lead Maine, a Republican-led advocacy group, submitted over 3,500 signatures petitioning the Maine Department of Health and Human Services to adopt new anti-fraud rules for the state's MaineCare program. The group, led by State Rep. Laurel Libby, argues the proposed changes would strengthen oversight of MaineCare providers and taxpayer spending. The petition seeks mandatory rulemaking to establish additional fraud prevention and program integrity requirements. If the petition meets statutory requirements, DHHS would be required to initiate a formal rulemaking process, including public comment periods and potential implementation timelines.
- State Policy · KY
Kentucky Medicaid Director Lisa Lee Discusses People-Centered Policy Approach
The National Academy for State Health Policy spotlighted Kentucky Medicaid Director Lisa Lee, who outlined her people-centered approach to shaping the state's Medicaid program. Lee discussed strategies for improving health outcomes across Kentucky's Medicaid population through policy design focused on beneficiary needs. The interview covered her leadership vision and priorities for the state's program. Kentucky operates a managed care delivery system serving over 1.6 million beneficiaries through five contracted MCOs.
- State Policy · MI
Michigan House Speaker Proposes Hospital Cost Review Board, 10% Price Caps
Michigan House Speaker Matt Hall introduced legislation establishing a state hospital cost review board with authority to cap healthcare prices and restrict hospital consolidation. The bill would impose a 10% reduction on certain hospital prices and create new regulatory oversight of hospital costs. The Michigan Health & Hospital Association opposes the measure, arguing it would worsen affordability challenges. If enacted, the law would apply to all hospitals operating in Michigan, including those contracting with Medicaid managed care organizations.
- State Policy · NV
Nevada Enacts AI Restrictions for Mental Health and Emergency Services
Nevada has enacted regulations limiting artificial intelligence use in mental and behavioral health situations and emergency planning, despite federal opposition to AI regulation. The state joins a small group of jurisdictions implementing AI guardrails in healthcare settings. The restrictions affect how providers and plans can deploy AI tools in clinical decision-making for mental health services and crisis response. Implementation details and effective dates were not specified in available reporting.