State Policy
Latest
- State Policy
Advocacy Group Recommends Using State Advisory Councils to Track Work Requirement Implementation
The National Health Law Program published guidance recommending that state advocates use Medicaid Advisory Committees and Beneficiary Advisory Councils to monitor implementation of work requirements mandated under recent federal legislation. The organization cites the rapid timeline states face to implement these changes as creating monitoring challenges. The guidance aims to help advocates track how states operationalize the new requirements through existing advisory body structures. While the article provides advocacy strategy recommendations, it does not detail specific work requirement provisions, state implementation timelines, or federal enforcement mechanisms.
- State Policy · MI
Michigan Medicaid Expansion Linked to Better Health Outcomes, Financial Stability
A University of Michigan study found that the Healthy Michigan Plan improved health care access, health outcomes, and financial stability for low-income adults enrolled in the state's Medicaid expansion program. The findings arrive as Congress prepares to implement new Medicaid work requirements starting January 2027, which will require many expansion enrollees nationwide to document employment or other qualifying activities. The study provides evidence of expansion's impact as policymakers debate work requirement policies.
- State Policy · OH
Ohio projects 51,000 job losses, $5.3B economic impact from Medicaid cuts by 2029
A new analysis projects Ohio will lose 51,000 jobs and $5.3 billion in economic activity by 2029 due to Medicaid and food assistance cuts enacted in 2025 federal spending legislation, combined with the expiration of Affordable Care Act subsidies. The projections reflect the full phase-in of these policy changes over the next several years. The analysis highlights state-level economic consequences of federal budget decisions affecting health coverage programs.
- State Policy · IN
Indiana Proposes Major Revisions to Residential Care Facility Rights and Eviction Rules
The Indiana Department of Health published proposed amendments to regulations governing residential care facilities, addressing resident rights, residency agreements, and involuntary evictions under 410 IAC 16.2-5. The proposal represents one of the most significant updates to Indiana's assisted living regulatory framework in recent years. The changes are intended to align Indiana's rules with current standards, though the effective date and comment period are not specified in the available excerpt. The revisions will affect assisted living providers and may impact Medicaid managed care organizations that contract with residential care facilities for long-term services and supports.
- State Policy · CA
California DMHC Finds 70 Knox-Keene Violations in Commercial Plan Behavioral Health Audits
The California Department of Managed Health Care identified 70 Knox-Keene Act violations across three investigation rounds involving commercial health plans' delivery of behavioral health services for mental health and substance use disorder treatment. The violations indicate systemic failures in timely access to care. While these investigations targeted commercial plans regulated under Knox-Keene, the findings may signal enforcement priorities that could extend to Medi-Cal managed care plans, which are also subject to DMHC oversight and similar network adequacy standards for behavioral health.
- State Policy · MS
Mississippi Medicaid Seeks Court Approval to Withhold $2.4M Payment to Greenwood Leflore Hospital
The Mississippi Division of Medicaid filed a motion in bankruptcy court Wednesday requesting permission to withhold a scheduled $2.4 million payment to Greenwood Leflore Hospital. The hospital, currently operating under Chapter 11 bankruptcy protection, has warned the payment withholding could force immediate closure. The dispute arises as the state Medicaid program exercises its authority to recoup or withhold payments from providers in financial distress. If approved, the action would remove critical operating revenue from a hospital serving a predominantly Medicaid-eligible population in the Mississippi Delta.
- State Policy · NC
North Carolina Proposes Stricter ABA Therapy Rules Amid $505M Medicaid Spending
North Carolina lawmakers are pursuing tighter regulatory requirements for applied behavioral analysis (ABA) therapy providers following combined state and federal Medicaid spending of over $505 million in 2025. The proposed rules aim to reduce fraud and abuse in the rapidly growing autism treatment sector. The legislation would impose additional credentialing, supervision, and documentation standards on ABA providers participating in Medicaid. This follows nationwide scrutiny of ABA billing practices and improper payments in state Medicaid programs.
- State Policy · TN
Tennessee Pharmacies Dispense High-Dose Ivermectin Under Standing Order Law
Since Tennessee enacted the nation's first law in 2021 allowing pharmacies to sell ivermectin without patient-specific prescriptions, dozens of pharmacies now dispense highly concentrated ivermectin pills under standing orders, many facilitated by a single anti-vaccine physician. The law permits pharmacies to dispense prescription drugs through protocol agreements with physicians rather than individual patient prescriptions. This arrangement allows pharmacies to sell potent formulations of ivermectin directly to consumers under medical standing orders, bypassing traditional prescribing requirements.
- State Policy · CT
Connecticut Faces Loss of 110,000 Adult Medicaid Enrollees
Connecticut anticipates approximately 110,000 low-income adults could lose Medicaid coverage, prompting state officials to develop strategies to prevent increased uninsured emergency department utilization. The coverage losses stem from ongoing Medicaid redeterminations following the end of continuous enrollment protections. State officials are working to transition affected enrollees to alternative coverage options and prevent gaps in care. The unwinding creates operational challenges for Connecticut managed care organizations managing member retention and care continuity.
- State Policy
State Reproductive Health Policies Create Unequal Access Across U.S., KFF Analysis Finds
A KFF analysis published in The Milbank Quarterly documents how state-level policy decisions create significant variation in reproductive healthcare access across the United States. The research examines state choices on contraception coverage, abortion restrictions, and maternal health programs that directly affect Medicaid beneficiaries. State policy differences impact managed care organizations' benefit design, network requirements, and care coordination obligations. The analysis highlights how states' Medicaid program structures and regulatory frameworks shape reproductive health service delivery and access for MCO enrollees.
- State Policy
States Propose Changes to Immigrant Health Coverage and Enforcement in 2025-2026 Sessions
Multiple states are introducing legislation affecting immigrants' access to state-funded health coverage and services during the 2025-2026 legislative sessions. The actions include both expansions and restrictions to coverage eligibility, with direct implications for Medicaid and CHIP programs that serve immigrant populations. Changes vary by state and may affect enrollment, eligibility verification processes, and state budget obligations. Medicaid managed care organizations should monitor state-level developments that could alter their member demographics, revenue streams, and compliance requirements for serving immigrant populations.
- State Policy · MO
Missouri Eliminates Medicaid Coverage for Chiropractic Services Due to Budget Cuts
Missouri has eliminated Medicaid coverage for chiropractic services following state budget cuts, reversing a 2018 legislative expansion that added chiropractors as covered providers. The change affects access to non-opioid pain management services for Medicaid enrollees. The elimination comes despite earlier projections that chiropractic coverage would reduce overall Medicaid costs. The policy change takes effect immediately as part of broader Medicaid budget reductions.
- State Policy · WA
Washington Sued Over Medicaid Assisted Living Funding Cuts
Washington state faces litigation over budget cuts that reduced tens of millions in state funding for assisted living facilities serving Medicaid patients. Democratic lawmakers made the cuts to address a budget shortfall this year. The lawsuit challenges the state's decision to reduce payments to these facilities. The cuts affect assisted living providers that rely on Medicaid reimbursement for long-term care services.
- State Policy
State Medicaid Fraud Crackdowns Reduce Provider Access for Disability Services
States are implementing stricter fraud enforcement measures in Medicaid programs serving people with disabilities, following federal directives. The increased scrutiny has led to provider exits from Medicaid networks, creating access challenges for beneficiaries requiring home and community-based services and other disability supports. States are balancing program integrity goals against network adequacy concerns as providers cite compliance burdens and payment delays. The enforcement trend affects multiple states and continues to evolve as federal Medicaid policy emphasizes fraud prevention.
- State Policy · IN
Indiana Expands Civil Commitment Standard, Links Homelessness Law to Emergency Detention
Indiana Senate Enrolled Act 285 broadens the state's definition of "gravely disabled" for involuntary civil commitment purposes and establishes a new framework requiring law enforcement to assess the need for emergency detention before enforcing criminal penalties for unauthorized camping or sleeping on public property. The misdemeanor street-camping provisions take effect July 1, 2026. The law creates a mandatory assessment pathway that directs individuals experiencing psychiatric crises toward treatment rather than immediate criminal sanctions. For Medicaid managed care organizations operating in Indiana, this changes the front-end pipeline for behavioral health emergency services and may affect contractual obligations around crisis response and emergency detention coordination.
- State Policy · MN
Minnesota Reinstates Medicaid Payments to Thousands of Providers After May Anti-Fraud Cutoff
The Minnesota Department of Human Services is resuming Medicaid payments to most providers cut off in May 2025 during a mass anti-fraud action tied to a federal deadline. The state notified providers Wednesday that payments would be reinstated for those who appealed their terminations. The original cutoff affected thousands of care providers across the state. This reversal follows pushback from providers who were caught in the broad enforcement sweep and suggests the state's initial termination process may have been overly expansive.
- State Policy
Child Medicaid and CHIP Enrollment Down 2 Million Since January 2025
Child enrollment in Medicaid and CHIP has declined by more than 2 million since January 2025, according to Georgetown University's Center for Children and Families. The declines vary significantly by state and affect children in working families who often lack access to affordable employer-sponsored coverage. The enrollment losses represent a continuation of coverage instability following the end of the Medicaid continuous enrollment provision. These drops matter because many affected children become uninsured rather than transitioning to other coverage.
- State Policy · PA
Pennsylvania Lawmakers Push PBM Oversight After 1,000+ Pharmacy Closures Since 2020
Pennsylvania has lost over 1,000 pharmacies since 2020, prompting state lawmakers to pursue legislative action targeting pharmacy benefit managers. A Pennsylvania Department of Human Services official expressed skepticism about a legislative proposal to hire a PBM to oversee other PBMs. The legislative effort aims to address pharmacy closures attributed to PBM practices, though specific proposals and timelines are not detailed in the available information.
- State Policy · RI
Rhode Island Faces Decision on Medicaid Coverage for GLP-1 Weight Loss Drugs
Rhode Island is considering whether to maintain Medicaid coverage for GLP-1 medications used to treat obesity, amid national debate over cost and access. The state has historically prioritized public health initiatives addressing health disparities and nutrition. The decision affects coverage policy for medications like Wegovy and Zepbound for Medicaid beneficiaries with obesity. Rhode Island's choice will impact managed care organizations' pharmacy benefits and utilization management protocols for this high-cost drug class.
- State Policy
Planned Parenthood Closes 60 Clinics Amid State Funding Restrictions
Nearly 60 Planned Parenthood clinics have closed or consolidated since last year due to state-level funding restrictions, according to a KFF report. The closures affect access to family planning, STI testing, and preventive care services in affected communities. The timing and specific states are not detailed in the brief article, but the trend reflects ongoing state policy actions targeting reproductive health funding. For Medicaid managed care organizations, these closures may disrupt member access to covered family planning services and require network adequacy adjustments in affected service areas.