State Policy
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- State Policy
NASHP Hosts Webinar on State Prescription Drug Cost Data and Policy Strategies
The National Academy for State Health Policy will hold a webinar on June 25, 2026, from 1–2 p.m. ET focusing on how states use prescription drug cost data to inform policy decisions. The session will examine state-level approaches to managing pharmaceutical spending. For Medicaid managed care organizations, state prescription drug cost initiatives can lead to new reporting requirements, formulary restrictions, or supplemental rebate negotiations that affect pharmacy benefit management and claims administration.
- State Policy
NASHP Summarizes State Medicaid Reentry Initiatives from Two-Year Learning Network
The National Academy for State Health Policy published findings from a two-year collaborative examining how states expand Medicaid access for individuals reentering communities after incarceration. The report highlights state approaches to enrollment, care coordination, and coverage continuity during the transition from correctional facilities. States face operational challenges linking justice systems with Medicaid eligibility systems and coordinating behavioral health and substance use disorder services. The work is relevant for MCOs operating in states implementing reentry initiatives, which may require dedicated care management protocols and cross-agency data sharing.
- State Policy · NC
North Carolina Prepares to Implement 2025 Reconciliation Law Medicaid Provisions Amid Budget Shortfalls
North Carolina is developing plans to implement Medicaid provisions from the 2025 reconciliation law while facing budget constraints. The state is preparing policy changes that will affect Medicaid coverage and beneficiary access to care. Implementation details are emerging as North Carolina managed care organizations and state officials work through operational and financial implications. The reconciliation law's Medicaid provisions, combined with state budget pressures, will require MCOs to adjust operations, network management, and benefit administration.
- State Policy · ID
Idaho Seeks Waiver to Move Medicaid Enrollees to ACA Marketplace Coverage
Idaho has submitted a waiver application requesting federal approval to transition certain Medicaid enrollees to ACA Marketplace plans while maintaining Medicaid-specific requirements, including work requirements. If approved, affected enrollees would face higher out-of-pocket costs and reduced benefit protections compared to traditional Medicaid coverage. The proposal would impact thousands of Idaho residents currently enrolled in Medicaid. Managed care organizations operating in Idaho should monitor this waiver for potential impacts on enrollment, member cost-sharing, and program design if the administration approves the state's request.
- State Policy · KS
Kansas Legislature Permanently Fixes CHIP Eligibility Law After Multi-Year Waiver Workaround
Kansas enacted legislation in its 2026 session to permanently update state CHIP eligibility rules, ending reliance on temporary federal waivers that previously allowed eligible children to access coverage. The statutory change ensures continuous CHIP enrollment for qualifying Kansas children without recurring waiver renewals. The law codifies eligibility standards that had only been maintained through waiver authority, eliminating administrative uncertainty for families and the state Medicaid agency. This matters for managed care organizations administering Kansas CHIP because it stabilizes the enrolled population and removes the risk of coverage disruptions tied to waiver expiration.
- State Policy
NASEM Report Highlights Maternal Mortality Gaps, Medicaid Coverage Extensions
The National Academies of Sciences, Engineering, and Medicine released a report on maternal mortality showing Black mothers face a maternal mortality rate of 44.8 deaths per 100,000 live births in 2024, significantly higher than other populations. The report emphasizes the importance of Medicaid postpartum coverage extensions, which 46 states and DC have now adopted to address pregnancy-related complications beyond 60 days. For Medicaid managed care organizations, this underscores the need for enhanced care coordination, cardiovascular screening protocols, and culturally competent care delivery for high-risk maternal populations through the extended 12-month postpartum period.
- State Policy · TX
Texas Case Highlights Medicaid Gaps in Postpartum Mental Health Coverage for Black Mothers
A Lufkin, Texas mother charged after exhuming her stillborn daughter's remains illustrates systemic failures in Medicaid postpartum mental health coverage, particularly for Black women who face maternal mortality rates nearly three times higher than white women. The case underscores inadequate screening, follow-up, and culturally competent behavioral health services during the extended postpartum period when grief and mental health crises peak. Texas Medicaid managed care plans must assess whether their networks adequately address perinatal mental health needs and racial disparities in maternal outcomes, especially as federal Medicaid postpartum coverage extends to 12 months in participating states.
- State Policy · NE
Nebraska Launches H.R. 1 Medicaid Work Requirements May 1 Despite Implementation Gaps
Nebraska became the first state to implement work reporting requirements under H.R. 1 on May 1, 2026, despite noted implementation gaps. The state initiated a "soft start" approach, though specifics of enforcement and beneficiary communications remain unclear. Medicaid managed care plans operating in Nebraska should expect member eligibility disruptions as work reporting compliance becomes a redetermination criterion. Plans must prepare for enrollment volatility, potential member outreach responsibilities, and coordination with state agencies on verification processes as other states follow Nebraska's rollout timeline.
- State Policy · CA
California to Cut Medi-Cal Dental Benefits for 2 Million Immigrants in July 2026
California will eliminate full-scope dental coverage for approximately 2 million adult immigrants enrolled in state-only funded Medi-Cal effective July 1, 2026, limiting them to emergency dental services only. Pregnant individuals retain full dental benefits during pregnancy and for 12 months postpartum. This policy reversal affects immigrants in state-funded Medi-Cal programs who previously gained comprehensive dental coverage. Managed care organizations administering Medi-Cal dental benefits will need to adjust benefit packages, care coordination protocols, and provider network contracts to reflect the reduced scope of services for this population beginning mid-2026.
- State Policy
NHeLP Brief Analyzes ADA Challenge to State Vaccine Mandate Prohibitions
The National Health Law Program released an issue brief examining potential Americans with Disabilities Act challenges to state laws that prohibit or weaken vaccine mandates. The brief addresses a growing trend of state legislation expanding vaccine exemptions, with Florida poised to become the first state to ban public vaccine requirements. The analysis is relevant to Medicaid managed care organizations that serve immunocompromised enrollees and children with disabilities who face heightened risks when community vaccination rates decline. MCOs may need to assess how state vaccine policy changes affect care management protocols and member safety.
- State Policy · CA
California Budget Proposes Cutting Community-Based Mobile Crisis Response Services
California's Administration has proposed cutting funding for community-based mobile crisis response services, which provide 24/7 in-person behavioral health crisis intervention in homes, schools, and community settings. These services involve specially trained crisis response teams with specific composition and timeliness requirements. The National Health Law Program argues the proposed cuts will harm beneficiaries without generating real savings. The timing and effective date of potential cuts remain unclear, but managed care organizations with behavioral health responsibilities should monitor this budget proposal as it could affect crisis service availability and network adequacy requirements.
- State Policy · CA
California Proposes Applying Federal Work Requirements to State-Funded Immigrant Medicaid Coverage
California is considering extending work requirements from the 2025 Reconciliation Act (H.R. 1/OBBBA) to immigrants covered through state-only Medi-Cal funding, despite the Governor's Office previously calling OBBBA "not cost-saving" and "cruel." State stakeholders project the requirements will cause coverage losses through administrative churn rather than generate savings. The proposal would affect immigrants ineligible for federally-funded Medicaid who currently receive state-funded benefits. This marks a significant policy shift as California would voluntarily apply federal work requirement provisions to populations the federal mandate does not reach.
- State Policy · CA
Federal Marketplace Rule and H.R.1 Target California Exchange Coverage
The Trump Administration's Marketplace Final Rule and pending H.R.1 legislation contain provisions that could significantly reduce enrollment and affordability in Covered California and other state-based marketplaces. The changes affect eligibility, premium subsidies, and plan requirements that have expanded coverage since the ACA's implementation. California Medicaid managed care organizations may see enrollment shifts as marketplace enrollees lose coverage or face higher costs. Implementation timelines depend on final regulatory effective dates and congressional passage of H.R.1.
- State Policy
Federal SNAP Changes Trigger Child Eligibility Losses in Multiple States
New federal legislation (H.R. 1) has resulted in a sharp decline in the number of children receiving SNAP food assistance, despite children not being an explicit target of the policy changes. The law has created cost shifts and access barriers at the state level that are reducing participation among low-income children. The changes affect dual-eligible families who often qualify for both SNAP and Medicaid, creating potential coordination issues for managed care organizations serving mothers and children. States must navigate new administrative requirements that may complicate enrollment processes for families receiving multiple benefits.
- State Policy
State Implementation Timeline for H.R. 1 Medicaid Work Requirements and Eligibility Changes
States are implementing eligibility changes mandated by H.R. 1, including work requirements for Medicaid beneficiaries, immigration-related funding restrictions, elimination of retroactive coverage, and transition to six-month renewals for certain populations. The resource provides key implementation dates as states operationalize these federal policy changes. Managed care organizations should prepare for enrollment volatility, increased disenrollment, and potential changes to capitation rates as states comply with these new requirements. MCOs will need to coordinate with states on member outreach, data reporting for work requirement verification, and network adequacy planning for smaller enrolled populations.
- State Policy
House Bill Would Expand Federal Authority to Block Safety Net Program Funding
Proposed federal legislation would make it easier for the administration to block funding for programs including Medicaid, SNAP, and housing assistance. The bill affects state-administered programs where states rely on federal matching funds and federal payment systems. Critics argue the measure could disrupt payments to eligible beneficiaries under the guise of fraud prevention, potentially affecting Medicaid managed care capitation payments and beneficiary enrollment. The timing and specific legislative text remain unclear from this excerpt.
- State Policy · MT
Montana Accelerates Medicaid Work Requirements Implementation Amid Budget Pressures
Montana is implementing federal Medicaid work requirements six months ahead of the federal deadline as the state faces budget constraints for health services. The accelerated timeline affects Medicaid beneficiaries who will need to meet work requirements sooner than originally planned. Montana joins several other states experiencing financial pressures while implementing these federal policy changes. The early implementation may impact managed care organizations' member enrollment and administrative processes as they prepare systems and provider networks for potential coverage changes.
- State Policy
Interactive Map Tracks Current Status of State Medicaid Expansion Decisions
A resource page provides an interactive map showing which states have adopted, rejected, or are considering the Affordable Care Act's Medicaid expansion. The map tracks the current status of all state decisions regarding expansion eligibility for adults up to 138% of the federal poverty level. This affects managed care organizations by indicating potential market opportunities in expansion states and enrollment growth projections. The resource includes additional links to Medicaid expansion policy materials.
- State Policy
States Align Community Supervision and Health Services for Justice-Involved Reentry
NASHP published guidance on how states can coordinate community supervision and health services to support individuals reentering communities from correctional facilities. The collaboration aims to reduce recidivism and improve public safety through aligned health and supervision services. States can use these strategies to better serve justice-involved populations who often qualify for Medicaid upon release. This matters for Medicaid managed care organizations because justice-involved individuals represent a high-need, high-cost population requiring coordinated behavioral health, substance abuse, and primary care services.
- State Policy · MA
Massachusetts Expands Behavioral Health Integration Through Sub-Capitation Program
MassHealth has implemented a sub-capitation program that uses tiered primary care payments to increase integrated behavioral health access. The program creates financial incentives for primary care providers to build advanced behavioral health capacity within their practices. This approach represents a significant shift in how states can structure payment mechanisms to promote behavioral health integration. The model could serve as a template for other state Medicaid programs seeking to improve behavioral health access through innovative payment arrangements.