State Policy
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- State Policy · AR
Arkansas Approves $48M Contract for Medicaid Call Center
The Arkansas Legislative Council approved a three-year, $48 million contract with the Arkansas Foundation for Medical Care to build a customer service center fielding questions about Medicaid, SNAP and other Department of Human Services programs. The center will launch with questions about the state's Medicaid expansion program before phasing in other programs monthly, with Division of Children and Family Services questions not covered until a possible fourth year. The agency has sought a vendor for about three years to consolidate what officials described as an uncoordinated system of multiple phone numbers and mailboxes across county offices. The contract comes as Medicaid and SNAP cuts under the 2025 federal budget law take effect January 1, and as Arkansas awaits formal word on the Trump administration's denial of a five-year extension of its Medicaid expansion program.
- State Policy · NC
North Carolina Funds Practice Supports to Expand Collaborative Care Model
In a NASHP blog post, the organization describes North Carolina's multi-year strategy to expand adoption of the Collaborative Care Model (CoCM), a behavioral health integration approach for primary care. Starting in 2022, the state raised Medicaid reimbursement for CoCM to 120 percent of the 2022 Medicare fee schedule, eliminated beneficiary copays, aligned billing across payers, and launched a statewide CoCM Consortium. In 2025, North Carolina added roughly $5 million in federal Medicaid expansion incentive funding to a Capacity Building Fund, awarding 81 grants of up to $50,000 across 113 primary care sites. Between CY2023 and the end of CY2025, monthly CoCM beneficiaries and billing providers grew 3.5-fold, reaching about 2,000 beneficiaries and 200 providers, with early data showing meaningful remission and symptom improvement rates.
- State Policy · CT
Low HUSKY Pay Drives Long Waits for Pediatric Eye Care in CT
The CT Mirror reports that low Medicaid reimbursement rates are causing many Connecticut pediatric ophthalmologists to limit or refuse HUSKY (Medicaid) patients, resulting in waits as long as nine to ten months for children needing eye care, versus three to four months for privately insured patients. Only five of roughly ten pediatric ophthalmologists in the state currently accept new Medicaid patients. Connecticut raised Medicaid rates in 2026 to about 60% of 2025 Medicare rates, its first broad increase since 2008, but doctors and legislators say Gov. Ned Lamont has repeatedly proposed smaller increases than needed. HUSKY covers about a quarter of state residents and half of Connecticut's children, so access gaps have statewide implications.
- State Policy
Missouri, Iowa Decline Hardship Exemptions From Medicaid Work Rules
Some conservative states, including Missouri and Iowa, are declining to adopt hardship exemptions available under new federal Medicaid work requirements, according to experts cited in the article. The requirements, set to take effect January 1, mandate that adults enrolled through ACA Medicaid expansion work, attend school, volunteer, or engage in another qualifying activity for at least 80 hours a month to keep coverage. Hardship exemptions are designed to let states shield low-income enrollees from losing coverage during difficult circumstances, but experts say some states appear to be forgoing them for political reasons. The piece examines how state-level discretion in implementing the federal mandate could affect coverage loss among expansion enrollees.
- State Policy · LA
Louisiana Renews Four Medicaid MCO Contracts Worth $16 Billion
Louisiana's Joint Legislative Committee on the Budget approved renewed Medicaid managed care contracts Thursday with four insurers: Aetna, AmeriHealth Caritas, Humana Health and Louisiana Healthcare Connections, covering roughly 1.2 million of the state's 1.3 million Medicaid enrollees. The deals, ranging from $3.2 billion to $5.8 billion each, bring total managed Medicaid spending to more than $16 billion in calendar year 2027. UnitedHealth and an Elevance Health-Blue Cross Blue Shield of Louisiana joint venture exited the state's Medicaid market this year. Lawmakers pressed state health officials to tie spending to measurable health outcomes, citing Louisiana's last-place national health ranking, and Medicaid director Seth Gold said the state will increase provider accountability and preventive care requirements, including well-baby visits and expanded access to substance-abuse medications. Louisiana Healthcare Connections and Ochsner also reached a network agreement covering 70,000 enrollees just before the vote.
- State Policy · NC
Stein Warns NC Counties Will Bear New Medicaid Rule Costs
Gov. Josh Stein says North Carolina counties will face new administrative costs and staffing burdens implementing federal Medicaid work and eligibility requirements, after the General Assembly rejected his request for state funding to cover those costs. Starting Jan. 1, more than 700,000 North Carolinians enrolled through Medicaid expansion must document at least 80 hours a month of work, education, or community service, and states must run eligibility checks twice yearly instead of annually. State officials estimate the changes will cost North Carolina $44 million in administrative costs and $6.5 million in implementation costs, with county social services departments handling the added eligibility workload. Stein's office estimates over 250,000 residents could lose coverage due to reporting barriers rather than ineligibility, and is urging the state's congressional delegation to reverse the cuts enacted under H.R. 1.
- State Policy · MN
Minnesota Warns It May Claw Back Medicaid Payments From Providers
Minnesota's Department of Human Services told Becker's it may need to recoup Medicaid funds from providers if CMS finalizes a disallowance following a $550 million deferral of state Medicaid funds, disclosed in an Oct. 2 letter from Temporary Commissioner John Connolly. CMS has also proposed deferring $2 billion annually in funding to the state. The dispute follows Minnesota's designation of 14 "high-risk" service areas, a provider enrollment pause across 13 programs starting Jan. 30, 2026, and an off-cycle revalidation of more than 5,000 providers amid fraud concerns federal prosecutors estimated could exceed $9 billion. Minnesota says it has met a CMS-approved corrective action plan and argues deferrals and withholds do not themselves establish fraud; the state's related federal lawsuit over the funding dispute is stayed until at least January.
- State Policy
Tracker Compiles State Abortion Ban Exceptions by Gestational Limit
A policy tracker catalogs the exceptions written into each state's most restrictive abortion gestational limit or total ban. The resource compiles existing state law provisions, such as exceptions for life endangerment, rape, incest, or fetal anomaly, rather than reporting a new policy action. It serves as an ongoing reference rather than a report on a single new development. No new state or federal action is described in this material.
- State Policy · MI
Michigan Erases $21M More in Medical Debt, Third Round
Michigan has eliminated more than $21 million in medical debt for 9,767 residents in its third round of relief through a partnership with nonprofit Undue Medical Debt, according to an Oct. 14 release from Gov. Gretchen Whitmer's office. The effort brings the state's total debt relief to over $221 million. Debt was purchased from anonymous local hospitals and collection agencies, with every $1 in funding eliminating about $100 in debt. Residents earning at or below 400% of the federal poverty level, or whose medical debt exceeds 5% of annual income, qualify automatically and will receive notification letters starting the week of Oct. 14; no application is required. The initiative is funded by a $4.5 million state appropriation from 2024, and Michigan plans further rounds.
- State Policy · KS
Kansas Reflector Ties Masterson's Legislative Record to ALEC Model Bills
A Kansas Reflector investigation finds that Kansas Senate President Ty Masterson, now a Republican candidate for governor, built much of his legislative record using model legislation from the American Legislative Exchange Council, a conservative policy nonprofit where he has served as board member and national chair. The report traces nearly 20 high-profile Kansas bills, including tax cuts, voter citizenship checks, and campus DEI restrictions, to ALEC templates, often without disclosure of their origin. The investigation also notes that Masterson, along with House Speaker Dan Hawkins, has used this ALEC-aligned legislative platform to block Medicaid expansion in Kansas year after year. Masterson has spent $21,000 in campaign funds on ALEC-related travel and dues since 2007.
- State Policy · SD
South Dakota Officials Disagree on Medicaid Ballot Amendment's Effect
South Dakota's Nov. 3 ballot includes Constitutional Amendment I, which addresses what happens to Medicaid expansion if the federal match drops below 90%. Republican legislative backers say the amendment would merely give lawmakers flexibility to decide whether to continue expansion, not end it automatically. But Republican Attorney General Marty Jackley's official ballot explanation states the amendment "ends the expanded Medicaid coverage" if federal funding falls below 90%, directly contradicting the lawmakers' framing. The conflicting interpretations leave roughly 31,000 South Dakotans covered under expansion uncertain about their coverage's fate, with voters deciding the measure without a clear understanding of its legal effect.
- State Policy · NC
Tillis Cites Medicaid Cuts in Criticizing Trump-Backed Megabill
Speaking at a Cary energy conference, retiring U.S. Sen. Thom Tillis and Rep. Tim Moore said they expect North Carolina Republicans to lose ground in the November election, citing weak polling for the GOP and President Trump's low approval rating in the state. Tillis reiterated that he voted against last year's federal budget bill because of provisions that cut roughly $800 million in Medicaid funding from North Carolina, arguing the cuts would hurt constituents and damage Republicans' electoral chances. Tillis is not seeking reelection, and Republican Senate candidate Michael Whatley has trailed Democrat Roy Cooper throughout the race. Moore predicted Republicans would keep their state legislative majority despite possibly losing a few seats.
- State Policy · MI
Benson, James Spar Over Medicaid Cuts in Michigan Governor Debate
Michigan gubernatorial candidates Jocelyn Benson and John James clashed at a Detroit debate hosted by WDIV, each blaming the other's party for the state's problems. Benson, the Democratic secretary of state, cited federal Republican cuts to Medicaid and other programs as a driver of rising healthcare costs, while James, the Republican congressman, pointed to energy policy and criticized eight years of Democratic leadership in Lansing. Benson also attacked James's congressional voting record on SNAP benefit cuts and healthcare premium increases. The debate, part of the general election cycle ahead of Michigan's gubernatorial race, also covered tariffs, gas taxes, and affordability, with no new policy action announced.
- State Policy · AR
Arkansas House Candidates Clash Over Trump Ties, Medicaid Cuts
Democrat Chris Jones and Republican incumbent Rep. French Hill debated Thursday in a closely watched Arkansas 2nd Congressional District race, sparring over Hill's alignment with President Trump and federal budget policy. Jones repeatedly criticized Hill's support for the One Big Beautiful Bill Act of 2025, which is projected to cut Medicaid and food stamp spending by more than $1 trillion over the next decade. The candidates also clashed over the national debt, housing affordability, and a bipartisan housing law Trump initially opposed before allowing it to become law without his signature. Forecasters have recently shifted the race from safe to likely Republican, making it a notable midterm contest in a solidly red state.
- State Policy · IA
CMS Adds Two Iowa Nursing Homes to Special-Focus Watchlist
The Centers for Medicare and Medicaid Services added Adel Acres and Northbrook Healthcare and Rehabilitation Center in Cedar Rapids to its list of facilities eligible for special-focus status, which flags homes with a history of serious, recurring resident-care problems. Adel Acres racked up 24 state and federal violations over the past year, including a resident death from a fall and blunt force head trauma, a medication overdose, and a sepsis case tied to delayed antibiotic treatment, drawing federal fines exceeding $57,000. Northbrook was cited after inspectors found staff failed to monitor catheterized residents' urinary output, leading to a resident's death following acute kidney injury and sepsis; the facility was fined $16,435. Iowa currently has 10 homes in the special-focus pipeline, with two, Garden View Care Center and Pine Acres Rehabilitation and Care Center, already enrolled and subject to inspections every six months.
- State Policy · ME
Dunlap, LePage spar over Medicaid, fraud in Maine House debate
Democrat Matt Dunlap and Republican Paul LePage clashed over Medicaid policy in their final debate for Maine's open 2nd Congressional District seat, hosted by WABI and WAGM ahead of the Nov. 3 election. LePage defended his gubernatorial vetoes of MaineCare expansion bills, arguing low provider reimbursement rates were his real concern, and emphasized fraud in the program while citing a $750 million hospital debt payoff during his tenure. Dunlap countered that LePage's record amounts to opposing Medicaid coverage and cited a federal review showing Maine's Medicaid payment error rate at 2.4%, below the 3.2% national average. The candidates also traded barbs over Social Security characterization and Dunlap's support for Medicare for All.
- State Policy · GA
Georgia Lieutenant Governor Candidates Clash Over Medicaid Expansion
Georgia's lieutenant governor race between Democratic state Sen. Josh McLaurin and Republican state Sen. Greg Dolezal has sharpened into a debate over Medicaid expansion, among other issues, during two debates hosted by the Atlanta Press Club and 11Alive this week. McLaurin is campaigning on fully expanding Medicaid, saying hundreds of thousands of uninsured Georgians, especially in rural areas, need coverage, and he criticized Gov. Brian Kemp's Pathways to Coverage program for spending more on consulting contracts than care. Dolezal backs a more limited "intelligent" expansion plan proposed by Republican gubernatorial nominee Rick Jackson, arguing full expansion would push people off private insurance onto a government plan. Early voting is already underway in Georgia ahead of the election.
- State Policy · MA
Boston Indicators: Work Rules Threaten Overdose Gains in MassHealth
Boston Indicators released a report Thursday estimating that 55 percent of Massachusetts adults with opioid use disorder enrolled in MassHealth, about 33,647 people, will need to satisfy new federal work requirements under the One Big Beautiful Bill Act. The law includes a mandatory "medical frailty" exemption covering people with substance use disorder or in active treatment, but the report warns bureaucratic hurdles in documenting that exemption could cause many to lose coverage. States can use self-attestation to verify work requirements and exemptions in 2027, but stricter verification begins in 2028, raising risk that people will fall through the cracks over time. The report ties potential coverage loss to interrupted access to medications for opioid use disorder, warning this could reverse recent declines in overdose deaths, which fell below 1,000 in Massachusetts in 2025 for the first time in over a decade.
- State Policy · KY
Kentucky Advocates Warn of Looming Medicaid Cuts, Urge Reversal
In a Kentucky Lantern commentary, the author argues that Kentucky faces its largest Medicaid cuts ever, citing federal OBBBA provisions that will strip coverage starting in January and reduce provider payments beginning in 2028, plus state-level cuts set for July 2027 unless the General Assembly restores funding. The author traces a decade-plus history of threatened Medicaid rollbacks in Kentucky, including the 2013 expansion, failed work-requirement bills, and this summer's reversed state payment cuts, arguing that organized public opposition has repeatedly forced lawmakers to pull back before harm occurred. The piece frames the upcoming cuts as the latest cycle in this pattern and calls on Kentuckians to pressure federal and state lawmakers to avert them. The author warns 35 rural hospitals could be at risk of closure if cuts proceed.
- State Policy · CA
California's Next Governor Faces Medi-Cal Funding Crisis
California's Medicaid program, Medi-Cal, faces a deepening financial crisis as the state's next governor takes office amid federal funding cuts from the One Big Beautiful Bill Act, expected to cut federal Medicaid spending by over $900 billion over ten years. The state borrowed $4.4 billion in 2025 to keep provider payments flowing, after years of expansions, including coverage for all low-income residents regardless of immigration status, drove Medi-Cal spending from $50 billion to $222 billion annually since 2010. Democratic lawmakers delayed several painful eligibility and benefit cuts until 2027, hoping the next governor would reverse them, but neither gubernatorial candidate, Republican Steve Hilton nor Democrat Xavier Becerra, has offered detailed plans for addressing the shortfall. A state commission co-chaired by former health official Mark Ghaly is exploring ways to modernize the program as advocates debate whether to scale back eligibility or protect coverage despite federal cuts.