State Policy
7State Policy·NC·7:37 AM MT
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·NC·7:31 AM MT
North Carolina is developing implementation plans for Medicaid provisions included in the 2025 reconciliation law while facing state budget constraints. The state is determining how to operationalize federal policy changes affecting eligibility, coverage, and program financing. Implementation timelines and operational details remain under development as state officials balance federal requirements with fiscal pressures. Managed care organizations should monitor how North Carolina translates federal reconciliation provisions into state-level policy and contract requirements.
Why it matters for managed careNorth Carolina's approach to implementing federal reconciliation changes will directly affect MCO capitation rates, covered populations, benefit design, and administrative requirements in one of the nation's largest Medicaid managed care markets.
State Policy·MT·1:00 PM MT
Montana is exploring implementation of Medicaid work requirements as the state faces significant budget pressures. The state is evaluating how to structure and administer work requirements under potential new federal flexibility from the Trump administration. Montana previously attempted work requirements but faced implementation challenges and legal obstacles. If pursued, the requirements would affect expansion population enrollees and require state investments in systems and administration despite current fiscal constraints.
Why it matters for managed careMontana's experience will test the operational and fiscal feasibility of work requirements in budget-constrained states, informing other states considering similar policies and potentially affecting MCO administrative responsibilities for member verification and reporting.
State Policy·1:38 PM MT
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·1:00 PM MT
The National Academy for State Health Policy published findings from a two-year learning collaborative focused on state Medicaid programs serving individuals reentering communities from incarceration. The report documents state strategies for expanding Medicaid enrollment and maintaining care continuity during the transition from correctional facilities to community settings. States participating in the NASHP/HARP Learning and Action Network shared approaches to address coverage gaps, expedite enrollment, and coordinate behavioral health and substance use services. The findings come as CMS has authorized Section 1115 waiver authority allowing states to provide pre-release Medicaid services in the 90 days before release.
Why it matters for managed careMedicaid managed care organizations in states pursuing reentry waivers will need operational protocols for pre-release enrollment, care coordination with correctional facilities, and behavioral health network capacity to serve this population.
State Policy·1:38 PM MT
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·1:00 PM MT
The National Academy for State Health Policy (NASHP) will host a webinar on June 25, 2026, examining how states are using prescription drug cost data to inform policy decisions. The session will focus on state-level approaches to drug cost transparency and policy interventions. This webinar is relevant for Medicaid managed care organizations as state prescription drug policies directly affect pharmacy benefit design, formulary management, and capitation rate adequacy. State drug cost transparency initiatives often lead to new reporting requirements or benefit mandates that MCOs must implement.
Why it matters for managed careState prescription drug cost policies increasingly drive MCO pharmacy benefit requirements, reporting obligations, and rate negotiations—understanding state policy direction helps MCOs anticipate operational and financial impacts.