Federal Policy
4Federal Policy·1:30 PM MT
HHS Secretary Robert F. Kennedy, Jr. announced $708 million in new funding opportunities for behavioral health programs, including $96 million for the STREETS (Safety Through Recovery, Engagement, and Evidence-based Treatment and Support) program targeting mental illness, addiction, and homelessness, plus $612 million for additional behavioral health initiatives. The funding opportunities are now posted and available for application. This represents significant new federal investment in community-based behavioral health infrastructure and services that Medicaid managed care organizations often coordinate or deliver.
Why it mattersThese federal grants will fund behavioral health services and infrastructure that MCOs typically integrate into their networks, creating opportunities for partnership and potentially shifting service delivery models in states that receive awards.
Federal Policy·7:30 AM MT
The FDA approved Rextovy, a 4mg naloxone nasal spray, for over-the-counter sale in pharmacies, convenience stores, and online for emergency treatment of opioid overdose. This is the third OTC naloxone product approved by FDA. The approval expands consumer access to overdose reversal medication without a prescription. For Medicaid managed care organizations, this may affect pharmacy benefit management, member education strategies, and harm reduction program design, particularly for plans serving populations with substance use disorders.
Why it mattersIncreased OTC naloxone availability may shift dispensing patterns, require updates to formulary management and prior authorization protocols, and create new opportunities for MCO-led overdose prevention initiatives.
Federal Policy·11:00 AM MT
HHS Secretary Kennedy announced $708 million in new behavioral health funding opportunities, including $96 million for the STREETS program targeting mental illness, addiction, and homelessness. The funding comprises multiple grant opportunities for behavioral health services. Funding opportunity announcements are now posted for eligible applicants to apply. The awards represent significant federal investment in community-based behavioral health infrastructure, potentially affecting Medicaid managed care organizations that serve members with serious mental illness, substance use disorders, or housing instability.
Why it mattersMCOs serving Medicaid members with behavioral health needs and housing instability may see expanded community resources and potential partnership opportunities through these federal grants, which could affect care coordination strategies and community provider networks.
Federal Policy·7:30 AM MT
The number and share of Americans without health insurance increased in 2024, marking the first rise since 2019, according to KFF's analysis of American Community Survey data. The growth in uninsured individuals follows the end of Medicaid continuous enrollment protections that expired in March 2023, resulting in millions of eligibility redeterminations across states. The increase reverses a five-year trend of declining uninsurance rates and signals potential coverage losses that disproportionately affect low-income populations eligible for Medicaid. This shift has immediate implications for uncompensated care costs and emergency department utilization that MCOs and safety-net providers must absorb.
Why it mattersRising uninsured rates following Medicaid unwinding indicate MCOs face shifting enrollment patterns, increased churn, and potential uncompensated care exposure as previously covered populations lose eligibility or fail to reenroll.
Managed Care
3Managed Care·7:30 AM MT
The Reconciliation Act (HR 1) established community engagement requirements for non-elderly, nonpregnant Medicaid adults effective 2027. CMS has released an implementation framework detailing how states must operationalize work requirements for beneficiaries aged 19-64. Health plans cannot contract directly with states to administer these requirements, but managed care organizations are developing member engagement and support strategies to maintain enrollment and help beneficiaries comply. The requirements will affect eligibility determination, member outreach, and care coordination workflows across Medicaid MCOs.
Why it mattersMedicaid MCOs must redesign member engagement strategies, care coordination processes, and reporting systems to support beneficiaries in meeting community engagement requirements while managing potential enrollment volatility and revenue impact starting in 2027.
Managed Care·1:30 PM MT
A nationwide survey of over 3,800 people who gave birth in 2023-2024 found Medicaid enrollees reported worse pregnancy and delivery outcomes compared to those with private insurance. The Listening to Mothers survey documented limited access to care, with pregnant Medicaid patients frequently reporting feeling unheard and disregarded during pregnancy and labor. The findings highlight persistent quality and access gaps in maternal care delivery for Medicaid-covered pregnancies. Survey results reflect care delivered across 2023-2024.
Why it mattersThese findings expose quality and patient experience gaps that directly affect managed care star ratings, HEDIS maternal health measures, and state contract performance requirements for MCOs covering pregnant enrollees.
Managed Care·1:30 PM MT
The CDC's National Vital Statistics System reported that infant mortality rates in the United States reached an all-time low in 2025, based on provisional death and birth data. The infant mortality rate measures deaths under age one per 1,000 live births. Final figures will be released later this year. The decline continues a multiyear trend in improved birth outcomes, though racial and geographic disparities persist.
Why it mattersDeclining infant mortality affects maternal and child health quality measures, HEDIS scores, and performance-based payments tied to birth outcomes in Medicaid managed care contracts.