HHS Secretary Robert F. Kennedy Jr. has prevented the U.S. Preventive Services Task Force from meeting, declined to replace members whose terms have expired, and fired the panel's leaders in May 2026. The task force determines which preventive medical services insurers must cover without cost-sharing under the Affordable Care Act. The disruption affects coverage recommendations for screenings, counseling, and preventive medications that Medicaid managed care plans must cover as essential health benefits. The timeline for new coverage recommendations and the panel's future composition remain uncertain.
Why it mattersMedicaid MCOs rely on task force recommendations to define required preventive services under essential health benefits and to design cost-sharing structures, and operational uncertainty around coverage standards creates compliance and network contracting risks.
Managed Care
The Substance Abuse and Mental Health Services Administration awarded $19 million in supplemental funding to 51 states, territories, and jurisdictions to build housing capacity for homeless individuals with serious mental illness. The funding provides additional resources for state programs serving this population. The announcement was made September 18, 2025. For Medicaid managed care organizations with behavioral health carve-ins or whole health responsibilities, these state funds may complement or require coordination with MCO housing-related supports and services for members experiencing homelessness.
Why it mattersMedicaid managed care organizations serving behavioral health populations will need to coordinate with state-administered housing programs to ensure continuity of care and maximize benefit coordination for homeless members with serious mental illness.
Behavioral Health · Managed Care
SAMHSA announced $69.1 million in available grant funding across three behavioral health programs: the Children's Mental Health Initiative (CMHI), Implementing Zero Suicide in Health Systems, and Assisted Outpatient Treatment (AOT). The funding opportunities target serious mental illness treatment and suicide prevention services. Applications are now open for eligible providers and health systems. For Medicaid managed care organizations with behavioral health carved-in or carved-out arrangements, these grants may affect network adequacy, crisis service capacity, and partnerships with community providers receiving federal funding.
Why it mattersMCOs managing behavioral health benefits should monitor which network providers secure this funding, as grant-funded enhancements to crisis services, children's mental health programs, and outpatient treatment capacity directly affect network adequacy compliance and member access to federally-supported services.
Behavioral Health · Managed Care
HHS through SAMHSA announced more than $1.5 billion in FY25 continuation funding for State Opioid Response (SOR) and Tribal Opioid Response (TOR) grants on September 22, 2025. The funding supports states and tribal communities in addressing the overdose crisis through prevention, overdose reversal medications, treatment including medications for opioid use disorder (MOUD), and recovery support services. These are continuation awards, meaning recipients were previously awarded these grants and are receiving ongoing funding for existing programs.
Why it mattersMedicaid managed care organizations with behavioral health carve-ins must coordinate with state SOR-funded providers on MOUD access, overdose prevention services, and recovery supports, particularly as these federal dollars supplement MCO contract obligations for substance use disorder treatment.
Behavioral Health · Managed Care
The Substance Abuse and Mental Health Services Administration announced $19 million in supplemental Community Mental Health Services Block Grant funding to strengthen housing capacity for homeless individuals with serious mental illness. The funding addresses the intersection of homelessness and SMI through state-administered block grant programs. States will receive allocations to expand housing-related services and supports for this population. This matters for Medicaid managed care organizations because behavioral health plans often coordinate with state housing programs and provide wraparound services for members experiencing homelessness with SMI diagnoses.
Why it mattersMedicaid MCOs with behavioral health contracts will see increased state capacity to support housing services for high-cost members with serious mental illness, potentially affecting care coordination responsibilities and whole-person care initiatives.
Behavioral Health · Managed Care
SAMHSA announced more than $45 million in supplemental funding to State Opioid Response (SOR) program recipients to support sober and recovery housing services for young adults. The funding supplements existing state SOR grants to expand residential treatment options for young adults with substance use disorders. States that currently receive SOR funding are eligible to apply for these supplemental awards. The funding addresses a gap in sober housing options for young adults, a population with elevated overdose risk and barriers to traditional treatment settings.
Why it mattersMedicaid managed care organizations with behavioral health contracts will need to coordinate with state-funded sober housing providers and may see increased demand for wraparound services as young adults transition from residential settings.
Behavioral Health
The Substance Abuse and Mental Health Services Administration distributed $794 million in block grant funding to states and territories for community-based mental health services and substance abuse treatment and prevention programs. The funding was distributed in February 2026 across all states and U.S. territories. This matters for Medicaid managed care organizations because block grant-funded community providers often serve as essential network partners for behavioral health services, and state allocation decisions may affect provider capacity, referral patterns, and care coordination requirements for Medicaid enrollees.
Why it mattersBlock grant distribution affects the capacity and stability of community behavioral health providers that MCOs rely on for network adequacy, crisis services, and care coordination for members with substance use disorders and serious mental illness.
Behavioral Health · Managed Care
The Substance Abuse and Mental Health Services Administration announced a $231 million funding opportunity to administer the 988 Suicide & Crisis Lifeline. The 988 Lifeline operates a national network of over 200 local crisis contact centers managed by a SAMHSA-funded network administrator. In 2025, the lifeline received more than 8 million contacts from help seekers via call, text, chat, and ASL videophone. The funding opportunity will support continued administration of the crisis response infrastructure that Medicaid managed care organizations increasingly coordinate with for behavioral health crisis services.
Why it mattersMedicaid MCOs contracting for behavioral health crisis services must coordinate with 988 infrastructure, and federal investment in lifeline capacity affects network adequacy and crisis response workflows.
Behavioral Health · Managed Care
The Substance Abuse and Mental Health Services Administration awarded $98 million for a Hepatitis C Elimination Initiative Pilot on September 24, 2025. The funding supports efforts to eliminate hepatitis C, which disproportionately affects individuals with substance use disorders who are frequently enrolled in Medicaid managed care behavioral health programs. Medicaid managed care organizations with behavioral health carve-ins or specialty behavioral health contracts may see increased screening and treatment activity for hepatitis C among their members. The initiative reflects federal prioritization of addressing co-occurring conditions in populations with substance use disorders.
Why it mattersMedicaid MCOs covering behavioral health services will likely experience higher hepatitis C screening and treatment utilization, requiring care coordination between behavioral health and infectious disease providers and potential impacts on medical loss ratios.
Behavioral Health · Managed Care
SAMHSA awarded $2 million in supplemental funding to Merakey Philadelphia to launch a pilot program expanding Certified Community Behavioral Health Clinic (CCBHC) services in the Kensington neighborhood. The program targets homeless individuals with mental illness and substance use disorders to facilitate treatment access. The funding supports service expansion in a neighborhood with significant behavioral health needs. This represents federal investment in the CCBHC model, which many states use through Medicaid demonstration programs to deliver comprehensive behavioral health services with enhanced federal matching funds.
Why it mattersMedicaid managed care organizations in states with CCBHC demonstrations must ensure network adequacy for these enhanced service models and understand federal priorities for integrated behavioral health and homelessness interventions.
Behavioral Health · Managed Care
The Substance Abuse and Mental Health Services Administration announced $43 million in supplemental funding for State Opioid Response (SOR) program grantees to expand recovery housing services for young adults ages 18-24. The funding is available immediately to existing SOR grantees. This supplements existing SOR grant awards and targets a population often transitioning out of foster care or juvenile justice systems, many of whom are Medicaid-eligible. The investment aims to fill gaps in residential recovery support for young adults with opioid use disorder.
Why it mattersMedicaid managed care organizations with behavioral health carve-ins should anticipate increased demand for care coordination and community-based services as SOR-funded recovery housing expands for a high-need, high-Medicaid-eligibility population.
Behavioral Health · Managed Care
The Partnership for Medicaid, a coalition of clinicians, providers, safety net health plans, and counties, issued a statement February 7, 2025 calling on Congress to reject proposed cuts to the Medicaid program. The statement does not specify which legislative proposals or budget reconciliation measures are targeted. No timeline for congressional action is provided. The coalition represents stakeholders across the Medicaid delivery system, including managed care organizations.
Why it mattersCongressional budget reconciliation discussions could include Medicaid spending reductions that affect MCO capitation rates, enrollment, covered benefits, or federal matching funds.
Managed Care · Finance
The Department of Health and Human Services is working with mental health professionals to develop guidance aimed at reducing the use of selective serotonin reuptake inhibitor (SSRI) antidepressants. HHS officials convened a private meeting to advance this effort. The timing and scope of any formal guidance release remain unclear. For Medicaid managed care organizations, this could signal future prior authorization requirements, utilization management changes, or quality measure adjustments affecting behavioral health pharmacy benefits and member care protocols.
Why it mattersFederal guidance discouraging SSRI use would require MCOs to redesign behavioral health pharmacy strategies, potentially affecting prior authorization protocols, provider education, and quality metrics for depression treatment.
Behavioral Health · Pharmacy · Managed Care