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CMS / Medicaid.gov

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CMS Issues Federal Funding Methodology for Basic Health Program Year 2027

CMS released an informational bulletin outlining the federal funding methodology for the Basic Health Program (BHP) in program year 2027. The guidance details how CMS will calculate federal payments to states operating BHPs — currently Minnesota and New York — for coverage of low-income individuals ineligible for Medicaid but below 200% of the federal poverty level. The methodology takes effect for the program year beginning in 2027. This matters for the two BHP states because the federal payment formula directly determines their program budgets and affects whether BHP remains financially sustainable compared to Marketplace coverage.

CMS

Federal Policy·36d ago

CMS Updates SSI and Spousal Impoverishment Standards for 2026

CMS released updated Supplemental Security Income (SSI) and spousal impoverishment standards effective for 2026. The bulletin provides revised income and resource thresholds that states must apply when determining Medicaid eligibility for aged, blind, and disabled individuals, as well as protections for spouses of institutionalized individuals. These standards affect eligibility determinations for coverage of long-term services and supports. State Medicaid agencies must implement these updated figures in their eligibility systems and processes.

CMS

Federal Policy·36d ago

CMS Issues 2026 Federal Poverty Level Standards for Medicaid Eligibility

CMS released the 2026 Federal Poverty Level standards in an informational bulletin dated January 23, 2026. The updated income thresholds apply to Medicaid and CHIP eligibility determinations starting February 2026. States must update their eligibility systems and Modified Adjusted Gross Income (MAGI) conversion tables to reflect the new FPL amounts. The guidance affects income-based eligibility for millions of Medicaid and CHIP beneficiaries nationwide, requiring states to adjust eligibility thresholds and redetermination processes.

CMS

Federal Policy·36d ago

CMS Delays HCBS Fee-For-Service Grievance System Enforcement Until December 2027

CMS will not enforce the federal requirement for states to establish fee-for-service grievance systems for home and community-based services until December 31, 2027. The enforcement discretion applies to 42 CFR 431.205(d), which requires states to implement grievance procedures for HCBS beneficiaries in FFS arrangements comparable to managed care protections. States must still comply with all other due process and fair hearing requirements under existing federal rules. The delay gives states additional time to develop compliant systems while CMS considers whether regulatory modifications are needed.

CMS

Federal Policy·36d ago

CMS Issues Guidance on Medicaid Eligibility After DHS Ends Parole Programs for Four Countries

CMS issued an informational bulletin on July 14, 2026, addressing how state Medicaid and CHIP agencies should handle eligibility and verification after DHS terminated parole programs for Cuban, Haitian, Nicaraguan, and Venezuelan nationals. The guidance clarifies that individuals who entered under these programs and whose parole has been terminated no longer meet the qualified non-citizen immigration status required for Medicaid eligibility in most categories, though emergency Medicaid remains available. States must update verification processes and eligibility determinations to reflect the changed immigration status of affected individuals. The guidance affects states with significant populations who entered under these parole programs and requires immediate attention to systems and procedures.

CMS

Federal Policy·36d ago

CMS Rescinds Fast-Track Review Process for Section 1115 Demonstration Extensions

CMS issued an informational bulletin on July 7, 2026, rescinding the fast-track federal review process for Section 1115 demonstration extensions. States seeking to extend existing Section 1115 demonstrations must now follow standard CMS review timelines and procedures, which typically require full public notice and comment periods and can take six months or longer. The rescission is effective immediately and applies to all pending and future extension requests. This change affects states with demonstrations expiring soon that planned to use expedited procedures, requiring them to build additional lead time into their extension planning and potentially delaying implementation of continuation authority.

CMS

Federal Policy·36d ago

CMS Issues Guidance on Medicaid Managed Care Monitoring and Oversight Requirements

CMS released an informational bulletin clarifying state agency responsibilities for monitoring and overseeing Medicaid and CHIP managed care organizations. The guidance addresses network adequacy monitoring, financial solvency review, quality performance measurement, and corrective action protocols that states must implement. States should review existing oversight processes against the CIB framework and adjust monitoring practices as needed to align with federal expectations. The bulletin provides operational direction for state Medicaid agencies on maintaining program integrity and beneficiary protections in managed care delivery systems.

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