Medicaid Monitor
Policy Intelligence
Medicaid Monitor
Policy Intelligence
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Georgetown CCF

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Federal Policy·2d ago

Georgetown CCF Submits Comments on Senate Finance RFI on Health Coverage

Georgetown University's Center for Children and Families (CCF) submitted comments responding to a Request for Information from Senate Finance Committee Ranking Member Ron Wyden on policy proposals to improve access, quality, and affordability of health coverage nationally. The RFI sought stakeholder input on a broad range of proposals affecting health coverage, including Medicaid and CHIP. CCF's submission reflects the organization's positions on how these proposals would affect children's and families' coverage. The specific policy recommendations and their implications for state Medicaid programs are detailed in CCF's full submission.

State Policy·NE·3d ago

Nebraska's First Work Requirement Data Show Coverage Losses

Nebraska, the first state to implement a Medicaid work reporting requirement, presented initial implementation data at a recent Medicaid Advisory Committee meeting. The data cover the first few months after the state began applying new work-reporting rules to new applicants, and show coverage losses attributed to administrative red tape rather than ineligibility. Beneficiaries affected include new Medicaid applicants subject to the reporting rules. The findings arrive as the work reporting requirement is set to become mandatory nationally, making Nebraska an early test case for how implementation affects enrollment.

Federal Policy·11d ago

White House Posts Fraud Ledger Tracking Task Force Findings Since January 2025

The White House has published a Fraud Ledger documenting fraud, waste, and corruption identified by a presidential task force established by executive order in March 2025. The task force is chaired by the Vice President and includes representatives from 11 federal agencies. The ledger serves as a public record of enforcement and recovery actions across federal programs. The article itself fact-checks the ledger's claims, though the specific findings and their application to Medicaid programs are not detailed in the excerpt provided.

State Policy·12d ago

Rural Maternal Health Access Deteriorates Following H.R. 1 Passage

Rural maternal health care access has worsened following passage of H.R. 1, compounding pre-existing challenges including 109 rural hospital closures since 2005, workforce shortages, and low reimbursement rates. The legislation's impact on rural maternity services adds to infrastructure vulnerabilities affecting pregnant Medicaid beneficiaries in rural areas. State Medicaid agencies face mounting pressure to address maternal health deserts through alternative delivery models, enhanced reimbursement, or emergency transport solutions as traditional brick-and-mortar access points continue closing.

Federal Policy·15d ago

Georgetown CCF Submits Comments on HHS Vaccination Policy RFI

The Georgetown University Center for Children and Families submitted comments to HHS responding to a Request for Information on federal vaccine recommendation categories and the role of shared clinical decision-making. The comments address how federal vaccination guidance affects clinical practice and policy implementation. The RFI reflects HHS consideration of potential changes to how vaccine recommendations are categorized and communicated to providers and patients. For Medicaid programs, this matters because federal vaccine recommendations drive EPSDT coverage requirements and Early and Periodic Screening, Diagnostic and Treatment mandates for children.

Federal Policy·15d ago

Census Bureau Releases 2025 Child Uninsured Data; ACS Release Delayed

The U.S. Census Bureau released Current Population Survey data for calendar year 2025 examining child uninsured rates, poverty, income, and health insurance trends. The American Community Survey, which typically releases simultaneously and provides larger sample sizes for state-level analysis, has not yet been published. The delay in ACS data limits the ability to conduct granular state and sub-state analysis of coverage trends. For state Medicaid agencies and advocates tracking coverage following recent policy changes, the absence of robust state-level data complicates assessment of enrollment shifts and children's coverage losses.

Managed Care·18d ago

Webinar Announcement on Medicaid Substance Use Services and Justice System Integration

A webinar titled 'Medicaid Connections: Substance Use Health & Justice' has been announced, focusing on how 21st-century legislative and system changes have shifted substance use disorder treatment from punitive systems toward health-based responses through Medicaid. The webinar will examine the evolving role of Medicaid in providing substance use services and the ongoing inequities in access. An audio transcript is available for download.

Federal Policy·19d ago

Rural Communities at Greater Risk of Harmful Impacts from New Medicaid Work Reporting Requirements

In 2025, Congress enacted H.R. 1, requiring work reporting as a condition of Medicaid eligibility in the 41 states that expanded coverage to low-income adults under the ACA, plus Wisconsin and Georgia. The law affects Medicaid expansion populations in those states. Rural communities face heightened risk of coverage loss due to barriers in meeting reporting requirements. The policy represents a significant shift in Medicaid eligibility standards, imposing new administrative and compliance obligations on state agencies and creating potential churn for health plans managing expansion populations.

Federal Policy·22d ago

Proposed Head Start Rule Changes Program Framework for Low-Income Children

The Trump Administration released a proposed rule in early August 2026 to alter the Head Start program framework. Head Start serves young children in low-income families and operates alongside Medicaid in child care centers. The proposal would change how the federal program supports early childhood services. Many Head Start-enrolled children are Medicaid beneficiaries, and the programs coordinate on preventive health services, developmental screenings, and referrals.

State Policy·22d ago

States Begin Outreach to Medicaid Enrollees on Work Reporting Requirements

States are sending initial notices to Medicaid expansion adults about work reporting requirements scheduled to take effect in the coming months. The outreach includes targeted communications to current enrollees and new applicants explaining compliance obligations. States are simultaneously updating eligibility systems and building websites to support implementation. This represents the operational rollout phase following federal approval of work requirement waivers.

Federal Policy·22d ago

Georgetown CCF Comments on CMS Proposed Provider Tax Hold Harmless Rule

The Georgetown University Center for Children and Families submitted comments to CMS on a proposed rule that would amend the indirect hold harmless threshold for health care-related taxes. Provider taxes are a major financing mechanism states use to draw down federal Medicaid matching funds, and changes to hold harmless provisions affect how states structure these tax arrangements. The proposed rule impacts state Medicaid financing strategy and federal matching fund availability. Comments are due as part of the federal rulemaking process.

Federal Policy·24d ago

Advocacy Group Critiques Foundation for Government Accountability Medicaid Work Requirement Data

An advocacy organization has published a methodological critique of research from the Foundation for Government Accountability supporting Medicaid work reporting requirements. The critique challenges FGA's data analysis used to justify work requirement policies at state and federal levels. The piece focuses on what the authors identify as flawed methodology in FGA's research on Medicaid eligibility policies. This represents ongoing policy debate over work requirements as states and federal policymakers consider changes to Medicaid eligibility rules.

State Policy·25d ago

Study Finds One in Three Maternity Hospitals Serve Medicaid Patients in Rural Areas

KFF researchers found that one in three hospitals providing inpatient maternity care serve Medicaid beneficiaries in rural areas and small towns. The research paper examines the role of Medicaid in sustaining maternity services at rural hospitals. The analysis comes as part of CCF's Rural Health Project tracking Medicaid's impact on rural healthcare access. The findings are relevant for states evaluating maternity care network adequacy requirements and rural hospital reimbursement policies.

Federal Policy·33d ago

New Maternity Care Billing Codes Take Effect in 2027 for All Payers

New maternity care billing codes will be implemented across all insurance payers beginning in 2027. The coding changes are designed to improve transparency and payment accuracy across the continuum of maternity care services. State Medicaid agencies must adopt these codes alongside other major program changes scheduled for 2027, including work reporting requirements. The new codes are intended to provide better data on maternity care delivery and enable more precise reimbursement for services throughout the pregnancy and postpartum period.

Federal Policy·39d ago

CDC Reports Declining Kindergarten Vaccination Rates for 2025-2026 School Year

The Centers for Disease Control and Prevention released data showing decreased vaccination coverage for incoming kindergartners across all vaccines during the 2025-2026 school year, including measles, mumps, rubella, and tetanus. The decline in coverage rates coincides with President Trump's executive order directing changes to the childhood vaccine schedule. Lower vaccination rates increase disease outbreak risk among Medicaid-enrolled children, who represent approximately 40% of all children nationally. The data reflects growing vaccine exemption trends that may affect Early and Periodic Screening, Diagnostic and Treatment (EPSDT) service delivery and preventive care quality measures under managed care contracts.

Federal Policy·40d ago

State Medicaid Systems Show Mounting Strain Before H.R. 1 Work Requirements Launch

Q1 2026 data on state Medicaid eligibility systems reveal deteriorating performance metrics as states prepare to implement federally-mandated work reporting requirements under H.R. 1. Most states are scheduled to begin notifying enrollees about the new requirements shortly, but current system capacity indicators show increasing strain in processing renewals and eligibility determinations. The data come from an ongoing tracker monitoring Medicaid and CHIP performance as states build infrastructure for the work requirement provisions. The findings suggest operational challenges ahead as states layer new compliance burdens onto already stressed administrative systems.

Managed Care·40d ago

CMS Webinar Addresses Health and Justice Needs for Children with Special Health Care Needs

The Centers for Medicare & Medicaid Services hosted a webinar on serving the 15 million children and youth with special health care needs (CSHCN) who have chronic physical, developmental, or behavioral health conditions requiring services beyond typical pediatric care. The session focused on coordination between health and justice systems for this population, which represents one in five children under age 18. The webinar covered strategies for Medicaid programs to better serve CSHCN involved in or at risk of justice system contact, addressing care coordination, behavioral health access, and cross-system collaboration.

Federal Policy·41d ago

Uninsured Rate for Infants and Toddlers Exceeds 5 Percent Nationally

The national uninsured rate for infants and toddlers has risen above 5 percent, exposing families to greater financial risk and reducing access to preventive care and developmental screenings. Children without coverage are less likely to receive regular well-child visits, immunizations, and early intervention services that support healthy development. The increase affects Medicaid and CHIP enrollment dynamics, as these programs cover the majority of young children nationally.

Federal Policy·46d ago

Georgetown Analysis Shows Medicaid Covers 43% of Children Under Age 3

Georgetown University's Center for Children and Families analyzed 2015-2024 Census data on health coverage for infants and toddlers under age 3. The analysis uses American Community Survey data to track coverage trends for this population, which has historically high Medicaid enrollment rates. The brief provides state-level and national estimates of coverage patterns over the decade. The findings offer a baseline for assessing coverage changes as states continue to complete Medicaid redeterminations following the end of continuous enrollment.

Industry·51d ago

Big Five Medicaid MCOs Report Q2 2026 Earnings Results

The five largest publicly-traded Medicaid managed care organizations — Centene, CVS Health/Aetna, Elevance Health, Molina Healthcare, and UnitedHealth Group — have released second-quarter 2026 financial results. These companies collectively serve approximately half of all Medicaid enrollees nationwide. The earnings reports provide insight into revenue trends, medical loss ratios, enrollment changes, and profitability across the Medicaid managed care sector during the quarter ending June 30, 2026.

Federal Policy·51d ago

CMS Clarifies Custodial Parents Largely Exempt from Medicaid Work Reporting Requirements

The Centers for Medicare and Medicaid Services released an Interim Final Rule clarifying exemptions from new Medicaid work reporting requirements set to take effect in January 2027. The guidance confirms that most custodial parents and caretaker relatives are excluded from work reporting mandates, addressing widespread confusion as 28 states prepare implementation. The clarification affects state planning and system development currently underway. The IFR provides critical operational guidance for state Medicaid agencies navigating compliance with federal work reporting provisions while minimizing improper coverage terminations for exempt populations.

State Policy·MO·57d ago

Missouri Voters Reject Constitutional Amendments That Would Have Raised Ballot Measure Thresholds

Missouri voters defeated two proposed constitutional amendments this week that would have made future ballot initiatives harder to pass. Proposed Amendment 4 failed 80% to 20%; it would have required constitutional amendments to win a majority in every congressional district. The rejected measures had implications for health policy ballot initiatives like Medicaid expansion, which Missouri voters approved via ballot measure in 2020. The defeat preserves the existing ballot measure process for future Medicaid policy changes at the state level.

Federal Policy·58d ago

Georgetown Researcher Testifies on Medicaid Program Before Senate Budget Committee

Andy Schneider of Georgetown University's Center for Children and Families testified before the U.S. Senate Budget Committee on August 4, 2026, at a hearing titled "Medicaid the Reality." The testimony addressed the current state of the Medicaid program for federal policymakers. The hearing reflects ongoing Congressional scrutiny of Medicaid financing and operations, which could inform future legislative or oversight activity affecting state agencies and managed care plans.

Federal Policy·64d ago

Updated Brief Examines Medicaid Coverage Among Early Childhood Educators Using 2024 Data

A coalition including the Center for Law and Social Policy and the National Association for the Education of Young Children has republished a brief examining Medicaid coverage among early childhood educators, incorporating 2024 data and recent federal policy developments. The brief analyzes how Medicaid serves this workforce population and discusses implications of federal actions over the past year. Early childhood educators represent a low-wage workforce with high rates of Medicaid enrollment. The updated analysis provides current context for policymakers and stakeholders assessing coverage needs in this sector.

Federal Policy·65d ago

Georgetown Center for Children and Families Submits Comments on Medicaid Work Requirements Interim Final Rule

The Georgetown University Center for Children and Families submitted comments to CMS regarding the interim final rule implementing Medicaid work reporting requirements mandated by H.R. 1. The rule establishes federal requirements for states to implement work reporting for certain Medicaid beneficiaries. The comments address implementation concerns and potential impacts on beneficiary enrollment and coverage continuity. The rule affects state Medicaid agencies responsible for implementing work reporting systems and health plans managing enrollment and disenrollment processes.

Federal Policy·65d ago

Commerce Order Bans Census Bureau Privacy Methods, Threatens Medicaid Enrollment and Utilization Data

On June 4, 2026, the Commerce Department issued Administrative Order 216-26 banning "noise infusion" privacy techniques in Census Bureau and Bureau of Economic Analysis data products, effective immediately. The order affects data systems that state Medicaid agencies and researchers rely on for enrollment projections, eligibility determination, and program evaluation, including American Community Survey data used to estimate uninsured rates and demographic trends. Census Bureau officials have warned the ban may compromise their ability to release small-area statistics while protecting respondent privacy, potentially limiting availability of county-level data critical for Medicaid managed care network adequacy assessments and CHIP outreach.

Federal Policy·67d ago

Senator Kim Introduces MediKids Act for Universal Child Health Coverage

Sen. Andy Kim (D-NJ) introduced S. 5037, the MediKids Act, to establish guaranteed healthcare coverage for all children in America. The bill was cosponsored by four Democratic senators and referred to the Senate Finance Committee. No timeline for committee consideration has been announced. If enacted, the legislation would significantly expand federal health coverage for children beyond current Medicaid and CHIP eligibility thresholds, affecting state program design and federal-state financing arrangements.

Federal Policy·68d ago

CMS Proposes Rule Implementing H.R. 1 Provider Tax Restrictions

CMS issued a proposed rule on July 21, 2026, implementing two of three provider tax restrictions from H.R. 1, which limits states' ability to use provider taxes to finance their Medicaid share. The rule prohibits new provider taxes and increases in existing taxes. This affects state Medicaid financing strategies and budget planning, with implications for how states fund their programs and potential pressure on state general funds. The proposal will proceed through standard notice-and-comment rulemaking.

Federal Policy·73d ago

Urban Institute Finds Postpartum Coverage Gains Stalling Among New Mothers

The Urban Institute reports that health insurance coverage for new mothers in the first year postpartum has improved in recent years but progress has stalled, according to Census Bureau American Community Survey data. The analysis examines uninsured rates among women ages 19 and older who gave birth within the past year. The findings come as states navigate the end of Medicaid continuous enrollment and implementation of the American Rescue Plan's optional 12-month postpartum coverage extension. The report signals potential erosion of maternal coverage gains that have reduced coverage gaps during the critical postpartum period.

Industry·73d ago

988 Lifeline In-State Call Answer Rate Data Unavailable Due to Access Restrictions

This content is password-protected and cannot be accessed for analysis. The title suggests it may contain data on in-state answer rates for the 988 Suicide and Crisis Lifeline. Without access to the underlying content, it is not possible to determine what information is presented, when any reported data applies, or whether it contains actionable intelligence for Medicaid managed care organizations. The 988 Lifeline, launched nationally in July 2022, is relevant to Medicaid MCOs that cover behavioral health crisis services, but the specifics of this protected content remain unknown.

Federal Policy·74d ago

Webinar Examines H.R.1 Impact on Medicaid Maternal and Infant Health Programs

A webinar titled 'Medicaid Connections: Maternal and Infant Health and Justice' addresses how H.R.1 legislation affects Medicaid-funded maternity care. The session focuses on reproductive justice and optimizing Medicaid to fund holistic, culturally centered care including midwifery and doula services. As the nation's largest payer for maternity care, Medicaid plays a central role in addressing systemic health inequities for maternal and infant populations. The webinar provides guidance for policymakers on funding structures that support comprehensive perinatal services.

State Policy·76d ago

KFF Examines State Strategies to Protect Pregnant Women from Medicaid Work Requirements

KFF published an analysis examining how states may structure Medicaid work reporting requirements to protect coverage for pregnant and postpartum women. The analysis reviews state options for exemptions, verification processes, and coverage continuity mechanisms as states implement work and community engagement requirements. States must balance federal compliance with maternal health access as work requirements return to consideration. For managed care organizations, the analysis highlights operational challenges in identifying exempt populations, managing enrollment disruptions, and maintaining continuity of prenatal and postpartum care under varying state policies.

Federal Policy·79d ago

CMS Issues Interim Final Rule Imposing Work Reporting Requirements on Medicaid Beneficiaries

CMS has published an interim final rule establishing work reporting requirements for certain Medicaid beneficiaries. The rule requires states to implement reporting systems for work activities as a condition of eligibility for non-exempt populations. The requirements take effect for state implementation planning immediately, with full compliance deadlines to be determined by state plan amendments. This marks a significant shift in Medicaid eligibility policy affecting managed care organizations' enrollment processes, member communication obligations, and systems for tracking beneficiary compliance with work requirements.

Federal Policy·87d ago

CMS Requests State Medicaid Provider Revalidation Strategies in April Administrator Letter

CMS Administrator Dr. Mehmet Oz sent a letter to State Medicaid Directors on April 23, 2026, requesting each state develop and submit a comprehensive two-year provider revalidation strategy focused on high-risk providers. The letter, identified as an SMD (State Medicaid Director letter), is not published on the official Medicaid.gov site but is available through Fox News. Minnesota's early implementation offers initial lessons for states responding to the directive. The request affects all state Medicaid agencies and their managed care partners responsible for provider enrollment and network adequacy.

State Policy·CO·89d ago

Colorado Maternal Health Initiative Leader Discusses Perinatal Care Transformation Under Medicaid

Elephant Circle founder Indra Lusero discusses Colorado's comprehensive maternal health initiatives under Medicaid in a Q&A format. Colorado was among the first states to pursue broad perinatal care reforms aimed at improving outcomes for pregnant and postpartum enrollees. The interview covers the state's maternal health strategy during a period described as involving recent federal funding constraints. The discussion addresses how Colorado's Medicaid program has approached perinatal care delivery and payment reform.

Federal Policy·89d ago

Proposed Medicaid Work Requirements Face Rural Service Delivery Challenges

A proposed federal rule implementing H.R. 1's Medicaid work and volunteer reporting requirements faces operational challenges in rural areas where postal service limitations may prevent beneficiaries from meeting documentation deadlines. The law, projected to result in 10 million Americans losing coverage, requires monthly work or volunteer activity reporting to maintain eligibility. Rural beneficiaries may face particular difficulty submitting timely verification due to mail delays and limited internet access. The rule remains in proposed form with implementation timing not yet finalized.

State Policy·93d ago

State Legislatures Respond to H.R. 1 Medicaid Cuts in 2026 Sessions

State legislatures concluded 2026 sessions with varied responses to federal Medicaid cuts enacted under H.R. 1 approximately one year ago. States faced budget shortfalls and policy changes requiring legislative action to address coverage gaps, provider payment reductions, and program restructuring. The article follows up on earlier reporting from March 2026 that examined ten state responses to what are described as the largest Medicaid cuts in history. Implementation timelines and specific state actions vary by jurisdiction.

Federal Policy·95d ago

Georgetown Hosts Webinar on Medicaid Federal-State Financing Basics

The Georgetown University Center for Children and Families held a webinar on June 30, 2026 covering foundational Medicaid financing concepts. The session explained the federal-state partnership structure, mandatory federal funding not subject to annual appropriations, and state financing mechanisms for their matching share. The webinar targeted audience members seeking to understand basic Medicaid funding mechanics. A recording will be made available on Georgetown's website.

Federal Policy·96d ago

Ten States Enter CCBHC Medicaid Demonstration as H.R. 1 Threatens Funding

Ten additional states have joined the Certified Community Behavioral Health Clinic (CCBHC) Medicaid demonstration program, expanding access to comprehensive community-based behavioral health services that meet federal certification standards. The expansion occurs as pending legislation H.R. 1 threatens the demonstration's continued funding. CCBHCs provide integrated behavioral health and physical health screening, crisis services, and care coordination under enhanced Medicaid payment structures. The timing creates uncertainty for managed care organizations with CCBHC network arrangements and for states planning implementation.

State Policy·99d ago

Young Children's Uninsurance Rises Faster Than School-Age Peers Pre-2025

Analysis shows young children experienced faster uninsurance growth compared to school-aged children prior to 2025 Medicaid enrollment declines. The trend emerged before recent federal policy changes including Trump administration actions and H.R. 1 proposals. The data suggests underlying coverage gaps for young children independent of current redeterminations. States may need targeted outreach and enrollment strategies for families with young children to reverse the trend.

Legal·HI·113d ago

HHS OIG Warns Hawaii of Potential Medicaid Fraud Sanctions Over Eligibility Concerns

On May 13, 2025, HHS Inspector General Christi Grimm sent a letter to Hawaii warning of potential administrative sanctions over alleged Medicaid eligibility fraud. The letter was announced by Vice President Vance at a White House Task Force press conference alongside news of a $1.3 billion federal Medicaid payment deferral to California. The OIG letter to Hawaii signals aggressive federal enforcement activity targeting state Medicaid programs for eligibility determinations. The timing and public announcement through the White House suggest coordinated federal pressure on states over Medicaid program integrity issues.

State Policy·115d ago

Child Medicaid and CHIP Enrollment Down 2 Million Since January 2025

Child enrollment in Medicaid and CHIP has declined by more than 2 million since January 2025, according to Georgetown University's Center for Children and Families. The declines vary significantly by state and affect children in working families who often lack access to affordable employer-sponsored coverage. The enrollment losses represent a continuation of coverage instability following the end of the Medicaid continuous enrollment provision. These drops matter because many affected children become uninsured rather than transitioning to other coverage.

Federal Policy·116d ago

CMS Issues First Major EPSDT Guidance Update in a Decade

CMS released updated guidance on the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit in 2024, marking the first comprehensive policy update in approximately ten years. The guidance, issued through a state health official letter, provides states with revised operational and coverage requirements for Medicaid's mandatory pediatric benefit. This updated playbook affects how states structure EPSDT services, including screening schedules, diagnostic services, and treatment coverage for Medicaid-enrolled children. The guidance clarifies federal expectations for state compliance and likely impacts how managed care organizations implement and document EPSDT services in their contracts.

State Policy·122d ago

2026 Maternal Mental Health State Report Cards Find No State Earns Overall F Grade

The Policy Center for Maternal Mental Health and George Washington University released the 2026 Maternal Mental Health State Report Cards, showing improvement in state-level performance with no states receiving an overall failing grade for the first time. The report evaluates state policies addressing maternal mental health conditions, which affect one in five mothers and impose significant financial costs when untreated. A new assessment category for parental support reveals widespread deficiencies across states. The report cards provide a framework for states to benchmark their maternal mental health infrastructure and identify policy gaps.

State Policy·124d ago

Uninsurance Rate for Children Under 6 Hits Decade High, Up 220,000 Since 2022

A new report shows uninsurance among children birth through age 5 has reached its highest level in nearly a decade, with more than 220,000 young children losing coverage between 2022 and 2024. The increase follows the end of Medicaid continuous enrollment protections and state redetermination processes. The trend represents a reversal of coverage gains achieved during the public health emergency. Young children are predominantly enrolled in Medicaid and CHIP, making these coverage losses directly relevant to state program performance and managed care plan enrollment.

Federal Policy·124d ago

Uninsured Rate for Children Under 6 Jumped 23% Since 2022 Medicaid Unwinding Began

The number of uninsured children under age 6 increased 23% between 2022 and 2024, reaching the highest level in nearly a decade, compared to a 17% increase for school-aged children. The sharper rise among younger children coincides with Medicaid redeterminations that began after the end of the continuous enrollment provision in spring 2023. Young children face higher procedural disenrollment risk due to more frequent address changes and verification requirements. The data suggests gaps in ex parte renewal processes and family communication strategies that disproportionately affect families with infants, toddlers, and preschoolers.

Federal Policy·128d ago

Child Medicaid and CHIP Enrollment Drops by 2 Million Since January 2025

Medicaid and CHIP enrollment among children declined by 2 million between January 2025 and April 2026, according to state-by-state enrollment data. The drop suggests a rising child uninsured rate during this period. The enrollment decline affects managed care organizations through reduced membership and capitation revenue, particularly in states with high CHIP and Medicaid managed care penetration. Plans should monitor monthly enrollment reports and assess financial impacts from membership losses in pediatric populations.

State Policy·KS·129d ago

Kansas Legislature Permanently Fixes CHIP Eligibility Law After Multi-Year Waiver Workaround

Kansas enacted legislation in its 2026 session to permanently update state CHIP eligibility rules, ending reliance on temporary federal waivers that previously allowed eligible children to access coverage. The statutory change ensures continuous CHIP enrollment for qualifying Kansas children without recurring waiver renewals. The law codifies eligibility standards that had only been maintained through waiver authority, eliminating administrative uncertainty for families and the state Medicaid agency. This matters for managed care organizations administering Kansas CHIP because it stabilizes the enrolled population and removes the risk of coverage disruptions tied to waiver expiration.

Industry·129d ago

Big Five Medicaid Insurers Report Q1 2026 Financial and Enrollment Results

The five largest publicly-traded Medicaid managed care organizations—UnitedHealth Group, Elevance, CVS Health/Aetna, Centene, and Molina—have released first quarter 2026 financial and enrollment data. These companies collectively serve a majority of Medicaid managed care enrollees nationwide. Their quarterly results typically reveal trends in redetermination impacts, rate adequacy, medical loss ratios, and profitability that signal broader market conditions. State Medicaid directors and MCO executives monitor these earnings reports to benchmark performance, assess competitive positioning, and anticipate contract strategy shifts.

State Policy·129d ago

NASEM Report Highlights Maternal Mortality Gaps, Medicaid Coverage Extensions

The National Academies of Sciences, Engineering, and Medicine released a report on maternal mortality showing Black mothers face a maternal mortality rate of 44.8 deaths per 100,000 live births in 2024, significantly higher than other populations. The report emphasizes the importance of Medicaid postpartum coverage extensions, which 46 states and DC have now adopted to address pregnancy-related complications beyond 60 days. For Medicaid managed care organizations, this underscores the need for enhanced care coordination, cardiovascular screening protocols, and culturally competent care delivery for high-risk maternal populations through the extended 12-month postpartum period.

Federal Policy·CA·129d ago

CMS Defers Federal Medicaid Matching Funds to California, Second Such Action

CMS has announced a deferral of federal Medicaid matching funds to California, marking only the second time in Medicaid's 60-year history such action has been taken. Vice President J.D. Vance announced the deferral at a White House press conference, following a similar announcement on February 25. Federal financial participation deferrals represent CMS's most severe enforcement tool and typically indicate suspected fraud, waste, or abuse requiring state corrective action. The action creates immediate cash flow implications for California's Medicaid program and may signal broader federal enforcement priorities affecting managed care oversight.

State Policy·TX·129d ago

Texas Case Highlights Medicaid Gaps in Postpartum Mental Health Coverage for Black Mothers

A Lufkin, Texas mother charged after exhuming her stillborn daughter's remains illustrates systemic failures in Medicaid postpartum mental health coverage, particularly for Black women who face maternal mortality rates nearly three times higher than white women. The case underscores inadequate screening, follow-up, and culturally competent behavioral health services during the extended postpartum period when grief and mental health crises peak. Texas Medicaid managed care plans must assess whether their networks adequately address perinatal mental health needs and racial disparities in maternal outcomes, especially as federal Medicaid postpartum coverage extends to 12 months in participating states.

Federal Policy·MN·129d ago

CMS Threatens $515M Federal Funds Withhold from Minnesota Medicaid Over Fraud Concerns

CMS Administrator Dr. Mehmet Oz, with support from Vice President J.D. Vance, initiated a two-pronged action against Minnesota's Medicaid program on January 6, threatening to withhold $515 million in federal matching funds. The action centers on alleged fraud concerns within the state's Medicaid program. The article suggests this fiscal enforcement action may be reaching resolution. Minnesota managed care plans and state officials face potential significant federal funding disruptions pending CMS review of state compliance with program integrity requirements.

State Policy·NE·129d ago

Nebraska Launches H.R. 1 Medicaid Work Requirements May 1 Despite Implementation Gaps

Nebraska became the first state to implement work reporting requirements under H.R. 1 on May 1, 2026, despite noted implementation gaps. The state initiated a "soft start" approach, though specifics of enforcement and beneficiary communications remain unclear. Medicaid managed care plans operating in Nebraska should expect member eligibility disruptions as work reporting compliance becomes a redetermination criterion. Plans must prepare for enrollment volatility, potential member outreach responsibilities, and coordination with state agencies on verification processes as other states follow Nebraska's rollout timeline.

Managed Care·129d ago

Medicaid MCOs Deploy Community Health Workers to Close Pediatric Care Gaps

Community health workers (CHWs) are emerging as a strategic tool for Medicaid managed care organizations to address missed well-child visits, immunization delays, and undiagnosed chronic conditions in pediatric populations. CHWs connect families to care by addressing social determinants and system navigation barriers that fragment service delivery. For MCOs, CHW programs offer a mechanism to improve HEDIS measures, close pediatric quality gaps, and meet contractual performance targets while addressing upstream factors that drive preventable utilization. State Medicaid agencies are increasingly encouraging or requiring MCO investment in CHW models as part of value-based care strategies.

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