Medicaid Monitor
Policy Intelligence
Medicaid Monitor
Policy Intelligence
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NASHP

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State Policy·9d ago

NASHP Convenes States on Children's Behavioral Health Service Delivery Models

The National Academy for State Health Policy (NASHP) reports it convened states through a policy academy focused on strengthening behavioral health services for children and youth. Participating states worked on expanding service capacity, supporting the behavioral health workforce, and improving care coordination across systems. The initiative addresses persistent challenges in children's behavioral health access and integration, particularly relevant for states expanding Medicaid-covered behavioral health benefits and managed care network adequacy requirements. Details on specific state participants, policy commitments, or timelines were not provided in the source material.

State Policy·19d ago

NASHP Hosts Webinar on EMS Post-Overdose Response Partnerships October 14

The National Academy for State Health Policy (NASHP) will host a webinar on October 14, 2026, from 3:00–4:00 p.m. ET focused on expanding emergency medical services partnerships to reduce opioid deaths through post-overdose response strategies. The session will likely address how state Medicaid agencies and health plans can collaborate with EMS providers to implement follow-up interventions after overdose events. For states implementing Section 1115 substance use disorder waivers or managing behavioral health through Medicaid managed care, this webinar may provide operational models for care coordination and overdose prevention initiatives.

Managed Care·19d ago

NASHP Releases Overview of State Medicaid Maternity Value-Based Payment Models

The National Academy for State Health Policy published an overview examining how states are implementing maternity-focused value-based payment models in their Medicaid programs. The report documents strategies states are using to link payment to quality metrics, care coordination, and improved perinatal outcomes. These payment reforms target maternal and infant health outcomes while aiming to control rising costs associated with pregnancy and childbirth care covered by Medicaid. The overview provides state Medicaid agencies and managed care organizations with comparative information on design approaches currently in use.

State Policy·NC·19d ago

North Carolina Tailored Plans Integrate Care for Children with Complex Needs

North Carolina's Tailored Medicaid managed care plans provide integrated physical health, behavioral health, and I/DD services for children and youth with chronic and complex conditions. The Tailored Plans, which launched statewide, aim to coordinate care across multiple service systems for beneficiaries with intellectual and developmental disabilities and serious behavioral health needs. The model assigns these members to specialized managed care organizations designed to address their unique needs. This approach represents North Carolina's strategy to improve care coordination and outcomes for its most vulnerable pediatric Medicaid population through specialized managed care delivery.

Industry·22d ago

NASHP Releases Hospital Cost Tool to Calculate Commercial Payment Breakeven Rates

The National Academy for State Health Policy (NASHP) has released a hospital cost tool that allows state payers to calculate commercial payment breakeven rates. The tool helps states and other payers analyze hospital pricing by determining the minimum commercial rates needed to cover costs when considering Medicare and Medicaid payments. This analysis is relevant for states evaluating hospital payment adequacy and negotiating commercial rates, which indirectly affects Medicaid programs through cross-subsidization dynamics and hospital financial viability. The tool is available now for state use.

State Policy·27d ago

NASHP Tracker Compiles State AI Policy Activity in Health Care

The National Academy for State Health Policy has published a resource tracking state-level activity on artificial intelligence in health care. The tracker compiles emerging policy questions and practical considerations states are addressing as they evaluate AI adoption in their health programs. It covers state legislation, regulatory approaches, and implementation frameworks across multiple health care sectors. The resource is designed for state policymakers navigating AI governance, including Medicaid agencies evaluating AI tools for care management, utilization review, and administrative functions.

State Policy·36d ago

NASHP Reports State Medicaid Expansion of Certified Midwife Coverage to Address Maternity Access

States are expanding Medicaid coverage to include certified professional midwives (CPMs) and certified midwives (CMs) as covered providers. The expansions aim to strengthen the maternal health workforce and improve access to maternity care services, particularly in underserved areas. States are using various policy mechanisms including state plan amendments and provider enrollment expansions to add these midwife categories to their Medicaid programs. The coverage expansions reflect state efforts to address maternal health outcomes and workforce shortages through broader provider networks.

Managed Care·36d ago

NASHP Reviews State Models for Specialized Children's Medicaid Managed Care Programs

The National Academy for State Health Policy published an analysis of how states structure specialized Medicaid managed care programs for children and youth with chronic and complex conditions. The review examines state design choices including eligibility criteria, carved-in versus carved-out services, care coordination requirements, and specialized plan contracting approaches. The analysis is intended to help state Medicaid agencies considering or refining specialized programs for medically complex pediatric populations. No federal policy change or state-specific implementation timeline is reported.

State Policy·40d ago

States Use Multisector Aging Plans to Expand Caregiver Supports

States are developing multisector plans for aging that include expanded caregiver support programs to address the needs of a growing older population. These plans coordinate efforts across state agencies, health systems, and community organizations to strengthen services for family caregivers of older adults. The initiatives typically include respite care, caregiver training, and financial assistance programs. This approach matters for state Medicaid agencies because family caregivers often delay or prevent institutional long-term care utilization, and caregiver burnout can accelerate higher-cost Medicaid LTSS spending.

State Policy·40d ago

Colorado and Rhode Island Launch Support Programs for Young Family Caregivers

Colorado and Rhode Island have established state-level support systems for youth who serve as family caregivers, aligning with expanding federal recognition of this population. The programs aim to provide resources and assistance to young people who provide care for family members with chronic conditions or disabilities. This development responds to growing awareness of caregiving responsibilities among minors and young adults, which can affect their health, education, and long-term outcomes. Both states are developing infrastructure to identify and support these caregivers through their Medicaid programs and related social service systems.

State Policy·MO·46d ago

Missouri Behavioral Health Healthcare Homes Address Serious Mental Illness Through Integrated Care Model

Missouri has implemented Behavioral Health Healthcare Homes to integrate physical and behavioral health services for Medicaid enrollees with serious mental illness. The program aims to reduce the lifespan gap—people with serious mental illness die on average 15-20 years earlier than the general population—by coordinating care and managing chronic conditions. The model targets improved health outcomes while controlling costs through enhanced care coordination and provider partnerships. Missouri's approach offers a replicable framework for other states addressing behavioral health integration under Medicaid.

State Policy·54d ago

NASHP Webinar to Cover State Multisector Aging Plans and Caregiver Support

The National Academy for State Health Policy will host a webinar on September 17, 2026, at 2:00 p.m. ET examining how states are using multisector plans on aging to advance caregiver support initiatives. The session will explore state strategies for integrating caregiver support across health and social service systems. States are increasingly using Medicaid waiver authorities and state plan options to fund and coordinate caregiver respite, training, and support services as part of broader efforts to sustain home- and community-based services delivery.

State Policy·61d ago

NASHP Tracker Compiles State Hospital Reference-Based Pricing Initiatives

The National Academy for State Health Policy has published an ongoing overview tracking state efforts to implement hospital reference-based pricing tied to Medicare rates. The tracker compiles state purchaser initiatives aimed at controlling hospital price growth through payment rate caps or benchmarks. These state policies primarily affect state employee health plans, not Medicaid programs. The tracker serves as a reference resource for state policymakers monitoring hospital pricing approaches across states.

State Policy·65d ago

States Deploy Mobile Clinics and EMS Partnerships to Expand Rural Substance Use Treatment

States are implementing mobile clinics and emergency medical services partnerships to address rural access gaps in substance use disorder treatment. These delivery models aim to reach Medicaid beneficiaries in underserved areas where traditional brick-and-mortar providers are scarce. The strategies focus on expanding medication-assisted treatment and overdose prevention services in communities with limited behavioral health infrastructure. State Medicaid agencies can use federal authorities including Section 1115 waivers and health home state plan amendments to finance these alternative delivery models.

State Policy·72d ago

NASHP Examines State Use of Community Health Workers for Oral Health Access

The National Academy for State Health Policy published an analysis of how states are deploying community health workers to expand oral health access in rural areas. The publication explores state-level strategies for integrating these workers into care delivery models where dental provider shortages limit access. The approach is particularly relevant for states addressing dental health disparities through Medicaid program design, as community health workers can connect beneficiaries to preventive services and coordinate care in underserved regions.

State Policy·75d ago

Georgia and Maine Evaluate Respite Care Programs to Improve Caregiver Outcomes

Georgia and Maine conducted evaluations of their respite care programs to assess effectiveness in supporting family caregivers and inform future state investments. The evaluations examined how respite services affect caregiver burden, health outcomes, and care continuity for individuals receiving long-term services and supports. Results are being used to guide state policy decisions on respite service design, reimbursement levels, and eligibility criteria. This work reflects growing state focus on caregiver support as a cost-effective strategy to maintain community-based care and reduce institutional placement.

Industry·79d ago

Commonwealth Fund Research Examines Private Equity Ownership in Four-State Hospital Analysis

The Commonwealth Fund is supporting new research analyzing private equity ownership patterns in hospitals and provider groups across four states. The research examines how private equity investments are affecting healthcare delivery organizations. The analysis provides state-level detail on ownership structures and operational changes. For Medicaid managed care organizations, private equity ownership of network providers can affect network stability, care continuity, service availability, and provider contracting dynamics.

State Policy·81d ago

NASHP Examines State Strategies for Primary Care SUD Treatment Referrals

The National Academy for State Health Policy published analysis on how states strengthen referral pathways from primary care settings to substance use disorder treatment and recovery services. The report focuses on state-level approaches to improve care coordination between primary care providers and SUD treatment systems. It appears to document ongoing state policy strategies rather than announce a specific new regulatory change or deadline. The findings are relevant to managed care organizations that contract with both primary care networks and behavioral health providers, particularly those operating integrated or carved-in SUD benefits.

Managed Care·89d ago

NASHP Publishes Behavioral Health Integration Resource for Medicaid MCOs

The National Academy for State Health Policy released a resource examining behavioral health integration strategies in Medicaid managed care contracts. The snapshot covers care coordination approaches, quality measurement frameworks, and payment methodologies states are using to advance integrated behavioral health delivery through MCO contracts. The resource is intended for state Medicaid programs and managed care plans developing or refining behavioral health integration requirements.

Federal Policy·94d ago

CMS Schedules Webinar on Interim Final Rule for Medicaid Community Engagement Requirements

The Centers for Medicare and Medicaid Services will host a webinar on July 9, 2026 from 12-1 p.m. ET to discuss an interim final rule on Medicaid community engagement requirements. The webinar follows CMS's issuance of new federal regulations governing work and community engagement provisions in state Medicaid programs. The session will provide technical guidance on the rule's implementation requirements and compliance expectations. Managed care organizations operating in states pursuing community engagement waivers will need to understand reporting, enrollment, and member communication obligations under the new federal framework.

State Policy·96d ago

NASHP Releases Five-State Behavioral Health Workforce Policy Academy Results

The National Academy for State Health Policy published findings from a multi-state policy academy focused on strengthening the behavioral health workforce. Five states participated in the initiative to develop and implement workforce development strategies. The report includes success stories and resources documenting state-level approaches to addressing provider shortages and building capacity. The findings are relevant to Medicaid managed care organizations operating in states that participated or considering similar workforce development partnerships with state agencies.

State Policy·96d ago

NASHP Releases Model Legislation Tying State Drug Pricing to Medicare Negotiated Rates

The National Academy for State Health Policy published revised model legislation allowing states to reference Medicare Maximum Fair Prices negotiated under the Inflation Reduction Act when setting prescription drug payment rates for state programs. The model act would apply to state-funded programs including Medicaid fee-for-service and potentially managed care pharmacy benefits. States can adapt the model to tie reimbursement rates to Medicare's negotiated prices for high-cost drugs, creating potential benchmark pricing constraints. The legislation offers states a mechanism to leverage federal negotiating power for prescription drug cost containment.

State Policy·KY·103d ago

Kentucky Medicaid Director Lisa Lee Discusses People-Centered Policy Approach

The National Academy for State Health Policy spotlighted Kentucky Medicaid Director Lisa Lee, who outlined her people-centered approach to shaping the state's Medicaid program. Lee discussed strategies for improving health outcomes across Kentucky's Medicaid population through policy design focused on beneficiary needs. The interview covered her leadership vision and priorities for the state's program. Kentucky operates a managed care delivery system serving over 1.6 million beneficiaries through five contracted MCOs.

Industry·118d ago

NASHP Hosts Webinar on Rural Health Payment Reform Models

The National Academy for State Health Policy (NASHP) will hold a webinar on June 16, 2026, from 3–4 p.m. ET focusing on payment reform strategies for rural health settings. The session will explore collaborative learning opportunities around alternative payment models designed for rural providers. Rural health care delivery intersects with Medicaid managed care in states where MCOs serve rural populations or where rural providers participate in value-based payment arrangements.

State Policy·120d ago

NASHP Hosts Webinar on State Nursing Home Quality Improvement Strategies

The National Academy for State Health Policy will host a webinar on June 9, 2026, from 3–4 p.m. ET focusing on state strategies to improve nursing home care quality. The session will examine state-level policy approaches and interventions aimed at enhancing care delivery in nursing facilities. For Medicaid managed care organizations with long-term services and supports responsibilities, the webinar may cover quality oversight mechanisms, rate-setting considerations, and regulatory approaches that could affect MCO contracts with nursing facilities.

State Policy·127d ago

NASHP Hosts Webinar on State Prescription Drug Cost Data and Policy Strategies

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·127d ago

NASHP Summarizes State Medicaid Reentry Initiatives from Two-Year Learning Network

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·129d ago

States Align Community Supervision and Health Services for Justice-Involved Reentry

NASHP published guidance on how states can coordinate community supervision and health services to support individuals reentering communities from correctional facilities. The collaboration aims to reduce recidivism and improve public safety through aligned health and supervision services. States can use these strategies to better serve justice-involved populations who often qualify for Medicaid upon release. This matters for Medicaid managed care organizations because justice-involved individuals represent a high-need, high-cost population requiring coordinated behavioral health, substance abuse, and primary care services.

State Policy·MA·129d ago

Massachusetts Expands Behavioral Health Integration Through Sub-Capitation Program

MassHealth has implemented a sub-capitation program that uses tiered primary care payments to increase integrated behavioral health access. The program creates financial incentives for primary care providers to build advanced behavioral health capacity within their practices. This approach represents a significant shift in how states can structure payment mechanisms to promote behavioral health integration. The model could serve as a template for other state Medicaid programs seeking to improve behavioral health access through innovative payment arrangements.

State Policy·129d ago

States Expand Perinatal Care Systems Through Coverage and Partnership Strategies

States are implementing comprehensive strategies to improve maternal health outcomes by expanding perinatal care services, extending postpartum coverage periods, and developing cross-sector partnerships. These initiatives affect Medicaid managed care organizations through enhanced coverage requirements for maternal health services and coordination with community-based organizations. Implementation varies by state based on existing policy frameworks and waiver authorities. These changes require MCOs to adapt network adequacy standards, care coordination protocols, and quality metrics to support comprehensive perinatal and postpartum care delivery.

Managed Care·129d ago

NASHP Hosts State-Only Webinar on PBM Oversight Approaches

The National Academy for State Health Policy will host a state-only webinar on May 20 covering state approaches to pharmacy benefit manager oversight and federal policy developments. The session targets state officials working on PBM regulation and oversight strategies. The webinar will likely address emerging state legislative and regulatory approaches to PBM transparency, contracting practices, and oversight mechanisms. This matters for Medicaid managed care organizations as states increasingly scrutinize PBM practices that affect prescription drug costs and access in Medicaid programs.

State Policy·129d ago

Five States Join NASHP Collaborative on Medicaid Sustainability Strategies

Five states have joined the National Academy for State Health Policy's new Medicaid Policy and Strategy Learning Collaborative to address sustainability challenges. The initiative focuses on helping states navigate ongoing fiscal pressures and upcoming changes from the Older Americans and Better Benefits for All Act (OBBBA). The collaborative will provide states with policy guidance and peer learning opportunities to strengthen their Medicaid programs. This matters for managed care organizations as state sustainability strategies directly impact MCO contracts, rate setting methodologies, and program requirements.

Industry·129d ago

NASHP Hosts Webinar on Private Equity Hospital Ownership Analysis

The National Academy for State Health Policy will host a state-only webinar examining private equity ownership patterns in hospitals and provider groups across four states on May 19. The analysis focuses on ownership structures that could affect provider networks and care delivery. State officials will review findings relevant to network adequacy monitoring and provider stability oversight. The research provides insights for states managing Medicaid managed care networks where private equity-backed providers participate.

State Policy·129d ago

States Implement National Family Caregiver Support Strategy Through Service Integration

States are implementing a national strategy to support family caregivers through enhanced services, protections, and care integration initiatives. The strategy focuses on better coordination between formal care systems and family caregivers who provide unpaid support to Medicaid beneficiaries. Implementation varies by state but includes caregiver assessments, respite services, and training programs. This matters for Medicaid MCOs because family caregivers are critical partners in long-term services and supports delivery, and better caregiver support can improve member outcomes while potentially reducing institutional care costs.

Federal Policy·129d ago

NASHP Hosts Rural Payment Reform Learning Session for States

The National Academy for State Health Policy (NASHP) is hosting a collaborative learning session on rural payment and delivery reform for state officials on Thursday, May 21 from 2-3 p.m. ET. The session will focus on innovative payment models and delivery strategies for rural healthcare providers. State Medicaid directors and managed care organizations operating in rural markets may gain insights into emerging payment reform approaches and delivery innovations that could inform future contract negotiations and provider network strategies.

State Policy·129d ago

State Medicaid Coverage of Certified Nurse Midwives Expands Maternal Care Access

States are increasingly using Medicaid reimbursement for certified nurse midwives (CNMs) to expand access to maternal care services and improve perinatal outcomes. This coverage strategy allows states to address provider shortages in maternal health while potentially reducing costs compared to physician-delivered care. The approach is particularly relevant for rural and underserved areas where obstetricians may be limited. For Medicaid managed care organizations, CNM coverage presents opportunities to expand provider networks and develop innovative maternal health programs while managing costs.

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