Medicaid news from every state
Medicaid reporting from more than 400 local newsrooms, public radio stations, advocates, attorneys general and state agencies, sorted into one feed per state and updated every four hours.
Medicaid stories from local newsrooms in every state, updated every four hours.
Latest from every state, page 13
- Published Oct 28
- Published Oct 28
- Published Oct 28DC
DC Launches Website, Campaign on Medicaid Work Requirements
The District of Columbia's Department of Human Services and Department of Health Care Finance have launched a public awareness campaign and a new website, workrequirements.dc.gov, to help residents understand new federal work requirements for SNAP and Medicaid created by H.R. 1, the One Big Beautiful Bill Act. The site includes a combined pre-screening tool that lets residents check whether the new requirements apply to them. The effort targets current Medicaid and SNAP recipients who must now meet federally mandated work or activity requirements to retain benefits. DC officials frame the campaign as implementation support to help residents avoid losing coverage as the law's requirements take effect.
Why it mattersDC Medicaid beneficiaries risk losing coverage if they fail to understand or document compliance with the new federal work requirements, making outreach and pre-screening tools critical to minimizing coverage loss.
- Published Oct 28PA
Pennsylvania Senate Passes Bill Expanding EMS Transport Destinations
The Pennsylvania Senate unanimously approved Senate Bill 1403, sponsored by Sen. Frank Farry, which lets EMS providers transport patients to a broader set of authorized receiving facilities beyond hospital emergency departments, including crisis centers and nonhospital drug and alcohol detoxification or rehabilitation facilities. The bill also establishes reimbursement protocols requiring insurers, Medical Assistance managed care plans and CHIP managed care plans to pay applicable emergency services payments for EMS agencies that treat and transport patients to these alternate destinations. Supporters, including the Hospital and Healthsystem Association of Pennsylvania and a local EMS chief, say the change will speed behavioral health crisis care and ease emergency department congestion. The bill passed the Senate and would need further action to become law.
Why it mattersMedical Assistance and CHIP managed care plans would face new mandatory reimbursement obligations for EMS transports to non-hospital destinations, requiring updates to payment policies and provider agreements.
- Published Oct 28ME
Judge Releases All Six Defendants in Maine Medicaid Fraud Case
A federal judge declined Tuesday to jail any of six defendants charged in Maine's first federal health care fraud indictment since 2019. Faysal Kalayaf Manahe, his wife Noora Abd and four others are accused of billing MaineCare for personal care and respite services never provided through Community Home Health Care, a South Portland agency Abd owns; prosecutors say the company received more than $600,000 from MaineCare but have not specified how much was fraudulent. Abd and Kalayaf Manahe also face obstruction charges for allegedly pressuring a witness, and one defendant is charged with lying to an FBI agent. The case follows months of Trump administration officials, including CMS administrator Dr. Mehmet Oz and Vice President JD Vance, publicly characterizing Maine as rife with Medicaid fraud, and arrives one week before a closely watched U.S. Senate election.
Why it mattersState Medicaid agencies and home health providers face heightened federal scrutiny as this marks the first criminal MaineCare fraud prosecution in six years amid escalating political pressure on state program integrity.
- Published Oct 28NY
New York Candidates Diverge on Managing Federal Medicaid Cuts
As federal Medicaid cuts begin taking effect, New York politicians ahead of the midterms are positioning themselves as defenders of the program, but their approaches to managing the reduced federal funding differ. Some candidates propose shifting more costs to the state budget to preserve coverage, while others focus on administrative efficiencies or eligibility protections. The differing strategies signal how state-level political responses to federal Medicaid funding reductions may play out elsewhere. New York's approach could serve as an early test case for other states facing similar federal funding pressure.
Why it mattersState Medicaid agencies and health plans in New York face divergent funding and policy scenarios depending on which candidates' approaches prevail, with direct implications for state budget allocations and coverage stability.
- Published Oct 28TX
EHF Argues Clinically Integrated Networks Should Anchor Rural Texas Strong
In a joint commentary, authors from the Episcopal Health Foundation (EHF), the Texas Association of Community Health Centers (TACHC), and the Texas Organization of Rural and Community Hospitals (TORCH) argue that clinically integrated networks (CINs), not one-off provider-payer deals, should be the core investment strategy for Texas's Rural Health Transformation Program effort, known as Rural Texas Strong. They cite EHF-funded evaluations of two statewide CINs, TACHC's My Texas My Health and the TORCH Clinically Integrated Network, as evidence that shared infrastructure, including data analytics, care management, quality improvement tools, and value-based contracting expertise, can scale across dozens of rural and safety-net providers more efficiently than funding individual provider-MCO partnerships. The authors note EHF has invested more than $2 million building this CIN infrastructure over several years, ahead of the state's current rural transformation planning. As Texas HHSC begins allocating Rural Texas Strong funds, the piece urges policymakers to channel public investment toward shared CIN platforms rather than fragmented, provider-by-provider arrangements.
Why it mattersState Medicaid and rural health officials deciding how to allocate Rural Health Transformation Program dollars face a direct choice between funding fragmented provider-MCO deals or scalable shared infrastructure that could determine whether rural safety-net providers can sustain value-based contracting long term.
- Published Oct 28ME
Six Indicted in MaineCare Home Health Fraud Conspiracy
A federal grand jury indicted the owner and five employees of Community Home Health Care LLC, a licensed Maine home health agency, on health care fraud conspiracy charges, according to the U.S. Attorney's Office for the District of Maine. The arrests prompted Maine Senate Republicans to renew calls for greater transparency and independent oversight of MaineCare, the state's Medicaid program. The case centers on alleged fraudulent billing tied to home health services. Lawmakers are using the indictment to push for stronger program integrity review mechanisms within the state Medicaid agency.
Why it mattersThe case exposes program integrity gaps in MaineCare's oversight of home health providers and could drive legislative action requiring tighter billing audits and independent review.
- Published Oct 28
- Published Oct 28
- Published Oct 28
- Published Oct 28
- Published Oct 28
- Published Oct 27
- Published Oct 27
- Published Oct 27
- Published Oct 27
- Published Oct 27
- Published Oct 27OR
Interim Oregon Health Authority Director Vows to Cut Red Tape
In a Q&A with The Lund Report, interim Oregon Health Authority Director Fariborz Pakseresht discusses his three months leading the agency and his plans to reduce administrative burden on providers and Medicaid coordinated care organizations. Pakseresht, a longtime state official who previously ran the Department of Human Services and Oregon Youth Authority, says he's working to close the gap between how the agency sees itself and how providers and hospitals perceive it as overly regulatory. He's asked providers to identify the top regulatory burdens creating the most friction, and says he supports Gov. Tina Kotek's recent executive order addressing administrative burden. Pakseresht also wants to streamline internal decision-making processes that have slowed the agency's responsiveness.
Why it mattersOregon Medicaid managed care organizations and providers should watch for concrete regulatory relief measures as the agency moves to formalize which administrative requirements it will streamline or eliminate.
- Published Oct 27
- Published Oct 27
- Published Oct 27
- Published Oct 27OH
CMS Chief Oz Pitches State Help Negotiating Gene Therapy Costs
CMS Administrator Dr. Mehmet Oz visited Cleveland to outline plans for CMS to assist states in negotiating costs for expensive gene therapies used to treat rare diseases, alongside discussion of relaxed approval rules for such treatments. The announcement signals a federal push to help state Medicaid programs manage the high price tags associated with gene therapies, which can cost millions of dollars per patient. Specific timelines, legal mechanisms, and program details were not outlined in the announcement. State Medicaid agencies and health plans covering rare disease populations would be most directly affected by any resulting negotiation framework.
Why it mattersState Medicaid agencies face mounting budget pressure from ultra-high-cost gene therapies, so any federal assistance with price negotiation could materially affect state drug spending and formulary decisions.
- Published Oct 27
- Published Oct 27
- Published Oct 27CA
Santa Clara County Opens First Youth Psychiatric Facility Nov. 3
Santa Clara Valley Healthcare, the county's public hospital system, is opening its $470 million Behavioral Health Pavilion on Nov. 3, marking the county's first inpatient psychiatric facility serving children and teens. The facility offers 77 inpatient beds, 35 for children and adolescents and 42 for adults, plus emergency psychiatric assessment and outpatient services, located on the Valley Medical Center campus in San José. For over a decade the county had zero acute psychiatric beds for youth, regardless of insurance status or ability to pay, forcing families to send children hours away, including roughly 65% of the 375 children placed in acute psychiatric care out-of-county in 2025. As a county facility, it will serve all patients regardless of insurance or income, including those on Medi-Cal.
Why it mattersThe county-run facility fills a longstanding gap in youth psychiatric inpatient capacity and guarantees access for Medi-Cal and uninsured children who previously had no local treatment option.
- Published Oct 27
- Published Oct 27
- Published Oct 27
- Published Oct 27ME
Federal Agents Arrest Six in Alleged MaineCare Fraud Case
Federal investigators announced six arrests Tuesday in connection with alleged fraud against MaineCare, Maine's Medicaid program. Officials shared few details about the allegations or defendants at a press conference, leaving the specific scheme, dollar amounts, and provider types involved unclear. Further information is expected as the case proceeds through the federal court system. The action signals active federal law enforcement attention on Maine's Medicaid program integrity.
Why it mattersMaine Medicaid providers and MCOs should expect heightened program integrity scrutiny and potential billing audits as the case details emerge.