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 20
- Published Oct 21
- Published Oct 21KS
Kansas Disability Waiver Waitlists Stretch Years Amid Midwest Trend
Families in Kansas and other Midwestern states report multi-year waits for Home and Community-Based Services (HCBS) Medicaid waivers that fund in-home supports allowing people with disabilities to avoid institutional care. The waitlists affect both adults and children with disabilities who qualify for services but cannot access funded slots due to capacity limits. No new policy change or funding fix is reported; the waits are described as an ongoing, longstanding condition across the region. The persistence of these backlogs matters because families often exhaust other options, and some individuals risk unnecessary institutionalization while waiting for a waiver slot to open.
Why it mattersState Medicaid agencies face mounting political and legal pressure to expand HCBS waiver capacity as waitlists signal unmet demand and potential ADA integration-mandate exposure.
- Published Oct 21
- Published Oct 21
- Published Oct 21
- Published Oct 21
- Published Oct 21NY
CMS's Oz Targets 80-Plus NYC Senior Centers Over Medicaid Billing
CMS Administrator Dr. Mehmet Oz put more than 80 New York City adult day and senior care centers on notice over suspected Medicaid fraud, citing billing levels he called far higher than they should be. The action signals heightened federal scrutiny of claims submitted by these facilities, which serve elderly and disabled Medicaid beneficiaries needing daily supervision or care. Oz's comments suggest investigations or audits may follow, though the article does not detail a specific enforcement mechanism or timeline. The move reflects broader federal attention to program integrity in Medicaid-funded long-term and adult day care services.
Why it mattersProviders flagged in the notice face potential audits, clawbacks, or enforcement action that could disrupt billing and operations for facilities serving vulnerable Medicaid-dependent seniors.
- Published Oct 20
- Published Oct 20
- Published Oct 20CA
HPSJ Launches Telephonic After-Hours Access Survey of Providers
Health Plan of San Joaquin/Mountain Valley Health Plan has contracted a vendor to conduct a telephonic survey of primary care providers' after-hours phone systems, beginning the week of October 14 and running through December. The survey checks four access requirements mandated by DHCS and DMHC: 24/7 availability of a recorded message or live attendant, emergency instructions to call 911 or go to the nearest ER, access to an on-call provider for urgent triage, and a stated 30-minute callback commitment. Providers found non-compliant will be notified and required to submit remediation or corrective action plans. Providers are urged to review and update their after-hours messaging now to avoid compliance findings.
Why it mattersPrimary care providers in the HPSJ/MVHP network face corrective action demands if their after-hours phone systems fail to meet DHCS/DMHC 24/7 access standards during this monitoring survey.
- Published Oct 20IL
Chicago Mayor's 2027 Budget Funds New Mental Health Clinic, CARE Program
Chicago Mayor Brandon Johnson's proposed 2027 budget includes city funding to reopen a community mental health clinic and makes the Crisis Assistance Response and Engagement (CARE) program permanent with $5 million in city funds. CARE dispatches mental health teams to certain 911 calls as an alternative to police response; it previously relied on about $5.2 million in American Rescue Plan Act funds that expire this year. Johnson plans to announce the investments Wednesday during his budget unveiling, citing a goal of reversing decades of clinic closures between 1989 and 2012. He intends to draw on escrowed revenue from the city's social media tax, currently held pending litigation, to help sustain the funding long-term.
Why it mattersCity and county behavioral health crisis programs that have relied on expiring federal pandemic-era funds now face replication pressure to find sustainable financing, a dynamic relevant to Medicaid behavioral health and crisis system planning nationally.
- Published Oct 20WY
Birth Center Deliveries Triple Over Two Decades, Report Finds
A new report finds that deliveries at midwife-run birth centers for low-risk pregnancies have tripled over the past 20 years, with notable growth in rural Western states. These freestanding centers offer an alternative to hospital labor and delivery units, typically serving patients with low-risk pregnancies who want a less medicalized birth experience. The report highlights their particular popularity in rural areas, where hospital obstetric units have been closing. Growth trends like this carry implications for state maternal health policy and access planning, especially in rural communities facing shrinking hospital-based delivery options.
Why it mattersState Medicaid agencies covering a large share of rural births need to track birth center capacity and reimbursement policy as hospital obstetric units close and low-risk deliveries shift to freestanding midwife-led settings.
- Published Oct 20
- Published Oct 20
- Published Oct 20
- Published Oct 20
- Published Oct 20NH
New Hampshire Allocates $11 Million for Rural EMS Overhaul
New Hampshire's GO-NORTH office announced an $11 million project to strengthen rural emergency medical services, unveiled during a Concord press conference attended by HHS Secretary Robert F. Kennedy Jr. The funding, drawn from New Hampshire's Rural Health Transformation Program allocation, will provide rural EMS providers with new equipment, workforce training, and resource-sharing partnerships, plus expand mobile integrated health programs to five new sites including the Concord area and North Country. State officials say the goal is to reduce emergency room strain from patients lacking primary care by treating more needs out-of-hospital. The announcement came alongside strong signals from Kennedy ahead of the program's mandated federal rescoring, which determines whether New Hampshire continues receiving its roughly $205 million annual allocation through 2030.
Why it mattersState Medicaid and rural health officials should note that continued federal funding hinges on annual performance rescoring, making program execution and documentation critical to sustaining the five-year, $50 billion allocation nationally.
- Published Oct 20OR
Missouri Rural Health Pilot Wins Evidence-Based Policy Innovation Award
The Center for Evidence-based Policy recognized Missouri's ToRCH (Transformation of Rural Community Health) Project with its Policy Innovation Award. The program, created through a waiver amendment by MO HealthNet, is a primary care case management pilot operating in six rural counties where hospitals lead local boards that screen Medicaid members for social needs, deliver services like transportation and medically tailored meals, and track outcomes. Launched in June 2023, the pilot reported gains in chronic disease management, behavioral health follow-up care, WIC enrollment, and reductions in avoidable emergency department visits and readmissions. The Center also gave an honorable mention to Wisconsin Medicaid for developing a GLP-1 weight management coverage policy, effective July 1, 2026, built on evidence reviews, cost modeling, and manufacturer price negotiations.
Why it mattersState Medicaid agencies designing rural health or value-based initiatives now have a documented model, including waiver structure, funding streams, and HEDIS-based outcome tracking, to replicate for addressing health-related social needs.
- Published Oct 20MN
Census Bureau Releases 2020-2024 County-Level Uninsured Rate Data
The U.S. Census Bureau has published 5-year American Community Survey (ACS) files for 2020-2024, offering uninsured rate estimates for every state and county, as detailed in a SHADAC resource post. Unlike single-year ACS estimates, which cover only areas with populations of 65,000 or more, the 5-year pooled data allow for more granular geographies, including areas under 20,000 people such as ZIP Code Tabulation Areas and Census tracts. SHADAC notes that Census Bureau definitions of family and income differ from the Health Insurance Unit and federal poverty guideline measures SHADAC uses in its own State Health Compare tool, so users should account for these methodological differences when comparing sources. The data are available now via an interactive map and data.census.gov.
Why it mattersState Medicaid agencies, researchers, and advocates rely on this granular uninsured-rate data to target outreach, justify coverage expansion proposals, and benchmark county-level enrollment gaps against federal poverty guideline-based eligibility thresholds.
- Published Oct 20TX
Evaluation Finds Tarrant County Maternal Health Payment Model Exceeds Goals
Stephens Consulting Group, commissioned by Episcopal Health Foundation, evaluated an alternative payment model between Cook Children's Health Plan (CCHP) and My Health My Resources of Tarrant County (MHMR) supporting the Family Connects postpartum home-visiting program. Under the model, which began in December 2019, MHMR delivers nurse home visits to CCHP's Medicaid and CHIP postpartum members, and CCHP makes periodic fixed payments tied to performance measures like postpartum care timeliness, depression screening, and well-child visits. The evaluation found MHMR met or exceeded most performance goals from 2023-2025, outperforming the state's 2024 STAR Medicaid postpartum care rate of 80.70% in nearly every payment period, though it fell short of the 90% home-visit goal once. Findings highlight that sustained collaboration, provider capacity to cover upfront costs, and integrated service delivery were key to the model's success, with CCHP and MHMR now discussing expanding it across the full perinatal period.
Why it mattersThe evaluation gives Texas Medicaid MCOs and safety-net providers a concrete performance and financing template for structuring value-based maternal health payment arrangements, including the upfront capital challenges smaller providers would need to overcome to replicate it.
- Published Oct 20PA
Pennsylvania Finalizes 2027 ACA Marketplace Rate Increases
The Pennsylvania Insurance Department has finalized 2027 premium rates for insurers selling plans on Pennie, the state's ACA marketplace. Rates will rise across all participating insurers, though the approved increases are lower than what carriers initially proposed. The announcement affects individuals and families who purchase coverage through Pennie rather than employer-sponsored or Medicaid coverage. New rates take effect for the 2027 plan year.
Why it mattersHigher marketplace premiums could push more low-income Pennsylvanians who lose or forgo exchange coverage toward Medicaid eligibility determinations, increasing churn and enrollment pressure on the state agency.
- Published Oct 20
- Published Oct 20
- Published Oct 20
- Published Oct 20
- Published Oct 20
- Published Oct 20CA
Justice in Aging Outlines State Options to Limit Estate Recovery Harm
In a Justice in Aging publication, the advocacy organization lays out strategies states can adopt to reduce the harms of Medicaid estate recovery on low-income older adults and their families. The piece examines how mandatory recovery of long-term care costs from deceased beneficiaries' estates can strip families of homes and intergenerational wealth, disproportionately affecting low-income and communities of color. It highlights state-level options such as expanding hardship waivers, narrowing the scope of recoverable costs, and limiting liens, within the flexibility states already have under federal estate recovery requirements. The resource is aimed at state policymakers and advocates considering changes to their estate recovery programs.
Why it mattersState Medicaid agencies retain significant discretion over how aggressively they pursue estate recovery, and policy choices here directly affect low-income beneficiaries' housing stability and family wealth.
- Published Oct 20FL
House Panel Probes Duplicate Medicaid Capitation Payments After MN Fraud
The House Committee on Energy and Commerce is examining cases where states made multiple capitated Medicaid managed care payments for the same beneficiary, an inquiry prompted by widely publicized fraud findings in Minnesota. The investigation focuses on how duplicate enrollments and capitation payments can occur within Medicaid managed care systems and what oversight gaps allowed them. States and managed care organizations face scrutiny over enrollment verification, data matching, and payment controls. The piece does not specify a timeline for findings or any resulting legislative or regulatory action.
Why it mattersState Medicaid agencies and MCOs should expect heightened federal scrutiny of enrollment reconciliation and capitation payment controls as a result of this inquiry.
- Published Oct 20
- Published Oct 20