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 25
- Published Oct 15AZ
Biggs Cosponsors Bill Requiring Annual State Medicaid Fraud Assessments
Rep. Andy Biggs (R-AZ) announced support for H.R. 10636, the Medicaid Fraud Prevention Act, introduced Sept. 28 by Rep. Michael Rulli (R-OH) and now referred to the House Energy and Commerce Committee. The bill would require states to complete annual Medicaid fraud risk assessments covering fee-for-service, managed care, and eligibility systems, rank vulnerabilities, and implement corrective action plans within 90 days, with annual reporting to HHS and HHS reporting to Congress on national trends. Biggs cited CMS findings that Arizona was among eight states reporting zero fraud referrals and overpayment recoveries in Medicaid managed care, plus Arizona's four consecutive years of missed federal Single Audit deadlines, as justification. The bill's cosponsorship comes amid Biggs' campaign for Arizona governor.
Why it mattersState Medicaid agencies would face new mandatory annual fraud risk assessments and corrective-action deadlines, with noncompliance risking federal funding conditions or payment suspensions.
- Published Oct 15
- Published Oct 15MS
Mississippi Nursing Home Operators Sue State Medicaid Agency
Hattiesburg Medical Park Management Corp. and several affiliated Bedford Care Center nursing facilities have filed suit against the Mississippi Division of Medicaid and its executive director, Cindy Bradshaw, in her official capacity. The case names multiple long-term care facilities across Mississippi, including locations in Mendenhall, Monroe Hall, Newton, Petal, Hattiesburg, and Marion, as plaintiffs. The filing indicates a dispute between nursing facility operators and the state Medicaid agency, though the specific claims and relief sought are not detailed in the case caption alone. Further proceedings will clarify the nature of the dispute and its potential impact on Medicaid nursing facility reimbursement or regulatory practices in Mississippi.
Why it mattersThe outcome could affect how Mississippi Medicaid reimburses or regulates nursing facilities, directly impacting long-term care providers' revenue and compliance obligations statewide.
- Published Oct 14
- Published Oct 14
- Published Oct 14
- Published Oct 14
- Published Oct 14IA
Rural Iowa Clinic Closures Push Patients Hours From Specialty Care
Iowa Starting Line profiles an Ottumwa couple whose access to specialty care has shrunk as rural clinics and hospital services close across southern Iowa, forcing long drives even for patients with Medicare and supplemental insurance. The piece ties local closures, including MercyOne's Ottumwa clinic and a Pella Regional Ottumwa practice, to inadequate reimbursement, provider recruitment struggles, and funding changes under the 2025 federal reconciliation law that cut Medicaid. A gubernatorial candidate quoted in the piece also blames Medicaid managed care privatization for raising administrative costs on providers and threatening rural hospitals. The story illustrates how insurance coverage does not resolve geographic access gaps once local care disappears.
Why it mattersState Medicaid officials and rural hospitals face mounting closures tied to reimbursement and federal funding cuts, intensifying access gaps that managed care coverage alone cannot fix.
- Published Oct 14
- Published Oct 14
- Published Oct 14
- Published Oct 14
- Published Oct 14
- Published Oct 14CA
HPSJ Updates Medi-Cal Medical Benefit Prior Authorization Rules
Health Plan of San Joaquin/Mountain Valley Health Plan's Pharmacy and Therapeutics Committee approved medical benefit changes for Medi-Cal managed care members, effective December 21, 2026. The update removes prior authorization for Aponvie (replacing an obsolete billing code) while adding new PA requirements and strict clinical criteria for Papzimeos, a recurrent respiratory papillomatosis treatment, and Exdensur, a new severe eosinophilic asthma biologic. The plan also tightened inhaled corticosteroid dosing criteria across existing severe asthma biologics, including Nucala, Fasenra, Cinqair, and Tezspire, requiring prescription by an allergist or pulmonologist and documented treatment failures before approval.
Why it mattersProviders billing these J-codes for Medi-Cal managed care members must meet the new documentation and specialist-prescribing requirements or face claim denials starting December 21, 2026.
- Published Oct 14
- Published Oct 14FL
Florida Appeals Court Orders Hope Florida Grand Jury Report Erased
Florida's 1st District Court of Appeal ruled this week that a Leon County grand jury exceeded its authority by naming and criticizing public officials over the diversion of $10 million from a Medicaid settlement without issuing any indictments, and ordered the grand jury's report expunged. The grand jury had found the funds were misappropriated from a settlement struck by the Agency for Health Care Administration and funneled through the Hope Florida Foundation and other nonprofits to oppose a marijuana legalization ballot measure, but found insufficient evidence to criminally charge anyone. State purchasing records show agencies have paid more than $444,000 since October 2025 to private law firms, some billing $800 an hour, representing officials including Attorney General James Uthmeier, AHCA's former secretary and former general counsel, and a former DeSantis deputy chief of staff during the closed-door grand jury fight. Gov. DeSantis called the ruling a vindication and said leakers of the report should be prosecuted.
Why it mattersThe underlying dispute centers on alleged diversion of Medicaid settlement funds by the state agency that administers Florida's Medicaid program, raising compliance and oversight questions even as the court quashes the grand jury's findings.
- Published Oct 14
- Published Oct 14
- Published Oct 14
- Published Oct 14CO
Colorado Disability Council Details Ballot Measures' Effects on HCBS Funding
The Colorado Developmental Disabilities Council published personal accounts from people with intellectual and developmental disabilities explaining how 2026 statewide ballot measures could affect disability services. Amendment 87 (graduated income tax), Proposition NN (spending above TABOR limits for schools and other purposes), and Proposition 136 (capping income tax at 4.4%) would each reshape the state General Fund that supports Home and Community-Based Services, Community First Choice, caregiver wages, and case management. One contributor describes losing personal assistant hours this year as the state phases down caregiver hours from 84 to 56 per week by July 2027 due to budget constraints. Amendment 85, which would require plain-language ballot questions, is also flagged for potentially eliminating detailed tax-impact disclosures voters currently receive. The measures go before Colorado voters in the 2026 election.
Why it mattersState revenue measures on Colorado's 2026 ballot will directly determine funding levels for HCBS waivers, Community First Choice, and caregiver wages that keep Medicaid enrollees with I/DD living in their communities.
- Published Oct 14
- Published Oct 14
- Published Oct 14
- Published Oct 14CA
California Hosts Webinar on Funding Peer Support Workforce
California Health & Human Services announced a webinar providing guidance on sustainable funding for peer support programs. Topics include Medi-Cal billing and certification, Behavioral Health Services Act (BHSA) funding, opioid settlement funds, and other reimbursement pathways. Experts will cover existing funding streams and how providers can achieve Medi-Cal certification and braid multiple funding sources to sustain peer workforce programs. The session targets behavioral health providers and organizations seeking to build long-term funding models for peer support services.
Why it mattersBehavioral health providers and peer support organizations need to understand Medi-Cal certification and braided funding options to keep peer workforce programs financially viable.
- Published Oct 14
- Published Oct 14
- Published Oct 14
- Published Oct 14CA
Capitol Weekly Op-Ed Urges Expanding California Behavioral Health Access
In a Capitol Weekly commentary, the author argues that California urgently needs to widen access to behavioral health services, posing the central question of where people can turn for help today. The piece contends current pathways to care are too narrow or hard to navigate, leaving many without timely support. While the article does not detail a specific new policy, rule, or funding mechanism, it frames the issue as a systemic gap affecting people who rely on publicly funded behavioral health services, including Medicaid beneficiaries in California.
Why it mattersFor California Medicaid stakeholders, continued advocacy pressure on behavioral health access could shape future state budget priorities and Medi-Cal behavioral health policy debates.
- Published Oct 14LA
Louisiana Gets CMS Waiver to Cover Inmates Before Release
Louisiana received federal approval for a waiver allowing Medicaid to cover services for incarcerated individuals before their release, state health officials announced. The program will let the state treat behavioral health conditions, provide a 60-day supply of medications leading up to release, and send inmates out with 30 days of prescriptions in hand. Inmates will also be connected to community doctors, case management, and durable medical equipment ahead of reentry. The initiative launches early next year at Elayn Hunt Correctional Center before expanding to other state prisons and parish jails, with full statewide coverage targeted for 2027.
Why it mattersState Medicaid officials and correctional health providers must stand up new pre-release enrollment, pharmacy, and care-coordination infrastructure to meet the waiver's reentry requirements.
- Published Oct 14