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 32
- Published Oct 6
- Published Oct 6CA
CenCal Health Opens D-SNP Readiness Grants for Providers
CenCal Health is inviting its contracted CareConnect providers to apply for D-SNP Readiness grant funding ahead of the January 1, 2026 launch of its new HMO Dual Special Needs Plan. Grant funds can be used to enhance staffing, support provider training, and upgrade technology systems needed to serve dual-eligible members. Applications are due by December 1. The program targets providers who will need operational and technical readiness to serve a new dually eligible population under the plan.
Why it mattersContracted providers need to apply by the December 1 deadline to secure funding that builds the staffing and systems capacity required to serve CenCal's new dual-eligible population starting January 2026.
- Published Oct 6CT
Connecticut Foundation Compiles October Medicaid Work Rule Resources
In its October advocacy newsletter, the Connecticut Health Foundation compiles resources on several developments affecting Medicaid and immigrant coverage in the state. These include a proposed federal Census rule that would bar race and ethnicity questions and exclude noncitizen immigrants from population counts, with public comment open until Oct. 13; guidance for HUSKY D caregivers on exemptions from new work requirements taking effect Jan. 1; fact sheets from the HUSKY 4 Immigrants coalition on coverage changes effective Oct. 1; and explainers on the newly effective federal public charge policy and related Medicaid eligibility changes for immigrants under the federal law known as HR 1. The newsletter points readers to state and advocacy group tools for navigating these changes.
Why it mattersConnecticut Medicaid beneficiaries, caregivers, and immigrant communities need to understand new work requirement exemptions and eligibility changes before the Jan. 1 enforcement date to avoid coverage loss.
- Published Oct 6
- Published Oct 6IA
Iowa PCA Awards $1.3 Million to Behavioral Health Providers
The Iowa Primary Care Association, using funding from the Iowa Department of Health and Human Services, named 32 recipients of a $1.3 million Organizational Development Funding Opportunity for community-based behavioral health organizations. Unlike direct-service grants, the one-time awards target internal capacity building such as leadership development, revenue cycle improvement, workflow redesign, data infrastructure, and technology modernization. Recipients include major behavioral health providers like Orchard Place, Tanager Place, Vera French, and several NAMI and crisis service affiliates. Projects begin October 1, 2026 and must conclude by June 30, 2027, with participants expected to share lessons learned to inform future statewide technical support.
Why it mattersBehavioral health providers that are part of Iowa's Medicaid-funded service network gain one-time resources to shore up financial sustainability and operations, which affects their long-term capacity to serve Medicaid beneficiaries statewide.
- Published Oct 6
- Published Oct 6
- Published Oct 6
- Published Oct 6
- Published Oct 6NC
Heartland Institute Ranks North Carolina 48th on Medicaid Management
The Heartland Institute, a free-market think tank, released a Sept. 27 report card ranking North Carolina 48th of 50 states for how it runs Medicaid, scoring 28 of 100 points. The state lost points for expanding Medicaid under the ACA, not implementing work requirements until now, restricting provider markets through certificate-of-need laws, and recording few fraud convictions relative to enrollees. North Carolina scored worst on program design (7 of 36 points) and also ranked poorly on fiscal sustainability, program integrity, and provider market measures. The report lands amid ongoing state budget fights over Medicaid funding and ahead of new federal work requirements taking effect Jan. 1, 2026 for the roughly 740,000 adults covered through expansion.
Why it mattersThe ranking adds political ammunition for state lawmakers debating Medicaid funding and work requirements just as North Carolina prepares to implement federal eligibility changes that could strip coverage from hundreds of thousands of expansion enrollees.
- Published Oct 6
- Published Oct 6
- Published Oct 6
- Published Oct 6SD
South Dakota Medicaid Details OB Billing Rules for 2027 Coding Shift
South Dakota Medicaid has issued updated obstetrical billing guidance ahead of AMA coding changes to maternity care that take effect January 1, 2027. Global obstetric codes remain valid for care fully completed by December 31, 2026, but providers may now elect to bill prenatal, delivery, and postpartum services individually before that deadline. If any portion of a pregnancy episode extends into 2027, providers must bill all components individually rather than using a global package code, and global and individual billing cannot be mixed within the same episode. The guidance also addresses claim corrections, timely filing, and coordination when care is transferred among clinicians.
Why it mattersObstetrical providers billing South Dakota Medicaid must choose and apply a consistent billing method per pregnancy episode now or risk claim denials and timely filing problems once the 2027 coding transition hits.
- Published Oct 6
- Published Oct 6
- Published Oct 6
- Published Oct 6
- Published Oct 6
- Published Oct 6IL
Pritzker Discloses GLP-1 Use, Highlights Illinois Medicaid's Diabetes-Only Coverage
Illinois Gov. JB Pritzker told the Chicago Sun-Times he lost 80 pounds since spring 2024 using a GLP-1 medication after being diagnosed with prediabetes and later Type 2 diabetes, and that he stopped taking insulin nine months ago. The interview, part of a broader explainer on GLP-1 drugs, notes that Illinois Medicaid covers GLP-1s only for a Type 2 diabetes diagnosis, not for weight loss alone, unlike the state's employee health plan, which expanded coverage in 2023 to include weight-loss use at a cost of $147 million in fiscal year 2025. The piece also covers FDA eligibility criteria, insurance coverage patterns, out-of-pocket pricing, and health risks including misuse of unapproved compounded versions. Pritzker's disclosure comes as he is seen as a potential 2028 presidential contender, though he says his focus is on reelection as governor this November.
Why it mattersThe gap between Illinois' generous state-employee GLP-1 coverage and its diabetes-only Medicaid policy underscores the budget pressure states face as they weigh whether to extend obesity coverage to Medicaid enrollees.
- Published Oct 6
- Published Oct 6NY
New York Bills Would Force Insurers to Divest Pharmacy, Provider Holdings
In its New York Health Policy Monitor, Isaac Michaels reports that state legislative committees are evaluating bills (S9191, S9192) banning vertical integration across health insurers, pharmacy benefit managers, pharmacies, and providers. Non-compliant entities would have three years to divest overlapping ownership and would be barred from receiving payments under the state medical assistance program until the Attorney General confirms the violations are resolved. The same roundup notes a separate proposal to cap state drug reimbursement using the federal maximum fair price, a 90-day provisional practice allowance for master's-level mental health counselors, and newly adopted or proposed state education department rules on pharmacy services, speech-language pathology, school athletic screenings, and immunizations. The bills remain in committee with no vote scheduled yet.
Why it mattersHealth plans and PBMs with integrated pharmacy or provider ownership in New York face potential loss of Medicaid payment eligibility and forced multi-year divestiture if these bills advance.
- Published Oct 6
- Published Oct 6
- Published Oct 6
- Published Oct 6FL
FGA Argues States Must Suspend Payments to Fraudulent Medicaid Providers
In a commentary piece, the Foundation for Government Accountability argues that states should enforce existing authority to suspend Medicaid payments to providers credibly accused of fraud. The piece contends that failing to act on fraud suspensions allows improper payments to continue flowing to bad actors at taxpayer expense. The organization frames this as a program integrity obligation for state Medicaid agencies rather than a new policy or legal development. No specific state action, enforcement case, or regulatory change is cited in the piece.
Why it mattersState Medicaid agencies face program integrity and fiscal exposure when fraud suspension authority goes unenforced, risking continued improper payments and federal audit findings.
- Published Oct 6
- Published Oct 5AZ
Yuma Doctor Sentenced for Defrauding Arizona Medicaid Program
A physician in Yuma, Arizona, has been sentenced for defrauding AHCCCS, the state's Medicaid program. The case stemmed from a scheme in which the doctor billed AHCCCS for services or claims that did not meet program requirements, resulting in improper payments. The sentencing follows investigation and prosecution of the fraud, holding the provider accountable under state and federal fraud laws. Details on the specific sentence and restitution were part of the court's ruling.
Why it mattersThe case signals continued enforcement scrutiny on Medicaid-billing providers in Arizona and reinforces compliance risks for physicians participating in AHCCCS.
- Published Oct 5
- Published Oct 5MO
Missouri Declines Optional Hardship Exemptions to Work Requirements
Missouri's Department of Social Services has decided not to adopt optional hardship exceptions to the state's new Medicaid work requirements, choosing instead to rely only on the mandatory exemptions already built into federal law. The agency says it will accommodate people facing acute medical events or who must travel for treatment through those existing mandatory carve-outs rather than creating additional state-specific exceptions. This decision affects Medicaid enrollees subject to work requirements who might otherwise have qualified for relief under broader hardship categories. Advocates warn the narrower approach could leave some medically vulnerable enrollees without protection from coverage loss due to noncompliance.
Why it mattersMissouri Medicaid enrollees facing medical crises or treatment-related travel now have fewer avenues to avoid disenrollment for failing to meet work requirements, raising coverage-loss risk the state agency will need to manage operationally.