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Thursday, September 17 · 29 stories
- State Policy · MT
Medicaid Work Requirements Create Medical Exemption Decisions for Disability Enrollees
States implementing Medicaid work requirements must now determine which disability enrollees qualify for medical exemptions, adding administrative burden to existing eligibility processes. The requirements affect cancer survivors and other disabled beneficiaries who attempt to work but face losing coverage when income or work activity triggers reviews. States must review medical cases for a broader population of Medicaid enrollees to adjudicate exemption requests. The policy creates operational challenges for state eligibility systems already managing disability determinations.
- Federal Policy
Federal Budget Cuts May Force States to End Medicaid Meal Delivery Programs
Federal budget cuts are threatening state Medicaid meal delivery programs that provide medically-tailored meals to beneficiaries with specific dietary needs. Multiple states are considering ending these services despite evidence showing the programs improve health outcomes and reduce overall healthcare costs. The timing of specific state decisions varies, but the federal budget pressure is immediate. For state Medicaid agencies, this creates difficult choices between cutting services that demonstrably reduce hospital readmissions and emergency room use versus maintaining other coverage areas.
- State Policy · ID
Idaho Considers Home and Community-Based Services Cuts Amid Budget Pressures
Idaho lawmakers debated Medicaid cuts in January 2026, including reductions to home and community-based services for people with disabilities. The legislature ultimately adopted a narrower cut to disability services than initially proposed by the governor. Advocates express concern that ongoing state budget constraints and shifting federal positions may lead to further HCBS reductions. The story reflects broader tensions between state fiscal pressures and HCBS program sustainability.
- Federal Policy · NC
Federal Medicaid Restrictions in H.R. 1 Set to Take Effect in North Carolina
Sweeping federal Medicaid restrictions included in H.R. 1 are about to take effect in North Carolina, affecting the program that covers one in four state residents. North Carolina Medicaid Director Melanie Bush characterized these provisions as likely the most significant changes in the program's history. The new federal restrictions will fundamentally reshape how Medicaid operates in the state, though specific implementation details and effective dates require further clarification from the full article text.
Wednesday, September 16 · 25 stories
- State Policy · CA
California Poll Shows Tight Race on Billionaire Tax to Fund Medi-Cal Cuts
A Public Policy Institute of California poll finds 52% of likely voters support Proposition 40, which would impose a 5% one-time tax on billionaire assets to offset federal Medi-Cal cuts, but slim majorities also back two competing measures (Props. 41 and 42) that would nullify it. Under California law, if competing measures both pass, the one with the most yes votes prevails. The measure has divided labor and liberal groups, with Democratic leaders including gubernatorial candidate Xavier Becerra opposing it. Voters will decide in November 2026.
- Managed Care
New Guide Details Health Plan-Community Development Partnership Models
The Build Healthy Places Network and Association for Community Affiliated Plans released a guide for health plans and community development organizations on structuring partnerships and investments addressing social determinants of health, particularly housing. The guide provides frameworks for identifying partners, building trust, and aligning investments with community priorities. It arrives as federal housing policy creates new opportunities for cross-sector collaboration. The resource targets Medicaid health plans seeking to operationalize social determinants investments beyond traditional medical services.
- Industry
ASHP Advocates for Medicare Pharmacist Coverage, 340B Protections in Congressional Meetings
The American Society of Health-System Pharmacists (ASHP) is conducting Capitol Hill meetings on September 16 to advocate for three pharmacy priorities: expanded Medicare coverage of pharmacist-provided care, protections for the 340B Drug Pricing Program, and pharmacy residency training support. The advocacy day reflects organized pharmacy's push for provider status recognition and safeguarding discount drug programs. ASHP announced the legislative agenda in a September 15 news release ahead of member meetings with congressional offices.
- Legal · AR
Arkansas Pharmacies File First Lawsuit Against Express Scripts Under State PBM Payment Law
Twelve independent Arkansas pharmacies filed suit against Express Scripts, marking the first use of a 2025 state law authorizing pharmacies to sue pharmacy benefit managers for underpayments. The lawsuit tests new enforcement authority granted to pharmacies under Arkansas legislation targeting PBM reimbursement practices. The case could establish precedent for pharmacy challenges to PBM payment methodology in Arkansas and influence similar legislative efforts in other states. The outcome affects Medicaid managed care plans that contract with Express Scripts for pharmacy services and may impact PBM reimbursement practices across state Medicaid programs.
- Managed Care
Psychedelic-Assisted Therapy Poses Coverage and Implementation Questions for Medicaid Programs
As psychedelic-assisted therapies move toward FDA approval and market entry, Medicaid programs face emerging policy and operational questions around coverage criteria, administration protocols, and workforce requirements. These therapies, being developed for treatment-resistant depression and PTSD, differ from traditional pharmaceuticals in requiring intensive clinical supervision and specialized settings. Medicaid leaders must consider prior authorization frameworks, benefit design, provider network adequacy, and reimbursement models as these treatments enter the behavioral health landscape. Early planning is necessary given Medicaid's role as the largest payer of behavioral health services and the complex operational requirements these therapies will demand.
- Legal
DOL Warns Plans to Maintain Mental Health Parity Compliance Despite Non-Enforcement Posture
The Department of Labor, HHS, and Treasury have adopted a non-enforcement posture for the final Mental Health Parity and Addiction Equity Act regulations published in fall 2024, but are warning employers and health plans that compliance remains expected. The guidance signals that while the agencies are not actively enforcing the 2024 final rule, they continue to monitor mental health parity compliance more broadly. This creates compliance uncertainty for Medicaid managed care plans and other health plans that must determine which parity requirements remain enforceable and how to demonstrate compliance without clear enforcement standards.
- Federal Policy
2.3 Million Young Adults Could Lose Medicaid Under Big Beautiful Bill
The Urban Institute estimates 2.3 million young adults could lose Medicaid coverage under the Big Beautiful Bill, a federal legislative proposal. Actual disenrollment numbers will depend on state implementation choices, particularly how states design income verification and renewal processes. Young adults face higher disenrollment risk due to frequent address changes and participation in gig economy work that complicates income documentation. The findings highlight operational challenges states and managed care plans will face in maintaining continuity of coverage for this population.
- Managed Care
Webinar Announcement on Medicaid Substance Use Services and Justice System Integration
A webinar titled 'Medicaid Connections: Substance Use Health & Justice' has been announced, focusing on how 21st-century legislative and system changes have shifted substance use disorder treatment from punitive systems toward health-based responses through Medicaid. The webinar will examine the evolving role of Medicaid in providing substance use services and the ongoing inequities in access. An audio transcript is available for download.
- State Policy
Pediatricians Report Immigrant Families Avoiding Medicaid, CHIP Amid Immigration Enforcement Fears
Forty percent of pediatricians surveyed by the American Academy of Pediatrics report children in immigrant families are avoiding healthcare due to immigration status concerns, with 31% reporting families avoided applying for Medicaid, CHIP, or food assistance. The survey of over 1,600 pediatricians conducted April-June 2026 found urban pediatricians reported higher rates of families retreating from care (48%) compared to rural providers (32%). A new federal public charge policy effective September 20, 2026 allows immigration officers reviewing green card and visa applications to consider enrollment in Medicaid, CHIP, housing assistance, and food programs as grounds for inadmissibility, which pediatricians say will further deter eligible families from enrolling.
- Federal Policy
SAMHSA Awards Supplemental Prevention Grants to Alabama, Kansas, West Virginia Faith-Based Organizations
HHS announced September 15, 2026 supplemental funding through SAMHSA's Strategic Prevention Framework–Partnerships for Success program to Alabama, Kansas, and West Virginia. The awards support faith-based organizations and leaders in substance use prevention activities. The funding supplements existing state prevention grants. This expands federal support for community-based prevention infrastructure in states with significant substance use disorder prevalence, potentially affecting Medicaid behavioral health service utilization and costs.
- State Policy · LA
Louisiana Congressional Candidates Diverge on Medicaid Work Requirements, ACA Subsidies
Four candidates competing for Louisiana's 6th Congressional District seat have outlined sharply different healthcare positions ahead of the November 3, 2026 election. Democratic candidates Pat Forbes and Lindsay Garcia support restoring expired Affordable Care Act subsidies and repealing new Medicaid work requirements set to take effect in January 2027, which will require many enrollees to earn $580 monthly or complete 80 hours of volunteer work or school to retain benefits. Republican state Sen. Rick Edmonds opposes restoring ACA subsidies, favors expanded health savings accounts, and supports the work requirements as an incentive for job training. The requirements, enacted by the Trump administration and Congress in 2025, affect certain low-income Medicaid recipients starting January 2027.
- Legal
Home-Based Care Providers Face Heightened Medicaid Program Integrity Oversight Amid AI Adoption
Home health and home-based care providers are experiencing increased Medicare and Medicaid program integrity scrutiny while navigating AI technology implementation. Providers are advised to prioritize AI governance, compliance protocols, and vendor management to mitigate regulatory risk. Recommended actions include conducting internal data reviews and compliance audits. The guidance addresses operational risks for providers serving Medicaid beneficiaries under heightened federal and state oversight of billing, documentation, and technology use.
- Legal · NC
Federal Court Ends 14-Year North Carolina Mental Health Settlement Oversight
U.S. District Judge James C. Dever III terminated court oversight of North Carolina's Transitions to Community Living program Monday, ending a 2012 settlement with the U.S. Justice Department. The settlement required North Carolina to transition people with serious mental illness from institutional settings to community housing with wraparound services. While the state exceeded some targets — housing 3,998 people against a 3,000 goal — an independent reviewer found the state failed to meet 2025 benchmarks for supported housing slots from adult care homes, providing only 1,022 of a required 2,000 slots. Both parties agreed to end oversight early despite gaps, citing substantial compliance overall.
- Industry · VT
Dartmouth Health and UVM Health Network Announce Over 600 Job Cuts
Dartmouth Health is eliminating 420 positions and UVM Health Network is laying off 199 staff, effective Oct. 1, 2026. Dartmouth is closing its Tele-ICU and Tele-ED services, the New England Alliance for Health collaborative, and an employee training program while consolidating executive roles. UVM Health is closing two patient care units and cutting positions across its six-hospital network in Vermont and New York. Both networks cite rising costs for drugs, supplies, and salaries combined with declining patient volumes and payment rates. The cuts are expected to save UVM Health $16.8 million annually.
- Federal Policy
Census Bureau Reports 2025 Income Growth and Poverty Decline Amid Safety Net Reductions
The Census Bureau's annual report shows median family income rose 2.6% in 2025 to $87,460, while the official poverty rate fell from 10.7% to 10.2%. Health insurance coverage remained stable. However, recent federal cuts to SNAP and enhanced ACA subsidies, along with pending stricter Medicaid work requirements, are expected to reverse these gains in future years. The supplemental poverty measure, which accounts for government benefits, showed 13.1% of Americans in poverty — unchanged from 2024.
- State Policy · AZ
Arizona GOP Gubernatorial Nominee Proposed Medicaid Elimination as State Senator in 2011
Andy Biggs, the Republican nominee for Arizona governor, introduced legislation as a state senator in 2011 to abolish Arizona's Medicaid program, citing unsustainable costs to taxpayers. The proposal sought to end state participation in Medicaid entirely rather than provide health coverage for low-income residents. As a gubernatorial candidate, Biggs' previous position on Medicaid elimination is resurfacing as voters and stakeholders assess his stance on the program. Arizona's Medicaid program currently covers approximately 2.4 million residents, including expansion populations adopted under the Affordable Care Act.
