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Tuesday, September 1 · 24 stories
- State Policy
Five States Face Medicaid Ballot Measures in November Midterm Elections
Multiple state ballot measures in the upcoming November midterm elections will determine Medicaid program direction, including potential coverage expansions, funding restrictions, or administrative changes. Specific proposals vary by state but could affect eligibility rules, state budget allocations for Medicaid, or program structure. Voters will decide these measures on Election Day, with implementation timelines depending on state law. The outcomes will directly shape Medicaid program scope and financing in affected states.
- State Policy · FL
Florida Task Force Reviews $2.7 Billion in Medicaid ABA Services, No Recommendations Yet
A Florida legislative task force met September 1 to review applied behavioral analysis (ABA) services for children with autism and developmental disabilities, examining $2.7 billion in annual Medicaid spending across home, school, office, and community settings. The panel, established by the Legislature in FY 2026-27 budget negotiations, is in information-gathering mode and heard presentations on service delivery patterns, including data showing average ABA service duration of 32.5 months and about 10,000 recipients receiving services for five years or more. The task force is charged with recommending revisions to Florida's ABA delivery model to improve care continuity and program sustainability, with final recommendations due to the Legislature by December 31, 2026.
- Federal Policy
SNAP Eligibility Changes Threaten Free School Meal Access for Low-Income Students
Over 1 million children lost SNAP benefits following implementation of the One Big Beautiful Bill Act, which imposed new work requirements and state cost-sharing provisions. Because many students qualify automatically for free school meals through household SNAP or Medicaid participation, reductions in those programs directly threaten school meal eligibility. Schools offering universal free meals under USDA's Community Eligibility Provision face potential loss of federal reimbursement, as funding formulas tie reimbursement rates to SNAP enrollment percentages. The 30-day grace period for previously qualified students is ending as the 2026-27 school year begins, with advocates warning of increased childhood hunger and academic impacts.
- State Policy · AR
Arkansas Expands Maternal Life360 Home Visiting Program to Northwest Arkansas
Arkansas expanded its Maternal Life360 program to Mercy Hospital Northwest Arkansas on August 31, 2026, providing home visits for high-risk Medicaid and expansion enrollees through a child's second birthday. The program, operated through Family Network, offers pregnancy education, postpartum support, and resource navigation in English, Spanish, and Marshallese. Mercy Northwest Arkansas becomes the fourth active site; the state plans further expansion to address Arkansas's high maternal and infant mortality rates.
- State Policy · KS
Kansas Pharmacist Reports Revenue Loss Under New PBM Transparency Law
Kansas pharmacist Will Anderson reports his Lawrence pharmacy is losing revenue following implementation of Senate Bill 20, which took effect in April 2026 after passage in March. The law bans spread pricing by pharmacy benefit managers, sets a floor for pharmacy reimbursement, and requires transparent reimbursement formulas based on actual drug acquisition costs plus dispensing fees. Anderson, who advocated for the law, expects the revenue loss to reverse as the industry adapts and says similar reforms in other states generated significant Medicaid savings — Ohio eliminated spread pricing and saved over $224 million in one year.
- State Policy · NH
New Hampshire Disability System Records 21 Abuse Cases, 30 Deaths in First Half of 2026
State records show 21 confirmed cases of sexual, physical, or emotional abuse and 30 deaths occurred in New Hampshire's state-run intellectual and developmental disability care system from January through June 2026. The system, which contracts with private agencies to serve people with disabilities including autism and cerebral palsy, received 280 reports of abuse, neglect, or exploitation during this period; state investigators deemed 75 credible, with 88 investigations still incomplete. The data indicates continued systemic problems nine months after a media investigation documented widespread abuse and neglect in the program, which serves Medicaid-funded LTSS beneficiaries.
- State Policy · TX
Texas Medicaid Application Backlog Reaches 210,000 Amid SNAP Accuracy Requirements
Texas' Medicaid application backlog grew by more than 209,000 cases between January and August 2026, reaching a total backlog exceeding 210,000, according to state data shared in stakeholder meetings. The SNAP backlog grew by over 146,000 during the same period. State officials and advocates attribute the delays to new SNAP accuracy requirements affecting eligibility processing capacity. The backlog directly delays coverage for eligible individuals and may affect states' federal performance metrics under Medicaid timeliness standards.
- State Policy
Developmental Disability Providers Report Financial Crisis From State Agency Payment Delays
Developmental disability service providers report they are nearing financial insolvency due to payment delays and administrative dysfunction at state Medicaid agencies, following more than two years of erroneous disenrollments during unwinding. Providers cite slow agency responses, unresolved eligibility issues, and accumulating unpaid claims for HCBS and developmental disability services. The timeline spans the entire unwinding period from 2024 through present day. This threatens the stability of the DD service delivery system and access to long-term services and supports for one of Medicaid's most vulnerable populations.
- State Policy · NM
New Mexico Projects 89,000 Medicaid Enrollees Could Lose Coverage Under Federal Work Requirements
New Mexico state officials estimate approximately 89,000 Medicaid enrollees — roughly 10% of total program enrollment — could lose coverage when federal work requirements in the "One Big Beautiful Bill Act" take effect. State agency leaders announced the projection during a Monday news conference. The work requirements represent a significant shift in Medicaid eligibility policy that would require certain adult enrollees to meet work or work-related activity thresholds to maintain coverage. The projected coverage losses would directly affect state budget planning, MCO enrollment, provider revenue, and uncompensated care levels.
- Federal Policy
Trump Administration Announces Medicaid Drug Pricing Agreements with Nine Companies
The Trump administration announced new Medicaid drug pricing agreements with nine midsize biotechnology and pharmaceutical companies. Under the agreements, companies will charge state Medicaid programs prices equal to the lowest available globally. President Trump stated the deals will apply to every drug from participating firms. The announcement was made Monday in the Oval Office with company executives present.
- State Policy · TX
Texas Hospitals Lose $27 Million Daily as Federal Medicaid Supplemental Payments End September 1
The Trump administration will terminate $9.8 billion in supplemental Medicaid funding to Texas hospitals effective September 1, 2026, resulting in $27 million in daily losses statewide. The funds currently help hospitals cover the gap between Medicaid reimbursement rates and actual service costs. Texas hospitals will face immediate financial pressure as the supplemental payments — which support uncompensated care and low Medicaid reimbursement — are eliminated. This action affects hospital margins, capacity to serve Medicaid beneficiaries, and potentially network adequacy for managed care organizations contracting with affected providers.
Monday, August 31 · 111 stories
- State Policy · NJ
Rutgers Dental School Expands Free Sealant Program in New Jersey Schools
Rutgers School of Dental Medicine launched a school-based dental sealant program serving low-income school districts across New Jersey, providing free preventive care including sealants and oral health screenings to students. The program treated 200 students in Franklin Township starting in February 2026 and plans to expand to Atlantic County schools in fall 2026. The state Department of Health provided $55,000 in grants to support the initiative, which addresses New Jersey's high rates of untreated dental disease among children — more than one-third of third graders have untreated decay compared to one-fifth nationwide. The program targets children in Medicaid and low-income families, who face higher decay rates and limited access to pediatric dentists accepting Medicaid.
- State Policy · GA
Georgia GOP Gubernatorial Candidate Jackson Pledges to Exit State Medicaid Staffing Contracts if Elected
Republican Georgia gubernatorial candidate Rick Jackson says he will terminate his healthcare companies' state contracts if elected governor in November 2026, but would not rule out contract extensions before the election. Jackson Healthcare subsidiaries have received nearly $1 billion from Georgia agencies since fiscal year 2020, primarily through medical staffing contracts with the Department of Community Health. A contract with the Department of Behavioral Health and Developmental Disabilities was recently extended through June 2027, six months into the next governor's term. Jackson stated he would invoke a 30-day termination clause immediately after the election if he wins.
- Industry
Employers Reassess Health Benefits as GLP-1 Drug Costs Strain Budgets
Employers are fundamentally reconsidering health benefit design as spending on GLP-1 medications (Ozempic, Wegovy, Mounjaro) drives unprecedented cost increases. Self-insured employers and commercial health plans are implementing new coverage restrictions, prior authorization requirements, and cost-sharing structures to manage expenses that some benefit managers describe as unsustainable under current benefit designs. The shift is occurring across 2026 plan years as employers finalize benefits for 2027. This development matters primarily for commercial payers but has spillover implications for Medicaid programs in states that cover GLP-1s for weight loss, as commercial market strategies often preview Medicaid managed care utilization management approaches.
- Federal Policy
KFF Survey Finds LGBTQ+ Adults More Likely to Forgo Healthcare Due to Cost
A KFF survey of 2,640 LGBTQ+ adults found 60% missed needed healthcare in the past year due to cost or provider availability, compared to 38% of non-LGBTQ+ adults. Transgender adults, those under 30, and those with lower incomes or no insurance were most likely to forgo care. Among uninsured LGBTQ+ adults, over three-quarters reported missing needed healthcare. Nearly a third of LGBTQ+ adults said their health worsened as a result, with transgender adults and those on Medicaid or self-purchased plans experiencing higher rates of insurance denials and delays.
- Managed Care · MA
New England Senior Care Provider Discusses Immigration and Medicaid Policy Impacts on Long-Term Care
Adam Scott, leader of New England's largest nonprofit senior care and housing provider, discussed how immigration policy changes and Medicaid program shifts are affecting long-term care operations during a Harvard T.H. Chan School of Public Health interview. The discussion addressed rising demand driven by Massachusetts' aging population and workforce challenges in the long-term care sector. Scott outlined how policy changes at the federal and state level are creating operational pressures for providers serving Medicaid beneficiaries in residential and community-based settings. The conversation highlights staffing shortages and reimbursement adequacy as key concerns for nonprofit LTSS providers.
- Industry
FDA Expands Mounjaro Approval to Reduce Cardiovascular Risk in Type 2 Diabetes
The FDA approved Mounjaro (tirzepatide) to reduce major adverse cardiovascular events — cardiovascular death, nonfatal heart attack, and nonfatal stroke — in adults with type 2 diabetes at high cardiovascular risk. The approval follows the Surpass-CVOT trial involving over 13,000 participants across 30 countries. The expanded indication is effective immediately. This matters for Medicaid managed care organizations because cardiovascular disease is a leading driver of costs in diabetic populations, and the new indication may affect prior authorization policies, formulary placement, and utilization management for tirzepatide in high-risk beneficiaries.
- Legal · FL
Florida AG Sues Express Scripts and Prime Therapeutics for Alleged Price Fixing
Florida's attorney general filed a lawsuit against pharmacy benefit managers Express Scripts and Prime Therapeutics alleging their partnership agreement artificially depressed pharmacy reimbursement rates through price fixing. The complaint represents the latest legal challenge to the Express Scripts-Prime arrangement. The lawsuit alleges anticompetitive conduct that affects how pharmacies are paid under prescription drug benefit arrangements. This matters for Medicaid managed care organizations that contract with these PBMs or their affiliates for pharmacy services, as the allegations relate to fundamental pricing mechanisms that affect both network pharmacy relationships and overall drug cost structures.
- Federal Policy
New Maternity Care Billing Codes Take Effect in 2027 for All Payers
New maternity care billing codes will be implemented across all insurance payers beginning in 2027. The coding changes are designed to improve transparency and payment accuracy across the continuum of maternity care services. State Medicaid agencies must adopt these codes alongside other major program changes scheduled for 2027, including work reporting requirements. The new codes are intended to provide better data on maternity care delivery and enable more precise reimbursement for services throughout the pregnancy and postpartum period.
- Federal Policy
NAMD Publishes Overview of Medicaid and Ryan White Program Coordination for HIV Care
The National Association of Medicaid Directors has published an explainer on how Medicaid and the Ryan White HIV/AIDS Program coordinate to provide comprehensive care for low-income people with HIV. The overview describes each program's distinct eligibility and coverage criteria and how they work together to ensure access to the full continuum of HIV care. The resource is available now on NAMD's website. It provides state Medicaid agencies with foundational information on program coordination and coverage responsibilities for this population.