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Monday, August 31 · 15 stories
- Federal Policy · TN
Economic Policy Institute Calculates State-by-State Taxpayer Cost of Federal Immigration Enforcement
The Economic Policy Institute released an online calculator estimating federal taxpayers' share of $268.9 billion in deportation costs through the end of the current presidential term. The tool provides state-level breakdowns, estimating Tennessee taxpayers will contribute $4.5 billion total, or $1,961 per taxpayer. The calculator compares immigration enforcement spending to alternative uses such as Medicaid coverage, teacher salaries, or firefighter positions. DHS disputed the analysis, stating illegal immigration costs taxpayers $150 billion annually.
- Federal Policy
DHS Inspector General: Fentanyl Seizures Fell 39% as ICE Shifted to Immigration Enforcement
Fentanyl seizures dropped 39% in the first year of the second Trump administration after Homeland Security Investigations shifted agents from drug enforcement to immigration cases, according to a DHS Office of Inspector General report published August 21, 2026. HSI dedicated 250,000 fewer hours to fentanyl investigations in fiscal 2025 compared to fiscal 2024, while immigration enforcement hours increased over 800%. One HSI field office devoted 99% of its resources to immigration, reducing a seven-agent drug team to three. ICE agreed with the inspector general's recommendation to review staffing levels and expects to complete that review by June 2027.
- Federal Policy · OH
Ohio Marketplace Premiums to Rise 14.7% After Third of Enrollees Drop Coverage
Eleven insurers in Ohio's ACA marketplace are proposing an average 14.7% premium increase for 2027 after 161,000 of 497,000 enrollees dropped coverage following the 2026 expiration of enhanced marketplace subsidies. The remaining pool is expected to be sicker and more expensive to cover. Congressional Republicans allowed the pandemic-era subsidies to expire as part of the 2026 Big Beautiful Bill, which also cut over $1 trillion from Medicaid over 10 years. CBO estimates 16 million more Americans will lack health insurance by 2034 due to combined subsidy expiration and Medicaid cuts taking effect January 1, 2027.
- Federal Policy
Federal Medicaid Cuts and State Budget Pressures Threaten Home- and Community-Based Services for Disabled Americans
The One Big Beautiful Bill Act reduces federal Medicaid funding, prompting states to cut home- and community-based services (HCBS) that allow people with disabilities to live outside institutions. Maryland and other states have enacted or proposed HCBS reductions in response to federal funding cuts and state budget shortfalls. Federal officials have also walked back longstanding requirements that states deliver disability services in community settings rather than institutions. Advocates report the combined federal and state actions reverse decades of policy favoring community integration over institutionalization for disabled Medicaid beneficiaries.
- Federal Policy
Trump Bill Allocates $213M for Rural Health, Cuts $900B from Medicaid Over Decade
President Trump's One Big Beautiful Bill Act (H.R. 1) includes $213 million for rural health programs while cutting over $900 billion from Medicaid over 10 years, per CBO analysis. North Carolina plans to use its share of rural health funding to expand maternal health initiatives including postpartum identification wristbands. Georgetown researchers warn the law's Medicaid cuts and new work requirements threaten state postpartum coverage extensions from 60 days to one year that nearly all states adopted since 2022. States may now eliminate those extensions or inadvertently drop postpartum enrollees who should be exempt from work requirements.
- Federal Policy · CT
Connecticut Reports 63,000 Residents Lost SNAP Benefits Under Federal Budget Reconciliation Act
Connecticut Voices for Children reports that approximately 63,000 adults and children have lost Supplemental Nutrition Assistance Program benefits in the first year following passage of the federal budget reconciliation legislation known as the "One Big Beautiful Bill," significantly exceeding state officials' initial estimates. The losses stem primarily from new work requirements that affect individuals deemed unemployable due to mental illness or other disabling conditions. Connecticut responded with one-time $300 grocery cards to 25,000 residents and $24 million for food banks, but advocates say these measures address only a fraction of the need, with the state legislature not convening until January 2027.
- Federal Policy
Trump Administration Announces Medicaid Drug Discount Agreements with Biotech Companies
The Trump administration plans to announce drug-pricing agreements with several midsized biotech companies on Monday, requiring the companies to provide discounts on outpatient drugs to state Medicaid programs aligned with foreign prices. Participation by state Medicaid programs is optional. In exchange, participating companies will be exempt from pilot programs forcing similar discounts in Medicare, and relief from tariffs is part of some discussions. The agreements represent a new federal approach to Medicaid drug pricing, though states retain discretion on participation.
- Federal Policy · ME
Vice President Vance Campaigns in Maine on Medicaid Fraud, Criticizes Mills Administration Response
Vice President JD Vance visited Maine on August 24, 2026, to rally for Republican candidates and criticize the Mills administration's handling of Medicaid fraud allegations. Vance said some state officials have been responsive to White House anti-fraud efforts but expressed lack of confidence in the state's commitment to enforcement. Maine DHHS has disputed these claims, announcing earlier in August that it suspended payments to five providers and terminated two contracts for serious health and safety violations. The visit follows a similar appearance by CMS Administrator Mehmet Oz earlier in the month, who also criticized Maine's fraud response without meeting state officials.
- Federal Policy
ACA Enhanced Subsidies Expiration Cuts Marketplace Enrollment by Nearly 3 Million Nationwide
Congressional inaction allowed enhanced ACA subsidies enacted in 2021 to expire at the end of 2025, causing marketplace enrollment to drop from 21.8 million to 19.2 million people nationwide as of August 2026 — a decline of nearly 3 million. Mississippi saw enrollment fall by nearly two-thirds in eight months. The subsidies, created as a pandemic-era measure under the American Rescue Plan Act and extended by the Inflation Reduction Act, made ACA coverage more affordable. Their expiration has left low-income adults without employer coverage, particularly in non-expansion states, facing higher premiums and loss of coverage.
- Federal Policy · GA
Justice Department Memo Signals End to Federal Enforcement of Olmstead Community Integration Requirements
A June 2026 Department of Justice memo states that federal disability laws do not require states to provide community-based services to people with disabilities and that DOJ lacks authority to monitor state compliance, reversing nearly two decades of federal oversight. The memo affects Georgia's disability care system, which has operated under a 2010 settlement agreement requiring community-based service expansion. Georgia's disability services agency director says he plans to continue following settlement requirements despite the federal policy shift. The timing coincides with anticipated Medicaid funding cuts and leaves states without federal pressure to maintain or expand home and community-based services for people with disabilities.
Saturday, August 29 · 36 stories
- Federal Policy
KFF Issue Brief Outlines Mandatory and Optional Medicaid Eligibility and Benefits
KFF published an issue brief describing federal mandatory and optional eligibility pathways and covered services in Medicaid. The brief explains how federal statute and regulations establish baseline coverage requirements while allowing states flexibility to expand eligibility and benefits beyond federal minimums. It serves as a reference guide for understanding the framework within which states design their Medicaid programs. The document provides foundational information on program structure rather than reporting new policy changes.
- Federal Policy
CMS Expands Joint Replacement Model Nationwide Through Medicare Program
CMS announced a nationwide expansion of its joint replacement bundled payment model through the Medicare program. The expansion builds on results from a previous demonstration that tested episode-based payments for hip and knee replacements. Medicare Advantage plans and traditional Medicare will implement the model across all states. The expansion does not directly affect Medicaid fee-for-service or managed care payment methodologies, though some dual-eligible beneficiaries may be affected if enrolled in Medicare Advantage.
- Federal Policy · OH
CMS Awards $3.15 Million to Expand Pharmacy Connectivity in Rural Ohio
CMS announced $3.15 million in funding to expand pharmacy connectivity infrastructure in rural Ohio communities. The grant supports enhanced electronic prescribing and health information exchange capabilities for pharmacies serving Medicaid and Medicare beneficiaries in underserved areas. The funding is part of broader federal efforts to improve prescription drug access and coordination in rural settings. Rural Medicaid managed care plans and provider networks may see improved medication management and reduced gaps in care coordination as pharmacy data integration improves.
- Federal Policy
MACPAC Comments on Proposed Medicare Advantage Rule for Contract Year 2027
The Medicaid and CHIP Payment and Access Commission submitted comments to CMS on proposed Medicare Advantage policy and technical changes for contract year 2027. The letter focuses on dual eligible special needs plans (D-SNPs), which serve beneficiaries enrolled in both Medicare and Medicaid. MACPAC has prioritized D-SNPs given their widespread use and the coordination challenges between Medicare Advantage plans and state Medicaid programs. The comment letter addresses proposed changes affecting how these plans operate and coordinate care for dual eligibles.
- Federal Policy
Medicaid Transitions for Youth with Special Health Care Needs Face Coverage and Benefit Gaps
Medicaid covers nearly half of all children and youth with special health care needs (CYSHCN), but when they age out of children's Medicaid and transition to adult coverage, they face significant changes to benefits, provider networks, and care coordination. These transitions can result in coverage gaps and disruptions in medically necessary services. The challenges are particularly acute for youth who rely on pediatric specialists, EPSDT benefits, and care coordination programs that do not continue into adult Medicaid. State Medicaid agencies and managed care organizations must address transition planning, benefit continuity, and provider capacity to support this population.
- Federal Policy
MACPAC Chapter Examines Medicaid Access to Residential Behavioral Health for Youth
The Medicaid and CHIP Payment and Access Commission released Chapter 4 of its report examining access to residential behavioral health treatment for children enrolled in Medicaid. Federal law requires that Medicaid provide behavioral health services to youth with disabilities, including those with intense treatment needs or who pose safety risks. The chapter addresses how states ensure appropriate access to residential treatment for youth who cannot be safely served in community or home settings. This review comes as states face pressure to expand community-based behavioral health capacity while maintaining necessary institutional options for high-acuity cases.
- Federal Policy
MACPAC Issues Recommendations to Ease CYSHCN Transition to Adult Medicaid Coverage
MACPAC's Chapter 5 outlines recommendations to improve transitions to adult Medicaid coverage for children and youth with special health care needs (CYSHCN). The recommendations address challenges CYSHCN face when aging into adult eligibility, including simultaneous SSI age-18 redeterminations and shifts in coverage structures. The timing for implementation is not specified in the excerpt. This matters because CYSHCN transitions involve complex eligibility changes and service disruptions that affect state Medicaid agencies, managed care organizations managing pediatric and adult populations, and specialty providers serving this population.
- Federal Policy
KFF Brief Examines Medicaid Reimbursement for School-Based Services Under IDEA
A KFF brief analyzes how Medicaid finances health and related services delivered in school settings for students with disabilities. Federal law allows state Medicaid programs to reimburse schools for covered services provided to Medicaid-enrolled children when medically necessary and included in an Individualized Education Plan (IEP). The brief addresses the intersection of Medicaid payment policy and Individuals with Disabilities Education Act (IDEA) requirements. This affects state Medicaid agencies' payment methodologies for school-based services and managed care organizations' responsibilities when schools are in-network providers.
- Federal Policy
CMS Data Shows 89,659 Enrollees in PACE Program as of 2023
The Program of All-Inclusive Care for the Elderly (PACE) served approximately 89,659 individuals in 2023, according to newly released demographic data. PACE provides fully integrated Medicare and Medicaid services to individuals age 55 or older who meet nursing facility level of care criteria but can live safely in the community. The report characterizes the demographic composition of PACE enrollees. PACE operates as an alternative to institutional long-term care, with states and CMS sharing financial responsibility for dual-eligible beneficiaries.
- Federal Policy
H.R. 1 Medicaid Provisions Expected to Increase State Payment Error Rates
H.R. 1 introduces Medicaid work requirements and other eligibility changes that are expected to complicate state eligibility determinations and increase payment error rates. The legislation adds new verification requirements and eligibility criteria that states must administer, creating additional documentation burdens and potential error points in the Payment Error Rate Measurement (PERM) process. These changes take effect upon enactment, with states required to implement new systems and processes to manage the added complexity. States face heightened risk of federal scrutiny and potential financial penalties as error rates climb due to the more complex eligibility landscape.