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Thursday, July 30 · 5 stories
- State Policy · IA
Iowa Democratic Gubernatorial Candidate Pledges to End Medicaid Managed Care
A Democratic candidate for Iowa governor has announced plans to eliminate the state's private Medicaid managed care program if elected, which would make Iowa the second state to exit managed care after implementing it. The candidate characterized the current managed care system as "a disaster." Iowa transitioned to managed care several years ago, contracting with private health plans to administer Medicaid benefits. The outcome of the gubernatorial race will determine whether Iowa's Medicaid MCOs retain their contracts or face termination, affecting coverage for hundreds of thousands of enrollees.
Wednesday, July 29 · 6 stories
- State Policy
Pennsylvania, Nevada, Wisconsin Medicaid Directors Detail Member Engagement Strategies
Three state Medicaid directors describe operational approaches for gathering and acting on member feedback, including advisory councils, community listening sessions, and embedding member voices in agency decision-making. The leaders discuss how they structure engagement to reach diverse populations, particularly members with complex needs, and translate input into policy and operational changes. These practices aim to improve program responsiveness and member experience across eligibility, benefits, and service delivery.
- State Policy · LA
Louisiana Enacts Commercial PBM Reimbursement Floor Using NADAC
Louisiana enacted Act 913 on June 12, establishing a commercial market reimbursement floor for pharmacy benefit managers that requires use of National Average Drug Acquisition Cost (NADAC) as the reimbursement benchmark. The law applies to commercial PBM arrangements and includes provisions intended to prevent cost-shifting to patients. The legislation took effect upon signing and affects how PBMs reimburse pharmacies in commercial insurance markets in Louisiana.
- State Policy · OR
Oregon Medicaid Enrollees Face New Requirements Under HR1 Starting January 2027
Oregon Health Plan enrollees will be subject to new eligibility requirements beginning January 2027 under the One Big Beautiful Bill Act (HR1). The federal legislation mandates a slate of new requirements for Medicaid beneficiaries that Oregon must implement. The changes take effect in approximately six months. Oregon Medicaid agencies and managed care plans will need to modify systems, processes, and beneficiary communications to comply with the federal mandate.
- State Policy
CHCS Report Outlines State Strategies to Address Social Isolation Among Older Adults
The Center for Health Care Strategies published a report examining how states and communities can help older adults build social connections and reduce isolation. The report identifies strategies for state Medicaid agencies and community organizations to support older adults in connecting to social resources. It addresses a population health priority relevant to states implementing Medicaid LTSS programs and managed care plans serving dual-eligible beneficiaries. The guidance is particularly relevant for states operating HCBS waivers and integrated care models where social determinants of health are increasingly incorporated into care management.
- State Policy · NM
New Mexico Launches Healthy Aging App for Older Adults via UNM Health Sciences
The University of New Mexico Health Sciences Center launched Vive Bien/Live Well, a healthy aging program designed to help older adults maintain health, independence, and quality of life. The program is funded by the New Mexico Health Care Authority and aligns with the World Health Organization's Integrated Care for Older People framework. The initiative targets the state's aging population with tools to support independent living and reduce care needs.
- State Policy · CA
California Business Group Opposes November Ballot Measure on Billionaire Tax for Medi-Cal
A California business association leader is opposing a November 2026 ballot measure that would impose a tax on billionaires to address Medi-Cal funding shortfalls and rising living costs. The op-ed argues the measure would harm long-term economic growth despite potential short-term revenue gains. The ballot measure has not yet been voted on. This matters for California Medi-Cal stakeholders because the measure, if passed, could alter the state's Medicaid funding landscape and sustainability.
Tuesday, July 28 · 5 stories
- State Policy · NM
New Mexico Reports Doubled Postpartum Visits After 2022 Medicaid Extension
New Mexico Department of Health reported that its 2022 Medicaid postpartum coverage extension doubled medical visits among new mothers, according to preliminary evaluation results. The extension, implemented in 2022, expanded postpartum Medicaid coverage beyond the standard 60-day period. State officials cite the increased utilization as evidence the policy may help reduce maternal mortality. The evaluation is ongoing and final results have not been released.
- State Policy · IN
Indiana Imposes Six-Month Enrollment Moratorium on HCBS Waiver Providers Effective August 1
Indiana received CMS approval to implement a statewide provider certification and enrollment moratorium for multiple Home- and Community-Based Services (HCBS) 1915(c) waiver provider types. The moratorium takes effect August 1, 2026, and will initially remain in place for six months. The action halts new HCBS provider certifications and enrollments across Indiana's waiver programs during this period. Indiana Medicaid managed care organizations will be unable to contract with new HCBS providers in the affected categories while the moratorium is in effect, potentially limiting network expansion and member access to services.
- State Policy · AL
Alabama Democratic Gubernatorial Nominee Jones Calls for Medicaid Expansion
Former U.S. Senator Doug Jones, now the Democratic nominee for Alabama governor, delivered a policy speech Monday calling for Medicaid expansion alongside other reforms including a lottery vote and broader government participation measures. The speech outlined what Jones described as 'three real opportunities' for Alabamians, with Medicaid expansion positioned as part of his health policy agenda. Alabama remains one of the states that has not expanded Medicaid under the Affordable Care Act. The policy positions represent a traditional Democratic platform in a state where Medicaid expansion has faced consistent Republican opposition.
- State Policy · CA
Los Angeles County Seeks Half-Cent Sales Tax to Shield Safety-Net Clinics from Medi-Cal Cuts
Los Angeles County voters will decide in June 2026 whether to approve a half-cent sales tax to generate approximately $1 billion annually for community health clinics. The proposed tax aims to protect safety-net providers from ongoing state Medi-Cal budget reductions and federal funding cuts. If approved, the measure would take effect following the June ballot. The initiative responds to financial pressures threatening clinic operations and access to care for Medi-Cal enrollees who rely on community clinics for primary care, behavioral health, and other essential services.
- State Policy · GA
Georgia Excludes HIV from Medically Frail Exemptions in Medicaid Work Requirement Proposal
Georgia's proposed Medicaid work requirement does not include HIV on its list of conditions qualifying beneficiaries as medically frail, meaning low-income Georgians living with HIV would need to meet work requirements to maintain coverage. The proposal is still under consideration by state officials. Advocates are questioning the exclusion, which could affect eligibility for vulnerable populations. The decision stands in contrast to other states that have included HIV in medically frail definitions for work requirement waivers.
Monday, July 27 · 5 stories
- State Policy
1.4 Million Uninsured in Ten Non-Expansion States Remain in Medicaid Coverage Gap
An analysis estimates 1.4 million uninsured individuals in the ten states that have not adopted Medicaid expansion remain in the coverage gap — earning too much for traditional Medicaid but too little to qualify for Marketplace premium tax credits. This population includes working adults, people of color, and individuals with disabilities. These individuals are ineligible for Medicaid because their states have not adopted the ACA's expansion to adults up to 138% of the federal poverty level and ineligible for Marketplace subsidies, which begin at 100% FPL. The analysis highlights the continued state-by-state variation in Medicaid eligibility and access to affordable coverage.
- State Policy
National Association of Medicaid Directors Elects New Board Leadership
State Medicaid directors have elected a new board of directors for the National Association of Medicaid Directors (NAMD). The organization represents state Medicaid agencies in policy discussions with CMS and serves as the primary vehicle for state-to-state coordination on Medicaid program operations. The new board will guide NAMD's advocacy priorities and engagement with federal policymakers during a period of ongoing program changes. State agencies should monitor NAMD communications for shifts in organizational priorities or focus areas under the new leadership.
- State Policy
KFF Tracker Compiles State Rural Health Transformation Plans
KFF Health News is maintaining an ongoing database of state rural health transformation plans as they become available through state responses and public records requests. The tracker aims to compile approved plans across states. This is a standing resource updated as new state plans are obtained, not a report of a specific policy development or deadline.
- State Policy · ID
Idaho to Implement Medicaid Expansion Work Requirements in 2027
Idaho will begin enforcing work requirements for Medicaid expansion enrollees in 2027, following state adoption of provisions from the federal One Big Beautiful Bill Act in April 2026. The Idaho Department of Health and Welfare will administer the requirements. State officials indicate most current expansion enrollees already meet the work requirement criteria, though specific exemption categories and compliance verification procedures have not been detailed.
- State Policy · NC
North Carolina AG Says Federal Medicaid Work Requirement Rule Shifts Millions to Counties
North Carolina's attorney general says a last-minute federal rule change regarding Medicaid work requirements will impose significant costs on counties. Congress included a medically frail exemption in last year's federal Medicaid work requirement law for individuals with serious or complex conditions like cancer, Parkinson's disease, and cystic fibrosis. The state AG contends recent federal regulatory changes will shift financial responsibility for administering or monitoring these exemptions to county governments, resulting in millions of dollars in unexpected local costs. The timing and specific implementation details of the rule change are causing concern about counties' ability to absorb these new expenses.
Friday, July 24 · 5 stories
- State Policy · WI
Wisconsin Medicaid Functional Screen Determines Long-Term Care Program Eligibility
Wisconsin Medicaid requires applicants for long-term care programs to pass a functional screen test in addition to meeting financial eligibility criteria. The functional screen assessment evaluates an individual's ability to perform activities of daily living and need for assistance to determine whether they meet the level of care required for program enrollment. The screen applies to programs including Family Care, IRIS, and institutional care. For applicants and providers, understanding functional screening requirements is critical to navigating Wisconsin's long-term care access and ensuring appropriate program placement.
- State Policy
KFF Tracker Compiles State Abortion Coverage Policies Across Medicaid and Exchange Plans
This interactive resource tracks state-level abortion coverage policies across Medicaid, private insurance, and ACA exchange plans as of 2025. The tracker shows the number of states with laws restricting abortion coverage in Medicaid and private insurance has increased since 2010. It provides a state-by-state breakdown of coverage restrictions, exceptions for life endangerment or other circumstances, and differences between Medicaid fee-for-service and managed care plan coverage. The tool allows Medicaid agencies, health plans, and advocates to compare abortion coverage rules across states and insurance types.
- State Policy · CA
California Medi-Cal Enrollment Drops 5% as 730,000 Disenroll Between June 2025 and March 2026
California's Medi-Cal program lost 730,000 enrollees—a 5% decline—between June 2025 and March 2026, according to California Health Care Foundation data analysis. Undocumented children and young adults experienced disproportionate coverage losses during this period. The enrollment decline follows the end of Medicaid continuous coverage requirements that had kept enrollment elevated during the public health emergency. State agencies and managed care plans should anticipate continued membership volatility and assess impacts on network capacity, risk adjustment, and community-based provider networks serving populations with higher disenrollment rates.
