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Thursday, June 18 · 3 stories
- State Policy · MS
Mississippi Medicaid Seeks Court Approval to Withhold $2.4M Payment to Greenwood Leflore Hospital
The Mississippi Division of Medicaid filed a motion in bankruptcy court Wednesday requesting permission to withhold a scheduled $2.4 million payment to Greenwood Leflore Hospital. The hospital, currently operating under Chapter 11 bankruptcy protection, has warned the payment withholding could force immediate closure. The dispute arises as the state Medicaid program exercises its authority to recoup or withhold payments from providers in financial distress. If approved, the action would remove critical operating revenue from a hospital serving a predominantly Medicaid-eligible population in the Mississippi Delta.
- State Policy · NC
North Carolina Proposes Stricter ABA Therapy Rules Amid $505M Medicaid Spending
North Carolina lawmakers are pursuing tighter regulatory requirements for applied behavioral analysis (ABA) therapy providers following combined state and federal Medicaid spending of over $505 million in 2025. The proposed rules aim to reduce fraud and abuse in the rapidly growing autism treatment sector. The legislation would impose additional credentialing, supervision, and documentation standards on ABA providers participating in Medicaid. This follows nationwide scrutiny of ABA billing practices and improper payments in state Medicaid programs.
Wednesday, June 17 · 2 stories
- State Policy · TN
Tennessee Pharmacies Dispense High-Dose Ivermectin Under Standing Order Law
Since Tennessee enacted the nation's first law in 2021 allowing pharmacies to sell ivermectin without patient-specific prescriptions, dozens of pharmacies now dispense highly concentrated ivermectin pills under standing orders, many facilitated by a single anti-vaccine physician. The law permits pharmacies to dispense prescription drugs through protocol agreements with physicians rather than individual patient prescriptions. This arrangement allows pharmacies to sell potent formulations of ivermectin directly to consumers under medical standing orders, bypassing traditional prescribing requirements.
- State Policy · CT
Connecticut Faces Loss of 110,000 Adult Medicaid Enrollees
Connecticut anticipates approximately 110,000 low-income adults could lose Medicaid coverage, prompting state officials to develop strategies to prevent increased uninsured emergency department utilization. The coverage losses stem from ongoing Medicaid redeterminations following the end of continuous enrollment protections. State officials are working to transition affected enrollees to alternative coverage options and prevent gaps in care. The unwinding creates operational challenges for Connecticut managed care organizations managing member retention and care continuity.
Tuesday, June 16 · 4 stories
- State Policy
State Reproductive Health Policies Create Unequal Access Across U.S., KFF Analysis Finds
A KFF analysis published in The Milbank Quarterly documents how state-level policy decisions create significant variation in reproductive healthcare access across the United States. The research examines state choices on contraception coverage, abortion restrictions, and maternal health programs that directly affect Medicaid beneficiaries. State policy differences impact managed care organizations' benefit design, network requirements, and care coordination obligations. The analysis highlights how states' Medicaid program structures and regulatory frameworks shape reproductive health service delivery and access for MCO enrollees.
- State Policy
States Propose Changes to Immigrant Health Coverage and Enforcement in 2025-2026 Sessions
Multiple states are introducing legislation affecting immigrants' access to state-funded health coverage and services during the 2025-2026 legislative sessions. The actions include both expansions and restrictions to coverage eligibility, with direct implications for Medicaid and CHIP programs that serve immigrant populations. Changes vary by state and may affect enrollment, eligibility verification processes, and state budget obligations. Medicaid managed care organizations should monitor state-level developments that could alter their member demographics, revenue streams, and compliance requirements for serving immigrant populations.
- State Policy · MO
Missouri Eliminates Medicaid Coverage for Chiropractic Services Due to Budget Cuts
Missouri has eliminated Medicaid coverage for chiropractic services following state budget cuts, reversing a 2018 legislative expansion that added chiropractors as covered providers. The change affects access to non-opioid pain management services for Medicaid enrollees. The elimination comes despite earlier projections that chiropractic coverage would reduce overall Medicaid costs. The policy change takes effect immediately as part of broader Medicaid budget reductions.
- State Policy · WA
Washington Sued Over Medicaid Assisted Living Funding Cuts
Washington state faces litigation over budget cuts that reduced tens of millions in state funding for assisted living facilities serving Medicaid patients. Democratic lawmakers made the cuts to address a budget shortfall this year. The lawsuit challenges the state's decision to reduce payments to these facilities. The cuts affect assisted living providers that rely on Medicaid reimbursement for long-term care services.
Monday, June 15 · 2 stories
- State Policy
State Medicaid Fraud Crackdowns Reduce Provider Access for Disability Services
States are implementing stricter fraud enforcement measures in Medicaid programs serving people with disabilities, following federal directives. The increased scrutiny has led to provider exits from Medicaid networks, creating access challenges for beneficiaries requiring home and community-based services and other disability supports. States are balancing program integrity goals against network adequacy concerns as providers cite compliance burdens and payment delays. The enforcement trend affects multiple states and continues to evolve as federal Medicaid policy emphasizes fraud prevention.
- State Policy · IN
Indiana Expands Civil Commitment Standard, Links Homelessness Law to Emergency Detention
Indiana Senate Enrolled Act 285 broadens the state's definition of "gravely disabled" for involuntary civil commitment purposes and establishes a new framework requiring law enforcement to assess the need for emergency detention before enforcing criminal penalties for unauthorized camping or sleeping on public property. The misdemeanor street-camping provisions take effect July 1, 2026. The law creates a mandatory assessment pathway that directs individuals experiencing psychiatric crises toward treatment rather than immediate criminal sanctions. For Medicaid managed care organizations operating in Indiana, this changes the front-end pipeline for behavioral health emergency services and may affect contractual obligations around crisis response and emergency detention coordination.
Friday, June 12 · 1 story
- State Policy · MN
Minnesota Reinstates Medicaid Payments to Thousands of Providers After May Anti-Fraud Cutoff
The Minnesota Department of Human Services is resuming Medicaid payments to most providers cut off in May 2025 during a mass anti-fraud action tied to a federal deadline. The state notified providers Wednesday that payments would be reinstated for those who appealed their terminations. The original cutoff affected thousands of care providers across the state. This reversal follows pushback from providers who were caught in the broad enforcement sweep and suggests the state's initial termination process may have been overly expansive.
Thursday, June 11 · 3 stories
- State Policy
Child Medicaid and CHIP Enrollment Down 2 Million Since January 2025
Child enrollment in Medicaid and CHIP has declined by more than 2 million since January 2025, according to Georgetown University's Center for Children and Families. The declines vary significantly by state and affect children in working families who often lack access to affordable employer-sponsored coverage. The enrollment losses represent a continuation of coverage instability following the end of the Medicaid continuous enrollment provision. These drops matter because many affected children become uninsured rather than transitioning to other coverage.
- State Policy · PA
Pennsylvania Lawmakers Push PBM Oversight After 1,000+ Pharmacy Closures Since 2020
Pennsylvania has lost over 1,000 pharmacies since 2020, prompting state lawmakers to pursue legislative action targeting pharmacy benefit managers. A Pennsylvania Department of Human Services official expressed skepticism about a legislative proposal to hire a PBM to oversee other PBMs. The legislative effort aims to address pharmacy closures attributed to PBM practices, though specific proposals and timelines are not detailed in the available information.
- State Policy · RI
Rhode Island Faces Decision on Medicaid Coverage for GLP-1 Weight Loss Drugs
Rhode Island is considering whether to maintain Medicaid coverage for GLP-1 medications used to treat obesity, amid national debate over cost and access. The state has historically prioritized public health initiatives addressing health disparities and nutrition. The decision affects coverage policy for medications like Wegovy and Zepbound for Medicaid beneficiaries with obesity. Rhode Island's choice will impact managed care organizations' pharmacy benefits and utilization management protocols for this high-cost drug class.
Wednesday, June 10 · 5 stories
- State Policy
Planned Parenthood Closes 60 Clinics Amid State Funding Restrictions
Nearly 60 Planned Parenthood clinics have closed or consolidated since last year due to state-level funding restrictions, according to a KFF report. The closures affect access to family planning, STI testing, and preventive care services in affected communities. The timing and specific states are not detailed in the brief article, but the trend reflects ongoing state policy actions targeting reproductive health funding. For Medicaid managed care organizations, these closures may disrupt member access to covered family planning services and require network adequacy adjustments in affected service areas.
- State Policy · MN
Minnesota Issues Provisional Licenses to 433 Autism Service Providers Under New Oversight Law
Minnesota's Department of Human Services received provisional license applications from 433 of 481 autism service provider sites under a new state law requiring licensure for Medicaid-funded autism services. The licensing requirement was enacted to increase oversight following explosive program growth and fraud allegations in recent years. The high application rate suggests most providers are seeking to remain in the Medicaid program under the new regulatory framework. This represents a significant expansion of state oversight over previously less-regulated autism service delivery.
- State Policy · MO
Missouri Drops 333,000 Medicaid Enrollees in 14 Months, 92% Due to Paperwork Issues
Missouri terminated Medicaid coverage for 333,265 beneficiaries between January 2025 and February 2026, with 91.9% disenrolled for procedural reasons rather than ineligibility determinations, according to CMS data. The state's high procedural termination rate indicates systemic renewal and redetermination processing problems. This disenrollment pattern affects managed care organizations through membership loss, revenue reduction, and potential contractual quality metric penalties tied to continuity of coverage. MCOs operating in Missouri face continued enrollment volatility as the state processes redeterminations.
- State Policy · OH
Ohio Withdraws Proposal to Ban Family Caregivers Under Medicaid
Ohio lawmakers removed language from House Bill 795 that would have prohibited family members living with Medicaid recipients from serving as certified caregivers. The provision was withdrawn Monday following significant public opposition. The proposal targeted Ohio's Medicaid home healthcare program, which allows beneficiaries to hire family members as paid caregivers. The reversal preserves existing caregiver arrangements for Medicaid managed care plans operating in Ohio's home and community-based services programs.
- State Policy · CA
California Union Sponsors Ballot Measures to Cap Healthcare Executive Pay, Regulate Clinics
A major California healthcare union has introduced two ballot initiatives targeting community clinics and capping executive and managerial compensation at hospitals and physician groups. The measures have triggered widespread opposition from healthcare industry stakeholders. The initiatives emerge amid anticipated Medicaid budget reductions in California, intensifying long-standing labor-industry tensions. If approved by voters, the measures would impose operational and financial restrictions on healthcare entities that contract with Medicaid managed care organizations.
Tuesday, June 9 · 1 story
- State Policy · IL
Illinois Awards Medicaid Managed Care Contracts to Six Insurers Including Humana
Illinois announced its intent to award new Medicaid managed care contracts to six health insurers: five incumbents and new entrant Humana. The contracts, each representing tens of billions of dollars in revenue over the contract period, will cover the state's Medicaid managed care program. The awards follow a procurement process and are subject to standard protest periods before final execution. This represents a significant market entry for Humana in Illinois Medicaid and continuation for existing plans in one of the nation's largest state programs.