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Monday, September 21 · 10 stories
- State Policy · DE
Delaware Officials Call Healthcare Spending Unsustainable, Eye Global Hospital Budgets
Delaware health officials told the Delaware Health Care Commission that current healthcare spending trends are unsustainable and threatened state budgets. Secretary of Health and Social Services Christen Linke Young said the state should pursue global budgeting models for hospitals, similar to Maryland's approach that sets fixed annual prices for services. Medicaid managed care organizations are already losing money despite rate increases, according to state Medicaid director Andrew Wilson, diverting funds from schools and infrastructure. Officials said providers must find efficiencies while the state creates market conditions incentivizing value-based care.
- State Policy · CA
California Requires Health Plans to Connect Callers to Live Agent Within 15 Minutes
California enacted legislation requiring large health care entities, including health plans, managed care organizations, PBMs, and pharmacies, to transfer callers from AI chatbots to human customer service representatives within 15 minutes upon request. The requirement applies to inquiries about medication refills, transfers, denied claims, prior authorizations, and specialist referrals. Hospitals obtained a broad exemption from the mandate. The law takes effect on a date not specified in this summary, and applies to large health care entities operating in California.
- State Policy · AR
Arkansas Medicaid Spending Rose $400M in Fiscal 2026, Finance Secretary Tells Lawmakers
Arkansas Medicaid spending increased $400 million between July 1, 2025 and June 30, 2026 compared to the prior year, according to Finance and Administration Secretary Jim Hudson's testimony to state legislators on September 18, 2026. The increase aligned with the Department of Human Services' fiscal 2026 operating plan. Hudson urged lawmakers to maintain full Medicaid funding going forward. The spending increase reflects rising enrollment, utilization, or rate pressures in the Arkansas Medicaid program.
- State Policy · CO
Colorado Faces $1.6B Budget Deficit Driven by Rising Medicaid Costs
Colorado projects a $1.6 billion state budget deficit for fiscal year 2027-28, driven primarily by escalating Medicaid costs. The shortfall reflects ongoing healthcare cost growth pressures that state lawmakers must address through budget adjustments, potential service cuts, or revenue increases. Colorado operates a managed care delivery system serving over 1.5 million Medicaid enrollees. The deficit timing suggests state agencies and health plans should anticipate potential capitation rate pressures, benefit changes, or provider rate adjustments in upcoming budget negotiations.
- State Policy · LA
Louisiana Estimates 58,000 Medicaid Enrollees May Need Steps to Meet January Work Requirements
Louisiana's health department projects approximately 58,000 Medicaid recipients may need to take additional steps to comply with new federal work requirements effective January 2027. The estimate indicates the potential scale of administrative burden and coverage risk facing the state's Medicaid program as implementation approaches. State agencies must prepare verification systems, outreach campaigns, and exemption processing to minimize coverage loss among working-age adults. The timeline gives Louisiana roughly three months to finalize operational readiness.
- State Policy · NJ
New Jersey Faces Loss of Medicaid Coverage for 25,000 Legal Immigrants October 1
A federal Medicaid eligibility change will terminate coverage for approximately 25,000 legal immigrants in New Jersey effective October 1, 2026. The policy shift affects noncitizen residents currently enrolled in the state's Medicaid program. New Jersey officials and advocates are assessing the impact on affected enrollees and state program operations. The change represents one of several federal policy modifications now affecting Medicaid eligibility for noncitizen populations.
Friday, September 18 · 13 stories
- State Policy · WI
Wisconsin Extends Civil Rights Compliance Period for Medicaid Providers Through 2028
The Wisconsin Department of Health Services extended the civil rights compliance period for recipients of federal financial assistance through December 31, 2028. The compliance period, which began January 1, 2022, was originally set to expire on December 31, 2026. This extension affects Medicaid providers and health plans that receive federal financial assistance through DHS and must maintain compliance with civil rights requirements. The extension provides an additional two years under the current compliance framework before any potential updates to civil rights compliance requirements take effect.
- State Policy
States Prepare for Medicaid Work Requirements, Expand Rural Health Programs in August 2026
State Health and Value Strategies compiled state Medicaid and health policy activity from August 2026. States prepared enrollees for upcoming Medicaid work reporting requirements under H.R. 1, awarded additional Rural Health Transformation Program grants, and established rural health advisory councils. Massachusetts returned $14.5 million in dental insurance rebates under state law, becoming the first state to enforce dental rebate requirements. Two states received CMS 1115 waiver approvals, and Oregon secured approval to transition to a State-Based Marketplace. States also acted on vaccine access, reproductive healthcare, healthcare affordability, primary care investment, and medical debt.
- State Policy
NASBO Data Shows State Revenue Trends Shaping FY 2027 Medicaid Budgets
A new brief analyzes state fiscal conditions using National Association of State Budget Officers revenue and spending data to provide context for state Medicaid budget decisions in fiscal year 2027. The analysis examines how current state revenue trends and overall spending patterns are likely to influence Medicaid funding levels and program priorities as states finalize their FY 2027 budgets. The brief is intended to help Medicaid stakeholders understand the fiscal environment in which states are making budget and policy decisions for the upcoming fiscal year.
- State Policy · SD
South Dakota AG Says Ballot Measure Would Auto-Repeal Medicaid Expansion
South Dakota Attorney General Marty Jackley has stated that a constitutional amendment on the November 3 ballot would automatically end Medicaid expansion if federal funding falls below 90%, contradicting Republican lawmakers who placed the measure and claim it would only grant them authority to consider ending expansion. The legal interpretation dispute centers on whether the amendment is self-executing or requires legislative action. The disagreement creates uncertainty for approximately 50,000 South Dakotans who gained coverage under the state's voter-approved expansion.
- State Policy · CT
Connecticut Poll Shows Voter Support for Increasing State Medicaid Spending Amid Federal Cuts
A poll of 602 Connecticut voters found 86% support using state surplus funds to offset federal cuts to social services, including Medicaid, and 54% favor adjusting budget caps to increase funding. An estimated 110,000 low-income adults in the HUSKY D Medicaid program face coverage loss in January 2027 due to new federal work requirements, and hundreds of lawfully present immigrants will lose Medicaid eligibility regardless of work status. Connecticut has run surpluses averaging $1.8 billion annually since 2017, and Governor Lamont created a $550 million fund for one-time assistance but has not committed to ongoing state-funded replacements for federal programs. The state increased nonprofit provider funding by $60 million in fiscal year 2027, but advocates say payments still lag inflation by over $300 million annually.
- State Policy · WV
West Virginia Allocates $855K in Federal Funds to Expand Health Information Exchange
West Virginia will allocate $855,400 in federal Rural Health Transformation Program funds to the West Virginia Health Information Network to expand statewide health information exchange capacity. The funding will support the Connected Care Grid initiative, increasing participation in secure data sharing among healthcare providers and organizations. The allocation is part of West Virginia's $199 million Rural Health Transformation award from CMS in 2026, aimed at strengthening rural healthcare infrastructure. The investment expands provider connectivity for care coordination across the state's rural healthcare delivery system.
- State Policy · MI
Michigan Lawmakers Push Coverage Expansion for Group Prenatal Care Programs
Michigan legislators are advancing bills to require Medicaid and private insurance coverage for group prenatal care services, defined as up to 12 visits in an evidence-based group setting. SB 415, requiring Medicaid coverage, has already been signed into law. Three companion bills extending similar mandates to private insurers remain in committee. Michigan currently operates 39 licensed Centering Pregnancy sites — second-most nationally — through a state health department partnership launched in 2024. The legislation aims to expand access to group care models that combine prenatal visits, education, and peer support for expectant mothers at similar pregnancy stages.
- State Policy · VT
Vermont Regulator Cuts Hospital Commercial Rates 1.2%, Expects $1.94B Revenue Cap
Vermont's Green Mountain Care Board issued budget orders Monday reducing commercial insurance rates charged by hospitals by approximately 1% statewide, with collective commercial revenue capped at $1.94 billion for fiscal year 2027 beginning October 1, 2026. The University of Vermont Medical Center faces the steepest reduction at 4.4%, while only Northwestern Medical Center and Springfield Hospital received 2% rate increases. The orders aim to slow health insurance premium growth in a state where residents pay among the nation's highest premiums, but hospital leaders warn the cuts will destabilize facilities already projecting collective deficits this fiscal year and next. Vermont hospitals have cut $57 million from projected fiscal 2026 expenses as part of a broader plan to reduce spending by $330 million by 2028.
- State Policy · GA
Georgia Remains Among 10 States Without Medicaid Expansion Despite Public Support
Georgia has not expanded Medicaid eligibility under the Affordable Care Act, remaining one of 10 non-expansion states. Public polling shows strong support for expansion among Georgia residents. The article discusses whether recent state proposals represent genuine expansion efforts or delay tactics. The continued non-expansion affects coverage for low-income adults in the coverage gap who earn too much for traditional Medicaid but cannot afford marketplace plans.
- State Policy
Colorado Medicaid Projects Service and Funding Cuts Amid Budget Overruns
Colorado’s Medicaid program is forecasting service reductions and funding cuts as the program significantly overspends its budget. State lawmakers attribute rising costs to multiple converging factors creating financial pressure on the program. The forecast signals potential cuts affecting the state's Medicaid beneficiary population. Specific timing, affected services, and dollar amounts were not detailed in available information.
- State Policy · CA
California Medicaid Rate Increase Expected to Shift Pediatric Care to Home Settings
California implemented a Medicaid rate increase for home-based pediatric care, prompting Aveanna Healthcare to raise caregiver wages and plan January recruiting expansion. The company anticipates hundreds of families will transition medically complex children from institutional settings to home care as a result of improved reimbursement. The rate adjustment addresses longstanding workforce shortages in California's home health sector by enabling providers to offer competitive wages. This shift affects California's Medicaid program, pediatric providers, managed care organizations with LTSS responsibilities, and families of children with complex medical needs.
- State Policy · MA
Massachusetts Reduces Estimate of Members Subject to Work Requirements by 50,000
MassHealth has lowered its projection of members who will be affected by upcoming Medicaid work and education requirements by approximately 50,000 individuals. The revised estimate reflects a recalculation of the member population subject to community engagement rules. The requirements will impose work, education, or volunteer obligations on non-exempt adult Medicaid beneficiaries. The reduction in projected impact suggests either narrower implementation scope or expanded exemption categories compared to initial projections, which will affect state administrative planning and managed care organizations' member engagement strategies.
- State Policy · PA
Pennsylvania Families Sue Shapiro Administration Over Medicaid Caregiver, Travel Restrictions
Four Pennsylvanians with intellectual and developmental disabilities filed a class action lawsuit challenging new Medicaid waiver rules that limit paid hours for family caregivers to 40–60 per week and restrict out-of-state travel support. The Shapiro administration imposed the limits through participation agreements after Commonwealth Court struck down nearly identical policies in February 2026 for failing to follow required rulemaking procedures. The administration gave participants an Aug. 6 deadline to sign new agreements or face involuntary service terminations; over 8,300 beneficiaries had signed by early September. Plaintiffs argue the state is bypassing the regulation process and forcing families to choose between uncompensated caregiving or institutional care.
Thursday, September 17 · 10 stories
- State Policy · CA
California Prop 36 Treatment Mandates Vary Widely by County, Leaving Gaps in Drug Treatment Access
Two years after California voters passed Proposition 36 requiring drug treatment for certain theft and drug offenses, counties are implementing treatment-mandated felony provisions inconsistently — with treatment durations ranging from three months in Ventura County to two years in San Luis Obispo County. Officials who supported the measure acknowledge gaps in the state's treatment infrastructure, with people waiting for services while charges remain pending. Defendants entering plea deals face challenges securing employment with felony convictions on record during court-mandated treatment periods that can extend well beyond residential program completion. The lack of state-funded treatment capacity and standardized implementation protocols has left some individuals the law intended to help falling through the cracks, according to state and local officials.
