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Alabama

Alabama Lawmaker Introduces 60-day Prenatal Medicaid Coverage Bill. The Alabama Reflector听听on January 27, 2025, that state Representative Marilyn Lands (D-Huntsville) has reintroduced a bill that would provide presumptive Medicaid eligibility for pregnant people for up to 60 days before formal approval of their Medicaid applications.听听aims to expand access to prenatal care, improve maternal and infant health outcomes, and lower the maternal and infant mortality rates.

Arizona

Arizona Medicaid Fraud Targeting Indigenous People Results in Deaths, $2.5 Billion in Costs for Taxpayers. The Arizona Mirror听听on January 27, 2025, that the Arizona Health Care Cost Containment System has acknowledged Medicaid fraud in the Phoenix area targeting Indigenous people in sober living homes that failed to prevent deaths and cost taxpayers up to $2.5 billion. A review of records from the Maricopa County Office of the Medical Examiner found at least 40 deaths from drug and alcohol use related to lax oversight in the treatment programs. Under the state鈥檚 American Indian Health Program, providers are able to set their own reimbursement rates, which led to high claims beginning in 2019. Behavioral health outpatient clinics drove the most significant increases as part of a Medicaid fraud scheme, partnering with unregulated sober living homes. A class action lawsuit was filed in December by families of those who have died.

Arkansas

Arkansas to Submit Section 1115 Demonstration Medicaid Work Requirement Amendment. The Arkansas Advocate听 on January 28, 2025, that Arkansas will submit a request to amend its Arkansas Health and Opportunity for Me (ARHOME) Section 1115 demonstration to add work requirements for its Medicaid expansion population. The amendment, titled Pathway to Prosperity, would require able-bodied adults receiving Medicaid to either work, go to school, volunteer, or take care of their children at home. Additionally, it intends to remove the reporting requirement burden off the enrollee by use of data matching, and will suspend recipients who do not meet the requirements instead of disenrolling them. Arkansas will submit the request to the Centers for Medicare & Medicaid Services following a 30-day public comment period.

Connecticut

Connecticut Lawmakers Propose Medicaid Provider Rate Increases. The Connecticut Mirror听听on January 28, 2025, that Connecticut Senator Matt Lesser (D-Middletown) and Representative Jillian Gilchrest (D-West Hartford) have introduced a plan to broadly increase Medicaid provider rates. The $250 million three-year plan aims to increase rates to be at least 75 to 80 percent of current Medicare rates, beginning with a $75 million funding infusion in 2026. The proposal would also establish a process to review and update provider rates every two to three years. The rate increase would not affect major hospital systems, which are subject to a settlement agreement expiring in 2026, but would affect the rates at specialty hospitals and Connecticut Children鈥檚 Medical Center.

Comptroller Releases Healthcare Report Outlining Medicaid Reimbursement Recommendations. Westfair Business Journal听听on January 27, 2025, that Connecticut Comptroller Sean Scanlon released the state鈥檚 2025 Healthcare Cabinet Report which outlines various legislative proposals and actions to improve healthcare for those in Medicaid. Recommendations include increasing reimbursement rates for various providers, hospitals, and other healthcare facilities. The report highlights the specific need to provide additional support to rural hospitals and federally qualified health centers, and to ensure reimbursement rates and strategies cover critical services like primary care, pediatrics, obstetrics, and behavioral healthcare. The comptroller also recommended preserving the 340B program for prescription drug prices.

Connecticut Lawmaker Proposes Medicaid Diaper Benefit. WTNH听听on January 27, 2025, that state House Human Services Committee co-chair Representative Jillian Gilchrest (D-West Hartford) has proposed legislation that would allow for Medicaid coverage of diapers for children with certain health conditions from birth to age three. The benefit aims to improve maternal and child health outcomes and save the state money by reducing use of the healthcare system for conditions such as diaper rash and urinary tract infections.

Florida

Florida New Statewide Medicaid Managed Care Contracts to Go into Effect February. The Florida Agency for Health Care Administration听听an alert reminder on January 28, 2025, that Florida鈥檚 new Statewide Medicaid Managed Care (SMMC) 3.0 contracts will go into effect on February 1, 2025.听 will now serve nine regions, consolidated from eleven regions as part of the procurement. Among other changes under the new contracts, specialty plans were not awarded separately; instead, they were awarded to a comprehensive or MMA plan. Contracts are scheduled to run through December 31, 2030.

Florida Medicaid Dental Plans to Cover Non-emergency Outpatient Dental Services in ASCs. The Florida Agency for Health Care Administration听听an alert on January 28, 2025, that Florida鈥檚 Medicaid dental plans will cover non-emergency outpatient dental services performed in ambulatory surgical centers (ASCs) and other outpatient settings under the new contracts. The state听听in June 2024 that it awarded statewide Medicaid Prepaid Dental Program contracts to incumbents Liberty Dental Plan of Florida and DentaQuest of Florida. Under the new Statewide Medicaid Managed Care contracts, dental plans are required to work with health plans to ensure continuity of care.

Idaho

Idaho Lawmakers Introduce Bill to Repeal Medicaid Expansion. The Idaho Capital Sun听听on January 24, 2025, that the state鈥檚 House Health and Welfare Committee Chairman John Vander Woude (R-Nampa) and House Assistant Majority Leader Josh Tanner (R-Eagle) have introduced a bill seeking to repeal Medicaid expansion.听听claims that repealing the expansion could save up to $110 million per year. Some state legislators are skeptical of the savings claim, however, and Idaho鈥檚 Medicaid director previously stated that repealing expansion could cost Idaho up to $78 million per year in federal funds. The House Health and Welfare Committee approved introducing the bill, which will allow for a full committee hearing with public testimony.

Maine

Maine IDD Providers Urge Governor Mills to Include Cost of Living Adjustments in Supplemental Budget. The Maine Morning Star听听on January 25, 2025, that providers serving individuals with intellectual and developmental disabilities (IDD) are urging Maine Governor Mills to include cost of living adjustments in the supplemental budget. Providers were informed in December that anticipated cost of living adjustments for Medicaid would not be coming January 1. MaineCare, the state鈥檚 Medicaid program, currently faces a $118 million budget gap this fiscal year. Mills鈥� proposed budget includes $117 million to eliminate the gap.

Minnesota

Minnesota Releases Report Outlining Medicaid Opportunities to Improve Care for American Indian Communities. The Minnesota Department of Human Services (DHS)听听on January 27, 2025, a report outlining pathways for the state to better support the health and wellbeing of American Indian communities through the Medicaid program. The report, titled 鈥淧athways to Racial Equity in Medicaid: Improving the Health and Opportunity of American Indians in Minnesota,鈥� highlights three recommendations, including investing in traditional healing services, reframing definitions of health and well-being to align with federal guidance on Indigenous knowledge, and establishing a Pathways to American Indian and Tribal Health Integration (PATH-I) Team at DHS to enhance community engagement and cultural competence. DHS will immediately begin working with American Indian communities to implement the recommended changes.

Mississippi

Mississippi House Medicaid Committee Advances Pregnancy Presumptive Eligibility Bill. Mississippi Today听听on January 22, 2025, that the Mississippi House Medicaid committee advanced a presumptive eligibility听听for pregnant women, which removes the requirement that women show proof of income. The bill, which passed both chambers last year but was not implemented due to a discrepancy between state law and federal regulations, was introduced by Committee Chairwoman Missy McGee (R-Hattiesburg).

Montana

Montana Lawmakers Consider Two Medicaid Expansion Extension Bills. Montana Public Radio听听on January 23, 2025, that Montana鈥檚 House Human Services Committee is considering two bills that could renew Medicaid expansion, which is set to expire in 2025.听, sponsored by Rep. Ed Buttrey (R-Great Falls), would remove the expansion鈥檚 sunset provision and keep the program as-is, including work requirements.听, sponsored by Rep. Mary Caferro (D-Helena), would remove the sunset provision, reopen 10 public assistance offices, make improvements to the state helpline, and reinstate continuous 12-month eligibility. Up to 75,000 people could lose Medicaid coverage if the expansion expires.

Montana to Update Mental Health, Developmental Disability Services Facilities. KFF Health News听听on January 27, 2025, that Montana is looking to update its behavioral health system by revamping the Montana State Hospital and updating facilities serving people with developmental disabilities. The state Department of Public Health and Human Services recommended multiple infrastructure updates to Montana Governor Greg Gianforte, including investing approximately $13.3 million in moving the Intensive Behavior Center for developmental disabilities out of Boulder, investing $19.2 million into upgrading the facilities at the Montana State Hospital, and establishing a 16-bed step-down facility for adults who have been committed to the state hospital but no longer need its intensive psychiatric facilities. The updates were developed in partnership with and approved by Montana鈥檚 Behavioral Health System for Future Generations Commission.

Nebraska

Nebraska Lawmakers Consider Assisted Living Memory Care Provider Rates Bill. The Nebraska Legislature听听on January 23, 2025, that state lawmakers are considering a bill that would establish a Medicaid reimbursement rate for assisted living memory care facilities. The bill would require the state Department of Health and Human Services to submit an amendment for its aged and disabled home and community-based services waiver to the Centers for Medicare & Medicaid Services by September 30, 2025, to include separate reimbursement rates for these providers. The current reimbursement structure has an umbrella rate for all assisted living facilities, regardless of the level of care.

New York

New York Launches Medicaid Health Equity Regional Organization Initiative Under Section 1115 Demonstration. The New York State Department of Health听听on January 24, 2025, that the state launched the Medicaid Health Equity Regional Organization Initiative, which aims to strengthen the integration of social services, including food insecurity, housing instability, and lack of transportation, with health care delivery. The state will work with the United Hospital Fund (UHF) to coordinate strategies. UHF will build off experience in the Delivery System Reform Incentive Payment program.

New York Judge Temporarily Blocks State from Removing Home Care Companies from Medicaid Program for Failure to Comply in CDPAP Consolidation. Crain鈥檚 New York Business听听on January 29, 2025, that a New York Nassau County judge has filed a temporary restraining order to block the state Department of Health from removing home care companies from the Medicaid program that failed to comply with requirements to turn over patient data as the state consolidates its Consumer Directed Personal Assistance Program (CDPAP) under a single fiscal intermediary (FI). There are approximately 600 FIs that have been ordered to turn over patient data so that Public Partnerships LLC can take over the $9 billion program on April 1, 2025. The restraining order protects approximately 50 FIs that sued the state over the consolidation while the litigation is ongoing. Governor Kathy Hochul鈥檚 office indicated the transition is still on track.

North Carolina

North Carolina Appoints Devdutta Sangvai as Medicaid Director. Q City Metro听听on January 27, 2025, that North Carolina Governor Josh Stein has named Devdutta Sangvai as secretary of the state Department of Health and Human Services. Sangvai, a doctor and former president of Duke Regional Hospital, replaces previous Medicaid director Kody Kinsley, who began his role in 2022. Sangvai was sworn into office January 12.

Oregon

Oregon Hospitals Request Additional Funding to Close Medicaid Reimbursement Gap. The Oregon Capital Chronicle听听on January 22, 2025, that the Hospital Association of Oregon is requesting additional funding to support struggling hospitals and make up for the reimbursement gap for Medicaid-covered services. According to the hospital group, the state鈥檚 Medicaid program, pays 56 cents for every dollar of care provided to Medicaid patients, according to the hospital association, which caused a $1 billion underpayment in 2023. Governor Tina Kotek鈥檚 budget proposal includes $35 million in general funding for hospital maternity reimbursement rates, a $4 million increase in medical education funding, and $25 million to pay hospitals with high numbers of uninsured or Medicaid-covered patients.

Oregon Finds Three Healthcare Entities Had Unreasonably High Spending From 2021 to 2022. The Oregon Health Authority听听on January 22, 2025, that most of Oregon鈥檚 healthcare systems, including insurance plans, hospitals, and medical groups, successfully met the Sustainable Health Care Cost Growth Target Program鈥檚 goal to limit healthcare cost growth to a 3.4 percent annual average increase per person between 2021 and 2022. However, OHA reported that three entities, including Moda Health鈥檚 Medicare Advantage plans, UnitedHealthcare鈥檚 Medicare Advantage plans, and Oregon Medical Group鈥檚 commercial plans, exceeded the target without an acceptable reason. In May, OHA will release a report on healthcare spending between 2022 and 2023. Entities that do not meet the cost targets after the May report can be placed on a performance improvement plan.

Vermont

Vermont Governor, Regulators Approve AHEAD Model Adoption. Health Payer Specialist听听on January 24, 2025, that Vermont Governor Phil Scott and the state鈥檚 Green Mountain Care Board have approved the adoption of the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. The Centers for Medicare & Medicaid Services announced Vermont as a participant in the model in July 2024. The AHEAD model aims to reduce healthcare cost growth, improve population health, and advance health equity by moving the state鈥檚 Medicare payment system to a global budget model and investing more in primary care. Vermont鈥檚 Agency of Human Services secretary must approve the model for the state to move forward with the plan, which is set to fully begin in 2027.

Virginia

Virginia Lawmakers Advance Bipartisan PBM Bill. Virginia Mercury听听on January 23, 2025, that the state Senate Education and Health Committee advanced a bipartisan bill that would eliminate pharmacy benefit managers (PBMs) operated by health plans in Medicaid and replace them with a sole, state-contracted PBM. If enacted, the legislation would also direct the Department of Medical Assistance Services to assess drug pricing, rebates, and administrative costs to give the state better oversight ability and would require the state-contracted PBM to protect pharmacy access in underserved areas. The bill aims to increase drug price transparency, support independent pharmacies, and create a more cost-effective system.

National

Trump Administration Rescinds Federal Funding Freeze. NPR听听on January 29, 2025, that the Office of Management and Budget has issued a memo rescinding its federal funding pause. The memo comes after confusion from states, including states听听difficulty accessing the federal payment management system for Medicaid. The White House has begun restoring states鈥� access, as Medicaid was meant to continue without pause, though some have still reported issues with the portal. The reversal also comes after a federal judge granted an听听to pause the freeze while the legality of the order was examined. Additionally, multiple states joined to听听the Trump administration over the pause, including Arizona, Illinois, Massachusetts, New York, and Oregon.

President Trump Orders Pause in Federal Award Funding. Modern Healthcare听听on January 28, 2025, that President Donald Trump has directed a pause to all federal award funding. Each federal agency must submit detailed information on programs, projects, and activities related to the pause by February 10, 2025, and pause the distribution of funds until the Office of Management and Budget (OMB) has reviewed each agency. OMB indicated that Medicare and Social Security are not affected by the pause. States have听听problems accessing the federal payment management system for Medicaid; however, the White House Press Secretary Karoline Leavitt attributed this to an 鈥渙utage鈥� and claimed payments are 鈥渟till being processed and sent.鈥� Illinois Attorney General Kwame Raoul has joined a coalition of other AGs听听the Trump administration over the pause, claiming it is unconstitutional. The lawsuit seeks a temporary restraining order against the memorandum ordering the pause.

President Trump Dismisses HHS Inspector General. Health Payer Specialist听听on January 27, 2025, that President Donald Trump has dismissed the U.S. Department of Health and Human Services (HHS) inspector general, Christi Grimm. Trump has not named his pick for Grimm鈥檚 replacement. Grimm was one of 17 inspectors general dismissed by the president.

HHS Pauses CDC Reports, Health Communications Due to Pending Review. NBC News听听on January 22, 2025, that the U.S. Department of Health and Human Services (HHS) has paused almost all external communication from federal health agencies, including reports from the Centers for Disease Control & Prevention (CDC) and the National Institutes of Health while President Trump鈥檚 administration conducts a review. Communications may be released if they are a matter of critical health and safety. Communication pauses are common when a new administration enters the White House.

OMB Nominee Russell Vought Expresses Support of Medicaid Work Requirements During Confirmation Hearing. The New York Times听听on January 22, 2025, that President Trump鈥檚 Office of Management and Budget nominee Russell T. Vought expressed his support of Medicaid work requirements during a confirmation hearing. During the last Trump administration, Vought also supported a universal Medicaid work requirement. The Congressional Budget Office estimates work requirements would cause 600,000 Medicaid beneficiaries to lose coverage.