HMA Weekly Roundup

Alabama

Alabama Medicaid Agency to Request $1.2 Billion for Fiscal 2026. The Alabama Reflector reported on February 7, 2025, that the state Medicaid Agency will request $1.184 billion in state funds for fiscal 2026, a $229 million increase from last year. Much of the requested funding makes up for discontinued federal aid that the state received during the COVID-19 pandemic, so the actual request reflects a total $53 million increase, according to the state Medicaid commissioner. The additional funds are needed for healthcare cost inflation. Alabama estimates that it will receive around $7 billion in federal funding for Medicaid in fiscal 2026.

Arkansas

Arkansas Governor Endorses Pregnancy Presumptive Eligibility Bill. The Arkansas Advocate reported on February 6, 2025, that Arkansas Governor Sarah Huckabee Sanders endorsed legislation introduced by Senator Missy Irvin (R-Mountain View) and Representative Aaron Pilkington (R-Knoxville), which would allow presumptive Medicaid eligibility for pregnant women and reimbursement for doulas and community health workers. The legislation would also unbundle Medicaid payments and establish pregnancy-related coverage for remote ultrasounds, blood pressure monitoring and continuous glucose monitoring. The legislation is estimated to cost about $45 million a year.

Connecitcut

Connecticut Governor Proposes Increase for Medicaid Provider Reimbursement. The CT Mirror reported on February 6, 2025, that Governor Ned Lamont’s biennium budget proposal for fiscal years (FY) 2026-27 includes an increase of $35.4 million in state funding for Medicaid reimbursement to providers, including $10.4 million in FY 2026 and $25 million in FY 2027. Hospitals would have to pay an additional $140 million in provider fees in FY 2027.

Florida

Florida Medicaid Secretary Jason Weida Leaving Position. Health News Florida reported on February 5, 2025, that Jason Weida, secretary of the state Agency for Health Care Administration, will be leaving his post after two years. Weida was appointed as Chief of Staff for Governor Ron DeSantis. No replacement has been named.

Georgia

Georgia Governor’s Proposed Budget Increases Health Services Spending by $274 Million; Includes Continuous Enrollment for Children. The Georgia Budget and Policy Institute reported on February 7, 2025, that Georgia Governor Brian Kemp’s fiscal 2026 proposed budget provides the Department of Community Health with $5.5 billion in state funds, an increase of $274 million. Approximately 94 percent of the Department’s proposed funding is allocated to the Medicaid and PeachCare programs due to anticipated enrollment and utilization growth. The proposal also includes $36.6 million to fund new high-cost medications; $22.8 million increase to implement 12 months of continuous eligibility for children; and $1 million increase to support the Program for All-Inclusive Care for the Elderly (PACE).

Idaho

Idaho IMPlus Contract With United to Begin June 1. The Idaho Department of Health and Welfare announced on February 5, 2025, that its contract with UnitedHealthcare for Idaho Medicaid Plus (IMPlus), a wraparound managed long term services and supports program, will begin June 1, 2025, changing from its original start date on January 1, 2026. United’s contract for the Medicare Medicaid Coordinated Plan (MMCP), a Fully Integrated Dual Eligible Special Needs Plan, is still set to begin January 1, 2026. The state awarded contracts to United and incumbent Molina Healthcare for the duals programs, but did not award a contract to incumbent Blue Cross of Idaho (BCI), which will be leaving the programs on June 2, 2025. BCI enrollees in both IMPlus and MMCP will be automatically enrolled in United’s IMPlus plan, unless they choose to receive benefits through incumbent plan Molina Healthcare. Molina’s new contracts are still set to begin January 1, 2026.

Idaho Medicaid Expansion Funding Created $1.5 Billion in Economic Output in Fiscal 2025, Analysis Finds. The Idaho Capital Sun reported on February 10, 2025, that the federal funding the state received due to Medicaid expansion generated $1.5 billion in “net additional gross activity” in fiscal 2025, according to an analysis by an economist with the University of Idaho. The economic output includes about $897.6 million in gross state product, $700 million in job compensation, and increased the state’s tax revenues by almost $47 million. The report also claims that repealing expansion and losing the additional federal funding would cost Idaho taxpayers more money through increased healthcare costs and private insurance premiums. Medicaid expansion covers approximately 89,300 Idahoans, and the Idaho Department of Health and Welfare estimates the program will cost $1.36 billion in fiscal 2026. State lawmakers have introduced legislation to either “reform or repeal”, or outright repeal the expansion.

Illinois

Illinois to Announce D-SNP Procurement Awardees Soon. Health News Illinois reported on February 10, 2025, that Illinois will soon announce the awardees for the state’s Dual Eligible Special Needs Plan (D-SNP) reprocurement. Six plans submitted proposals: Aetna Better Health Premier Plan, Centene/Meridian Health Plan, Molina Healthcare, Humana Health Plan, UnitedHealthcare, and Health Care Service Corporation. Contracts will begin January 1, 2026, and run through December 31, 2029, with extensions up to five years and six months.

Indiana

Indiana Lawmakers Advance Medicaid HCBS Diversion Bill. WFYI Indianapolis reported on February 11, 2025, that Indiana lawmakers have advanced a bill that would establish a pilot program allowing the state to utilize home and community-based services (HCBS) available through the state’s Area Agencies on Aging and away from the state’s Medicaid HCBS waivers. House Bill 1391, sponsored by Representative Ed Clere (R-New Albany), focuses on sending elderly Medicaid beneficiaries to the Community and Home Options to Institutional Care for the Elderly and Disabled (CHOICE) program and is meant to divert them away from more expensive Medicaid HCBS, which are partially credited for the state’s $1 billion Medicaid budget shortfall discovered in 2024. The pilot will initially be extended to about 1,000 individuals.

Kansas

Kansas Legislators Introduce Medicaid Expansion Bill. KCTV5 reported on February 9, 2025, that a Medicaid expansion bill, the Healthcare Access for Working Kansans (HAWK) Act, was introduced in committees in both the House and Senate, which would also address the healthcare workforce shortage and safeguard rural hospitals. The bill was introduced in the House Appropriations Committee by Representative Barbara Ballard (D-Lawrence) and in the Senate Ways and Means Committee by Senator Pat Pettey (D-Kansas City). An estimated 150,000 Kansans would benefit from expansion. Kansas Governor Laura Kelly has proposed expansion in her fiscal 2026 budget.

Maine

Maine Legislature Fails to Pass Supplemental Budget for Medicaid Funding Gap. Spectrum News reported on February 12, 2025, that the Maine Legislature has failed to approve a $118 million supplemental budget designed to address a Medicaid funding gap in the fiscal 2025 budget. Republicans cited concerns over process and demands for structural changes to MaineCare, including work requirements and a three-month limit on general assistance. The Legislature will hold another vote on February 25.

Maine Extends NEMT Contracts Through June 2025 Due to Legal Disputes. The Maine Monitor reported on January 5, 2025, that Maine has extended contracts with Penquis Transportation, Waldo Community Action Partners, and Modivcare to provide regional non-emergency medical transportation (NEMT) services through June 2025. Modivcare Solutions was awarded a single statewide contract for NEMT services, and Penquis Community Action Agency subsequently sued over the award process with Waldo Community Action Partners listed as the interested party in the lawsuit.

Montana

Montana House Advances Medicaid Expansion Renewal Bill. The Missoula Current reported on February 9, 2025, that the Montana House has approved House Bill 245, which would remove the Medicaid expansion sunset provision and keep the program as-is, including work requirements. The bill now moves to the Senate. Currently, Montana’s Medicaid expansion is set to expire in June 2025 without legislative action. 

Montana Senate Approves Bill to Eliminate Board of Public Assistance. KFF Health News reported on February 6, 2025, that the Montana Senate passed a bill, requested by the state Department of Public Health and Human Services (DPHHS), to eliminate its Board of Public Assistance. The board provides a forum for citizens to contest actions taken by DPHHS related to public assistance, including Medicaid services, before the case goes to district court. In Montana, about 2,300 public assistance appeals a year go first to the health department’s Office of Administrative Hearings, and last year about 15 of those cases went on to the Board of Public Assistance.

Nebraska

Nebraska Legislature Advances Medicaid-covered Postpartum Home Services Bill. The Nebraska Examiner reported on February 11, 2025, that the state legislature has advanced a bill seeking to add postpartum home care services as a Medicaid benefit. Legislative Bill 22, sponsored by Senator George Dungan (D-Lincoln), would require the state Department of Health and Human Services to apply for a State Plan Amendment to offer Medicaid coverage for home nurse visits for eligible mothers up to six months postpartum. The bill would make an existing pilot program – Family Connects – available in Lincoln and Lancaster counties available statewide.

New York

New York CDPAP Program Sees Slow Enrollment Under New System. Crain’s New York Business reported on February 11, 2025, that New York has enrolled 35,000 individuals as of January in the state’s consumer directed personal assistance program (CDPAP) under the new system, which now includes a single statewide fiscal intermediary. The Hochul administration maintains that the state is on track to meet its goal of transitioning 250,000 enrollees to the new CDPAP system by April 1.

New York Comptroller Finds MMIS Improperly Paid $16.2 Million in Medicaid Claims. The Office of the New York State Comptroller Thomas P. DiNapoli released on February 6, 2025, an audit which found that the state Medicaid Management Information System (MMIS), eMedNY, improperly paid $16.2 million in Medicaid claims between October 2023 through March 2024. Of the total improper payments, $11.8 million went to pay Medicaid managed care premiums for recipients who were ineligible for coverage. Additionally, $2 million was paid out for fee-for-service inpatient claims that should have been paid by managed care.

North Dakota

North Dakota Legislature Considers Bill Adding Dental Coverage to Medicaid Expansion. The North Dakota Monitor reported on February 12, 2025, that the North Dakota Legislature is considering two bills that aim to improve dental care access for Medicaid beneficiaries. House Bill 1567 would fund a study of the dental health care status among Medicaid recipients and examine dental care provider recruitment, while Senate Bill 2231 would add dental coverage to Medicaid Expansion. Adding dental benefits for Medicaid expansion is estimated to cost the state about $500,000 per year.

Pennsylvania

Pennsylvania Governor’s Proposed Budget Omits Long-term Care Provider Rate Increase. McKnight’s Long-Term Care News reported on February 6, 2025, that Pennsylvania Governor Josh Shapiro’s proposed budget for 2025-2026 did not include an increase for long-term care provider Medicaid reimbursement rates. However, within his $2.5 billion proposal for the Medicaid program, Shapiro recommended a rate increase for direct care workers that provide home and community-based services to Community HealthChoices beneficiaries. Shapiro’s proposal also highlights the rising cost of care and prescription drugs, and allocates $4.8 million for Medicaid-covered reentry services for eligible incarcerated individuals.

National

Federal Judge Rules Trump Administration Failed to Comply with Mandate to Lift Funding Freeze. The New York Times reported on February 11, 2025, that Federal Judge John J. McConnell, Jr. of the U.S. District Court for the District of Rhode Island ruled that the Trump administration failed to comply with his January 29 order to lift the freeze the president put on federal funding. After the most recent ruling, the president’s lawyers filed an appeal with the U.S. Court of Appeals for the First Circuit seeking to pause the judge’s initial order to keep federal funds flowing while the case is being considered.

Health Insurers Seek Changes to CY 2026 Medicare Advantage, Part D Proposed Rule. Modern Healthcare reported on February 10, 2025, that health insurers and trade associations are calling on the Trump administration to change provisions of the Contract Year (CY) 2026 Medicare Advantage (MA) and Part D proposed rule, which was released under the Biden administration. In the public comments on the proposed rule, many organizations expressed concerns over the potential regulation and want the Centers for Medicare & Medicaid Services (CMS) to drop the proposal to cover anti-obesity medication for Medicare and Medicaid beneficiaries, delay or abandon a proposal that would require timely updates to provider directories, and bring back the Value-based Insurance Design model, which is set to sunset at the end of 2025. Insurers are also seeking to scale back or eliminate the use of the Health Equity Index in the MA Star Ratings Program.

Congress Members Introduce Nationwide Medicaid Work Requirement Bill. Med City News reported on February 11, 2025, that U.S. Senators John Kennedy (R-LA) and Eric Schmitt (R-MO) have introduced a bill to implement Medicaid work requirements nationally. The Jobs and Opportunities for Medicaid Act would require all able-bodied adults without dependents on Medicaid to work or volunteer at least 20 hours per week. The bill text estimates the move could save $100 billion over ten years.

Improper HHS, CMS Payments Total $88.5 Billion in 2024. Modern Healthcare reported on February 7, 2025, that improper payments in the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) reached $88.5 billion in 2024. These payments accounted for 5.6 percent of all outlays, down from 7 percent in 2023. Improper payments most often involve missing or insufficient documentation for claims, and can also include errors and fraud. Improper payments as a percentage of program spending decreased in Medicaid and Medicare Advantage, increased in Medicare fee-for-service, and and stayed flat in Medicare part D between 2023 and 2024.

More than 60 Percent of Medicaid Beneficiaries Were Employed in 2023. Fierce Healthcare reported on February 6, 2025, that 44 percent of Medicaid enrollees under the age of 65 were employed full-time in 2023, and additional an 20 percent were working part-time, according to an analysis from KFF. Of those that were unemployed, 8 percent were retired, unable to find work or for other reasons; 10 percent were not working because of an illness or disability; and 12 percent were serving as a caregiver. The study found that Medicaid enrolled individuals in better health and with higher levels of education were more likely to be working.

DOGE Examines CMS Contracts, Spending. Modern Healthcare reported on February 5, 2025, that the Department of Government Efficiency (DOGE) has gained access to and is examining the Centers for Medicare & Medicaid Services’ (CMS) technology systems and contracts to check for fraud and wasteful spending. DOGE is also examining CMS’ staffing and organizational design, which is being done across multiple federal agencies. President Donald Trump created the DOGE to conduct a government-wide audit, and it is not a budgeted part of the United States government.