HMA Weekly Roundup

Alabama

Alabama House Advances Prenatal Presumptive Eligibility Bill. The Alabama Reflector reported on February 14, 2025, that the state House of Representatives approved a bill that would provide prenatal presumptive Medicaid eligibility in a 102-0 vote. House Bill 89, sponsored by Representative Marilyn Lands (D-Huntsville), would provide Medicaid coverage to pregnant people for up to 60 days while their eligibility status is reviewed, and would not allow for retroactive denial of coverage if formal eligibility is not approved. The bill includes a sunset provision to end the program in October 2028.

Arkansas

Arkansas House Advances Prenatal Presumptive Eligibility Bill. The Arkansas Advocate reported on February 12, 2024, that the Arkansas House approved House Bill 1427 which would allow presumptive Medicaid eligibility for pregnant women, reimbursement for doulas and community health workers, and unbundle Medicaid payments. The identical Senate Bill 21 was approved by the Senate. House Bill 1427, estimated to cost about $45 million a year, now moves to the Senate Committee on Public Health, Welfare and Labor.

Colorado

Colorado Terminates NEMT Contract with MedRide. Denver 7 ABC reported on February 12, 2025, that the Colorado Department of Health Care Policy and Financing (HCPF) has officially terminated its non-emergency medical transport (NEMT) contract with MedRide. The NEMT provider was initially suspended on February 7, 2025, over concerns it might be part of a Medicaid fraud scheme, and then was allowed to resume after MedRide appealed the suspension in court. HCPF cited consistent failure to meet state and federal regulations, even after issuing MedRide with a corrective action plan in November 2024, as the reason for contract termination. MedRide plans to appeal the decision with the state Attorney General.

Idaho

Idaho House Committee Advances Medicaid Expansion ‘Reform-or-Repeal’ Bill. The Idaho Capital Sun reported on February 12, 2025, that the Idaho House Health and Welfare committee has advanced a bill that would require Idaho to implement 11 policy changes in Medicaid or repeal Medicaid expansion. Provisions in House Bill 138, sponsored by Representative Jordan Redman (R-Coeur d’Alene), include implementing work requirements for able-bodied adults, capping expansion enrollment either at 50,000 or no more than all disabled and elderly adults on Medicaid, and banning Medicaid expansion eligibility after a person has received benefits for three years. The changes would be implemented by July 1, 2026. The bill now heads to the full House for consideration.

Illinois

Illinois Governor Creates Behavioral Health Division as Lawmakers Propose Rate Increases. Health News Illinois reported on February 18, 2025, that Governor J.B. Pritzker has issued an executive order to combine the Illinois Department of Human Services (DHS) Division of Mental Health and the Division of Substance Use Prevention and Recovery to create the Division of Behavioral Health and Recovery. The new division, which aims to address an overlap in patients who receive services from both divisions, remains part of DHS. Meanwhile, Illinois lawmakers are considering a bill package that would increase reimbursement rates for behavioral health services. Senate Bill 55, sponsored by Senator Karina Villa (D-West Chicago), and House Bill 1085, sponsored by Representative Lindsey LaPointe (D-Chicago), would set the minimum reimbursement rates for in-network behavioral healthcare at 141 percent of Medicare rates. The bills would also improve network adequacy requirements for behavioral health services, require same-day coverage of behavioral health services, and allow providers working toward licensure to work under a fully licensed provider.

Indiana

Indiana Senate Approves HIP Enrollment Cap, Medicaid Work Requirement Bill. The Indiana Capital Chronicle reported on February 19, 2025, that the Indiana Senate voted 40-9 to advance a bill that would cap enrollment in the state’s Medicaid expansion program, the Healthy Indiana Plan (HIP), at 500,000; current enrollment sits above 700,000. Senate Bill 2, sponsored by Senator Ryan Mishler (R-Mishawaka), would also require the Indiana Family and Social Services Administration to seek federal approval to implement Medicaid work requirements for HIP enrollees, require the agency to check for all Medicaid eligibility quarterly instead of annually, and ban all advertising for Medicaid, which is currently not allowed due to an executive order by Governor Mike Braun. The bill now moves to the House for consideration.

Kansas

Kansas Legislature Rejects Medicaid Expansion, Approves Public Assistance Oversight Bill. The Kansas Reflector reported on February 18, 2025, that Kansas Senate and House Democrats attempted to add Medicaid expansion to legislation but failed in both chambers. In the Senate, an amendment to include the Healthcare Access for Working Kansans (HAWK) Act in Senate Bill 161 was rejected, while a House budget amendment proposing expansion failed despite the potential for $78 million in savings. Senate Bill 161 passed without amendments, requiring legislative approval for changes to eligibility, costs, federal waivers, or intellectual or developmental disability services.

Michigan

Michigan Expands Behavioral Health Investments with $186 Million in Fiscal 2026 Budget. Michigan Department of Health and Human Services (MDHHS) announced on February 19, 2025, that its fiscal 2026 budget proposes $185.9 million for behavioral health which builds on previous investments to expand access to care, and $96.4 million to raise the Medicaid spend-down threshold. The plan also includes $46.8 million in opioid settlement funds, and $15.2 million for a new state psychiatric hospital. Other funded initiatives include $2.5 million for mental health resources for first responders and $7.5 million from a new vape tax for children’s behavioral health programs.

Montana

Montana Senate Committee Advances Medicaid Expansion Renewal Bill. Montana Free Press reported on February 17, 2025, that the Montana Senate Finance and Claims Committee has approved House Bill 245, which would renew Medicaid expansion and remove the Medicaid expansion sunset provision, keeping the program as-is. The expansion also includes a work requirement that the state would need a federal waiver to put into action. The bill now moves to the full Senate.

New Jersey

New Jersey Releases Two RFAs to Expand PACE Program Statewide. The New Jersey Department of Human Services (DHS) released on February 14, 2025, two request for applications (RFAs) to establish a Program of All-Inclusive Care for the Elderly (PACE) in Warren, Sussex, Morris, and Hunterdon Counties. Seven organizations currently operate PACE in 17 New Jersey counties. Applicants can be government entities, nonprofits, or for-profit organizations that meet federal and state requirements. The state may award the service area to more than one applicant if it determines that the area can support multiple PACE programs. Letters of intent are due April 16.

New York

New York Releases RFA to Administer NHTD, TBI HCBS Waiver Services. The New York State Department of Health released on February 12, 2025, a request for applications (RFA) seeking potential regional resource development centers (RRDCs) to administer services available through the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) home and community-based services Medicaid 1915c waivers. The department will contract with not-for-profit agencies to manage between one and nine of the geographical regions designated in the RFA. The department has nearly $65 million available over five years to support the RRDCs. Applications are due March 27, and contracts are expected to run from February 1, 2026, to January 31, 2031.

Ohio

Ohio Proposed Medicaid Work Requirements Receives Public Opposition. The Ohio Capital Journal reported on February 14, 2025, that the Ohio Department of Medicaid’s (ODM) proposed Group VIII Section 1115 demonstration received 450 public comments during the feedback period, 400 of which opposed the proposal. The demonstration would require expansion beneficiaries to meet one of the following conditions: be at least fifty-five years of age, employed, enrolled in school or an occupational training program, participating in an alcohol and drug addiction treatment program, or have intensive physical health care needs or serious mental illness. If the proposed requirements are put in place, up to 61,000 Ohioans could lose health insurance, according to ODM. Now that comments have been received, ODM can send a 10-day advance notice to the state Speaker of the House and Senate President before submitting the demonstration application to the Centers for Medicare & Medicaid Services.

Wisconsin

Wisconsin Senate Committee Considers Postpartum Medicaid Coverage Extension. Milwaukee Journal Sentinel reported on February 13, 2025, that the Wisconsin State Senate’s Committee on Health is considering Senate Bill 23, which proposes to expand postpartum Medicaid coverage to one year after birth. Wisconsin is one of two states that has not extended postpartum Medicaid coverage, instead providing the federally-required 60 days for mothers who make more than 100 percent of the federal poverty level. If passed, the bill would cover approximately 5,000 additional women per month at an annual cost of $18.5 million in state and federal funds.

National

Trump Administration Oversees Layoffs of Thousands at HHS, Other Agencies. Fierce Healthcare reported on February 17, 2025, that the Trump administration fired thousands of probationary workers across the Department of Health and Human Services (HHS) agencies, cutting up to 5,200 jobs. The layoffs, led by HHS Secretary Robert F. Kennedy, Jr. and Department of Government Efficiency (DOGE) leader Elon Musk, affected the Centers for Medicare & Medicaid Services (CMS), National Institutes of Health (NIH), Food and Drug Administration (FDA), Advanced Research Projects Agency for Health (ARPA-H), and Substance Abuse and Mental Health Services Administration (SAMHSA), with layoffs at the Indian Health Service (IHS) partially reversed. Lawsuits have been filed against Musk and the administration, alleging unfair terminations and federal overreach.

CMS Cuts ACA Navigator Funding to $10 Million. The Centers for Medicare & Medicaid Services (CMS) reported on February 14, 2025, that it is reducing Affordable Care Act (ACA) Navigator program funding to $10 million annually, down from $98 million in 2024, citing inefficiencies and low enrollment for cost. The Trump administration estimates the cut will save $360 million over four years and result in lower premiums for consumers. The cut reverses former President Biden’s pledge to provide $500 million to Navigators through 2029.

Trump’s Deregulation Order May Lead to Consolidated Medicare, Medicaid Rulemaking. Modern Healthcare reported on February 14, 2025, that Trump’s executive order requiring agencies to eliminate 10 regulations for each new one is unlikely to significantly impact the Centers for Medicare & Medicaid Services (CMS) since most of the rules are mandated by law. However, it may lead CMS to consolidate multiple policies into broader rules and issue fewer guidance documents that help businesses navigate regulations. Additionally, the regulatory process is expected to slow down, with agencies bundling multiple policies into larger omnibus rules to comply with the executive order.

Robert F. Kennedy Jr. Confirmed as HHS Secretary. Modern Healthcare reported on February 13, 2025, that the U.S. Senate voted 52-48 to confirm Robert F. Kennedy Jr. as secretary of the U.S. Department of Health and Human Services (HHS).

President Trump Forms Health Commission to Address Childhood Disease Crisis. The White House announced on February 13, 2025, that President Trump signed an executive order establishing the Make America Healthy Again Commission, chaired by the Department of Health & Human Services (HHS) Secretary Robert F. Kennedy Jr. The commission aims to investigate and address childhood chronic diseases. The commission will release an initial assessment within 100 days and a strategy within 180 days to improve children’s health based on its findings.

House Budget Committee Resolution Includes Significant Healthcare Cuts. Fierce Healthcare reported on February 12, 2025, that the House Budget Committee released a budget resolution proposing $4.5 trillion in tax cuts and a $4 trillion increase in the debt limit, alongside a mandate for the Energy and Commerce Committee to reduce healthcare spending by $880 billion over the next decade, which will likely target Medicaid and Medicare. The proposed reforms include Medicaid work requirements, per capita caps, modifications to the federal medical assistance percentage (FMAP), and repealing a finalized Medicaid and Children Health Insurance Plan access rule.

CMMI to Discontinue Data Collection on Race, Gender. Politico Pro reported on February 11, 2025, that the Center for Medicare and Medicaid Innovation (CMMI) will stop collecting data on the race, ethnicity, sexual orientation, gender, and preferred language of its payment model participants. The agency will consider collecting self-reported disability status after further review. The policy seeks to align CMMI with President Donald Trump’s executive order to remove diversity, equity, and inclusion (DEI) policies.

Up to 20 Million Medicaid Beneficiaries Could Lose Coverage if ACA Federal Match Expires, KFF Finds. KFF released on February 13, 2025, an analysis which examines the potential impacts of eliminating the 90 percent federal match rate for the Affordable Care Act (ACA) Medicaid expansion on states and Medicaid enrollees. States may choose to maintain expansion and take on the extra costs, with federal Medicaid spending decreasing by $626 billion over 10 years, while state spending would increase by the same amount. Another scenario assumes states drop Medicaid expansion due to the loss of federal funding, which would reduce state and federal Medicaid spending by nearly $1.9 trillion and cause about 20 million beneficiaries to lose coverage by year 10.

Medicaid Home Care Faces Workforce Shortages, Funding Threats Amid Proposed Cuts. KFF issued on February 18, 2025, an issue brief which found that states are facing critical workforce shortages in Medicaid home care, with all 48 responding states reporting staffing challenges, particularly among direct support professionals, personal care attendants, and nursing staff. To address this, most states have increased provider payment rates, but the $2.3 trillion proposed federal Medicaid cuts over the next decade could threaten these efforts, forcing states to reduce payments or seek alternative funding. Additionally, as enhanced federal funding from the American Rescue Plan Act (ARPA) phases out, 30 states identified maintaining increased provider payment rates as a top priority.