HMA Weekly Roundup

Alabama

Alabama Senate Advances Prenatal Presumptive Eligibility Bill. AL.com reported on February 20, 2025, that the Alabama Senate approved Senate Bill 102 that would provide prenatal presumptive Medicaid eligibility for up to 60 days, similar to House Bill 89. The Senate bill includes a repeal clause in October 2028, while the House bill has a three-year sunset provision. The Senate bill now moves to the House, while the House version awaits action in the Senate committee.

Arizona

Arizona Proposes Medicaid Work Requirements, Lifetime Coverage Limits. The Arizona Health Care Cost Containment System (AHCCCS) announced on February 19, 2025, that it is seeking public input on a proposal that would implement Medicaid work requirements, a five-year lifetime coverage limit for certain adults, and cost-sharing requirements to discourage non-emergency use of emergency services. The program would require adults aged 19 to 55 to engage in at least 20 hours per week of employment, education, or job training to maintain coverage. Public comments will be accepted until March 20, 2025.

Senate Committee Approves Bill for Medicaid Covered Traditional Healing. The Arizona Republic reported on February 20, 2025, that the Arizona Senate Health and Human Services Committee approved Senate Bill 1671, introduced by Senator Sally Ann Gonzales (D-Tucson), which would allow Medicaid coverage for traditional Indigenous healing practices. The bill proposes allocating $1.3 million from the state general fund for the 2026 fiscal year to support this initiative. Covered services would include sweat lodges, prayers, songs, and talking circles provided by tribal facilities.

Arkansas

Arkansas Governor Signs Bill for Prenatal Presumptive Eligibility. The Arkansas Advocate reported on February 21, 2025, that Arkansas Governor Sarah Huckabee Sanders signed the Healthy Moms, Healthy Babies Act. The legislation establishes prenatal presumptive Medicaid eligibility, reimbursements for doulas and community health workers, and establishes pregnancy-related Medicaid coverage for specific treatments.

Colorado

Medicaid Costs Expected to Surpass Previous Estimates by $86 Million in Fiscal 2026. The Colorado Sun reported on February 21, 2025, that Colorado estimates it will need to spend an additional $73 million on Medicaid than originally projected during the current fiscal year, ending June 30, and that it will spend $86 million more than projected in the upcoming fiscal year. Medicaid spending accounts for about one-third of Colorado’s budget. The state is facing a potential total budget shortfall of $1.2 billion, 20 percent more than the state estimated a few months ago.

Colorado Paid $7 Million to Cover Deceased Medicaid Members, HHS OIG Audit Finds. The Denver Post reported on February 25, 2025, that Colorado paid out more than $7 million to insurers between 2018 and 2020 on behalf of almost 9,000 Medicaid enrollees who were deceased, including $3.8 million in federal funds, according to an audit by the U.S. Department of Health and Human Services Office of the Inspector General (HHS OIG). The report recommends that the state Department of Health Care Policy and Financing (HCPF) return the federal funds, recover unallowable capitation payments from during and after the audit period, and strengthen internal controls to prevent further improper payments. HCPF partially contested the findings over HHS OIG’s audit methods and plans to dispute the financial findings directly with the Centers for Medicare & Medicaid Services.

Florida

Florida Lawmakers to Consider Bills Expanding Scope of Practice. The Florida Phoenix reported on February 25, 2025, that state lawmakers are set to consider multiple scope-of-practice bills aimed at expanding the amount of providers in the state. House Bill 21, sponsored by Representative Linda Chaney (R-St. Petersburg), and Senate Bill 82, sponsored by Senator Jay Collins (R-Tampa), would create a new classification for dental therapists authorizing them as midlevel physicians between dental hygienists and dentists, while requiring them to work under a licensed dentist. House Bill 449, sponsored by Representative Alex Rizo (R-Hialeah), would give optometrists authority closer to ophthalmologists, including potentially being able to perform eye surgery and prescribing narcotics to patients. Senate Bill 718, sponsored by Senator Ana Maria Rodriguez (R-Hialeah), and House Bill 649, sponsored by Representative Mike Giallombardo (R-Cape Coral), would allow certified registered nurse anesthetists to work at hospitals and ambulatory surgical centers without supervision from an anesthesiologist and without written practice protocols.

Senate Advances Bill to Exempt Mental Health Medications from Step Therapy. Health News Florida reported on February 20, 2025, that a Florida Senate Health Policy committee advanced Senate Bill 264 sponsored by Senator Gayle Harrell (R-Stuart), which would exempt certain mental health medications from step therapy requirements for Medicaid patients. Medications for bipolar disorder, major depressive disorder, and obsessive-compulsive disorder are exempt from step therapy, expanding on a 2022 exception for schizophrenia.

Idaho

Idaho Legislature Introduces Second Medicaid Reform Bill with Medicaid Managed Care. The Idaho Capital Sun reported on February 25, 2025, that the Idaho House Health and Welfare committee has introduced a bill sponsored by Representative Jordan Redman (R-Coeur d’Alene) that is designed to control the cost of the state’s Medicaid expansion program but does not add a trigger to repeal Medicaid expansion. House Bill 328 directs the state to submit a plan to the federal government to move toward comprehensive Medicaid managed care, add work requirements, and implement cost-sharing, among other changes. The bill could save an estimated $15.9 million in fiscal 2026, depending on the timing of federal approval. Redman sponsors another Medicaid reform bill that passed the full House 38-32, which includes a trigger that would repeal expansion if all 11 policy changes included in the legislation are not met.

Idaho Request to Restrict Postpartum Medicaid Revisited by Trump Administration. Politico Pro reported on February 21, 2025, that the Trump administration announced it will reconsider Idaho’s request to deny extended postpartum Medicaid coverage for individuals who have had abortions, a request previously denied by the Biden administration. The Federal Register published a notice indicating that health officials will review the proposal in early April. If approved, Idaho could become the first state to exclude women from postpartum Medicaid based on the outcome of their pregnancy.

House Passes Medicaid “Reform-or-Repeal” Bill. The Idaho Capital Sun reported on February 19, 2025, that the Idaho House voted 38-32 to pass a bill that would repeal Medicaid expansion if the program is not reformed. House Bill 138, sponsored by Representative Jordan Redman (R-Coeur d’Alene), would require the state to implement Medicaid work requirements, cap expansion enrollment at 50,000 or no more than the number of disabled and elderly adults on Medicaid, and ban expansion eligibility after an enrollee has received three years of benefits. If the bill passes and reforms are not implemented by July 1, 2026, the legislation would repeal Medicaid expansion. The bill now heads to a Senate committee for consideration.

Illinois

Illinois Governor’s Budget Proposal Includes Funding for CCBHC Medicaid Demonstration, Maternal Home Care Programs. Health News Illinois reported on February 20, 2025, that Governor J.B. Pritzker’s $55.2 billion budget proposal allocates $191.8 million to support the Certified Community Behavioral Health Clinic (CCBHC) Medicaid Demonstration Program, $27.9 million to maintain the state’s maternal and child home health programs, and $27.7 million to support non-hospital facilities providing psychiatric care to people under 21. Additionally, Pritzker’s plan eliminates funding for Medicaid-like coverage for undocumented adults between ages 42 and 64, which cost approximately $420 million in one year, but allocates $132 million for a similar program for undocumented adults aged 65 and older. During the budget address, the governor also called upon the state legislature to enact more regulations on pharmacy benefit managers and the health insurance industry, raise the state’s medical loss ratio to 87 percent, ban spread pricing, and ban prior authorization for outpatient behavioral healthcare services. The budget also includes funding to shift the state’s Exchange to a State-Based Marketplace, ending use of the federal platform.

Indiana

Indiana Governor Signs Executive Order to Create Working Group Focused on Containing Medicaid Costs for ABA Therapy. WRTV Indianapolis reported on February 19, 2025, that Indiana Governor Mike Braun has signed an executive order aimed at containing Medicaid costs for applied behavioral analysis (ABA), a type of therapy for children with autism. Medicaid ABA payments in Indiana increased from $14.4 million in 2017 to $120 million in 2019, and an audit found more than $56 million in improper payments. The order establishes a working group of various stakeholders to evaluate solutions, including the best clinical care models to provide the correct therapy, financially stable recommendations for a better coordinated experience, quality metrics for ABA services, potential caps on hours of therapy provided per week and number of months a child can receive services, an appeals process for extenuating circumstances, and establishing provider enrollment and billing requirements to address issues identified in the audit.

Missouri

Missouri Senate Committee Debates Medicaid Work Requirements Bill. Missouri Independent reported on February 19, 2025, that a Missouri constitutional amendment proposed by Senator Jill Carter would require able-bodied Medicaid recipients ages 19 to 49 to complete 80 hours per month of work, education, job search, childcare, or volunteering to keep coverage. If approved by the legislature, the amendment would go to a statewide ballot. The state Senate Families, Seniors and Health committee held a debate on the bill, with no definitive legislative action taken.

New Hampshire

New Hampshire Governor’s Budget Proposal Would Implement Some Medicaid Premiums, Higher Prescription Copays. New Hampshire Public Radio reported on February 24, 2025, that Governor Kelly Ayotte’s proposed budget for fiscals 2026 and 2027 proposes implementing copays equaling five percent of income for Medicaid recipients in families making above 255 percent of the federal poverty level (FPL) or individuals enrolled in the expansion program, Granite Advantage, making above the FPL. Additionally, the plan would raise copays for people below these income thresholds from the current $1 to $2, up to $4. Officials estimate the premiums and increased copays will save the state $27.8 million total over the two year budget cycle.

New York

New York Medicaid Sees Enrollment Growth in Emergency Medicaid. Empire Center for Public Policy reported on February 19, 2025, that New York’s Medicaid enrollment growth over the past decade has been partially driven by the Medicaid for the Treatment of an Emergency Medical Condition (Emergency Medicaid) program for legal temporary visitors and undocumented immigrants, which has increased by over 1,200 percent since 2014 to reach 480,000 enrollees as of March 2024. Emergency Medicaid accounts for 7 percent of total enrollment and is concentrated mainly in New York City. Over the past decade, Emergency Medicaid spending tripled from $207 million to $639 million, even as preemptive enrollments drove service usage down and reduced annual costs per enrollee from $5,700 to $1,300.

Oregon

Oregon Hospitals Allocate 80 Percent of Community Benefit Spending to Medicaid Unreimbursed Care. The Oregon Health Authority released on February 24, 2025, a data brief which found that Oregon hospitals and health systems spent 8.7 percent less on community benefit activities in fiscal 2023, marking the first decline since 2014, largely driven by a temporary increase in Medicaid reimbursements for large hospitals which was limited to calendar year 2023. Despite overall reductions, Medicaid-related costs, including unreimbursed care, continued to account for 80 percent of hospital community benefit spending.

Wisconsin

Wisconsin Governor Proposes Medicaid Expansion in Fiscal 2025-27 Executive Budget. The Wisconsin Examiner reported on February 19, 2025, that Governor Tony Evers proposed a budget for the 2025 to 2027 biennium recommending expanding Medicaid to cover people up to 138 percent of the federal poverty level, which would extend eligibility to approximately 95,800 individuals. This is the fourth time Evers has proposed expansion in his budget. Expansion could save the state an estimated $1.9 billion in state funds and make Wisconsin eligible for an additional $2.5 billion in federal funds over the biennium. The executive budget also proposes extending postpartum Medicaid coverage from the current 60 days to one year after birth.

National

House Passes GOP Budget Resolution. The Associated Press reported on February 25, 2025, that House Republicans, under President Donald Trump’s guidance, passed a GOP budget blueprint with a 217-215 vote, advancing a plan to extend tax breaks and impose $2 trillion in spending cuts. Under the budget, the House Energy and Commerce Committee, which oversees health care spending, will to reduce federal spending by $880 billion over the decade.

President Trump Signs Executive Order on Healthcare Price Transparency. Fierce Healthcare reported on February 25, 2025, that President Donald Trump signed an executive order to strengthen healthcare price transparency regulations, initially introduced in 2019. The order directs the Department of Treasury, Department of Labor, and the Department of Health and Human Services to develop a plan to improve enforcement of regulations requiring hospitals and insurers to disclose actual prices and ensure comparability—including for prescription drugs.

Medicare Advantage Sees Slowest Enrollment Growth Since 2007. Modern Healthcare reported on February 26, 2025, that for 2025, Medicare Advantage enrollment grew 4 percent to 34.4 million—the slowest increase since 2007—amid rising medical costs, new regulations, and lower federal reimbursements that have prompted insurers to pull back on selling new policies. Despite these challenges, the market’s three largest insurers, UnitedHealthcare, Humana, and CVS/Aetna, remained dominant, though their combined share slipped to 58 percent.

MACPAC Meeting Is Scheduled for February 27-28. The Medicaid and CHIP Payment and Access Commission (MACPAC) announced on February 20, 2025, that its next meeting will be held on February 27 and 28. The meeting will feature a special panel discussion on Substance Use Disorder Section 1115 Waivers. Other discussion topics include proposed recommendations for improving transitions of care for children and youth with special health care needs; hospital non-disproportionate share hospital (DSH) supplemental and directed payment targeting analyses; background and findings on self-direction in home and community-based services; and improving access to medications for opioid use disorder.

HHS Could Limit Federal Funding for Gender-inclusive Programs. The U.S. Department of Health and Human Services (HHS) issued on February 19, 2025, new guidance redefining sex-based terminology, aligning with a January executive order by President Donald Trump. The new guidance is expected to have implications for federal funding related to gender-based healthcare.

Dr. Oz to Divest From Healthcare Companies if Confirmed as CMS Administrator. Modern Healthcare reported on February 19, 2025, that President Trump’s pick for the Centers for Medicare & Medicaid Services (CMS) administrator, Dr. Mehmet Oz, has agreed to divest millions of dollars in healthcare companies and step down from various advisory roles if he is confirmed for the position. Oz has investments in health plans, health technology companies, drug manufacturers, and fertility treatment groups. The confirmation process will begin with a hearing with the Senate Finance Committee.

Former CMS Administrator Raises Concerns Over DOGE’s Expedited Federal Program Cuts. The Hill reported February 19, 2025, that former CMS Administrator Chiquita Brooks-LaSure expressed concern over Elon Musk’s Department of Government Efficiency (DOGE) rapidly cutting federal programs, particularly in healthcare. She warned that changes to Medicare and Medicaid require careful consideration to avoid harming beneficiaries.