HMA Weekly Roundup

Arizona

Arizona Will Not Reprocure EVV Vendor; To Transition In-House October 2025. The Arizona Health Care Cost Containment System (AHCCCS) announced on February 5, 2025, that it has decided to bring Electronic Visit Verification (EVV) in-house and build its own EVV aggregator, and therefore will not seek a new EVV vendor after its contract with Sandata ends on October 1, 2025. Currently, Sandata provides both EVV services and aggregation, but the state aims for streamlined oversight, long-term sustainability, and more provider choice in vendors.

California

California Releases Behavioral Health Transformation Provider Training, Technical Assistance RFA. The California Department of Health Care Services (DHCS) released on January 27, 2025, a request for applications (RFA) seeking contractors that could provide training and technical assistance services to county behavioral health departments, local Boards of Supervisors, and provider partners as part of the state’s Behavioral Health Transformation (BHT) project. The BHT aims to address gaps in the continuum of care. Applications are due February 24, 2025, and DHCS intends to select a contractor by March 10, 2025. Contracts are anticipated to be effective from March 31, 2025, to October 31, 2026.

Florida

Florida Receives Federal Approval for MMA Section 1115 Demonstration Behavioral Health, Housing Pilot Amendment. The Centers for Medicare & Medicaid Services (CMS) announced on January 31, 2025, that it has approved an amendment to Florida’s Managed Medical Assistance (MMA) Section 1115 demonstration. The amendment expands the Behavioral Health and Supportive Housing Pilot to two additional regions, provides voluntary MMA enrollees and dental managed care enrollees a choice of managed care plan, moves behavior analysis services from fee-for-service to managed care, authorizes the state to provide non-emergency dental services performed in ambulatory surgical centers or hospitals through dental managed care plans, and incorporates specialty products into comprehensive managed care plans. The MMA demonstration is authorized through January 30, 2030.

Idaho

Idaho Releases Medicaid EQRO RFP. The Idaho Department of Health and Welfare released on January 28, 2025, the External Quality Review Organization (EQRO) request for proposals (RFP) to design, implement, and conduct reviews of the current Medicaid managed care organizations. These plans include the Idaho Behavioral Health Plan, the Idaho Smiles Dental Plan, the Idaho Medicaid Plus plan, and the Medicare-Medicaid Coordinated Plan. The EQRO will also be responsible for completing an abbreviated review of the non-emergency medical transportation (NEMT) prepaid ambulatory health plan for program evaluation purposes. Contracts will run from April 15, 2025, through April 14, 2030. A former EQRO RFP released in 2023 received no responses, so Idaho released a request for information in May 2024 to refine the requirements.

Idaho Lawmaker Introduces Bill to Implement Medicaid Work Requirements, Expansion Cap or Repeal Medicaid Expansion. The Idaho Capital Sun reported on February 4, 2025, that state Representative Jordan Redman (R-Coeur d’Alene) has introduced a bill that would require the state Department of Health and Welfare to either implement work requirements for able-bodied adults on Medicaid or repeal Medicaid expansion. House Bill 138 would also cap expansion enrollment either at 50,000 or no more than all disabled and elderly adults on Medicaid, and ban Medicaid expansion eligibility after a person has received benefits for three years. The bill would require all of its provisions to be implemented by July 1, 2026, and would repeal Medicaid expansion if that deadline is not met. Idaho’s House Health and Welfare Committee voted to introduce the bill, and it now awaits a full committee hearing.

Indiana

Indiana House Advances Legislation Addressing Attendant Care, Medicaid Program Waitlists. The Indiana Capital Chronicle reported on February 5, 2025, that the Indiana House advanced multiple bills addressing the Medicaid program, including House Bill 1689, sponsored by Representative Edward Clere (R-New Albany), which relates to the state’s previous decision to stop reimbursing family caregivers providing attendant care for medically complex children. The bill would require the state Family and Social Services Administration (FSSA) to present a report to its Division of Disability and Rehabilitative Services Advisory Council highlighting information related to the family caregiving program or possible reimbursement for family caregivers providing attendant care. HB 1592, sponsored by Representative Brad Barrett (R-Richmond), would prohibit FSSA from implementing waitlists for federal waiver programs if there are slots available, such as Pathways for Aging program, and directs the state to apply for more slots if none are available. Lawmakers also advanced HB 1112, sponsored by Representative Joanna King (R-Middlebury), which would eliminate prior authorization requirements for medication used to treat opioid use disorder.

Indiana Proposes Medicaid Spending Limits on ABA Services. The South Bend Tribune reported on February 2, 2025, that the Indiana Family and Social Services Administration plans to submit a State Plan Amendment (SPA) to the Centers for Medicare & Medicaid Services proposing limits on Applied Behavioral Analysis (ABA), a type of therapy for people with autism. The proposed changes would limit ABA services to 30 hours per week for no longer than three years as a lifetime maximum. After a beneficiary reaches the three year maximum, they could continue with ABA services for limited hour behavior-specific therapy if it is deemed medically necessary. The limit would save the state up to $115 million over the next two years, according to Indiana’s Medicaid director. The public comment period for the SPA is open until February 14, 2025, and the changes are set to take effect April 1, 2025.

Indiana Lawmakers Advance State Directed Payment Program Legislation. The Indianapolis Recorder reported on January 31, 2025, that the Indiana House Public Health Committee voted to advance House Bill 1586, sponsored by Representative Brad Barrett (R-Richmond), which would create a State Directed Payment Program. The program would allow Indiana to assess its hospitals at the federal maximum tax rate through the Hospital Assessment Fee. The additional tax revenue will allow the state raise hospital Medicaid reimbursement rates.

Iowa

Iowa Reaches Preliminary Settlement Agreement in Medicaid Mental Healthcare for Children Class Action Lawsuit. The Des Moines Register reported on January 31, 2025, that Iowa has reached a preliminary settlement agreement for a class-action lawsuit filed in early 2023 over claims it was denying Medicaid-eligible children their right to adequate mental healthcare. The state has agreed to take steps to ensure child beneficiaries with mental illness diagnoses receive their needed behavioral healthcare services across the state. The state Department of Health and Human Services has developed an implementation plan called the Iowa REACH initiative, which includes specific steps the state will take to develop and implement services, which must be completed by 2032. The final settlement hearing will be held in May.

Minnesota

Minnesota Submits New Section 1115 Demonstration Request to Provide Reentry Services. The Centers for Medicare & Medicaid Services announced on January 31, 2025, that Minnesota has submitted a request for a new Section 1115 Reentry demonstration to provide Medicaid coverage for incarcerated individuals up to 90-days prior to release. Services under the proposed demonstration would include case management, substance use disorder treatment, and a 30-day supply of all prescription medications. The state aims to address three critical challenges: reducing post-release mortality rates, decreasing recidivism, and addressing the persistent health disparities that disproportionately impact formerly incarcerated populations. Public comments will be accepted through March 2, 2025.

Mississippi

Mississippi Governor Urges State Legislators to Oppose Medicaid Expansion. Mississippi Today reported on January 30, 2025, that Governor Tate Reeves urged state legislators to oppose Medicaid expansion in the 2025 legislative session during his State of the State Address. Reeves highlighted the possibility of the new Trump administration making major changes to the program, which could cost the state more money. The Senate and House Medicaid Chairs, Senator Kevin Blackwell (R-Southaven) and Representative Missy McGee (R-Hattiesburg), have both passed ”dummy bills” that have no details related directly to Medicaid expansion but are placeholder bills that lawmakers can visit later in the session after seeing what possible changes the new administration could make that might impact Medicaid expansion, while still meeting legislative deadlines.

Missouri

Missouri Governor Requests Supplemental Medicaid Spending in 2025 to Cover Shortfall, Proposes Increased Medicaid Spending in 2026. The Missouri Independent reported on January 30, 2025, that new Missouri Governor Mike Kehoe has proposed $15.8 billion to cover the Medicaid program in the fiscal 2026 budget, up from the $13.6 billion lawmakers approved for fiscal 2025. Kehoe also issued a $942 million supplemental spending request to cover a gap in the Medicaid budget in fiscal 2025. Items in the supplemental request include $129.8 million for the Department of Mental Health to clear developmental disability and behavioral health services waiting lists, $110 million for the agency to pay community providers that serve people with developmental disabilities, and $95 million to cover home and community-based services in Medicaid.

Nebraska

Nebraska Increases Oversight of Medicaid-covered ABA Services to Reduce Spending. The Nebraska Examiner reported on January 31, 2025, that the Nebraska Department of Health and Human Services issued stricter guardrails for applied behavioral analysis (ABA), a type of therapy for people with autism, after ABA costs rose more than 1,000 percent over three years. Key changes to the program include requiring a parent or caregiver to be engaged in treatment and planning for two to four hours per month, requiring lower-level ABA technicians to be certified by the Behavior Analyst Certification Board and enrolled with the state’s Medicaid program, and adding a 30 hour per week limit to what providers can get reimbursed for providing ABA services. Providers can request permission for reimbursement beyond 30 hours through a prior authorization process with Medicaid managed care organizations. The new guidelines take effect February 7, 2025.

New York

New York Releases Office of the Medicaid Inspector General 2025 Work Plan. The New York State Office of the Medicaid Inspector General (OMIG) announced in January 2025, the 2025 Work Plan which includes its Medicaid program integrity key focus areas: compliance, self-disclosure, Medicaid managed care audits, provider audits, and investigations. OMIG anticipates completing approximately 100 compliance program reviews in 2025, and expects to increase the number of Medicaid managed care operating reviews conducted and to incorporate reviews of managed long-term care plans.

Oregon

Oregon Releases Dashboard to Track Strategic Plan Progress to Eliminate Health Inequities. The Oregon Health Authority (OHA) announced on January 30, 2025, that it has launched a dashboard to track the goals outlined in its strategic plan, one component of Oregon Health Forward, which aims to eliminate health disparities by 2030. The dashboard outlines the strategies and measures the agency uses to determine the progress toward its goals under five pillars: transforming behavioral health, strengthening access to affordable care for everyone, fostering healthy families and environments, achieving healthy Tribal communities, and building OHA’s internal capacity to eliminate health inequities.

Oregon Medicaid Rent Assistance Benefit has Extended Wait, Processing Times. Fox 12 Oregon reported on February 4, 2025, that Medicaid beneficiaries in Oregon are experiencing extended processing times and issues obtaining the state’s new housing assistance program benefit, which launched in November 2024. Nearly 7,000 people have requested rent assistance since the program began.

Rhode Island

Rhode Island Cancels New $15.5 Billion Medicaid Contract Awards. The Rhode Island Current reported on February 4, 2025, that the state Executive Office of Health and Human Services (EOHHS) is cancelling the implementation of new Medicaid managed care contracts with Neighborhood Health Plan of Rhode Island and UnitedHealthcare of New England, who were set to run the state’s $15.5 billion Medicaid program starting July 2025. EOHHS confirmed that it would need to redraft the model contracts due to updated federal regulations and possible changes to Medicaid under the new Trump administration, and that the cancellation was not related to the protests from Blue Cross Blue Shield of Rhode Island and Tufts Public Health Plans over the July awards. Rhode Island is extending its current contracts with incumbents Neighborhood, United, and Tufts for one year, through June 30, 2026.

Rhode Island Governor Proposes Lower Hospital Medicaid Reimbursement Rate Increases for Fiscal 2026. The Rhode Island Current reported on February 3, 2025, that Rhode Island Governor Dan McKee’s fiscal 2026 budget proposes to reduce the required Medicaid reimbursement rate increases for hospitals and nursing homes. McKee proposed a 2.3 percent rate increase to match the state’s projected revenue growth rate. However, under current state law, the rates automatically increase at the start of each fiscal year based on pricing by the Centers for Medicare & Medicaid Services, which would mean a 3.4 percent increase for inpatient services and a 2.9 percent increase for outpatient services beginning July 1, 2025. Additionally, the governor proposed realigning hospital licensing fees based on fiscal 2023 data instead of fiscal 2022 data, which has the effect of increasing the fees owed, and ending the state’s upper payment limit program. Rhode Island is facing a projected $223 million budget shortfall, so the governor’s budget proposal reflects cost-saving measures. McKee proposed a total $4.2 billion for the Executive Office of Health and Human Services for fiscal 2026.

Virginia

Virginia Lawmakers Look to Repeal Medicaid Expansion Trigger Laws. The Virginia Mercury reported on January 30, 2025, that Virginia Senators Creigh Deeds (D-Charlottesville) and Ghazala Hashmi (D-Chesterfield) are looking to remove a trigger law that would automatically repeal Medicaid expansion if Congress chooses to cut the federal share of Medicaid funding. The legislators have introduced budget language that would keep expansion intact, but if the budget amendment passes and federal Medicaid funding is reduced, Virginia would need a special session to determine how to keep expansion going. Approximately 630,000 Virginians could lose Medicaid coverage if expansion is repealed.

Wisconsin

Wisconsin Releases Medicaid Managed LTC RFP for GSR 2, 7. The Wisconsin Department of Health Services (DHS) released on February 5, 2025, a request for proposals (RFP) for the Medicaid managed long-term care (LTC) programs – Family Care and Family Care Partnership programs – for low-income frail, elderly and adult individuals with developmental, intellectual, or physical disabilities. This procurement, which covers geographic service regions (GSR) two and seven, is part one of a three part process that will award multiple managed care organizations. The state intends to award two to four contracts for Family Care and one to three contracts for Family Care Partnership. Family Care Partnership is the state’s fully integrated dual eligible program. DHS is currently in the process of transitioning GSRs, and the new regions will consist of former GSRs 2, 3, and 8. Contracts are expected to begin on January 1, 2026, and will run for two years with three two-year renewals. Proposals are due March 25, 2025, and awards are expected on June 25, 2025. Current incumbents For Family Care are Community Care, Inclusa, Lakeland Care, and My Choice Wisconsin; incumbents for Partnership are Community Care, Humana/Independent Care, and My Choice Wisconsin.

Wisconsin Lawmakers Propose Postpartum Medicaid Coverage Extension. The Wisconsin Examiner reported on January 30, 2025, that a bipartisan group of state lawmakers is advocating to expand postpartum Medicaid coverage to one year after birth. Wisconsin is now 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. Lawmakers previously passed legislation to extend postpartum coverage to 90 days, but the Centers for Medicare & Medicaid Services did not approve the state’s waiver application. Most state Senators and around 65 Assembly representatives have signed onto the proposed legislation, according to bill co-author Representative Patrick Snyder (R-Weston), but it faces opposition from the Assembly Speaker.

National

Senate Finance Committee Approves Robert F. Kennedy Jr. to Lead HHS. NBC News reported on February 4, 2025, that the Senate Finance Committee approved Robert F. Kennedy Jr. to lead the U.S. Department of Health and Human Services (HHS) in a 14-13 vote. The nomination now moves to the full Senate for consideration.

Second Federal Judge Blocks Trump Administration Federal Funding Freeze. The New York Times released on February 3, 2025, that a second Federal Judge, Loren L. AliKhan of the Federal District Court for the District of Columbia has issued a temporary restraining order blocking the freeze on federal spending ordered by President Donald Trump. Unlike the Rhode Island order, Judge AliKhan’s order explicitly applied to all federal grants, loans and other spending to which the freeze had been subject.

Federal Judge Indefinitely Blocks Trump Administration Federal Funding Freeze. Fierce Healthcare reported on January 31, 2025, that Federal Judge John J. McConnell, Jr. of the U.S. District Court for the District of Rhode Island has indefinitely blocked the freeze on federal spending ordered by President Donald Trump. McConnell’s ruling allows the Trump administration to conduct the review of federal programs described in the original freeze memo as long as that spending continues during the review.

President Trump’s Tariffs Could Increase Insurance Premiums, Disrupt Medical Supply Chain. Fierce Healthcare reported on February 3, 2025, that nearly half of payer executives believe that health insurance premiums will rise within the next 12 months due to increased supply chain expenses from President Donald Trump’s tariffs on imports from Canada, Mexico, and China, according to a Black Book Market Research poll. The survey also predicts costs for hospitals and health systems will go up by at least 15 percent in the next six months due to increased import expenses and pharmaceutical costs will rise by at least 10 percent as a result of the China tariff on active pharmaceutical ingredients.

U.S. Representatives Introduce Bipartisan Bill to Increase Medicare Physician Rates by 6.6 Percent. Fierce Healthcare reported on January 31, 2025, that United States Representatives introduced the Medicare Patient Access and Practice Stabilization Act of 2025, which would give physicians a 6.6 percent rate increase, effective April 1, 2025, through December 31, 2025. The bill aims to offset a 2.9 percent Medicare cut, which took effect at the beginning of 2025 and will remain in place for services furnished from January to March.