HMA Weekly Roundup

Alabama

Alabama Senate Passes PBM Regulation Bill. The Associated Press reported on March 20, 2025, that the Alabama Senate voted 32-0 to advance a bill that would impose regulations on pharmacy benefit managers (PBMs). Senate Bill 252, sponsored by Senator Billy Beasly (D-Clayton), would require PBMs to reimburse independent pharmacies at the state Medicaid agency’s reimbursement rate and ban spread pricing. The bill now moves to the House for consideration.

Arkansas

Arkansas House Committee Advances Postpartum Medicaid Coverage Extension Bill. KATV reported on March 24, 2025, that the Arkansas House Public Health, Welfare, and Labor Committee advanced a bill sponsored by Representative Aaron Pilkington (R-AR) to extend postpartum Medicaid coverage from 60 days to one year. Nearly 40 percent of new mothers in Arkansas lose Medicaid coverage after the initial 60-day postpartum period, according to the Arkansas Department of Human Services.

Connecticut

Connecticut Committee Advances Bill to Cap LTC Rate Hikes, Increase Transparency. CT Mirror reported on March 19, 2025, that the Connecticut Government Oversight Committee advanced a bill which would require public hearings for long-term care insurance rate increases over 10 percent, mandate clearer disclosures about potential premium hikes, and cap certain rate increases based on the consumer price index. It also calls for a comprehensive review of long-term care insurance regulations, with a report due by February 2026, and requires biennial state audits of Connecticut’s long-term care insurance partnership plan.

Georgia

Georgia New Medicaid Foster Care Contract Raises Concern from Advocacy Group. The Georgia Recorder reported on March 24, 2025, that Georgia’s plan to shift Medicaid services for foster children to UnitedHealthcare has raised concerns from the Foster Care Institute advocacy group and parents about reduced access to mental health care. The award, announced in December, coincided with a ProPublica report accusing UnitedHealthcare of denying necessary autism treatments. The contract remains under protest and is not yet final.

Idaho

Idaho Governor Signs Bill to Transition to Managed Care, Add Work Requirements. The Idaho Press reported on March 19, 2025, that Idaho Governor Brad Little has signed a bill to implement Medicaid work requirements for the expansion population and move the state toward fully-capitated managed care. House Bill 345, sponsored by Representative Jordan Redman (R-Coeur d’Alene), directs the state Department of Health and Welfare (DHW) to submit a Section 1115 demonstration proposal to require able-bodied adults in the Medicaid expansion program to meet certain work requirements, and will also direct the DHW to seek federal approval to transition to managed care. The bill will also implement Medicaid cost sharing, end automatic eligibility renewal using information from other programs, and give DHW more authority to cut costs if the federal government reduces its federal medical assistance percentage for the expansion program.

Iowa

Iowa Senate Approves Medicaid Work Requirements Bill. The Iowa Capital Dispatch reported on March 25, 2025, that the Iowa Senate passed Senate File 615, which requires Medicaid expansion beneficiaries to work 80 hours per month, with exceptions for those with disabilities, in substance use treatment, or caring for young children. Approximately 142,000 of the 181,000 current expansion enrollees would be subject to the new requirements, with the state estimating up to 32,000 losing coverage. The bill includes a provision directing the state to terminate its expansion program if federal approval for work requirements is denied. Similar measures have advanced in the House and Senate committees.

Iowa Subcommittee Advances Bill to Impose Medicaid, SNAP Work Requirements. The Iowa Capital Dispatch reported on March 20, 2025, that Iowa’s Senate Appropriations Subcommittee approved Senate File 599, a bill that would impose work requirements on recipients of Medicaid under the Iowa Health and Wellness Plan (IHAWP) and Supplemental Nutrition Assistance Program (SNAP) benefits. If the required federal waiver is denied, the bill calls for suspending the state’s Medicaid expansion program. The legislation does not specify how many work hours are required and includes exemptions for people with disabilities and parents of young children.

Maine

Maine to Submit Section 1115 SUD Demonstration Renewal for Reentry Services, Tribal Health. Maine’s Department of Health and Human Services (DHHS) released on March 21, 2025, a draft five-year renewal application for its Section 1115 demonstration—currently the Maine Substance Use Disorder (SUD) Care Initiative—proposed to begin January 1, 2026, under a new name: Maine’s Whole Person Care Waiver. The draft proposal includes expanded behavioral health services, contingency management, pre-release Medicaid coverage for incarcerated individuals, recuperative care for people experiencing homelessness, and traditional healing services in partnership with tribal communities. DHHS is also requesting $15 million in capacity-building funds to support cross-system implementation. Public comments are open through April 22.

Lawmakers Introduce Bill for Medicaid IMD Exclusion Demonstration. News Center Maine reported on March 25, 2025, that Maine lawmakers introduced legislation sponsored by Senators Joe Baldacci (D-Bangor) and Rick Bennett (R-Oxford) directing the Department of Health and Human Services (DHHS) to seek a federal waiver removing the Institutions for Mental Diseases (IMD) exclusion, which currently prevents Medicaid reimbursement for inpatient psychiatric care in facilities exceeding 16 beds. 

Massachusetts

Massachusetts Seeks New Vendors as Commonwealth Care Alliance Plans to Cease Operations. The Boston Globe reported on March 19, 2025, that Massachusetts officials are preparing for Commonwealth Care Alliance (CCA), an insurer serving 50,000 elderly, disabled, and low-income members, to cease operations due to ongoing multimillion dollar operating losses. The members will transition to the state’s fee-for-service program, MassHealth, which does not include the more robust services offered by CCA. The state is seeking vendors to take over care coordination services for members transitioning to MassHealth to ensure they receive the same level of services. The state may also step in to keep CCA’s primary care clinics open in Boston and Springfield. The state previously froze new enrollments in two CCA Medicaid programs after the insurer reported severe financial instability.

New York

New York Extends CDPAP Enrollment Grace Period. Crain’s New York Business reported on March 24, 2025, that the New York State Department of Health is extending the deadline for users to register with the single statewide fiscal intermediary taking over the Consumer Directed Personal Assistance Program (CDPAP). Public Partnerships LLC will take over CDPAP on April 1, 2025, but the state is allowing users to enroll through April 30. The extension does not impact the fiscal intermediaries currently running the program who must cease operations by April 1. Personal assistants who provide services during the month of April will receive retroactive payments.

North Carolina

North Carolina Receives Federal Approval for PHE Section 1115 Hurricane Helene Demonstration. The Centers for Medicare & Medicaid Services (CMS) announced on March 25, 2025, that it has approved North Carolina’s Section 1115 Hurricane Helene Public Health Emergency Demonstration, allowing the state to provide retainer payments to personal care service providers impacted by the public health emergency. The demonstration also extends Healthy Opportunities Pilots (HOP) services to eligible beneficiaries who were displaced from the affected region due to the hurricane. The waiver is retroactive to September 25, 2024—the start of the public health emergency—and will remain in effect through March 23, 2025.

National

Senate Finance Committee Advances Dr. Oz Nomination for CMS Administrator. NPR reported on March 25, 2025, that the Senate Finance Committee voted 14-13 in favor of advancing Dr. Mehmet Oz’s nomination as administrator for the Centers for Medicare & Medicaid Services (CMS). The nomination now moves to the full Senate for a final vote.

President Trump Nominates March Bell for HHS Inspector General Position. Modern Healthcare reported on March 25, 2025, that President Donald Trump has chosen Attorney March Bell to run the U.S. Department of Health and Human Services (HHS) Office of the Inspector General. Bell currently serves as general counsel for the House Administration Committee, and previously served as senior advisor and chief of staff at the HHS Office for Civil Rights during the first Trump administration.

CMS Increases Hospital Price Transparency Rule Enforcement. Modern Healthcare reported on March 25, 2025, that the Centers for Medicare & Medicaid Services (CMS) issued seven notices of monetary penalties against hospital systems for non-compliance with price transparency rules during the first two months of 2025, already more than the three penalties issued in all of 2024. The amount of the penalties is less, averaging $71,671 per penalty in 2025, compared to last year’s average penalty of $322,028. President Trump signed an executive order in late February 2025 strengthening the agency’s oversight of price transparency requirements.

Health Plans Invest in C-SNPs for 2025 Amid Medicare Advantage Shifts. Modern Healthcare reported on March 19, 2025, that health insurers like SCAN Health Plan, Alignment Health, and UnitedHealthcare are investing more in Chronic Condition Special Needs Plans (C-SNPs) in 2025 as the Medicare Advantage market shifts with higher competition in Dual Eligible Special Needs Plans (D-SNPs) and fewer people age into Medicare. C-SNPs are also adding supplemental benefits to address conditions like depression and are expanding where these policies are sold. In addition, C-SNP enrollment has increased 67.3 percent in the past year to 1.1 million as of February 2025, according to an analysis done by the publication using the Centers for Medicare & Medicaid Services data, the largest increase since C-SNPs began.

Proposed Medicaid Cuts Would Result in 29 Percent Increase of State Medicaid Spending Per Resident Per Year, KFF Finds. KFF released on March 24, 2025, an issue brief which found that Congress’ proposal to cut $880 billion in Medicaid spending over 10 years would result in a 29 percent average increase state spending per resident per year in order keep Medicaid spending and eligibility at current levels. States would have to increase taxes by an average of 6 percent in order to offset the cost, or make cuts to other large budget items such as education. The projected impact includes over 1 million job losses—primarily in healthcare and social services, according to a separate report by the Commonwealth Fund.