H.R. 1 will bring wide-reaching changes to the Medicaid program and as these provisions take effect, states will face questions about how the changes are impacting both the Medicaid program and the individuals who rely on it for coverage. This expert perspective outlines the case for state H.R. 1 data dashboards, provides practical design guidance, and highlights successful examples of recent state dashboards.

State health updates as of May 15, 2026.

State updates as of May 8, 2026.

State updates as of May 1, 2026.

On February 26, 2026, the Centers for Medicare and Medicaid Services released the actuarial value calculator (AVC) for 2027, a tool published annually that measures the actuarial value of plans in the individual and small group markets. This expert perspective describes key AVC changes for 2027 and a potential future change that raise novel issues state regulators should be aware of.

State updates as of April 24, 2026.

On April 8, the Centers for Medicare & Medicaid Services (CMS) issued a State Health Official Letter interpreting section 71109 of H.R.1, which significantly restricts non-citizen coverage in Medicaid and the Children’s Health Insurance Program (CHIP). This expert perspective provides background on Medicaid and CHIP coverage for non-citizens; highlights key policy issues, implementation and operational considerations, and outstanding areas in CMS’ new guidance; and discusses potential consequences of these new changes on non-citizens, states, and providers.

State updates as of April 17, 2026.

H.R.1 adds significant new limits on which lawfully present non-citizens will be able to receive health coverage through Medicaid and the Children’s Health Insurance Program as well as subsidized coverage through the Marketplaces. This list of frequently asked questions is intended to serve as an added resource for states as they plan eligibility and systems updates and has been updated to reflect the State Health Official Letter released by CMS on April 8. 

H.R.1 makes significant changes to how individuals enroll and stay enrolled in the Affordable Care Act Marketplaces, with two of those changes taking effect for plan year (PY) 2028—the end of both auto-reenrollment and advanced premium tax credits during pending verification. In advance of these changes, State-Based Marketplaces (SBMs) can leverage the upcoming open enrollment period beginning in fall 2026 to build capacity, test approaches, and identify what works before the stakes rise for PY 2028, to help ensure eligible enrollees remain covered without disruptions to care. This expert perspective highlights preparatory actions that SBMs can take, including operational and communications pilots.