States of Innovation: July 2025
Following the passage of the federal budget reconciliation legislation (H.R. 1), states continued their efforts highlighting the value of Medicaid. California, New Mexico, and North Carolina released statements on the negative impacts of the legislation, while New Jersey, New York, Pennsylvania, and Wisconsin published updated analyses about the impact of the legislation on Medicaid enrollment and their state budgets. Meanwhile, State-Based Marketplaces in Connecticut and New York are highlighting the value of Marketplace coverage and highlighting the projected coverage losses resulting from the federal budget reconciliation legislation. State insurance regulators in Colorado are emphasizing the urgency to extend Marketplace affordability, as health insurers are filing significant increases to requested rate changes for 2026 due to federal policy changes and uncertainty.
In July, states continued to react to federal policy. Alaska and Mississippi are gathering input to prepare applications for the Rural Health Transformation Program, and Rhode Island created a Federal Compliance Advisory Group. California filed a multistate lawsuit challenging the sharing of personal health data with the Department of Homeland Security, and California and New Mexico reaffirmed their commitment to serving everyone who calls 988 for crisis care after the elimination of federal funding for the LGBTQ+ 988 crisis line.
Also in July, states received state plan amendment and waiver approvals from CMS, including Texas, which received CMS approval for a five-year extension of a demonstration allowing expanded postpartum benefits. Maine submitted a request to extend its Substance Use Disorder Care Initiative waiver for five years, rename it “Maine’s Whole Person Care Waiver,” and expand services.
States also advanced policies to improve affordability and address costs: New Jersey enacted legislation eliminating consumer fees for appealing health insurance decisions through the state’s Independent Health Care Appeals Program. Arizona and Michigan eliminated $429 million and $144 million in medical debt, respectively. In an effort to expand access to care, Rhode Island enacted legislation to facilitate access to ADHD medications by allowing 90-day prescriptions.
Other state actions in July included Michigan and Oregon announcing community engagement opportunities, New Jersey breaking ground on a new center to improve maternal and infant health, and Washington addressing reproductive and women’s health by announcing it will cover the funding gap for Planned Parenthood caused by the federal budget reconciliation bill’s one-year Medicaid funding moratorium. To improve mental and behavioral health, North Carolina announced the NC Black Youth Suicide Prevention Action Plan, and South Dakota announced a $3.8 million state funding award to build an 18-bed facility serving pregnant and parenting mothers in residential substance-use disorder therapy.
Affordability and Efforts to Address Cost
New Jersey enacted legislation eliminating consumer fees for appealing health insurance decisions through the state’s Independent Health Care Appeals Program. Governor Murphy signed legislation to permanently eliminate fees consumers were required to pay when they appealed their health insurance carrier’s decisions under the Independent Health Care Appeals Program, an external review program administered by the Department of Banking and Insurance.
Artificial Intelligence
Virginia launched an agentic artificial intelligence regulatory reduction pilot. Governor Glenn Youngkin issued an executive order launching an agentic artificial intelligence (AI) regulatory reduction pilot to ensure that the Commonwealth captures the benefits of the latest AI technology in reducing regulatory burdens and keeping regulations and guidance documents streamlined and up to date.
Washington convened the first meeting of an advisory board to examine the insurance industry’s use of AI. Insurance Commissioner Patty Kuderer convened the first meeting of an advisory board to examine the insurance industry’s use of AI and make recommendations on policy development, regulatory oversight, and consumer education efforts.
Community Engagement
Michigan is seeking applicants for the Community Voice Subgroup of the Health Information Technology Commission’s Community Information Exchange Advisory Committee. The Health Information Technology Commission (HITC) Community Information Exchange (CIE) Advisory Committee is seeking applications for its Community Voice Subgroup. Organizations across Michigan use different data systems to connect people to health, human and social services. CIE supports communities by making it easier to know what services are available and how people can access those resources. The Community Voice Subgroup will help guide the CIE Advisory Committee on state-level policy development and effective implementation of community information exchange.
Oregon announced a new funding opportunity for community-based organizations to support long-term public health efforts. Oregon Health Authority (OHA) has released a new funding opportunity for local community-based organizations (CBOs) with the goal of building strong partnerships that put community-led ideas first. OHA’s Equity Office will work with CBOs and programs within the Public Health Division to engage communities on long-term public health efforts rooted in health equity in areas like overdose prevention and immunizations.
Expanding Access to Care
Rhode Island enacted legislation to facilitate access to ADHD medications by allowing 90-day prescriptions. Governor Dan McKee signed into law legislation to allow 90-day prescriptions for ADHD medications. Until now, Schedule II drugs were limited to a 30-day supply. Over the last two years as the nation has experienced a shortage of the prescription drugs to treat ADHD, the 30-day limit meant a time-consuming monthly hassle for those who rely on them, sometimes resulting in hours of phone calls and long drives to locate a pharmacy that had the drug at the proper dosage in stock.
Extending Marketplace Affordability
Colorado announced that health insurance premiums are set to increase by an average of 28%, citing the federal reconciliation bill and the expiration of enhanced premium tax credits as key drivers. The Colorado Division of Insurance (DOI) announced that the statewide average for submitted premium increases is an alarming 28%, and insurance companies estimate nearly 100,000 Coloradans will lose their health coverage. DOI points to the passage of the federal reconciliation bill combined with the expiration of the enhanced premium tax credits driving the historic rate increases. Connect for Health Colorado, the state’s official health insurance Marketplace, published a blog post explaining the linkage between proposed premium increases and the end of the enhanced premium tax credits (ePTCs). Connect for Health Colorado estimates that over 50,000 of their customers would no longer be able to afford coverage if the ePTCs are not extended.
For more information about early 2026 rate filings demonstrating significant rate increases, see this blog from Georgetown University’s Center for Health Insurance Reforms.
Highlighting the Value of Medicaid
California released a stakeholder update on the impact of federal budget reconciliation legislation on Medi-Cal. The Department of Health Care Services (DHCS) released a stakeholder update on the federal budget reconciliation legislation, which will reduce funding for Medi-Cal and other safety net programs. DHCS leaders have emphasized that these cuts pose risks to essential services that support the health, stability, and economic security of families and communities across California. DHCS is reviewing the impacts of these changes and will provide more information and direction as it becomes available. The California Health & Human Services Agency also hosted a presentation on navigating federal cuts and how changes will impact Californians.
New Jersey released estimates showing that the federal budget reconciliation legislation could cause 350,000 residents to lose Medicaid coverage. Human Services Commissioner Sarah Adelman released a statement on the impact of the budget reconciliation legislation on Medicaid and SNAP. New Jersey estimates that 350,000 eligible residents will lose healthcare coverage because of bureaucratic barriers and predicts a $3.3 billion annual cut in funding to hospitals and public health funding, as well as a $360 million annual cut to the state budget due to reductions in federal funding and provider assessments.
New Jersey has also directed state agencies to assess the impacts of the federal budget reconciliation law on their budgets, operations, and programs. Governor Phil Murphy signed Executive Order No. 393, directing state agencies to immediately evaluate the impacts of the budget reconciliation law on their budgets, operations, and programs. By October 1, 2025, state agencies are required to submit to the Governor’s Office a preliminary assessment of these impacts along with any related legislative measures they recommend the Governor support during the current annual session of the Legislature to protect the state’s finances and its residents’ interests.
New Mexico released a statement warning that the federal budget reconciliation legislation will negatively impact patients. Alanna Dancis, Chief Medical Officer of New Mexico Medicaid, released a statement highlighting the impact the federal reconciliation legislation will have on patients through added cost-sharing, cuts to rural hospital funding, and work requirements.
New York released new data showing that over two million residents could lose insurance coverage under the federal budget reconciliation legislation. Governor Kathy Hochul released new data on the impacts of the federal budget reconciliation legislation on New York. More than two million New Yorkers will lose their current insurance coverage, including approximately 730,000 lawfully-present non-citizens who could lose Essential Plan (EP) coverage as over half of EP’s budget—$7.5 billion in federal funding—is eliminated, and a further 1.3 million New Yorkers who will lose Medicaid coverage due to new eligibility and verification hurdles. Governor Hochul also convened a cabinet meeting to discuss the impacts of the budget reconciliation bill on New York state and has directed state agencies to prepare comprehensive strategies to help limit the long-term damage to vital programs facing federal cuts.
North Carolina released a statement regarding the impact of the federal budget reconciliation legislation. Health and Human Services Secretary Dev Sangvai released a statement regarding the impact of the federal budget reconciliation legislation on North Carolinians. The North Carolina Department of Health and Human Services is reviewing the final legislation to determine its full impact on the state and will provide additional information as more details become available.
Pennsylvania released new data estimating that nearly 310,000 residents could lose Medicaid coverage due to the federal budget reconciliation bill. The Shapiro administration released new data on how many Pennsylvanians will lose Medicaid and SNAP benefits as a result of the budget reconciliation bill. Statewide, nearly 144,000 Pennsylvanians who receive SNAP could lose their access to critical food assistance, while 310,000 Pennsylvanians could lose Medicaid coverage.
Wisconsin released an updated analysis showing how the federal budget reconciliation bill will affect Medicaid enrollees. The Department of Health Services issued an updated analysis detailing how the federal budget reconciliation bill will impact Wisconsinites who receive healthcare coverage and nutrition assistance through Medicaid and FoodShare.
SHVS recently hosted a webinar on the budget reconciliation legislation and the sweeping changes that it will make to state Medicaid program expenditures, enrollment, and operations now and in the years to come.
SHVS also published updated estimates of the impact of Senate-Passed H.R.1 to state Medicaid coverage and expenditures and had been tracking the states publicly reporting their own estimates of proposed cuts to Medicaid. This expert perspective compiles those estimates, which reflect an important snapshot in time, highlighting how states sought to understand the potential impact of sweeping federal Medicaid reforms.
Highlighting the Value of Marketplace Coverage
Connecticut released estimates of coverage losses resulting from the federal budget reconciliation bill. Access Health CT, the state’s health insurance Marketplace, released estimates of coverage losses that will result from the passage of the budget reconciliation bill, H.R. 1. The state also highlighted the immediate impacts of the law and the recently enacted Marketplace Program Integrity rule.
New York’s State-Based Marketplace published a webpage outlining the projected impact of the federal budget reconciliation bill. New York State of Health published a webpage which highlights the impact of the reconciliation budget bill on New York, including estimated coverage losses of over one million Medicaid enrollees, 730,000 Essential Plan enrollees, and 65,000 to 80,000 enrollees in qualified health plans.
SHVS recently hosted a webinar for State-Based Marketplace and Division of Insurance officials on the budget reconciliation law and the recently finalized Program Integrity rule that also creates new requirements for Marketplaces. During the webinar, SHVS’ experts discussed the immediate changes that states are facing and what steps to take in the coming days and weeks.
Maternal and Infant Health
California released a report on the first 18 months of its Medi-Cal doula benefit, showing that over 1,000 members used doula services. DHCS posted the Doula Benefit Implementation Report evaluating the first 18 months of implementation since doula services were added as a covered Medi-Cal benefit on January 1, 2023. The report finds utilization is steadily increasing—as of June 30, 2024, more than 1,000 Medi-Cal members utilized one or more doula services, with wide variation by county and Medi-Cal managed care plan.
New Jersey’s Nurture NJ initiative was highlighted for its positive outcomes in a series of briefs from the Rutgers School of Public Health. The Rutgers School of Public Health released a series of briefs highlighting the positive impact of various Nurture NJ initiatives. Nurture NJ is a multi-pronged, multi-agency initiative that aims to make New Jersey a safer, more equitable place to deliver and raise a baby. The briefs highlight a 10% decline in low-risk Cesarean births and a 70% increase in use of paid family leave benefits, among other positive impacts.
New Jersey also broke ground on its Maternal and Infant Health Innovation Center. First Lady Tammy Murphy and Governor Murphy joined representatives from the New Jersey Economic Development Authority and the New Jersey Maternal and Infant Health Authority as well as other stakeholders to break ground on the first-of-its-kind Maternal and Infant Health Innovation Center (MIHIC) in Trenton. The MIHIC will serve as the epicenter for advancing equitable maternal and infant healthcare across Trenton and the nation.
Marketplace Innovations
Washington announced new lead organizations for Marketplace enrollment assistance. The Washington Health Benefit Exchange, the state’s health insurance Marketplace, announced the new lead organizations for enrollment assistance, including two new partnerships in the state. The lead organizations manage enrollment centers and support enrollees during the application and plan selection process.
Medicaid Innovations
Arizona Medicaid launched an improved online provider directory. The Arizona Health Care Cost Containment System (AHCCCS) announced the launch of its new and improved Online Provider Directory, designed to make it easier for members to find AHCCCS-enrolled providers who meet their unique healthcare needs. The directory pulls real-time data from the AHCCCS Provider Enrollment Portal and is updated daily, ensuring users have access to the most current provider information available.
Connecticut announced an agreement with 17 community health centers to increase Medicaid reimbursement rates. Governor Ned Lamont and Connecticut Department of Social Services Commissioner Andrea Barton Reeves announced that the administration has reached an agreement with the 17 community health centers in Connecticut regarding a three-year plan to boost Medicaid reimbursement rates for the centers that service 440,000 people across the state each year. The agreement will phase in rate increases over three years totaling approximately $80 million by June 30, 2028.
Maryland launched the Maryland Benefits One Application, a mobile-friendly tool that allows residents to apply for Medicaid and other programs through a single streamlined platform. Governor Wes Moore announced the launch of Maryland Benefits One Application, a new mobile-friendly tool that will help eligible Marylanders apply for vital benefits. The application will make it easier to apply for Medicaid, Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Women, Infants, Children (WIC) programming, and energy assistance in a single application from a computer or smartphone.
Minnesota announced new expedited criteria and a dedicated team within the State Medical Review Team (SMRT) to speed up disability determinations. The Department of Human Services announced expedited criteria for the disability determinations by the State Medical Review Team (SMRT), and a new SMRT expedited referrals team unit. SMRT determines disability status for individuals not certified as disabled by the Social Security Administration, in order to establish eligibility for Medicaid.
Nevada announced the launch of the Nevada Health Authority (NVHA) to streamline healthcare and human services programs. Governor Joe Lombardo and the Nevada Department of Health and Human Services announced the launch of the NVHA effective July 1, 2025. The NVHA was created through Senate Bill 494, to further streamline management of state healthcare and human services programs. NVHA will house several key healthcare programs, including Medicaid, the state’s health insurance exchange, and public employees’ benefits program. The new authority will be led by Stacie Weeks, with Ann Jensen taking over as Administrator of the Division of Nevada Medicaid.
Virginia announced the launch of the Cardinal Care Managed Care program. Governor Youngkin and the Virginia Department of Medical Assistance Services announced the launch of the new Cardinal Care Managed Care program which aims to modernize healthcare delivery and enhance the care and support provided to Virginians served by the program.
Medical Debt
Arizona announced that $429 million in medical debt has been erased for over 352,000 residents. Governor Katie Hobbs announced that $429 million in medical debt has been erased for more than 352,000 Arizonans. This is part of Governor Hobbs’ initiative announced last year to erase $2 billion in medical debt using American Rescue Plan Act funding.
Michigan announced it has relieved over $144 million in medical debt for nearly 210,000 residents. Governor Gretchen Whitmer announced that the state has relieved more than $144 million of medical debt for nearly 210,000 Michiganders. This initiative is part of the $4.5 million allocated in the 2024 state budget for medical debt relief.
For more information on state efforts to prohibit medical debt reporting and eliminate existing debt, see the SHVS expert perspective Mapping State Efforts to Address Medical Debt and a Health Affairs Forefront article which examines the burgeoning trend of state efforts to cancel medical debt for just pennies on the dollar. SHVS also published a state spotlight profiling North Carolina’s Comprehensive Medical Debt Relief and Reform Incentive Program.
Mental and Behavioral Health
California expanded mental health access through new regulations enforcing the Mental Health Parity Act. Department of Insurance Commissioner Ricardo Lara announced he has expanded mental health access with a final rulemaking to enforce California’s Mental Health Parity Act. The newly enacted regulations include rules for insurers, requiring the coverage of services that are medically necessary to diagnose, prevent, and treat all mental health conditions, as well as substance-use disorders, equal to coverage provided for other medical conditions. These regulations also establish a formal process for patients to file complaints.
North Carolina announced the NC Black Youth Suicide Prevention Action Plan. The North Carolina Department of Health and Human Services announced the NC Black Youth Suicide Prevention Action Plan. This effort sheds light on communities which have been marginalized, where mental health challenges persist, and outlines initiatives to be implemented over the next five years to reduce injury and save the lives of Black youth and young adults.
North Carolina also launched a campaign to end stigma related to substance-use disorder. The North Carolina Department of Health and Human Services and First Lady Anna Stein, in collaboration with Shatterproof, announced the launch of the Unshame North Carolina (Unshame NC) campaign to end the stigma related to substance-use disorder (SUD). Unshame NC aims to increase knowledge and awareness of SUD and medications for opioid-use disorder as a treatment option.
Oregon launched a new 988 data dashboard to increase transparency and track usage. The Oregon Health Authority announced the launch of a new 988 data dashboard to increase transparency, track usage and demonstrate the impact of 988 in Oregon and the start of a new public awareness campaign, called “988 Oregon: Connect to Hope.”
South Carolina enacted a behavioral health restructuring law, consolidating three existing agencies into a single, cabinet-level entity. Governor Henry McMaster signed a behavioral health restructuring bill, S.2, into law—establishing the Department of Behavioral Health and Developmental Disabilities. The legislation merges the former Department of Mental Health, Department of Disabilities and Special Needs, and Department of Alcohol and Other Drug Abuse Services into a single, cabinet-level agency directly accountable to the governor.
South Dakota announced a $3.8 million state funding award to build an 18-bed facility serving women, including pregnant and parenting mothers, in residential substance-use disorder therapy. Governor Larry Rhoden announced that Avera Sacred Heart Hospital will be receiving $3.8 million in state general funds to construct a new 18-bed facility that will be used to serve women, including pregnant mothers and mothers with children, participating in residential substance-use disorder therapy. Funding was made available through SB196 which passed during the 2022 legislative session.
Washington announced the first major pharmacy chain to join the state’s Lock Up Your Meds program. The Washington State Health Care Authority (HCA) announced that Fred Meyer is the first major pharmacy chain to participate in HCA’s Lock Up Your Meds safe storage program. The safe storage program supplies participating Washington pharmacies with free medication locking devices to distribute to patients with opioid prescriptions, as part of an ongoing effort to help prevent opioid misuse and overdose deaths in Washington’s communities.
Reproductive and Women’s Health
Washington announced it will cover the funding gap for Planned Parenthood caused by the federal budget reconciliation bill’s one-year Medicaid funding moratorium. Governor Bob Ferguson announced that Washington state will cover the gap caused by the federal government’s defunding of Planned Parenthood. The federal budget reconciliation bill included a one-year moratorium on Medicaid funding for Planned Parenthood that went into effect as soon as the bill was signed.
Wisconsin’s Supreme Court released a decision protecting access to abortion care in the state. Wisconsin’s Supreme Court has ruled in favor of maintaining access to abortion care, following a legal challenge from Governor Tony Evers and Attorney General Josh Kaul. The case targeted the enforcement of an 1849-era abortion ban that resurfaced after the U.S. Supreme Court overturned Roe v. Wade.
States React to Federal Policy
Alaska released a Request for Information (RFI) for the Rural Health Transformation Fund (RHTP) and a dedicated webpage on the impact of the federal budget reconciliation law. The Alaska Department of Health published a webpage on the reconciliation bill’s impacts to Alaska, including changes to Medicaid, SNAP, and other federal programs. The webpage also links to an RFI seeking to gather input from stakeholders to inform Alaska’s strategic approach to the Rural Health Transformation Program.
California filed a lawsuit challenging the sharing of personal health data with ICE. California Attorney General Rob Bonta, leading a multistate coalition, filed a lawsuit challenging the HHS decision to provide unfettered access to individual personal health data to the Department of Homeland Security, which houses Immigration and Customs Enforcement (ICE).
California also responded to the loss of federal funding for the LGBTQ+ 988 crisis line, by partnering with the Trevor Project to provide enhanced training for the state’s 988 crisis counselors. Following the announcement that the U.S. Department of Health and Human Services (HHS) will eliminate federal funding for the 988 Suicide and Crisis Lifeline service dedicated to LGBTQ+ youth services, Governor Gavin Newsom announced a partnership with the California Health and Human Services Agency and the Trevor Project to provide the state’s 988 crisis counselors enhanced competency training from experts, ensuring better attunement to the needs of LGBTQ youth, on top of the training they already receive.
New Mexico announced that its 988 Suicide & Crisis Lifeline continues to provide support with counselors trained in LGBTQIA+ cultural competency, following the removal of the national lifeline’s “Press 3” option. Following the national 988 Suicide & Crisis Lifeline’s removal of its “Press 3” option for LGBTQIA+ youth, the New Mexico Health Care Authority (HCA) issued a statement that New Mexico’s 988 service continues operation with counselors that receive ongoing training in LGBTQIA+ cultural competency and affirming practices to ensure quality care for all callers. HCA is also exploring additional options to enhance LGBTQIA+ crisis support through the 988 system.
New York highlighted an analysis projecting over $8 billion in hospital funding cuts due to the federal budget reconciliation bill. Governor Kathy Hochul highlighted an analysis from the Greater New York Hospital Association and the Healthcare Association of New York State, which estimates a total $8 billion in cuts to New York’s hospitals and health systems alone due to the budget reconciliation bill.
Mississippi is seeking public input and soliciting quotes from consultants to prepare the state’s application for the RHTP. The Mississippi Division of Medicaid (DOM), in coordination with the Office of the Governor and the Mississippi State Department of Health (MSDH), is soliciting quotes from consultants to prepare the state’s application for the RHTP. The Office of the Governor, in coordination with DOM and the MSDH, is seeking public input through a public survey and a stakeholder forum to develop a Rural Health Transformation Plan and submit a timely application for the grant funding.
Rhode Island formed a Federal Compliance Advisory Group to analyze potential impacts of federal actions on the Medicaid program. The Executive Office of Health and Human Services, in conjunction with the Governor’s Office, established a Federal Compliance Advisory Group to assist in the review and analysis of potential impacts of any federal actions related to the Medicaid Program.
Waiver and State Plan Amendments, Requests and Approvals
Arkansas received CMS approval for a five-year extension of its TEFRA-like section 1115 demonstration, and a new demonstration to provide Medicaid services to adults with substance-use or serious mental illness in institutions for mental disease and support community reentry. CMS approved a five-year extension of the “Arkansas Tax Equity and Fiscal Responsibility Act (TEFRA)-like Section 1115 Demonstration.” This extension allows the state to continue receiving federal financial participation (FFP) for providing coverage of services, in home settings, to children with certain disabilities who would otherwise be at risk of or require institutional care and who would also otherwise be eligible for Medicaid under section 134 of the Tax Equity and Fiscal Responsibility Act. CMS also approved a new section 1115 demonstration titled “Arkansas Opportunities to Test Transition-Related Strategies to Support Community Reentry from Incarceration and Institutions for Mental Disease.” This demonstration allows the state to receive FFP for Medicaid state plan services provided to adult enrollees who are in institutions for mental disease for substance use disorder or serious mental illness treatment.
Illinois submitted a five-year extension request for its “Continuity of Care and Administrative Simplification” demonstration. The state submitted a five-year extension request of its “Illinois Continuity of Care and Administrative Simplification” demonstration. The state requests authority to allow the state to treat out-of-state address changes as reliable based on information from the United States Postal Service National Change of Address database and managed care organizations (MCOs) if the MCO has received information directly from or verified the information with the enrollee. This would allow the state to send a termination notice to the updated out-of-state address as the enrollee would no longer meet the state residency requirement. The enrollee would retain appeal rights and would be reinstated into coverage if there was an error.
Kentucky submitted an application for a new section 1115 demonstration to automatically refer certain Medicaid expansion enrollees for job placement assistance. The state submitted an application for a new section 1115 demonstration to automatically refer non-exempt individuals in the Medicaid expansion eligibility group who have been enrolled for more than 12 months to the Kentucky Education and Labor Cabinet’s Department of Workforce Development to provide information about available job placement assistance programs.
Maine submitted a request to extend its Substance Use Disorder Care Initiative waiver for five years, rename it “Maine’s Whole Person Care Waiver,” and expand services. The state submitted a request for a five-year extension of the Maine Substance Use Disorder Care Initiative Section 1115 Demonstration. The state seeks to change the name of the demonstration to “Maine’s Whole Person Care Waiver” and to include the following additional services: pre-release Medicaid services for justice-involved individuals; food is medicine; recuperative care; structured recovery housing services; traditional healing therapies for Native Americans; and more.
Minnesota received CMS approval to extend Medicaid to individuals under 26 who were formerly in foster care and to allow their enrollment in the former foster care group regardless of other eligibility. CMS approved Minnesota’s request to amend its section 1115 demonstration, titled “Minnesota Prepaid Medical Assistance Project Plus” (PMAP+). The amendment authorizes the state to extend Medicaid eligibility for individuals under age 26 who were in foster care and enrolled in Medicaid when they aged out of the foster care system. In addition, the amendment enables the state to enroll individuals into the eligibility group serving former foster care children, regardless of whether they are eligible for or enrolled in a separate mandatory eligibility group.
Montana released its proposed 1115 Medicaid Demonstration Waiver application for public review, seeking federal approval to implement work requirements and cost sharing. The Department of Public Health and Human Services released its proposed 1115 Medicaid Demonstration Waiver application for public review. The application will request federal authority for enrollees to be subject to work requirements and cost sharing as a condition of Medicaid enrollment in accordance with H.R.1 and the Montana Code.
North Dakota is seeking public comment on proposed amendments to two Medicaid waivers that expand access to services for children. North Dakota Health and Human Services (HHS) is seeking public comment on proposed amendments to two Medicaid children’s waivers that expand access to services for qualifying children. The autism spectrum disorder waiver provides services to eligible children and supports parents in their efforts to maximize their child’s development, while also preventing out-of-home placements. The Medicaid waiver for medically fragile children allows Medicaid to pay for services for children between the ages of 3 to 18 who are medically fragile.
Oklahoma submitted a request to extend its section 1115 demonstration allowing Medicaid coverage for inpatient mental health and substance-use treatment for adults. The state submitted a request for an extension to the Medicaid section 1115(a) demonstration entitled the “Oklahoma Institutions for Mental Disease [IMD] Waiver for Serious Mental Illness [SMI]/Substance Use Disorder [SUD] Demonstration.” This demonstration aims to provide access to mental health and substance-use treatment by allowing Medicaid coverage and reimbursement for inpatient treatment services provided to eligible adults with SMI/SUD, ages 21-64, within IMDs.
South Carolina submitted a five-year section 1115 demonstration application to provide Medicaid coverage to certain adults in the parent caretaker relative group, including work requirements for eligible individuals. The state submitted an application to CMS for a five-year section 1115 demonstration to offer Medicaid coverage for adults ages 19 through 64 who qualify under the parent caretaker relative group with incomes between 67% to 100% of the federal poverty level. The proposal includes work requirements for individuals eligible for this demonstration.
Texas received CMS approval for a five-year extension of a demonstration allowing expanded postpartum benefits. CMS approved a five-year extension of the “Healthy Texas Women (HTW)” section 1115 demonstration. The approval provides new authority for the state to expand the benefit package to include additional postpartum services and move the demonstration from fee-for-service to managed care.
Utah submitted a request to amend its Medicaid reform 1115 demonstration to provide wraparound benefits to qualified individuals with disabilities. The state submitted a request to amend its Medicaid reform 1115 demonstration to provide benefits available under Medicaid but not provided by individuals’ minimum essential coverage to qualified individuals who have minimum essential coverage and have a disability. The state is also requesting to shift all Medicaid dental services for children under age 21 and pregnant and postpartum individuals from managed care to a fee for service model.
Utah submitted a separate request to amend its Medicaid reform 1115 Demonstration to implement a work requirement for Medicaid expansion adults. Utah submitted a request to amend the Medicaid reform 1115 demonstration to implement a work requirement for the Medicaid expansion population. This requirement would apply to eligible individuals ages 19 through 59 with an income between 0% to 138% of the federal poverty level who are not included in the list of exempted individuals.