State updates as of November 14, 2025.

Changes to the Marketplaces ushered in by recent federal policy actions and the scheduled expiration of the enhanced premium tax credits will raise premiums and may ultimately lead consumers to forgo coverage. Targeted surveys can be a quick and inexpensive way for State-Based Marketplaces (SBMs) to better understand why consumers are not reenrolling in coverage. This expert perspective includes sample survey questions that SBMs could send during or after open enrollment to gather more information from consumers, including an example from Maryland, and general guidance on question language, timing, and more.

State updates as of November 7, 2025.

On November 5, 2025, the Centers for Medicare and Medicaid Services (CMS) announced that all 50 states have submitted applications for the Rural Health Transformation Program (RHTP). Created by Congress to address concerns stemming from the deep funding cuts in H.R.1, the RHTP will distribute $10 billion annually from 2026 through 2030; 50% of those payments will be distributed equally across states with an approved Rural Health Transformation Plan, while the remaining half will be distributed to states at the discretion of CMS, according to factors detailed in the funding announcement. This expert perspective identifies states that have formally announced their submission and/or publicly released their application materials, and includes links to the publicly-available material.

State updates as of October 31, 2025.

With rural healthcare in distress and looming cuts from H.R.1, there has been intense state interest in the $50 billion Rural Health Transformation Program, and states are working quickly to create the Rural Health Transformation Plans that are a requirement of the application for funding. To inform their plans, most states have solicited public input via surveys and requests for information and taken other actions, such as hosting community listening sessions. Several states have already begun reporting themes from their efforts to engage stakeholders, including Alaska, California, Georgia, North Dakota, and Washington. This expert perspective summarizes the key themes that have emerged across these five states during their stakeholder processes, as identified by the states. 

With the passage of H.R.1, states face the most extensive transformation of eligibility and enrollment policies and operations since the enactment of the Affordable Care Act in 2010. The law’s provisions require fundamental updates to how states administer the Medicaid program. Data and technology will be critical to implementing work reporting requirements, and states are being approached by many vendors offering data and technology solutions ranging from full system platforms to new data sources for verifying compliance. This expert perspective explores key human-centered principles that states should consider when evaluating vendor solutions to implement work reporting requirements, with the goal of mitigating coverage losses and reducing administrative burdens for state staff.

State updates as of October 24, 2025.

Managed care plans (MCPs) are well-positioned to support state Medicaid agencies as they develop their policy, operational and information technology (IT) system plans to implement federally mandated work reporting requirements. While MCPs cannot make determinations of work reporting compliance or exemptions under H.R.1, they can provide states with data analysis, evidence, and recommendations which states can use to make determinations. This expert perspective describes MCP partnership strategies to support the implementation of work reporting requirements to promote continuity of coverage and minimize procedural disenrollment risks.

State updates as of October 17, 2025.