In This Week’s Update:
- Ensuring Person-Centered Care for Children with Autism Spectrum Disorder
- Reducing Coverage Losses Through Effective Implementation of Medicaid Work Requirements
- Interventions to Automate Medicaid Renewals, Reduce Procedural Denials, and Increase Coverage
- State Applications to Transform Rural Health
- Tracking Marketplace Enrollment in 2026
- State updates: AZ, CA, CO, CT, NC, NH, NM, NY & OR
Ensuring Person-Centered Care for Children with Autism Spectrum Disorder
The North Carolina Department of Health and Human Services released a new report, Ensuring Person-Centered Care for Children with Autism Spectrum Disorder in the NC Medicaid Program. States are facing significant cost growth associated with the applied behavior analysis (ABA) benefit, in part because of an influx of private equity in the space. In North Carolina, total spending is projected to increase 425% from 2022 to 2026, reaching $639 million in 2026 which would make it one of the most costly services in the NC Medicaid array. The paper analyzes the drivers of the utilization and spending increases in North Carolina and proposes 11 policy actions to stabilize the program while also improving the quality of autism services in the state.
Reducing Coverage Losses Through Effective Implementation of Medicaid Work Requirements
H.R.1 requires certain Medicaid applicants and enrollees to document at least 80 hours per month of work or other qualifying activities or qualify for an exemption. While past experience shows that this requirement will lead many people to lose coverage, state policy and implementation choices will largely determine how many people lose coverage. A report from the Center on Budget and Policy Priorities describes how states can mitigate coverage loss from the work requirement by choosing policies that minimize burden, streamlining verification processes, and creating accessible and user-friendly forms, portals, and communication methods.
Interventions to Automate Medicaid Renewals, Reduce Procedural Denials, and Increase Coverage
In spring 2023, the pause in Medicaid disenrollment resulting from the COVID-19 public health emergency ended, and states began redetermining eligibility for more than 90 million enrollees. In the early months of these redeterminations, a large majority of those disenrolled lost coverage for procedural reasons, such as missing paperwork. A study published in Health Affairs examined an effort by the federal government to work with four states to increase automated ex parte Medicaid renewals with the goal of reducing procedural denials and coverage loss. The analysis of state Medicaid enrollment data found that compared with other states, ex parte renewals in the four states increased by 21.6 percentage points, overall renewals increased by 7.7 points, and procedural denials decreased by 8.3 points. The findings demonstrate that reducing burdens by automating Medicaid renewals ensures eligible enrollees remain covered, and policies only work when states have the capacity to implement them.
State Applications to Transform Rural Health
This week, the Centers for Medicare and Medicaid Services announced that all 50 states have submitted applications for the Rural Health Transformation Program (RHTP). State Health and Value Strategies (SHVS) published an expert perspective featuring an interactive map identifying states that have formally announced their submission and/or publicly released their application materials. The map also includes links to the publicly-available material. Thirty states have announced their submissions to date and of those, 24 have posted either a summary or the full application. SHVS will continue to track state announcements regarding the RHTP and will update this map to reflect new developments.
Tracking Marketplace Enrollment in 2026
As open enrollment (OEP) is underway, understanding the impact of the scheduled expiration of the enhanced premium tax credits and other recent federal legislative and regulatory policy changes on Marketplace coverage uptake is crucial. SHVS published an expert perspective which will serve as a one-stop resource for tracking real-time 2026 State-Based Marketplace (SBM) enrollment data. Two states, Connecticut and Kentucky, are reporting this information, and SHADAC will continue to update this tracker throughout OEP to reflect the latest developments in SBM reporting.
State updates: AZ, CA, CO, CT, NC, NH, NM, NY & OR
- Arizona – Governor Katie Hobbs and the Arizona Department of Health Services launched AZRx, an initiative that allows Arizonans to save money on their prescription drugs. Arizonans can sign up for a discount card through ArrayRx, the multistate public pharmacy collaborative that Arizona joined earlier this year through the governor’s executive order. The discount card is available at no cost to Arizona residents and helps Arizonans save up to 80% on their medications.
- California – The Department of Health Care Services announced that the Children and Youth Behavioral Health Initiative Fee Schedule program, which allows local educational agencies to sign up to participate in a reimbursement pathway for mental health and substance-use screenings, treatment, and case management, is demonstrating early positive results. Schools and their partners have received more than $1.8 million in new funding for services provided to more than 5,000 students.
- Colorado – The Colorado Department of Agriculture, the Colorado Department of Public Health and Environment, and Colorado Parks and Wildlife announced the signing of a new memorandum of understanding (MOU) to enhance interagency cooperation and information sharing. The MOU strengthens the ability of Colorado’s health, agriculture and wildlife agencies to collaboratively address a wide range of concerns, including zoonotic diseases, foodborne illness outbreaks, and bioterrorism threats.
- Connecticut – Governor Ned Lamont announced the release of a new Connecticut guide for navigating dementia care. Developed by the Connecticut Department of Public Health and the Connecticut Department of Aging and Disability Services, the guide was created to provide people living in Connecticut with information on resources to support someone living with Alzheimer’s or dementia.
- New Hampshire – Following the state’s submission for RHTP funds (see this expert perspective for details), Governor Kelly Ayotte established the Governor’s Office of New Opportunities & Rural Transformational Health (GO-NORTH) to oversee the state’s efforts to make healthcare more affordable and accessible to improve health outcomes in rural communities.
- New Mexico – The New Mexico Health Care Authority issued a notice of funding opportunity for behavioral health regions across the state to apply for immediate funding to expand mental health and substance-use disorder services statewide. Up to $26 million will be awarded to New Mexico’s behavioral health regions to support immediate investment addressing one or more of four critical behavioral health access shortages, including: residential treatment continuum of care, crisis continuum of care, medication assisted treatment for justice-involved individuals, or prenatal and perinatal substance-use disorder treatment programs.
- New York – Governor Kathy Hochul announced the release of New York’s first-ever maternal mental health report detailing the challenges pregnant women are facing and recommendations for improvements statewide. In addition to the report, the state also made available funding to help OBGYN and family medicine practices support perinatal pregnant women with behavioral health needs and is hosting a series of virtual roundtables to discuss maternal mental health issues.
- North Carolina
- Governor Josh Stein called an extra session of the North Carolina General Assembly on November 17, 2025, to fund Medicaid. The North Carolina Department of Health and Human Services first alerted the General Assembly’s Fiscal Research Division in May 2025 that more money would be needed to keep the Medicaid program whole, and the cuts went into effect on October 1. Governor Stein previously sent a letter to the General Assembly laying out three options to reverse the cuts: a) fully funding NC Medicaid at $319 million in recurring funds, b) partially funding NC Medicaid at $190 million in recurring funds and delaying cuts until at least January 1, 2026, or c) using non-recurring funds from the $500 million Medicaid Contingency Reserve to fill the funding gap.
- Governor Stein hosted a roundtable discussion to hear from advocates, faith leaders, practitioners, and patients about the burden of living with medical debt and highlight the state’s medical debt relief program (see this SHVS state spotlight for more information). Governor Stein also sent a letter to the three major national Credit Reporting Agencies urging them to recommit publicly to their policies of not including certain medical debt in credit reports and highlighted the benefits of eliminating all medical debt from consumers’ credit reports entirely.
- Oregon – The Oregon Health Authority (OHA) has appointed Dr. Steven Nakana as the new permanent director of OHA’s Equity & Inclusion Division. The appointment underscores OHA’s commitment to creating systems where everyone can thrive, guided by shared values and responsibility.