In This Week’s Update:
- Understanding the Impact of Medicaid Estate Recovery: Research Insights
- How Policymakers Are Fighting the Healthcare Affordability Crisis
- Work Impairment and Financial Outcomes Among Adults With Long COVID
- Resources for Work Requirement Implementation
- State updates: CA, CO, GA, IL, MI, MT, NC, ND, NJ, NM, NY, OR, PA, UT, VA & WI
Understanding the Impact of Medicaid Estate Recovery: Research Insights
A research paper in the Journal of Health Politics, Policy and Law investigates the impacts of Medicaid estate recovery and exploring current reform efforts. Since Congress enacted Medicaid estate recovery into law in 1993, there have been few changes to the policy and little research to investigate its effectiveness. Under Medicaid estate recovery—a response to the rising and uncertain costs associated with long-term custodial care among a rapidly aging population—states have the right to track former Medicaid enrollees’ assets and seek recovery from their estate after their death. While it makes an insignificant dent in state budgets, Medicaid estate recovery nonetheless can have a lasting impact on the lives of families subject to its repayment requirements. For low-income families where homeownership is their primary source of wealth, policies aimed at homeowners may exacerbate longstanding disparities in wealth and disproportionately burden Black and Hispanic families. Recently, some states have initiated policy changes to address problems with Medicaid estate recovery and similar legislation also has been introduced in Congress. For more information on making Medicaid estate recovery policies more equitable, see this State Health & Value Strategies (SHVS) toolkit.
How Policymakers Are Fighting the Healthcare Affordability Crisis
As legislative sessions draw to a close in many states, one thing is clear: state leaders are stepping up to strengthen healthcare protections where federal policies may fall short, are nebulous, or are under attack. An analysis from United States of Care of the 2025 legislative session reveals three state policy trends to address the healthcare affordability crisis: 1) states took action to lower hospital prices and address hospital consolidation; 2) states advanced healthcare consumer protections; and 3) states preserved access to healthcare coverage.
Rethinking Work Impairment and Financial Outcomes Among Adults With Long COVID
A study published in JAMA Network asks the question: what are the differences in long-term financial and work outcomes among individuals with self-reported long COVID (LC) and those with resolved or never LC? In this prospective cohort study of adults with SARS-CoV-2 infection, participants with current self-reported LC reported worse work impairment, missed work, and financial distress compared with those who never had LC, while vaccination was associated with improved work outcomes and less financial distress even among individuals with LC. These data underscore the need for post-pandemic assistance programs, as well as vaccination to decrease societal harms.
Resources for Work Requirement Implementation
Last week, SHVS released the first set of resources to help states plan for the new work reporting requirements in Medicaid with the goal of preserving coverage and minimizing the administrative burden for those who are eligible. The first resource, Medicaid Work Reporting Requirements: Implementation Basics and State Decision Points, lays out the details of the requirements in H.R.1 and identifies the policy options that states will need to address. The expert perspective also highlights the topics where guidance is expected from the federal government, though that guidance may not be released until the middle of 2026. The second resource, Medicaid Work Reporting Requirements: Implementation Planning Milestones, provides states with a clear workplan with key steps to be ready for the deadlines set in the new law, including opportunities to engage directly with individuals and communities affected by these changes. SHVS will continue to develop resources for states to inform their planning and implementation of H.R.1 with a focus on maintaining access to needed health services.
State updates: CA, CO, GA, IL, MI, MT, NC, ND, NJ, NM, NY, OR, PA, UT, VA & WI
- California – Covered California, the state’s official health insurance Marketplace, is highlighting a preliminary weighted average rate increase of 10.3%, which would be reduced if Congress extends the enhanced premium tax credits. For 2026, the state has allocated $190 million to provide state subsidies for individuals earning up to 150% of the federal poverty level (FPL), ensuring monthly premiums remain comparable to 2025 levels, and some additional assistance for those earning up to 165% FPL, but the funding does not fill the $2.1 billion hole if Congress does not extend the enhanced premium tax credits.
- Colorado – The Department of Health Care Policy and Financing (HCPF) published an explainer of the Rural Health Transformation Program which includes an update on the work HCPF is doing to prepare for the release of the application.
- Georgia – The Georgia Department of Community Health (DCH) is now accepting public input on ideas that will potentially shape the Rural Health Transformation Program grant process. In addition to the form submission, DCH will have three in-person-only town hall meetings and a virtual town hall meeting.
- Illinois – Get Covered Illinois announced that CMS approved Illinois’ transition to a State-Based Marketplace. The Customer Assistance Center, along with a newly designed website, will go live on October 1. Beginning November 1, Illinoisans who were previously enrolled through HealthCare.gov will transition to Get Covered Illinois for their 2026 coverage.
- Michigan – Governor Gretchen Whitmer signed an executive directive asking the Michigan Department of Insurance and Financial Services (DIFS) to support Michiganders’ access to affordable health insurance, in response to recent federal actions that will make it harder for people to get and keep their health coverage and raise the cost of healthcare. The directive asks DIFS to raise awareness and educate Michiganders on what they need to do to keep or get health insurance during this open enrollment period and requires DIFS to answer Michiganders’ insurance questions on their helpline as well as connect Michiganders with Navigators and other support available.
- Montana – The Montana Department of Public Health and Human Services released a request for information to help shape Montana’s Rural Health Transformation Program application and overall strategy.
- New Jersey
- Nurture NJ announced the launch of the NJ Supports Breastfeeding initiative, a central element of the 2022-2027 New Jersey Breastfeeding Strategic Plan. The website is a one-stop resource for breastfeeding education, support, and empowerment. NJ Supports Breastfeeding also includes a directory of lactation support providers by county.
- Acting Governor Way signed two bills protecting individuals seeking substance-use treatment from being misled, exploited, or referred for profit. These measures strengthen accountability within the substance-use treatment industry, supporting patients in making informed choices and ensuring that care decisions are driven by clinical need rather than financial gain.
- New Mexico – The New Mexico Health Care Authority announced that in a new cross-agency partnership, nine incarcerated individuals trained inside correctional facilities are poised to become Certified Peer Support Workers (CPSW). A CPSW is someone who has experienced long-term recovery from mental health and/or substance-use conditions and is trained to help others in their recovery. The training is a partnership between the Health Care Authority’s Office of Peer Recovery & Engagement and the New Mexico Corrections Department and additional training is planned in prisons and jails across the state in the coming months to prepare more incarcerated individuals to serve as peer support workers.
- New York – Governor Kathy Hochul announced $300 million in new state funding to support healthcare transformation projects across New York. The awards, made through the Statewide Health Care Facility Transformation Program IV, will support more than 50 projects aimed at expanding access to inpatient, primary, behavioral health and long-term care services.
- North Carolina – The North Carolina Department of Health and Human Services is gathering ideas, data, and approaches from partners such as rural healthcare providers, professional associations, public institutions, industry associations, and academia, in support of North Carolina’s proposed application to CMS for the Rural Health Transformation Program.
- North Dakota – North Dakota Health and Human Services launched a request for information survey to gather public feedback on how the state could shape its new Rural Health Transformation Program to build a stronger, more sustainable rural healthcare system.
- Oregon – Governor Tina Kotek announced that the budget reconciliation bill is projected to cut $15 billion in federal funding from Oregon for health insurance coverage, food benefits, and other programs. The announcement is the result of a preliminary analysis by the State of Oregon’s Chief Financial Officer and an impact analysis summarizing the loss of federal funding to the Oregon Health Authority is available here.
- Pennsylvania
- Pennsylvania Insurance Department (PID) Commissioner Michael Humphreys is urging health insurers and pharmacy benefit managers (PBMs) to take immediate steps to protect patients’ access to prescription medication as Rite Aid stores across Pennsylvania continue to close. Through Notice 2025-07, PID reminded insurers and PBMs that network adequacy rules are in place to protect consumers.
- The Doula Advisory Board, established by Act 115 of 2024, was created to advise the Secretary of the Department of Human Services on key issues including: doula best practices; doula participation in the state’s Medicaid program; and addressing racial and geographic disparities in maternal health services. The Advisory Board will meet twice a year, with the first meeting scheduled for September 4.
- Utah – The Department of Health and Human Services (DHHS) is gathering a group of stakeholders to help develop Utah’s application for a five-year Rural Health Transformation Program. Stakeholders are invited to share input, develop priorities, and shape program investments. DHHS held a kickoff meeting to provide an overview of the program on August, 13 and included a Q&A with Deputy Director Nate Checketts, Population Health Assistant Director Ashley Moretz, and Medicaid Medical Director Dr. Ronak Iqbal.
- Virginia
- Governor Glenn Youngkin issued an executive directive launching a Rural Health Transformation effort. The Governor’s directive instructs the Secretary of Health and Human Resources, in conjunction with other stakeholders, to develop a plan to leverage funds provided by the Rural Health Care Transformation Fund Program to support quality access to healthcare in rural Virginia. The Secretary is also directed to conduct stakeholder outreach efforts on the rural healthcare transformation plan, the new Medicaid work requirements, and the new twice-a-year Medicaid eligibility determination for the expansion population.
- Governor Youngkin signed Executive Order 52, launching a series of initiatives to strengthen oversight of nursing homes in Virginia, with the intended goal of ensuring nursing homes meet the highest standards for safety, quality, and transparency.
- Wisconsin – The Wisconsin Department of Health Services launched a request for information to inform Wisconsin’s application for the Rural Health Transformation Program. Respondents are encouraged to consider how their input may align with local or regional efforts, and where appropriate, to collaborate with other organizations serving the same communities or populations.