July 14 Update

In This Week’s Update:

  • Beneficiary Advisory Council Implementation: How States Are Getting Ready
  • Understanding Insurance Transitions in Periods of Churn
  • A Report on Child Health in the U.S.
  • Next Steps After Reconciliation
  • The Reconciliation Bill’s Impact on State Medicaid Programs
  • State updates: CA, CT, KY, ME, MN, MT, NC, NJ, NM, NY, OK, OR, SC, UT, VA & WA

 

Beneficiary Advisory Council Implementation: How States Are Getting Ready
July 9, 2025 marks the effective date of new federal requirements that states engage people with lived experience of the Medicaid program. For most states, the Beneficiary Advisory Council (BAC) is a novel advisory body which will, for the first time, provide people with lived experience of the Medicaid program with the opportunity to participate in the design of policies and programs in their state. State Health & Value Strategies published an expert perspective that highlights examples of how states have been preparing for implementation of BACs—including raising awareness about the BAC, recruiting and selecting members, and establishing policies for their meetings.

 

Understanding Insurance Transitions in Periods of Churn 
As states begin planning for coverage transitions that will result from the passage of the budget reconciliation bill, SHADAC published a brief that investigates the coverage outcomes of those who lost Medicaid during the Public Health Emergency Unwinding. The brief centers on the coverage outcomes using publicly available survey data.

 

A Report on Child Health in the U.S.
A study published in JAMA highlights declines in both the physical and mental health of children across the country. The U.S. mortality rate in those 19 and under is more than twice that of all Organisation for Economic Co-operation and Development (OECD) countries. An accompanying editorial discusses the potential causes of the health declines and considerations for policy changes. 

 

Next Steps After Reconciliation
Last week, State Health and Value Strategies hosted a webinar for State-Based Marketplace and Division of Insurance officials. On July 4, the president signed the reconciliation budget bill into law, starting the clock on a number of changes to Marketplace coverage and premium tax credit eligibility. Just two weeks earlier, CMS finalized its 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 weeks. The slide deck for the webinar is posted on our website and if you missed the webinar you can watch a recording.

 

The Reconciliation Bill’s Impact on State Medicaid Programs
On Thursday, July 24, SHVS will host a webinar on the budget reconciliation legislation (H.R.1) and the sweeping changes to Medicaid that it will make to state Medicaid program expenditures, enrollment, and operations now and in the years to come. The webinar will review how the law concentrates cuts to the ACA’s Medicaid expansion population, limits use of provider taxes and state directed payments and adds major restrictions on access to affordable health coverage for noncitizens. Registration is required.

 

State Updates: CA, CT, KY, ME, MN, MT, NC, NJ, NM, NY, OK, OR, SC, UT, VA & WA

 

  • California
    • 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.
    • 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.
  • Connecticut – 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.
  • Kentucky – The state submitted an application for a 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 – 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 – MNSure, the state’s health insurance Marketplace, is accepting applications for the MNsure Board Advisory Committee. The advisory committee will provide guidance, advice, and recommendations to the board as it carries out its mission.
  • Montana – The Montana Department of Public Health and Human Services has opened a 60-day period within which the public may comment on its planned 1115 Medicaid demonstration waiver application for Montana’s Health and Economic Livelihood Partnership program. The waiver seeks approval from CMS to implement work requirements and cost sharing as required in state and federal law.
  • New Jersey
    • 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.
    • 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 Mexico – 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
    • Governor Kathy Hochul released data on the impacts of the federal budget reconciliation legislation on New York. More than 2 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 released the final report for New York’s first-ever Master Plan for Aging (MPA). The MPA Final Report contains more than 100 proposals directed towards all levels of government, the social sector and private enterprise, all with the aim of helping individuals age with dignity, independence, and the support they need and deserve to thrive.
  • North Carolina – 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. 
  • Oklahoma – 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.
  • Oregon – Oregon Health Authority (OHA) has released a 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.
  • South Carolina – 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.
  • Utah – 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.
  • Virginia – 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