In This Week’s Update:

• CMS’ Medicaid Work Requirements Rule Projected to Worsen Coverage Loss
• State Strategies for Childcare & Rural Health Delivery
• Americans Want Major Reform on Healthcare Costs
• Tracking Litigation
• State updates: CA, CO, DE, ID, IN, KY, MD, MI, MN, MO, MT, ND, NE, NY, OR, PA, SD & WA

CMS’ Medicaid Work Requirements Rule Projected to Worsen Coverage Loss
A Manatt Health report examines the projected national and state-level impact of the Centers for Medicare & Medicaid Services’ (CMS) Interim Final Rule (IFR) implementing Medicaid work reporting requirements. The analysis finds the IFR goes beyond the statutory language and will significantly exacerbate coverage losses, affecting nearly 1 in 10 Medicaid enrollees and increasing average annual disenrollment from 6.4 million to 8.2 million people from federal fiscal year 2027 through 2034.

State Strategies for Childcare & Rural Healthcare Delivery
This University of Kansas Center for Public Partnerships and Research report examines strategies in state Rural Health Transformation (RHT) Program plans that support developing childcare capacity, and finds most states addressing childcare are primarily providing financial incentives for providers to practice in rural communities.

Americans Want Major Reform on Healthcare Costs
A Century Foundation report examines public sentiment regarding the escalating financial burden of medical expenses. The analysis highlights that more than half of U.S. residents are rationing care or accumulating debt to cope with rising healthcare costs, driving a strong public consensus for reform.

Tracking Litigation on Marketplace Rules
State Health and Value Strategies (SHVS) published an analysis summarizing the status of challenged provisions of the Marketplace Integrity Rule and the 2027 Notice of Benefit and Payment Parameters for plan year 2026 and beyond, given ongoing litigation. SHVS will update the analysis as litigation proceeds.

State updates: CA, CO, DE, ID, IN, KY, MD, MI, MN, MO, MT, ND, NE, NY, OR, PA, SD & WA

• California‘s Department of Health Care Services issued a statement on CMS deferring an additional $646.4 million from in-home care, following an initial $1.1 billion deferral in May. The state’s health insurance Marketplace released health plans and rates for the 2027 coverage year, with a preliminary weighted average rate increase of 9.9%.
• Colorado‘s Department of Health Care Policy & Financing responded to the Inspector General’s audit of its personal care services and electronic visit verification system. The Department of Public Health and Environment also released the Rural Health Equity Report, an assessment of rural health outcomes, community needs, and innovative solutions.
• Delaware‘s governor signed three bills:
  • Permanently requiring state-regulated insurers to spend at least 11.5% of medical costs on primary care.
  • Expanding hospital financial assistance so patients earning less than 300% of the federal poverty level may qualify for free care regardless of insurance status.
  • Establishing a two-year moratorium on private equity and other for-profit actors purchasing nonprofit health systems.
• Idaho’s Department of Health and Welfare updated its work requirements for the Medicaid expansion population, effective January 1, 2027.
• Indiana‘s Health Coverage Programs received CMS approval to implement a six-month, statewide provider certification and enrollment moratorium on home- and community-based services 1915(c) waiver providers.
• Kentucky’s unexpected influx of state funds will be used to reverse the General Assembly’s cuts to Medicaid, support senior meals, and fund additional costs for Michelle P. Waiver slots for families of children with autism. The funding comes from an unbudgeted $476 million budget surplus and corporate income taxes totaling more than $350 million.
• Maryland‘s Health Benefit Exchange Board of Trustees appointed a new executive director. 
• Michigan’s governor signed 10 bills to lower costs and expand access to healthcare. The governor also signed the fiscal year 2027 budget to fund initiatives that protect access to healthcare and ensure the future sustainability of Medicaid. The state’s Department of Health and Human Services launched a community partner toolkit and public awareness campaign to help enrollees prepare for upcoming changes to Medicaid.
• Minnesota is extending a pause on enrolling new Medicaid providers in 12 high-risk services. The freeze began in January 2026 to revalidate each of the nearly 5,600 providers as part of a federal corrective action plan the state must complete or risk losing more than $2 billion in Medicaid funding.
• Missouri‘s Department of Social Services (DSS) selected Hub Anchor organizations to help lead implementation of its RHT Program. DSS is also partnering with the Office on Women’s Health and the state Doula Association to expand the rural maternal health workforce.
• Montana‘s Department of Public Health and Human Services (DPHHS) director announced the availability of $4 million in first-year grants to strengthen emergency medical services in rural Montana. DPHHS officials also scheduled the summer 2026 RHT Program Stakeholder Advisory Committee meeting for August 6.
• Nebraska received CMS approval on a request for a temporary hardship exemption from Medicaid work requirements for expansion enrollees related to high unemployment in Dawson County.
• New York‘s Department of Health, NY State of Health, and United Hospital Fund hosted the second roundtable to address the implementation challenges of H.R.1.
• North Dakota‘s Health and Human Services (HHS), in partnership with Blue Cross Blue Shield of North Dakota, is sending texts, email messages, and letters to raise awareness about Medicaid work requirements. HHS also created a webpage about work requirements and how members can update their contact information.
• Oregon‘s Health Authority, Morrison Child and Family Services, and Path Home are embedding behavioral health support for infants and young children in a family shelter, including referrals for mental health treatment and in-person parenting classes.
• Pennsylvania insurers operating in individual and small group markets requested average weighted rate increases of 17.1% and 11.5%, respectively, for 2027 rates. The state’s Department of Human Services announced the first qualified projects to receive $42 million in RHT Program funding to support renovations, make structural improvements, purchase equipment, and secure supplies for entities like hospitals, healthcare providers, and rural health facilities.
• South Dakota‘s governor awarded 28 Rural Strong grants totaling $31.5 million to support health systems’ projects, expand rural care access, modernize technology, strengthen care coordination, and more.
• Washington‘s Health Benefit Exchange summarized how federal policies are impacting immigrant health coverage.