In This Week’s Update:

• SHVS Webinar: Marketplace and Private Insurance Provisions in the Reconciliation Bill
• CMS Updates on Enhanced Scrutiny, Data, and Care
• Call for Medicaid Leadership Institute Applications
• Reconciliation Bill and End of Enhanced Subsidies Would Cut Provider Revenue and Spike Uncompensated Care
• The Epidemics of Alcohol, Drug and Suicide Deaths
• State updates: AZ, CA, CO, CT, KY, MA, MI, NC & WA

Marketplace and Private Insurance Provisions in the Reconciliation Bill
State Health and Value Strategies (SHVS) hosted the second in a two-part webinar series on the reconciliation bill. During the webinar, experts reviewed proposed changes to policies governing the Affordable Care Act Marketplace and what they might mean for health insurance Marketplace and Division of Insurance officials. We have posted the slide deck from the webinar and a recording of the webinar will be available this week.

Call for Applications: Medicaid Leadership Institute
The Medicaid Leadership Institute, a program of the Center for Health Care Strategies, provides Medicaid directors and their leadership teams from states and territories across the political spectrum a unique opportunity to strengthen their leadership skills. This intensive 10-month professional development program equips Medicaid directors and their senior staff with the leadership skills needed to transform Medicaid agencies and advance policies that positively impact the health of those who live in their states and territories. Medicaid directors in all states, commonwealths, and territories are eligible to apply, and up to six Medicaid directors will be selected. Applications are due June 23, 2025 by 5 p.m. ET. 

Reconciliation Bill and End of Enhanced Subsidies Would Cut Provider Revenue and Spike Uncompensated Care
A new brief from the Urban Institute combines findings from two previous Health Insurance Policy Simulation Model analyses and the most recent projections from the Congressional Budget Office of increased uninsurance associated with the reconciliation bill and the elimination of the enhanced subsidies to estimate the likely impact of 15.9 million individuals losing health insurance coverage on provider revenue and uncompensated care costs over the next 10 years. The analysis found a projected decrease in spending on healthcare services of $1.03 trillion between 2025 through 2034 and an increase in uncompensated care sought by the uninsured of $278 billion over that same time period.

The Epidemics of Alcohol, Drug and Suicide Deaths
A report from Trust for America’s Health discusses how new data show that deaths due to drug overdose and alcohol are down nationally, but this progress is uneven across population groups and at risk due to cuts to federal health programs and workforce. The data also show that much more needs to be done to ensure that the reductions in alcohol, drug overdose, and suicide deaths are occurring in every community and among all population groups.

• Arizona – Governor Katie Hobbs and healthcare providers across Arizona joined together to highlight the proposed federal Medicaid cuts and the impact on both funding and coverage for people in the state.
• California – The Department of Health Care Services recently submitted to CMS the state’s Annual Report on Community Supports, which reviews the progress and impact of Community Supports in 2024 provided through the state’s CalAIM waiver. For the first time, the report also includes a cost-effectiveness analysis for 2023. The report highlights key achievements, such as reduced emergency room visits, hospitalizations, and long-term care use, pointing to early evidence of both improved health outcomes and reduced costs when compared to the services they are replacing, such as inpatient, emergency department, and long-term care services. Of the 12 Community Supports studied, 9 are already proving cost-effective, and the remaining 3 are expected to prove to be cost-effective over time.
• Colorado – Governor Jared Polis signed several healthcare bills into law: SB 25-128 helps ensure agricultural workers have access to healthcare providers when working on their employer’s private property; SB 25-118 requires health insurance plans to cover at least three prenatal care visits without cost-sharing; and SB 25-296 ensures that people are not charged cost-sharing for any diagnostic or supplemental imaging related to breast cancer screening as long as the services are provided according to evidence-based guidelines. HB 25-1309 codifies GAC treatments in statute and prohibits a health plan from denying or limiting medically necessary GAC.
• Connecticut – Governor Ned Lamont announced that his administration has reached a three-year agreement with SEIU 1199 NE that will result in significant wage increases for direct care workers in Connecticut’s nursing homes and group homes. As a result, the union has withdrawn its plans to strike. The agreement includes incremental increases in Medicaid for nursing homes and group homes and creates a pathway to increase wages for certified nursing assistants to $26 per hour by 2028.
• Kentucky – Governor Andy Beshear and Lieutenant Governor Jacqueline Coleman joined leaders from the Kentucky Pediatric Cancer Research Trust Fund Board to present more than $1.9 million in financial and psychosocial support grants for children living with cancers and their families.
• Massachusetts
  • Governor Maura Healey, Senator Elizabeth Warren and Senator Ed Markey joined together to highlight concerns about the House reconciliation bill to cut $1.75 billion from the Massachusetts healthcare system. The bill passed by the House would terminate coverage for 250,000 Massachusetts families, seniors, veterans and people with disabilities.
  • The Massachusetts Health Connector, the state’s official health insurance Marketplace, published a one-pager summarizing the impacts of the House reconciliation bill on the Marketplace. Over 85,000 enrollees will become uninsured and residents will lose $750 million per year in federal support for health coverage through the Health Connector. Alongside other changes in the bill, Massachusetts could see its uninsured rate double to over 400,000 residents.
• Michigan – The Michigan Department of Health and Human Services (MDHHS) released results from its survey soliciting feedback on specialty behavioral health service delivery by Prepaid Inpatient Health Plans (PIHP). MDHHS received more than 2,600 responses representing a variety of individuals with lived experience of the Medicaid program and other stakeholders. The survey results will be used to inform four strategic pillars of the upcoming procurement for the state’s contracts. PIHPs are responsible for making sure people receive the behavioral healthcare services and support they need and manage the network of behavioral healthcare providers including Community Mental Health Service Providers.
• North Carolina – The North Carolina Department of Health and Human Services (NCDHHS) hosted a symposium highlighting the impact Medicaid expansion and the Healthy Opportunities Pilots are having on the health and wellbeing of North Carolinians. Since Medicaid expansion began in 2023, more than 650,000 newly eligible North Carolinians have gained access to affordable healthcare through Medicaid expansion. Additionally, the NCDHHS highlighted how following the implementation of the first of its kind Healthy Opportunities Pilots, the state is seeing $1,020 in annual healthcare costs savings per Healthy Opportunities enrollee.
• Washington – The Office of the Insurance Commissioner announced that 14 health insurers have requested an average rate change of 21.2% for the state’s 2026 individual health insurance market. According to the Washington Health Benefit Exchange, as many as 80,000 people will drop coverage if the enhanced premium tax credits are not extended, and health plans took this into account when creating their request for 2026. Based on the assumptions in the initial requested rate changes, renewing the tax credits could reduce the proposed rate changes by as much as 6.4%.