March 17 Update

In This Week’s Update:

  • State Estimates on Medicaid Cuts
  • Updates to CMS’ Medicaid Premium Payment Rule
  • Beneficiary Advisory Council (BAC) Implementation Checklist
  • Five States Leading Efforts to Increase Primary Care Spending
  • State Updates: AZ, CA, CO, DC, IL, MI, MT, NC, NJ, NY, OH & OR

 

State Estimates on Medicaid Cuts
Last week, State Health and Value Strategies (SHVS) published a new expert perspective, which highlights states that have produced estimates to quantify the potential impacts of federal policy changes to the Medicaid program currently being debated in Congress. These estimates can provide examples for states as they consider how to evaluate the enrollment and cost impacts of various proposed federal cuts to Medicaid. SHVS will continue to monitor state activity and will update this expert perspective as other states publish estimates.

 

Updates to CMS’ Medicaid Premium Payment Rule
Also last week, CMS released a proposed rule that makes several policy and operational changes to the Affordable Care Act Marketplaces and insurance rules. SHVS published an expert perspective which reviews provisions of the proposed rule to assess their impact on State-Based Marketplaces and state insurance regulators. Updates follow.

 

Beneficiary Advisory Council (BAC) Implementation Checklist
In 2024, CMS issued a rule requiring states to establish or strengthen Beneficiary Advisory Councils (BACs) and Medicaid Advisory Committees (MACs) to ensure that member experience and input are integrated into program and policy decision-making processes. The Center for Health Care Strategies (CHCS) released a checklist for states, which serves as an at-a-glance reference to assist in designing and implementing the BACs and MACs. CHCS also released a Community Member Engagement Landscape Assessment and a companion guide designed to help state Medicaid agencies systematically document existing efforts to engage community members through mechanisms such as advisory boards and committees, patients’ groups, and other health-related organizations. The goal is to understand the existing landscape to design or strengthen the BAC effectively.

 

Five States Leading Efforts to Increase Primary Care Spending
More people in the United States are struggling to find appointments with a primary care doctor or clinic for checkups and sick visits. To address primary care workforce shortages and help keep care more affordable, a growing number of states are engaged in efforts to strategically invest in primary care–a core component of a strong health system proven to keep populations healthier and promote more equitable access to care. A new Milbank Memorial Fund report profiles efforts in five states (California, Connecticut, Oklahoma, Rhode Island, and Virginia) that are at different stages of enacting and implementing primary care spending targets, including early planning, active efforts to engage state policymakers, and implementation or revision of an enacted state policy.

 

Costs of Cutting Medicaid Expansion
A new series of Urban Institute briefs, published by the Robert Wood Johnson Foundation, explore the effects of proposed federal cuts to Medicaid. The latest brief in the series, Hospital Revenue Losses And Increased Uncompensated Care If Medicaid Funding Is Cut, shows huge hits to providers across states if Medicaid expansion funds are cut, as a consequence of nearly 11 million people losing health insurance coverage. The analysis shows if all states were to drop the Medicaid expansion, this would spark an $80 billion reduction in revenue going to healthcare providers in 2026. Costs of uncompensated care—services that hospitals must provide under law but are not reimbursed by anyone—would increase by nearly $19 billion. The first brief looked at state cost and coverage implications if Congress were to cut the enhanced Federal Medical Assistance Percentage in expansion states and the second brief looked at the impact of per capita caps.

 

State Updates: AZ, CA, CO, DC, IL, MI, MT, NC, NJ, NY, OH & OR

  • Arizona – The Arizona Health Care Cost Containment System (AHCCCS) announced the implementation of a newly reorganized leadership team structure. This restructuring is part of AHCCCS Director Carmen Heredia’s ongoing efforts to improve efficiencies and evolve the agency to better serve its members. Key focus areas of the newly updated organizational structure include: strengthening financial oversight; enhancing managed care partnerships; focusing on the Arizona Long-Term Care System; leveraging physician leadership for quality improvement; and building analytical and legal expertise.
  • California – The Department of Health Care Services issued a stakeholder update regarding the recent rescission of previous guidance on health-related social needs (HRSNs), emphasizing that existing approvals, including California’s 1115 waivers supporting community supports, remain unaffected and that California supports Medi-Cal members having access to essential services that address HRSNs.
  • Colorado – Governor Polis, Lieutenant Governor Primavera and the Colorado Department of Higher Education announced that Colorado has made community college free for over 10,000 healthcare professionals through Care Forward Colorado. Care Forward Colorado has awarded over 2,600 Certified Nursing Assistants, 3,500 Emergency Medical Technicians, and 1,100 Medical Assistants. Early employment data shows that over 90% of graduates are now employed in healthcare roles across Colorado, addressing critical workforce gaps in communities.
  • District of Columbia – Wayne Turnage, Director of the Department of Health Care Finance (DHCF), issued a public notice on budget challenges for Medicaid, highlighting that growth patterns in the Medicaid program for fiscal year (FY) 2025 will require over $173 million in additional local funds for FY2026. This budget gap, combined with a decline in forecasted revenues and some measure of a federal fund reduction, would require DHCF to make budget proposals that fundamentally reshape the District’s Medicaid program.
  • Illinois – The Illinois State Senate confirmed the appointment of Morgan Winters as the Director of Get Covered Illinois, the state’s official health insurance Marketplace. Director Winters will lead Illinois’ transition to a State-Based Marketplace for plan year 2026.
  • Michigan
    • The Michigan Department of Health and Human Services (MDHHS) is seeking members for the Beneficiary Advisory Council (BAC), a new committee that will allow Michigan Medicaid members to share experiences about services received through Medicaid. As a reminder, SHVS published template materials designed to support state agencies in recruiting members for the BAC. States can customize the content of the materials, which include a recruitment flyer, social media graphics, core messages, website copy, and newsletter copy.
    • MDHHS launched the Michigan Public Health Data Dashboard, providing policymakers with a data-driven snapshot of public health trends in each state House and state Senate district. The publicly accessible dashboard aims to equip lawmakers, local officials, advocacy groups, and the public with key health metrics, enabling them to identify challenges, allocate resources effectively and craft policies to improve health outcomes.
  • Montana – Governor Greg Gianforte announced a $700,000 investment to expand peer support services, specifically for families and caregivers of youth with serious emotional disturbance. Family peer support services are provided by those who have lived experience raising a child with behavioral health challenges or special healthcare needs and are equipped to provide emotional support and resources to another family who is raising a child with similar needs.
  • New Jersey – The New Jersey Department of Labor and Workforce Development announced a $2.5 million grant opportunity through the Cultivating Access, Rights, and Equity (CARE) grant program, which aims to increase awareness and access to worker benefits and protections. In seeking to ensure equitable access to benefits, the CARE grant program is part of the Murphy administration’s mission, through Nurture NJ, to improve maternal and infant health outcomes.
  • New York – Governor Kathy Hochul announced awards to establish five step-down programs to help adults living with co-occurring mental illness and intellectual or developmental disabilities safely transition back into their community. Administered by the State Office of Mental Health, the $85 million in funding over five years will help service providers develop enhanced ‘step-down’ programs that couple critical intervention teams with transitional housing to ensure individuals can live in independent settings once they are discharged from a hospital or other inpatient settings.
  • North Carolina