November 17 Update

In This Week’s Update:

  • Uncovering the Why: Surveying Consumers Who Don’t Maintain Marketplace Coverage
  • States of Innovation: October 2025
  • Medicaid Officials Project Flat Enrollment Post Unwinding but Increased Spending and Budget Pressure
  • The Future of Health in the United States
  • Medicaid Work Requirement Exemption: Medical Frailty
  • State updates: AZ, CT, IN, LA, MI, NC, NE, OR, RI, SC & WV

Uncovering the Why: Surveying Consumers Who Don’t Maintain Marketplace Coverage
Changes to the Marketplaces ushered in by recent federal policy actions and the scheduled expiration of the enhanced premium tax credits will raise premiums and may ultimately lead consumers to forgo coverage. Last week, State Health & Value Strategies (SHVS) published an expert perspective which describes how targeted surveys can be a quick and inexpensive way for State-Based Marketplaces (SBMs) to better understand why consumers are not reenrolling in coverage. This expert perspective includes sample survey questions that SBMs could send during or after open enrollment to gather more information from consumers, including an example from Maryland, and general guidance on question language, timing, and more. 

States of Innovation: October 2025
Last week, SHVS published the latest post in its States of Innovation series, which profiles state activity in October 2025. Throughout the month, states prepared to submit Rural Health Transformation Program (RHTP) applications by the November 5 deadline and State-Based Marketplaces made the case for Congress to extend the enhanced premium tax credits in time for open enrollment on November 1. In October, states also made progress towards improving affordability, leveraging artificial intelligence and technology, engaging community members through newly established Medicaid Beneficiary Advisory Councils, and protecting vaccine access.

Medicaid Officials Project Flat Enrollment Post Unwinding but Increased Spending and Budget Pressure
According to a report from Kaiser Family Foundation, as states completed the unwinding of pandemic-era continuous coverage, Medicaid enrollment fell 7.6% in fiscal year (FY) 2025 and is expected to be largely flat in FY 2026. At the same time, total Medicaid spending grew by 8.6% in FY 2025 and is expected to grow by 7.9% in FY 2026. In addition to increasing spending demands, slower revenue growth and heightened fiscal uncertainty have created a more tenuous fiscal climate for states in FY 2026. States are also preparing for $911 billion in federal Medicaid spending cuts enacted by H.R.1, including new financing restrictions and work requirements, which will exacerbate existing budget challenges. The challenging fiscal climate and the magnitude of federal Medicaid cuts will make it difficult for states to absorb or offset the reductions.

The Future of Health in the United States
The latest podcast episode of The Princeton Pulse features a conversation with former CMS Administrator Chiquita Brooks-LaSure to discuss the future of U.S. healthcare policy. This candid and rich discussion addresses the future of Medicare and Medicaid, policy pathways to strengthen these programs, and opportunities for improving health outcomes.

Medicaid Work Requirement Exemption: Medical Frailty
Last week, SHVS published a toolkit for operationalizing the medical frailty exemption for Medicaid work reporting requirements under H.R.1. The toolkit provides a structured roadmap for defining medical frailty, developing and validating data-driven code lists, and integrating those requirements into state eligibility and enrollment workflows, while reducing the burden on individuals and state administration.

State updates: AZ, CT, IN, LA, MI, NC, NE, OR, RI, SC & WV

  • Arizona – The Arizona Health Care Cost Containment System announced its support of Governor Katie Hobbs’ submission of Arizona’s application to the federal RHTP. SHVS continues to track state announcements regarding the RHTP, including links to publicly available applications.
  • Connecticut – Governor Ned Lamont announced that he has signed a declaration enabling the Connecticut General Assembly to adopt legislation appropriating the funding necessary to create an emergency reserve that will facilitate the state response to millions of dollars in federal cuts toward health and human services. This includes cuts made through H.R.1, the impact of the federal government shutdown and future shutdowns, and any potential future federal reductions.
  • Indiana – Indiana Family and Social Services Administration Secretary Mitch Roob announced the recommendations of the Applied Behavior Analysis (ABA) Working Group, convened earlier this year to address the rapid growth and sustainability challenges of Medicaid-funded ABA therapy. The Working Group issued five interdependent recommendations to protect access, improve quality, and ensure sustainability: align ABA utilization with clinical evidence; ensure high-quality care and optimal outcomes; establish sustainable rates; strengthen program management and oversight; and support a sustainable ecosystem for ABA.
  • Louisiana – The Louisiana Department of Health has appointed Seth J. Gold as Medicaid Director. Gold brings nearly a decade of experience in federal health policy. Most recently, he served as a professional staff member for the U.S. House Committee on Energy and Commerce, where he advised members of Congress on Medicaid, CHIP, and the 340B Drug Pricing Program. He led the development of major legislation to expand care for people with disabilities, modernize home and community-based services, and enhance rural healthcare access.
  • Michigan
    • The Michigan Department of Health and Human Services (MDHHS) Bureau of Aging, Community Living, and Supports is seeking public input regarding the needs and gaps in programs and services that impact quality of life for older residents, to inform the development of a multi-year State Plan on Aging.
    • MDHHS issued a competitive grant funding opportunity for crisis response initiatives that would establish or expand community-based mobile crisis intervention services. The purpose of this program is to provide increased behavioral health crisis service provisions across the state for all Michigan residents, regardless of location, diagnosis, or insurance status. A total of approximately $9.5 million in funding is available, and MDHHS anticipates issuing up to nine awards.
  • Nebraska – Nebraska submitted an amendment to its Substance-Use Disorder Program Section 1115 Demonstration seeking federal matching funds for services provided to individuals with serious mental illness or severe emotional disturbance who are short-term residents in facilities. The amendment also proposes adding medical respite care for adults who are homeless or at risk of homelessness and recovering from acute physical health conditions after discharge.
  • North Carolina – The North Carolina Department of Health and Human Services (NCDHHS) announced extended hours for NCServes and the launch of AskMeNC, two initiatives that expand access to care for North Carolina’s veterans and their families. These efforts strengthen the state’s coordinated network of support and underscore NCDHHS’s commitment to ensuring the more than 600,000 veterans who live in North Carolina have timely access to mental health care, housing, employment, and peer support services.
  • Oregon – New Oregon Health Authority (OHA) data show that when air quality worsens in Oregon, more people visit emergency departments and urgent care clinics for breathing-related illnesses and mental health conditions. The findings come from OHA’s newly updated Air Quality & Health Outcomes data dashboard, which tracks near-real-time health trends across the state. The data reveal clear connections between days with high levels of smoke or pollution and spikes in visits for asthma, chronic obstructive pulmonary disease (COPD), anxiety, and other respiratory or stress-related symptoms.
  • Rhode Island – The Rhode Island Executive Office of Health and Human Services, in consultation with the Office of Governor Dan McKee, formed the Federal Compliance Advisory Group in July 2025 to assist in the review and analysis of potential impacts of any federal actions related to the Medicaid program, Supplemental Nutrition Assistance Program, as well as the health insurance exchange, HealthSource RI. The advisory group announced it submitted a report to the Governor’s Office and the General Assembly and a summary of the report is also available.
  • South Carolina – The South Carolina Department of Health and Human Services announced it will host a webinar to review the state’s RHTP application. South Carolina developed its RHTP application and outcomes-driven initiatives by leveraging longstanding relationships with state agencies, healthcare providers, advocates, community leaders, and local and state officials.
  • West Virgina – Governor Patrick Morrisey concluded a series of appearances throughout West Virginia promoting the state’s application for the RHTP. The governor highlighted programs that aim to enhance access to quality, affordable healthcare and foster economic growth throughout the state.