In This Week’s Update:

• Medicaid Managed Care Oversight Toolkit
• Work Requirements Implementation Toolkit
• Expiring ePTCs Could Lead to 340,000 Jobs Lost in 2026
• Digital Vendors, Human-Centered Principles, and Work Requirements
• Themes from Rural Health Transformation Plan Public Input
• State updates: AZ, CA, CO, CT, DE, KY, MN, NC, NJ, NM, OK, WA & WI

Medicaid Managed Care Oversight Toolkit
Medicaid managed care contracts are among the largest state contracts from a financial perspective. In addition, these contracts are complex and lengthy, requiring state Medicaid agencies to have expertise, processes, and data to interpret, implement, and assess plan performance to ensure enrollee access to necessary covered services. State Health & Value Strategies published a toolkit, authored by Bailit Health, designed to assist state Medicaid agencies in maximizing the value states obtain from contracted managed care entities, on behalf of enrollees and taxpayers.

• Arizona – The Arizona Health Care Cost Containment System and the Governor’s Office announced two public webinars to provide an update on Arizona’s RHTP application and the state’s engagement with rural communities, Tribal partners, and rural healthcare providers and hospitals. The second webinar on November 13 will highlight the application submitted and will discuss the next steps regarding the program award.
• California
  • The California Health and Human Services Agency hosted a webinar to provide updates on H.R.1’s impacts to the state. The slide deck also includes an update on the state’s efforts to engage the public on the RHTP and summarizes proposed rural health initiatives from the stakeholder feedback.
  • Department of Insurance Commissioner Ricardo Lara commissioned the School of Public Health at San Diego State University to conduct a comprehensive fiscal and economic impact study of California’s Medi-Cal coverage and Covered California expansions for undocumented Californians. The study will quantify and analyze the financial impacts of these expansions by evaluating how increased access to healthcare affects utilization, spending, financing, and labor market outcomes in California, providing policymakers with insights into the net fiscal impacts.
• Colorado – Connect for Health Colorado, the state’s official health insurance Marketplace, analyzed the Division of Insurance’s (DOI’s) release of final approved premiums for plan year 2026. The vast majority of consumers enrolled in Colorado’s individual Marketplace will see a statewide approximate net average premium increase of 101% due to Congressional inaction to extend the enhanced premium tax credits. The DOI estimates approximately 75,000 Coloradans will lose access to health coverage as a result.
• Connecticut – The Connecticut Office of Health Strategy launched the Connecticut Health Equity Dashboard, an interactive tool that brings together health outcomes and social and health drivers (such as socioeconomic status, race/ethnicity, housing, and transportation) that influence health and wellbeing. The dashboard is intended to support the development and implementation of targeted interventions to improve health outcomes and reduce health disparities.
• Delaware – A Delaware law that took effect on October 27 will ensure that medical debt can no longer be included on consumer credit reports. Senate Bill 156 was signed into law by Governor Matt Meyer earlier this year along with a state initiative to leverage $500,000 in state funds to purchase and eliminate up to $50 million in medical debt for an estimated 17,000 or more Delawareans. SHVS has updated our expert perspective tracking state efforts to cancel medical debt and prohibit medical debt reporting to credit agencies.
• Kentucky – Governor Andy Beshear and U.S. Congressman Morgan McGarvey joined together to urge Congress to extend the enhanced premium tax credits as nearly 100,000 Kentuckians with insurance plans through Kentucky’s marketplace, kynect, will see up to 37% higher costs.
• Minnesota – Governor Tim Walz announced that he has ordered a third-party audit of Medicaid billing. Payments for certain high risk Medicaid services will be paused for up to 90 days in order to detect suspicious billing activity and scrutinize the use of public funds. Pre-payment review will initially impact state payments for 14 services identified by the Department of Human Services (DHS) as high-risk for billing irregularities or fraud. Using funding passed during the 2025 legislative session, DHS has contracted with Optum, which will analyze fee-for-service claims data to identify irregularities such as missing documentation, unusually high billing patterns, or inconsistencies suggesting that a claim may not meet program requirements. The new layer of review will safeguard Medicaid dollars before payments go out.
• New Jersey – Governor Phil Murphy announced that the state is delivering a fifth round of medical debt relief, impacting over 48,000 New Jersey residents who owed a combined $59 million in medical bills. To date, the initiative has reached $1.3 billion forgiven for over 780,000 New Jerseyans.
• New Mexico – The state announced it is funding an evaluation to identify additional opportunities to augment healthcare and social services for Medicaid members with serious mental illness. This comprehensive behavioral health assessment and feasibility study will examine how to better serve individuals with serious mental illness or substance-use disorders, a population that often relies on emergency interventions. 
• North Carolina – The North Carolina Department of Health and Human Services and First Lady Anna Stein will host an event to highlight a new program to help people with severe mental illness released from detention. NC Forensic Assertive Community Treatment Teams (NC FACT) will deploy across the state to provide individualized assistance to people after they are released from jail or prison including mental healthcare, housing support, vocational/educational support, substance-use disorder care, day-to-day living support, and referrals to other professional support services as required.
• Oklahoma – The Oklahoma Health Care Authority announced the appointment of Melissa Miller as state Medicaid director and deputy chief of staff. Miller brings extensive experience in public service and health policy leadership, having served in state government healthcare roles throughout her career. 
• Washington – The Washington State Health Care Authority (HCA) posted a chart on its RHTP webpage detailing the priority initiatives for its RHTP application, as informed by public input. HCA also hosted a webinar to provide a broad overview of its draft application and, in a webinar Q&A document, committed to sharing its application materials publicly on its RHTP webpage.
• Wisconsin – Governor Tony Evers and Insurance Commissioner Nathan Houdek released 2026 plan year rates for Wisconsin’s individual Marketplace that show healthcare coverage costs are expected to skyrocket for Wisconsinites due to the expiration of the enhanced premium tax credits. Many Wisconsinites and their families will see their premiums double, with some seniors seeing an increase of over $30,000 per year.