In This Week’s Update

• SHVS Webinar: Medicaid and Marketplace Reforms Under Consideration
• Protecting Access to Preventive Services
• Proposed Medicaid Cuts to Increase Coverage Losses
• A Roadmap for Improving Health Insurance Affordability Through Rate Review
• A Medicaid Per Capita Cap: State by State Estimates
• State Updates: AR, CO, CT, IL, MA, MD, ND, NE, NJ, NM, NV & NY

Proposed Medicaid Cuts to Increase Coverage Losses
Leadership in the House of Representatives has proposed substantial federal funding cuts to the Medicaid program over the next 10 years. A new report published by the Urban Institute focuses on the proposal to reduce the 90% federal matching rate that states receive for the Medicaid expansion population covered under the ACA, known as enhanced FMAP. Since state responses to the loss of enhanced FMAP are hard to predict, the report estimates the impacts on health coverage and state and federal government spending under two scenarios. The scenarios represent the largest and smallest impacts on coverage: first, all states preserve their Medicaid expansions and fund the reductions in federal funding by cutting costs or raising new revenue, and second, all states drop the ACA’s Medicaid expansion.

A Roadmap for Improving Health Insurance Affordability Through Rate Review
States have the power to help reduce healthcare costs, and several are pursuing policies to do so. However, when attempting to target the root cause of the affordability problem—high and rising provider prices—states have faced two primary challenges: (1) enforcing industry adherence, and (2) ensuring that savings are passed on to consumers. An “enhanced” form of health insurance rate review can help solve both problems. A new report published by the Milbank Memorial Fund and authored by our friends at Georgetown’s Center on Health Insurance Reforms provides a roadmap for states to take control of unsustainable healthcare cost increases and deliver direct premium relief to consumers by leveraging the rate review process. The roadmap highlights several state examples, such as those implemented by Rhode Island, Colorado, and Delaware.

A Medicaid Per Capita Cap: State by State Estimates
There are several options under consideration in Congress to significantly reduce Medicaid spending. KFF published an analysis that examines the potential impacts on states, Medicaid enrollees, and providers of implementing a per capita cap on federal Medicaid spending, which is one proposal that has been discussed in Congress. The analysis assumes, based on proposals floated in Congress, that the plan would cap federal Medicaid spending growth per enrollee for each of the five major eligibility groups at medical inflation. Given the likelihood of multiple, simultaneous changes to Medicaid and the interactive nature of those changes, the analysis also illustrates the effects of a per capita cap on Medicaid if implemented jointly with the elimination of the 90% federal match rate for the ACA expansion. For more on per capita caps, SHVS previously hosted a webinar examining the critical design issues that influence the impact of capped funding on states.

State Updates: AR, CO, CT, IL, MA, MD, ND, NE, NJ, NM, NV & NY 

• Arkansas – Governor Sarah Huckabee Sanders signed legislation which establishes prenatal presumptive Medicaid eligibility, reimbursements for doulas and community health workers, and established pregnancy-related Medicaid coverage for specific treatments.
• Colorado – Governor Jared Polis spoke with members of Congress, urging them to reject the $880 billion proposed cuts to Medicaid.
• Connecticut – Access Health CT, the state’s official health insurance Marketplace, reported a record number of 151,151 Connecticut residents enrolled in health and dental insurance for 2025 during the open enrollment period. The figure includes 41,165 residents enrolled in the no-cost Covered CT Program.
• Illinois – Governor JB Pritzker announced the latest round of relief in the Illinois Medical Debt Relief Program has abolished more than $220 million for approximately 170,000 additional individuals statewide. This brings the program’s total erased debt to more than $345 million for nearly 270,000 Illinois residents. As a reminder, SHVS published an expert perspective and a Health Affairs Forefront article which tracks state medical debt cancellation initiatives, as well as state efforts to prevent the inclusion of medical debt on credit reports.
• Maryland – The Maryland Department of Health announced it is expanding access to school-based mental health services for children and youth. The expansion allows Local Education Agencies to offer certain behavioral health services to all students enrolled in Medicaid. Previously, Medicaid payment for these services was limited to Medicaid-enrolled students who have an approved Individualized Education Program or Individualized Family Service Plan.
• Massachusetts – The Healey-Driscoll administration announced that it is awarding $5.5 million in grants to 60 school districts, educational collaboratives, and charter schools across Massachusetts to improve student access to behavioral and mental health services and support.
• Nebraska – The Nebraska Department of Health and Human Services launched two new features on the iServe Nebraska Portal to improve accessibility for Medicaid renewals and home and community-based services (HCBS) waiver applications. The new features are designed to help Nebraskans renew Medicaid online for the upcoming year; apply for HCBS waivers online; update contact information; and manage benefits, services, and supports.
• Nevada
  • Governor Joe Lombardo sent a letter to Congress regarding the potential impact of proposed changes to Medicaid funding, warning that the cuts could spell financial trouble for the state and destabilize the healthcare system.
  • Attorney General Aaron D. Ford announced the publication of model immigration policies, mandated by the Nevada legislature, which include guidance for five specific essential public service providers, including healthcare facilities. The model policies are aimed at helping healthcare facilities and their employees understand and navigate immigration agents’ inquiries
• New Jersey – The New Jersey Department of Human Services released a report evaluating the impact of potential reductions in federal Medicaid matching funds to the state. New Jersey considered proposals to: remove the Federal Medical Assistance Percentage (FMAP) floor, eliminate the 90% federal match for the Medicaid expansion population, and impose per capita caps on Medicaid funding, and noted the changes have significant potential effects on provider pay, eligibility, and benefits.
• New Mexico – Governor Michelle Lujan Grisham signed legislation to improve behavioral health services across New Mexico. Senate Bill 1 establishes a dedicated trust fund to provide sustainable, long-term financing for behavioral health programs. Senate Bill 2 creates a behavioral health executive committee to coordinate statewide reform efforts through a regionalized approach based on local needs assessments.
• New York – Governor Kathy Hochul announced that new network adequacy regulations for behavioral health services will now entitle New Yorkers to an initial appointment for behavioral healthcare within 10 business days of the request, or seven calendar days following hospital discharge. Insurers unable to meet these timeframes will have to offer out-of-network mental health or substance-use disorder coverage without increasing the cost for the consumer.
• North Dakota – North Dakota Health and Human Services is seeking public comment on a five-year renewal to the state’s Medicaid 1915(i) state plan amendment. The amendment would allow Medicaid to pay for additional in-home and community-based services for qualifying children and adults with mental health conditions, substance-use disorders, and/or brain injuries.