Medicaid Innovation Models
Expert articles and analysis related to medicaid innovation models.
AI Summary ā Last 7 Days
Medicaid innovation is being squeezed from two directions: the Trump administration is enforcing tighter budget-neutrality rules for Section 1115 waiversāputting Arkansas coverage and potentially other expansion demonstrations at riskāwhile the 2025 reconciliation lawās caps on Medicaid state directed payments could reduce hospital funding across at least 37 states, with large exposure in California, Texas, Illinois, Kentucky, North Carolina, Louisiana, Arizona, and Michigan. For VBC leaders, the near-term risk is that states and managed care plans may have less room to finance hospital-based transformation, supplemental quality pools, and waiver-enabled population health initiatives just as CMS is also pushing more operational transparency and automation around utilization management through FHIR-enabled prior authorization and new insurer denial-rate reporting. See KFFās analysis of state directed payment exposure and KFF Health News on the Trump CMS waiver decision in Arkansas.
Related Articles
Analysis: At Least 37 States Have Medicaid State Directed Payments for Hospital Services That Could Be Reduced by the 2025 Reconciliation Law Limits
An estimated $60 billion in federal Medicaid spending in 37 states (including the District of Columbia) would likely exceed new federal limits on state directed payments for hospital services once ful...
At Least 37 States Have Medicaid State Directed Payments for Hospital Services That Could Be Reduced by the 2025 Reconciliation Law Limits
This analysis estimates the number of states impacted by and the amount of current federal spending on Medicaid state directed payments for hospital services that exceeds the new limits established by...
CMS ends Medicaid coverage of gender-affirming care for minors
Federal Medicaid funding no longer will be available to cover gender-affirming healthcare for minors, according to a CMS final rule issued Aug. 11. The rule blocks Medicaid and Childrenās Health Insur...
Trump administration cuts Medicaid funding for youth gender-affirming care
CMS Administrator Dr. Mehmet Oz argues the rule will protect children from āirreversible harm.ā LGBTQ+ advocates say itās an attack on transgender youth.
āWay off the reservationā: Brookings researchers slam assumptions in CMS work requirements rule
The rule made it harder for sick Medicaid enrollees to prove theyāre exempt from work requirements than many expected. The CMS got sued. And now, the agency is being accused of fudging the data at the...
Ohio Medicaid Announces August 1, 2026 Statewide Expansion of Next Generation MyCare Program - open minds
Ohio Medicaid Announces August 1, 2026 Statewide Expansion of Next Generation MyCare ProgramĀ Ā open minds
āPrivate optionā Medicaid expansion under threat from CMS
āPrivate optionā Medicaid expansion under threat from CMSĀ Ā Modern Healthcare
Final Rule Ends Federal Funding for Gender-Affirming Procedures for Children
New York Did Not Ensure That Selected Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior Authorization - Office of Inspector General (.gov)
New York Did Not Ensure That Selected Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior AuthorizationĀ Ā Office of Inspector...
Optional Medicaid and CHIP Coverage for Lawfully Present Immigrant Children Could Mitigate Coverage Losses Due to 2025 Reconciliation Law
This brief provides an overview of health coverage of noncitizen children to provide greater insight into the potential role of Immigrant Childrenās Health Improvement Act (ICHIA) coverage in limiting...