HMA Weekly Roundup

Maryland

Maryland Lawmakers Introduce Bill to Require Medicaid Coverage of Weight Loss Drugs. CBS News reported on March 4, 2025, that Maryland Senate Minority Leader Steve Hershey (R-Kent) and Senator John Mautz (R-Talbot) have introduced a bill seeking Medicaid coverage of weight loss drugs. Senate Bill 867 would require Medicaid to provide comprehensive coverage for obesity treatment, including behavioral therapy, bariatric surgery, and any drug approved by the Food and Drug Administration (FDA) for use in chronic weight management for patients with obesity. The Maryland Department of Health estimates covering this treatment would cost more than $200 million per year, but the bill sponsors argue the cost would be lower. If passed, coverage would begin July 1, 2026.

Maryland Medicaid Managed Care Plan Loses NCQA Accreditation. The Associated Press reported on February 28, 2025, that the National Committee for Quality Assurance has suspended the accreditation of Priority Partners, Maryland’s largest Medicaid managed care organization serving 350,000, nearly a quarter, of the state’s enrollees. The suspension will not affect benefits for current enrollees, however. Beginning March 17, 2025, enrollees will have a 60-day window to switch to another plan, and Priority Partners will not be able to take on new enrollees. Details of the suspension are not public, but it will remain in place until Priority Partners implements a corrective action plan and undergoes a resurvey.

Massachusetts

Massachusetts Medicaid Agency Suspends Enrollment in MCO. The Boston Globe reported on March 4, 2025, that MassHealth suspended the Medicaid managed care organization Commonwealth Care Alliance (CCA) from taking on new enrollees in November 2024 as the insurer faces ongoing multimillion dollar operating losses. MassHealth is monitoring CCA’s financial situation. Disability advocates suggest MassHealth should appoint a receiver to oversee the insurer. CCA serves nearly 50,000 Massachusetts residents dually enrolled in Medicaid and Medicare.

Michigan

Michigan Seeks Public Feedback on Behavioral Healthcare Access Ahead of PIHP Reprocurement. The Michigan Department of Health and Human Services (MDHHS) announced on February 28, 2025, that it is seeking public feedback to identify opportunities to improve behavioral healthcare services and supports provided by Pre-Paid Inpatient Health Plans (PIHPs) as the state moves toward reprocuring the PIHP contracts. The state invites current Medicaid enrollees and other stakeholders such as advocacy groups, providers, and federally recognized tribal governments to complete an online survey that will inform MDHHS on where it should focus their efforts. The survey is open until March 31, 2025.

Minnesota

Minnesota Appoints Shireen Gandhi as Temporary Commissioner of DHS. The Minnesota Department of Human Services (DHS) announced on February 28, 2025, that Shireen Gandhi has been appointed to serve as temporary commissioner of DHS, until a permanent commissioner is appointed. Gandhi joined DHS in 2017 and succeeds Jodi Harpstead.

Mississippi

Mississippi Medicaid Costs Rise to $8.1 Billion as Lawmakers Weigh Policy Changes. The Magnolia Tribune reported on March 4, 2025, that at a legislative hearing, Mississippi Medicaid Director Cindy Bradshaw warned lawmakers that the program’s budget has grown from $6 billion five years ago to $8.1 billion in 2025, with projections reaching $9.9 billion within five years. She cautioned that each percent reduction in federal funding could cost the state an additional $83 million annually. Lawmakers raised concerns over enrollment errors, delayed reimbursements, and the lack of pregnancy test requirements for presumptive eligibility.

Missouri

Missouri House Passes Bill to Cover Hearing Aids, Cochlear Implants for All Medicaid Members. The Salem News Online reported on March 3, 2025, that the Missouri House passed a bill, sponsored by Representative Cameron Parker (R-Campbell), expanding Medicaid coverage for hearing aids and cochlear implants to all eligible adults. Coverage is currently limited to children, pregnant women, and the blind, and expanding coverage will cost an estimated $10.6 million in the first year. A similar bill stalled in the Senate last year.

Montana

Montana Senate Approves Medicaid Expansion Renewal Bill with Work Requirements. The Associated Press reported on February 27, 2025, that the Montana Senate approved House Bill 245, which would renew Medicaid expansion and remove the Medicaid expansion sunset provision. The expansion also includes a work requirement that the state would need a federal waiver to put into action. The bill now moves to Governor Greg Gianforte for approval.

North Carolina

North Carolina Lawmakers Propose Bill to Increase Medicaid Dental Reimbursements. NC Health News reported on February 28, 2025, that North Carolina House Representative Brian Biggs (R-Trinity) introduced, along with other lawmakers, House Bill 60 to raise Medicaid dental reimbursement rates from 34 percent of charges to 46 percent, aiming to address the shortage of dentists accepting Medicaid patients. North Carolina’s Medicaid expansion, which launched in 2023, has covered $28.6 million in dental claims. The bill would require $52 million in state funds, matched by $95 million in federal contributions.

Ohio

Ohio Submits Section 1115 Demonstration to Add Work Requirements to Medicaid Expansion. The Ohio Department of Medicaid announced on February 28, 2025, that it has submitted a Section 1115 Group VIII Demonstration application to the Centers for Medicare & Medicaid Services (CMS), which would implement Medicaid work requirements for some expansion beneficiaries. If approved by CMS, beneficiaries would have to meet at least one of the requirements under the new demonstration, including being at least fifty-five years of age, employed, enrolled in school or an occupational training program, in a recovery program, or having intensive physical health care needs or serious mental illness. The application requests a January 1, 2026, start date.

Oregon

Oregon House Passes Bill to Extend Hospital, Insurer Taxes Through 2032 to Fund Medicaid. The Oregonian reported on February 27, 2025, that the Oregon House approved House Bill 2010, renewing taxes on hospitals and health insurers to secure $2.1 billion in funding for the state’s Medicaid program, Oregon Health Plan. The state’s hospital tax is set to expire in September, and the health insurance tax in 2026, but the bill would extend both through 2032. The bill now heads to the Senate for further consideration.

South Dakota

South Dakota Senate Advances Medicaid Expansion Funding 2026 Ballot Measure. South Dakota Searchlight reported on March 3, 2025, that the South Dakota Senate approved a 2026 ballot measure, House Joint Resolution 5001, sponsored by Representative Tony Venhuizen (R-Sioux Falls), the Lieutenant Governor of South Dakota, on whether to continue Medicaid expansion if federal funding drops below 90 percent. Medicaid expansion was passed by voters in 2022 and currently covers 30,000 residents. The measure does not require signature from the Governor.

Vermont

Vermont Medicaid Audits Show Opportunity to Improve Fraud Prevention, Health Outcome Evaluation. Vermont Biz reported on February 27, 2025, that two audits of the state Medicaid program, performed by Vermont State Auditor Doug Hoffer, showed that the state could improve its prevention of fraud, waste, and abuse, and also improve its evaluation of the Blueprint for Health program, a Patient-Centered Medical Home model that provides care coordination. The audit on the Department of Vermont Health Access’ (DVHA) Special Investigative Unit (SIU), found that SIU identified $1.2 million in improper payments, nearly $517,000 of which will not be recovered due to DVHA management decisions, and identified programmatic risks within DVHA. The audit recommends that DVHA work with SIU to address its recommendations more directly. The Blueprint audit found that the program has not had a sufficient evaluation of its effectiveness that is supported by evidence and lacks a strategic plan. The state auditor recommends Blueprint officials recommit to evaluating the effectiveness of the program.

National

CMS Rescinds Medicaid, CHIP HRSN Guidance. The Centers for Medicare & Medicaid Services (CMS) released on March 4, 2025, an informational bulletin rescinding Medicaid and CHIP guidance on health-related social needs (HRSN). The guidance includes Coverage of Services and Supports to Address Health-Related Social Needs in Medicaid and the Children’s Health Insurance Program, originally released on November 16, 2023, and the Coverage of Services and Supports to Address Health-Related Social Needs in Medicaid and the Children’s Health Insurance Program, released in December 2024. CMS will consider applications to cover HRSN services from states on a case-by-case basis.

HHS Announces Policy Narrowing Public Input on Policies. Modern Healthcare reported on February 28, 2025, that the Health and Human Services Department (HHS) is ending a 54-year-old transparency practice, reducing public notice and comments on federal healthcare policymaking by following only the minimum requirements of the Administrative Procedures Act of 1946. The department will no longer require public input on policies related to agency management, personnel, public property, loans, grants, benefits, or contracts. Although certain Medicare rules will still require public review, HHS will now decide case by case when public input is needed.

Special Needs Plan Enrollment Rises 10.1 Percent During 2025 Enrollment Period. Modern Healthcare reported on March 3, 2025, that Medicare Special Needs Plan (SNP) enrollment rose 10.1 percent in February 2025 to 7.3 million, compared to the previous year, exceeding expectations despite a slowing Medicare Advantage market. Dual Eligible Special Needs Plans D-SNPs, covering Medicare-Medicaid beneficiaries, now make up 83 percent of all SNP enrollments and remain the most profitable for insurers.

GOP Congress Members Consider Plan to Prevent States from Using Insurer, Provider Taxes for Medicaid Match Funds. Politico reported on February 28, 2025, that Republican lawmakers are considering preventing states from using provider and insurer taxes to raise money to cover their share of Medicaid funds. The proposal is gaining momentum as the House Energy and Commerce Committee looks for ways to reach the $880 billion federal savings necessitated by the budget resolution passed on February 25. House Speaker Mike Johnson (R-LA) said Congress would not impose federal spending caps based on state Medicaid enrollment or reduce the percentage of Medicaid spending the federal government will match to reach that goal. Without the taxes, states could face an estimated $612 billion budget shortfall over the next decade.

Federal Judge Temporarily Blocks Trump Administration Layoffs. Health Payer Specialist reported on February 28, 2025, that U.S. District Judge William Alsup has temporarily blocked the Trump administration’s order to fire thousands of probationary federal workers. The judge’s ruling said the order, which came from the Office of Personnel Management, was likely illegal, and that the office does not have the authority to direct other agencies to hire and fire employees. The U.S. Department of Health and Human Services expected to lose approximately 5,200 probationary employees, approximately a third of its workforce. An additional court hearing on the matter will take place March 13.

Medicaid Spending Cap Could Threaten Coverage for 15 Million Beneficiaries, KFF Finds. KFF released on February 26, 2025, an analysis which found that if Congress imposes a per capita cap on federal Medicaid spending, federal contributions could drop by $532 billion over 10 years, potentially forcing states to cut their own spending and eligibility—resulting in up to 15 million people losing coverage by 2034. According to KFF, if this cap is combined with eliminating the enhanced federal matching rate for Medicaid expansion, federal savings could rise even higher, ranging from $1 trillion to $2.1 trillion, and coverage losses could reach 30 million enrollees. This proposal is part of broader efforts by House Republicans to reduce Medicaid spending to help finance extended tax cuts.

Lawmakers Push for PBM Reform in House Subcommittee Hearing. Modern Healthcare reported on February 26, 2025, that the House Energy and Commerce Committee’s Health Subcommittee renewed efforts at a hearing to reinstate rules on pharmacy benefit managers (PBMs). Lawmakers are planning to reintroduce legislation that is designed to lower prescription drug prices by enhancing transparency, banning practices like spread pricing, and requiring PBMs to pass along negotiated discounts. This legislation is unlikely to be included in the government funding bill needed by March 14. However, some Representatives are seeking to bring the legislation directly to the floor for a vote.