Category: Curator

Alternative Headline: Rural Health Faces Medicaid Shifts

[MM Curator Summary]: Under federal law H.R. 1, the Rural Health Transformation Program, $50 billion is designated for rural healthcare—$25 billion allocated equally among states and $25 billion available competitively.

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Eastern Shore Rural Health System, Inc. is reviewing recent federal and state actions related to Medicaid eligibility and rural health funding.

CEO Jeannette Edwards stated that the organization is tracking developments following Governor Glenn Youngkin’s Executive Directive Twelve, signed August 13, 2025, and the Centers for Medicare & Medicaid Services’ nationwide initiative to remove ineligible Medicaid enrollees announced this week.

Under federal law H.R. 1, also referred to as the Rural Health Transformation Program, $50 billion has been designated to support rural health care. Half of the funding will be distributed among all 50 states, while the remaining $25 billion will be available to states through competitive applications. Executive Directive Twelve requires Federally Qualified Health Centers to participate in creating Virginia’s Rural Health Transformation Plan in order to compete for these additional funds. Eastern Shore Rural Health qualifies as a Federally Qualified Health Center and is preparing to provide input.

The directive also notes upcoming changes to Medicaid. Federal guidance on work and community engagement requirements for Medicaid recipients is due by December 31, 2025. Until that information is issued, Virginia has not provided details to Community Health Centers, including Eastern Shore Rural Health, on how the requirements will be implemented.

In addition, changes connected to the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) could alter Medicaid eligibility for certain non-U.S. citizens. The Trump administration has expanded the definition of “federal public benefit” and revised eligibility standards for immigrants holding various visas. Eastern Shore Rural Health noted that the implications of this reinterpretation will not be clear until further federal direction is issued.

Edwards said the organization will continue monitoring policy developments from both Washington, D.C., and Richmond, and will provide updates to the community as more details become available.

https://shoredailynews.com/headlines/eastern-shore-rural-health-monitoring-federal-and-state-medicaid-rural-health-policy-changes/

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Alternative Headline: Medicaid Work Rules Add Hurdles

[MM Curator Summary]: New Medicaid work rules risk millions losing coverage, while Code for America pushes states to adopt simpler, human-centered systems to reduce reporting burdens.

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Terry Gerton I want to start by having you give us a little bit of background on Code for America, what you are and what you do.

Danny Mintz Sure, Code for America is a 501c3 non-profit civic technology organization. We work shoulder to shoulder with government to help government meet people’s needs more effectively in the digital age. In practice, what this means is that we try to make government programs more hassle-free to access and government agencies more efficient and effective at meeting their goals.

Terry Gerton Well, that hassle-free part is the next piece I want to talk to you about, because in the reconciliation bill that passed this summer, there was a tremendous addition of requirements for Medicaid and SNAP recipients to document their work, to add new work requirements. And I know Code for America has been working on that very kind of issue with a number of states. So can you tell us first what these additional work requirements mean for the recipients of these benefit programs, and how Code for America helps make that process easier?

Danny Mintz So the new community engagement requirements, as they were called in the bill that were introduced for Medicaid, impose very significant new policy and new operational hurdles up front for folks who are trying to access Medicaid to get their health coverage. In practice, what it says in the legislation is that folks need to be working at least 80 hours a [month] or meeting that requirement through volunteering, through participation in a work program. Or through being in school at least half time or more, or they need to earn at least $580 a month in income. While that sounds pretty cut and dry on paper, in practice what we’ve seen in our work in a wide variety of public benefit programs is that communicating that you are meeting these requirements or that you meet an exemption from these requirements can be very significant challenges for people who are trying to get or maintain their health coverage.

Terry Gerton So for an individual, what kinds of information do they have to provide, and how complicated is that process?

Danny Mintz You know, it can range from pretty easy and straightforward if they have a job situation where all their income is reported on a W-2 from a single source at the end of the year, to what is much more common among people who are participating in the low-wage labor market, which is conveying a wide variety of information about work that they’ve done as an Uber driver, as a driver for DoorDash, babysitting that they may be using to pay their bills, other sources of income for a three-month period that goes back before they applied for Medicaid. One huge change in this version of work reporting requirements from what we’ve seen in the past is that the approach that the bill took to Medicaid was to look back before the date of application. So for somebody who’s trying to get access to medical care, states have an option of looking back either one month or up to three months. That means if you lose your job, you better apply for Medicaid right away, because if you have lost health coverage because it’s no longer provided by your employer and then try to apply after two months or so, when you need to get a prescription refilled or need to go see the doctor for a checkup or some urgent issue, it’s going to be quite likely that folks will no longer qualify because of the very reason that they’ve lost their health coverage. CBO estimated that about 5.2 million people are likely to lose health coverage as a result of the new requirements in the law.

Terry Gerton I know that Code for America has worked with many states — California, Minnesota, Louisiana — to try to simplify the benefits application process. What sort of lessons have you learned from that work that could be especially applicable to this new requirement?

Danny Mintz It’s a great question, Terry. We’ve learned two key lessons. One is that there are a lot of improvements that can be made through automating data exchanges at the state level as much as possible and simplifying the mechanisms that people use to submit information to government agencies. We’ve also learned that there are real limits to what technology improvement can do. So we have a great deal of experience in trying to make government technology more human-centered. Easier for people to understand, less jargony, and easy for folks to use on a mobile phone with a limited-bandwidth connection from their homes in rural areas that have unreliable internet access. Not all government technology is set up to meet those needs as it is now, but even when government technology is set up for those needs, there are still very significant practical hurdles that people can encounter simply in understanding what the requirements are, gathering information to meet those requirements, and conveying that information effectively to the government. We saw in Arkansas in 2018 and 2019, when Medicaid work requirements were briefly implemented there, that a huge number of Medicaid participants lost coverage, despite the fact that they were likely already meeting the requirements in practice, because they didn’t know that they needed to separately report their income on a monthly basis and their participation on a monthly basis. We would anticipate that even with really significant and well thought-out efforts to inform the public about what these new requirements are and what they mean, that there are still going to be the same kind of challenges that people not covered by government programs may find when trying to interact with private insurance and understand all of the rules and regulations that cover their ability to access care.

Terry Gerton I’m speaking with Danny Mintz. He’s the associate director of safety net policy at Code for America. So Danny, let’s go back to that human-centered design for a minute. We’re going to assume that everybody who’s in state government that’s responsible for implementing these programs really wants to do it and do it well, so that people who are eligible for these benefits can receive them. What are the key points in terms of designing this kind of new reporting requirement so that it can be successful?

Danny Mintz It’s very important that governments, as they’re designing new systems, are testing those systems with the people who are going to be using them. And this is true both for members of the public who are going to be using systems to get and maintain their coverage, and for the workers who are using the information that’s submitted through these systems to process cases and ensure that medical coverage is still accessible to people who still qualify to receive it. We are strong advocates of working incrementally to put things into the field, test them, and improve on them. We know that government technology doesn’t always follow that pattern. We also know that states are facing very significant budgetary pressures in the near future and that there’ll be a strong impetus to get technology in the field as quickly as possible. We would advise states to try as much as possible to take the burden off of members of the public to report information that states might already be able to access from backend data sources. And this means not just using the sources that they have, that they’re very familiar with, but also looking into new opportunities to gather data from increasingly common forms of low wage and variable hour income, like gig work and other ones.

Terry Gerton So there’s a period before these new rules go into effect, presumably that’s to allow the federal agencies to write their regulations, but also to allow states to prepare to implement this. What should states be doing now to make sure that they’re ready when the timeframe begins?

Danny Mintz  States should be looking closely at what capabilities they have in their systems and what the gaps are likely to be in terms of getting information, particularly about folks who might be exempt from these requirements. You know, SNAP has a long history of similar work requirements that have slightly different parameters, but what SNAP and Medicaid doesn’t is an interview. So in the SNAP program, states and county agencies have a chance to talk with people who are applying and really assess their situation. In Medicaid, states don’t have that option. And so states should be thinking really carefully about how their applications are structured, how they’re asking about information that’s going to be critical for people to supply in order to demonstrate either that they’re meeting these requirements or that they are exempt from them. And states should thinking about how they’re going to adjust their processes on the worker side to make it easier to flag potential areas for follow-up, to make sure that folks keep their health coverage, don’t start going into medical debt or overwhelming emergency rooms.

Terry Gerton I know as you’ve been working with states, you’ve probably been seeing a growing uptake of this concept of human-centered design and simplifying benefits. Do you think that these new rules around Medicaid and SNAP might be sort of the tipping point in terms of moving states sort of collectively towards a more empathetic and effective benefits application process?

Danny Mintz Well, I would hope so. I think in practice, some of the new policies in the reconciliation bill that passed this past year are going to make it a little bit harder for states to implement technology flexibly, because states will have fewer resources to do so. I think we do see a big shift in this new budget environment towards states trying to find efficiencies, do more with less, and human-centered design is a huge part of that. I think what remains to be seen is how states are going to be able to execute on those goals. It’s definitely the case that states are more aware of the need to provide services in ways that are empathetic and human-centered from the first interaction that a person has with government through to their whole case lifecycle. I think there are still structural challenges in place for how states can actually put that into practice.

Copyright © 2025 Federal News Network. All rights reserved. This website is not intended for users located within the European Economic Area.

https://federalnewsnetwork.com/technology-main/2025/08/human-centered-design-could-help-medicaid-recipients-meet-new-work-rules-without-losing-coverage/

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Alternative Headline: Trump Orders Monthly Medicaid Checks

[MM Curator Summary]: The Trump administration mandated monthly Medicaid and CHIP eligibility checks, sparking legal and advocacy challenges over their impact on immigrants and vulnerable groups.

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The Trump administration will require monthly eligibility checks for Medicaid and CHIP to curb improper payments, sparking concerns over effects on vulnerable groups.

The Centers for Medicare and Medicaid Services (CMS) have launched a nationwide oversight initiative to ensure that those enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) are U.S. citizens, nationals, or have a satisfactory immigration status. This initiative aims to remove ineligible beneficiaries and uphold citizenship requirements, thereby maintaining program integrity and safeguarding taxpayer funds.

Monthly verification mechanism

CMS now provides states with monthly enrollment reports identifying individuals whose citizenship or immigration status could not be confirmed through federal databases, including the Department of Homeland Security’s SAVE program. States must review these cases, verify status, request additional documentation if necessary, and take appropriate actions, such as adjusting coverage or applying eligibility rules for non-citizens. CMS will monitor progress monthly.

Official justifications and key statements

U.S. Secretary of Health and Human Services, Robert F. Kennedy Jr., emphasized the importance of protecting Medicaid from abuse, stating,

"Medicaid is a lifeline for vulnerable Americans, and I will protect it from abuse."

CMS Administrator Dr. Mehmet Oz highlighted the commitment to program integrity, noting,

“Every dollar wasted is a dollar taken from an eligible and vulnerable individual who needs Medicaid and CHIP.”

Impact on immigrants

Individuals without satisfactory immigration status will only receive limited services under certain circumstances. Medicaid eligibility rules for immigrants will change, and starting October 1, 2026, only U.S. citizens, nationals, or a smaller group of legally present immigrants will qualify. This could affect groups previously eligible without being permanent residents, such as refugees or asylum seekers. 

Context of broader legislation

These changes are part of the "Big Beautiful Bill," signed by President Trump on July 4, 2025, which includes approximately $1 trillion in Medicaid cuts. Other significant changes include new work requirements for adults, more frequent eligibility reviews, increased out-of-pocket costs, shorter retroactive coverage periods, and reduced funding for reproductive health clinics.

Controversy and legal opposition

New York Attorney General Letitia James and 20 other attorneys general have sued the Trump administration over directives that prevent health, education, and social services programs from serving all residents, regardless of immigration status. James criticized these measures for "uprooting" support systems and endangering vital services like cancer screenings and primary care.

Patient advocates warn that the loss of continuous eligibility waivers could lead to vulnerable populations losing coverage. The changes could also strain state resources as they implement more frequent eligibility checks and adjust to new federal requirements.

The Trump administration’s changes to Medicaid and CHIP rules represent a significant shift in policy, with the potential to impact millions of Americans. While the goal is to protect taxpayer dollars and ensure program integrity, the implications for vulnerable populations, particularly immigrants, remain a point of contention and concern.

https://www.mibolsillo.co/news/Medicaid-and-CHIP-rules-change-Trump-orders-monthly-eligibility-checks-20250820-0002.html

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Alternative Headline: CMS Tightens Medicaid Oversight

[MM Curator Summary]: CMS will send states monthly lists of Medicaid enrollees with unverified citizenship status to tighten eligibility enforcement.

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The federal government is continuing efforts to strengthen Medicaid program integrity, announcing Tuesday the Centers for Medicare & Medicaid Services (CMS) will begin providing states new eligibility information.

Starting today, the agency will send monthly enrollment reports containing lists of people with unconfirmed citizenship and immigration status, the agency said in a news release. These individuals were not found in other federal databases such as the Department of Homeland Security’s Systematic Alien Verification for Entitlements program.

The new process will make sure Medicaid or Children’s Health Insurance Program enrollees are citizens, nationals or have a “satisfactory immigration status,” the agency said.

“Medicaid is a lifeline for vulnerable Americans—and I will protect it from abuse,” said Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. in a statement. “We are tightening oversight of enrollment to safeguard taxpayer dollars and guarantee that these vital programs serve only those who are truly eligible under the law.”

States are told they must change an individual’s coverage and enforce eligibility rules after reviewing the cases they receive from the federal government.

The Trump administration has aimed to rein in Medicaid spending and cut waste, fraud and abuse, primarily through the flagship reconciliation bill passed this summer.

Privacy experts sounded the alarm in March when President Donald Trump signed an executive order requiring the HHS to modify guidance that restricted access to unclassified records, after the Department of Government Efficiency, or DOGE, had already accessed sensitive systems at the CMS.

A federal judge told the HHS this week to quit handing sensitive information of Medicaid enrollees over to deportation officials, reported the Associated Press.

https://www.fiercehealthcare.com/payers/cms-seeks-state-compliance-new-medicaid-verification-process

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Alternative Headline: Youth Psych Boarding Rates Vary

[MM Curator Summary]: Over 1 in 10 psychiatric ED visits by youth Medicaid patients involve boarding, with significant variation by state.

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More than one in 10 psychiatric emergency department visits by young Medicaid patients lead to boarding, with rates of boarding varying widely from state to state, according to a recent analysis.

Boarding, or a delay in the time until an ED patient is given an inpatient bed, has been cited as an increasing issue across the country’s EDs. The longer wait for appropriate care not only imposes a potential physical and emotional toll on patients, but can increase the costs of care delivery while increasing stress and personal safety risks for staff.

The “considerable” incidence of boarding outlined in the study is concerning considering that pediatric Medicaid patients already face systemic barriers to timely behavioral healthcare, researchers wrote of their findings in JAMA Health Forum.

The analysis of more than 255,000 ED visits for a primary mental health diagnosis found boarding among more than one in five visits in five states—Iowa, Florida, Maine, North Carolina and Montana, where rates ranged from 27.3% to 21.8%. Substantial variation between these and other states could be due to factors including mental health condition prevalence, Medicaid coverage levels and psychiatric bed capacity, the researchers wrote.

The analysis reviewed Medicaid claims data from 2022 among non-dual Medicaid enrollees aged five to 17 years in 44 states. Boarding was defined as a visit spanning two to six midnights. Longer stays were excluded to minimize the risk of coding errors, which the researchers admitted could have lead to a “more conservative estimate” of boarding frequency and duration.

Overall, 11.9% of psychiatric visits resulted in boarding, which was more prevalent among those with primary diagnoses related to suicide or depressive disorders. The average duration of a stay was 2.1 days across the full sample, with the average length of a boarding event running 4.5 days.

In contrast to the five states over 20%, there were 20 states in which boarding rates were below 10%, led by Arkansas’ 2.7%.

“The substantial state-level differences we observed suggest that state-level policies—including an assessment of the continuum of care that includes inpatient and residential beds, subacute beds, non-ED crisis support, and accessible outpatient care—could play a key role in reducing boarding and its impact on youths and their families,” the researchers wrote. 

https://www.fiercehealthcare.com/providers/considerable-ed-boarding-rates-among-pediatric-medicaid-patients-seeking-psychiatric-care

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Alternative Headline: Subsidies Boost Staffing, Shift Patients

[MM Curator Summary]: Medicaid payroll subsidies raised nursing home staffing but reduced Medicaid patient access as facilities shifted toward Medicare and private-pay residents.

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Five states that used payroll subsidies to drive nursing home staffing increases succeeded, but they also saw nursing homes fill more of their beds with Medicare patients during the same period.

That’s the finding of a new study examining the role of rate add-ons tied to Medicaid census over 13 years.

“Subsidies did in fact induce nursing homes to substantially increase their staffing levels, with the average nursing home increasing their number of direct care worker minutes per resident-day by 7.4%,” Thomas A. Hegland, a senior health and labor economist with the Agency for Healthcare Research and Quality, reported in a study published online ahead of September’s edition of the Journal of Health Economics.

That equated to just over 10 minutes more of per resident-day staffing for each additional dollar of per-resident day subsidies offered in 2010.

But even though the size of the subsidies was linked to the share of Medicaid residents present in a facility, many nursing homes still reduced new Medicaid admissions in favor of “more lucrative” Medicare-covered and private pay patients. 

Each additional dollar in subsidies decreased the Medicaid share of new nursing home admissions by about 1.8 percentage points. Across five states with varying rate add-ons, that led to an 11.5% decrease over the study window. 

“This appears to have been part of a broader shift where subsidy-receiving nursing homes increased their patient turnover rates and shifted toward serving patients with lower overall care needs,” Hegland wrote.

He noted that nursing homes in states with Medicaid payroll subsidies also took on more patients requiring less care, with Activities of Daily Living index scores falling by 2.5% relative to pre-subsidy scores. The states reviewed were not named in an abridged copy of the study reviewed by McKnight’s Long-Term Care News. 

In recent years, more states have considered or implemented Medicaid rate add-ons for quality measure performance or speciality care such as behavioral health. 

But Hegland said policymakers should be aware of the unintended consequences revealed in his study and consider whether the same could occur when adopting other incentives meant to improve quality. He predicted similar reductions in Medicaid patient access could happen where nursing homes face “a substantial gap between Medicaid and other insurers’ payment rates” and when nursing homes are operating at high occupancy levels.

“While nursing home payroll subsidies can be effective tools for increasing nursing home staffing levels and, hopefully thereby, care quality, the broader context of the relatively unique institutional environment in which nursing homes operate can cause nursing homes to respond to the subsidies in a fashion that potentially reduces access to nursing home care among Medicaid enrollees,” he wrote.

https://www.mcknights.com/news/states-created-medicaid-add-ons-to-protect-access-nursing-homes-started-taking-more-medicare-patients-instead/

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