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Getting MAGI Right: When Does Social Security Income Count?
When the Affordable Care Act was implemented, we released a primer on the basics of MAGI – how rules for counting household size and income to determine eligibility for Medicaid and CHIP were changed to align with Marketplace subsidies. The move to MAGI has brought about a number of changes in Medicaid and CHIP, but…
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ACIP’s Hepatitis B Recommendation Threatens Future Vaccine Access Issues for Children and Families
Last week, the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) met for two days to discuss, among other topics, the hepatitis B vaccine. Specifically, the committee heard presentations on and discussed the initial dose of the vaccine, typically given to babies within the first 24 hours of life, before…
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Congress Reauthorized the SUPPORT Act, Now Comes the Hard Part
On December 1, President Trump signed into law the SUPPORT for Patients and Communities Reauthorization Act of 2025, extending a number of substance use disorder (SUD) prevention, treatment, and recovery programs through fiscal year 2030. The bipartisan bill—which passed the House 366-57 in June and the Senate by unanimous consent in September—reauthorizes critical programs including…
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CMS Guidance on Medicaid Work Requirements Leaves States Hanging
CMS released preliminary guidance on H.R. 1’s mandatory Medicaid work requirements on December 8. The much-anticipated guidance fell far short of answering all the questions states need answered, but it did acknowledge that implementing the Medicaid work reporting requirements mandated by the One Big Beautiful Bill (H.R. 1) will be a “serious undertaking for states…
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The Clock is Ticking. Can Congress Prevent an Imminent Spike in Marketplace Premiums on January 1?
Congress has returned to Washington, D.C. from its Thanksgiving break, but has yet to resolve the debate on whether or how to extend enhanced premium tax credits (ePTCs) scheduled to expire on December 31. These enhanced subsidies make coverage more affordable for millions of Americans who buy plans in the Affordable Care Act (ACA) Marketplaces. The clock…
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Cash is No Substitute for Coverage: Why Health Insurance Matters
As Congress ends the federal government shutdown, the underlying debate about extending enhanced premium tax credits (ePTCs) that help enrollees purchase coverage in the Affordable Care Act (ACA) marketplaces is not only unresolved, but is lurching into unexpected territory. President Donald Trump has suggested that instead of extending ePTCs into 2026 and beyond to support…
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Florida Leaders Have Failed to Implement Bipartisan Plan Approved Over 2 Years Ago to Help Families Afford Health Insurance for Their Children
Florida’s children are more likely to go without health insurance than children in most other states. In a rare display of bipartisan unity, the Florida Legislature recognized the need to address the high cost of health insurance for families with children and took action by unanimously approving a bill to expand the state’s Healthy Kids…
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988 Mental Health Crisis Line Evolves Nationally, States Seek Stable Funding
We haven’t done an update on the 988 mental health crisis line in quite some time and some big changes have been happening! However, in the interim, we have been keeping up to date with the monthly data published by Vibrant Emotional Health to track state-by-state progress in a previous blog. You can find all…
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Public Charge Changes Will Have Far-Reaching Consequences for Children, Pregnant Women and Families and Sow Fear in Immigrant Communities
The Trump Administration’s Department of Homeland Security (DHS) released a Notice of Proposed Rulemaking (NPRM) this week on the Public Charge Ground of Inadmissibility (2025 NPRM). “Public charge” is a term used in U.S. immigration law to refer to a person who is likely to become dependent on the government in the future. An immigrant…
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CMS Issues New Guidance on H.R. 1’s Restrictions on State Use of Provider Taxes to Finance Medicaid
On November 14, 2025, the Centers for Medicare & Medicaid Services (CMS) issued new guidance with some new detail about how it will implement provisions in H.R. 1 — the budget reconciliation law also known as the One Big Beautiful Bill Act — that restrict states’ use of provider taxes to finance their share of…
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Several Key Questions about Trump Administration’s Drug Pricing Deals and Their Impact on Medicaid Remain Unaddressed
[Editor’s Note: This blog was updated on November 21, 2025, to reflect changes to the Request for Applications.] On November 6, 2025, the Centers for Medicare & Medicaid Services (CMS) announced a new Center for Medicare and Medicaid Innovation (CMMI) model to implement pricing agreements with two drug manufacturers — Pfizer and AstraZeneca — which…
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New Data Highlight Risks to Children and Parents if Enhanced Marketplace Subsidies Expire
Marketplace subsidy enhancements which have been in place since 2021 are set to expire at the end of December 2025, and their fate is currently uncertain. Since 2014, when Affordable Care Act (ACA) Marketplaces were established, most Marketplace enrollees have received premium tax credits (PTCs) that make plans more affordable. In 2021, the American Rescue…
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As Government Shutdown Looks Likely to End, Some Final Fact-Checking on Claims about Impact on Health Care Coverage for Immigrants and Citizens
As Congress votes again on a bill that would essentially re-open the government, there have been a lot of statements—of widely varying accuracy—about who exactly would benefit from calls to repeal the health cuts in H.R. 1 (formerly the One Big Beautiful Bill Act) and/or extend the enhanced Advanced Premium Tax Credits (APTCs) which expire…
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The Future of ACA’s Medicaid Expansion: What do Changes in HR1 Mean?
The federal budget reconciliation bill signed by President Trump, H.R. 1, made multiple cuts to the Medicaid program that were designed to deter states from expanding Medicaid. Ten states, mostly in the South, have not expanded Medicaid to low-income adults. Despite many attempts by proponents of large Medicaid cuts to lower the expansion match of…
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Medicaid Managed Care: The Big Five in Q3 2025
Q3 2025 is the first quarter of a new chapter in the Medicaid managed care narrative. At the beginning of the quarter, H.R. 1 was enacted. As explained by our colleagues Edwin Park and Sabrina Corlette, the new law will upend Medicaid enrollment and financing for years to come, cutting federal payments to states by…
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Threats to Maternal and Infant Health Won’t End After Shutdown Resolved
The current federal government shutdown is driven by failure of the Congress to finalize this year’s federal budget appropriations or adopt a Continuing Resolution (CR). The shutdown is already impacting the Supplemental Nutrition Assistance Program (SNAP), Head Start programs and other family supports, as Congress remains in a stand-still over extending ACA marketplace enhanced premium…
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CMS’s Georgia Waiver Extension Underscores the Failure of Medicaid Work Requirements
As regular readers of SayAhhh! know, on January 1, 2027, 42 states and DC will be required by HR 1 to impose work reporting requirements on many adults covered by Medicaid. The only state in the country that is currently implementing work reporting requirements is Georgia through a Section 1115 demonstration — officially known as…
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Many Unanswered Questions: Will the Trump Administration’s Drug Pricing Deals Result in Any Cost Savings for State Medicaid Programs?
Over the last month, the White House has widely touted pricing agreements from two drug manufacturers — Pfizer and AstraZeneca — which it claims will result in substantial prescription drug cost savings for state Medicaid programs. According to the White House, under these agreements, the manufacturers will provide “Most Favored Nation (MFN)” prices, based on…
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What to Expect for Open Enrollment, 2026 Edition
The Affordable Care Act (ACA) Marketplaces have had their ups and downs over the last decade, but it’s hard to find a year when consumers have faced more uncertainty going into an open enrollment period. “Window shopping” for 2026 Marketplace health plans has already begun in several states and open enrollment begins in most states on November…
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Trump Administration Severely Limits Rural Health Transformation Funds for Rural Hospitals and Clinics – Capped at 15%
Passage of the budget reconciliation law signed into law by President Trump (HR1) will result in a gross reduction of $990 billion in federal Medicaid and CHIP spending over 10 years and an increase in the number of uninsured Americans of 10 million. These are the largest health cuts in Medicaid’s history, and passage of…
