Blog
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Transforming Perinatal Care in Colorado: Q&A with Elephant Circle Founder Indra Lusero
We have been watching and tracking all of the progress in states to improve Medicaid for pregnant and postpartum people during a period of rapid, positive change, even during the most recent legislative sessions under a backdrop of federal cuts. Colorado was one of the early states to pursue comprehensive maternal health initiatives, so we…
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Post Office Rural Service and Proposed Medicaid Work Reporting Requirements on Collision Course
I recently wrote about problems with the federal government’s suggested definition of “volunteer” in the proposed rule implementing the new law (H.R. 1) passed by Congress that requires patients to meet work/volunteer reporting requirements to maintain Medicaid coverage. The changes in this law are estimated to increase the number of uninsured Americans by 10 million people…
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Georgetown CCF Medicaid/CHIP Expert Tricia Brooks Retires (sort of) and Will Return as Professor Emeritus
For anyone who has worked with Tricia Brooks over the last twenty years, it is impossible to imagine her retiring. Tricia has been the heart and soul of much of the Center for Children and Families’ work with state and national partners and a leading national expert on Medicaid eligibility and enrollment, health care quality,…
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How H.R. 1 Cuts and Changes to Medicaid Played out in 2026 State Legislative Sessions (Part 2)
It’s been nearly a year since H.R.1 was signed into law, enacting the largest Medicaid cuts in history and setting off a scramble in state capitals to respond. Back in March, we took a look at how ten state legislatures were grappling with the impending budget holes and policies created by H.R.1. Now that most…
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Medicaid Work Reporting Requirements: States Ask a Federal Court to Protect Medically Frail Individuals from CMS Overreach
On June 3, CMS issued an Interim Final Rule (IFR) misinterpreting the work reporting requirements enacted last July in H.R. 1. The H.R. 1 provisions were bad enough, but as my colleague Leo Cuello has explained, the IFR imposes policies on states and individuals that the Congress did not enact. Most notably, the IFR makes…
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Professor, Mentor, Researcher, and Data Pioneer: Celebrating Lynn Blewett’s Retirement
I first met Lynn Blewett as a graduate student at the University of Minnesota School of Public Health, where her courses on the U.S. health care system fundamentally shaped how I understand policy and evidence. What struck me most was her ability to translate complex health systems into their human dimensions and to remind us…
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Early Signals Suggest a Second Year of Double-Digit Marketplace Premium Increases
It’s the start of rate review season for state insurance departments. Although most proposed premium rates for 2027 Marketplace coverage are not due to federal regulators until mid-July and will not be public until the end of July, some state regulators require insurers to submit proposed rate filings in May or June and release varying levels of…
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Emerging State Data Paint a Bleak Picture of 2026 Marketplace Enrollment
Congress’s failure to extend premium tax credit enhancements led to unprecedented net premium increases in Affordable Care Act (ACA) marketplaces in 2026. As a result, fewer people signed up for coverage during the 2026 open enrollment period, and many others “bought down” to less expensive plans that carry higher out-of-pocket costs. However, to more fully…
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Ten New States Join the CCBHC Medicaid Demonstration, H.R. 1 Puts Its Success at Risk
As readers of the blog know, the Certified Community Behavioral Health Clinic (CCBHC) model has been one of the rare bright spots in more recent federal behavioral health policy and one with deep bipartisan roots. As a reminder, CCBHCs are community-based behavioral health providers that meet federal certification criteria. While some operate independently, the CCBHC…
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Young Children’s Uninsurance is On the Rise – What Can Be Done to Protect Child Health?
Earlier this month, we released an analysis of uninsurance trends that found that young children were becoming uninsured at a faster rate than their school-aged peers. The trend is alarming and predates the massive declines we are seeing in child Medicaid enrollment since President Trump took office and before H.R. 1 Medicaid cuts and policy…
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Trump Administration Issues Section 1115 Medicaid Waiver Financing Guidance Which Goes Far Further Than H.R. 1 (Again)
On Friday, June 11 the Centers for Medicare and Medicaid Services (CMS) issued new guidance on the Secretary’s approach to implementing Section 1115(g) which was added to the Social Security Act by H.R. 1 – the President’s signature budget bill enacted last year. (Our explainer of the health provisions in the bill can be found…
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Would Benjamin Franklin’s Volunteer Fire Brigade Satisfy DHHS’s Proposed Rule on Medicaid Work Reporting “Community Engagement” Requirements?
Americans, as French political scientist Alexis de Tocqueville observed in 1831, have a special propensity for coming together outside of government as volunteers for community improvement. From Benjamin Franklin’s organization of the nation’s first volunteer fire brigade to President George H. W. Bush’s 1989 call for Americans to volunteer as a “thousand points of light,”…
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CMS Ignores the Law (Again) – This Time Taking Health Insurance Away from Individuals with Substance Use Disorders, Mental Health Conditions, and Serious Health Conditions
Just a few weeks ago, we explained how the Center for Medicare and Medicaid’s (CMS) proposed regulation on state directed payments goes far beyond the statutory authority in H.R. 1 to incredibly harmful effect. Now it has happened again. This time CMS has issued an interim final rule on work reporting requirements (the “IFR”) that…
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The Administration Weaponizes Fraud Against Medicaid: HHS OIG Hammers Hawaii
On May 13, Vice President Vance, the chair of the White House Task Force to Eliminate Fraud, held a press conference. He announced the deferral of $1.3 billion in federal Medicaid matching payments owed to California, which received considerable attention. He also announced that the HHS Inspector General had by letter that day warned state…
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Which States Are Seeing the Largest Declines in Child Medicaid/CHIP Enrollment?
Georgetown CCF has been closely monitoring Medicaid/CHIP enrollment for many years — especially during periods of rapid change. Unfortunately, we are in another period where large declines in child Medicaid/CHIP enrollment are happening—more than 2 million fewer children have been enrolled since January 2025. Why is this bad news? Because children in working families don’t…
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A Decade Later, CMS Updates the Medicaid EPSDT Playbook for States: Here’s What You Need to Know
The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit is the heart of Medicaid’s coverage for children, and something we have been tracking for a long time. As highlighted in past blog posts, the Centers for Medicare & Medicaid Services’ (CMS) released a landmark state health official letter in 2024 followed up by issuance…
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Inside the 2026 Maternal Mental Health State Report Cards: No More Overall ‘F’s, But a Brand New Failing Grade for U.S. Parental Support
Last week, the Policy Center for Maternal Mental Health, in collaboration with the George Washington University Milken Institute School of Public Health, released the much-anticipated 2026 Maternal Mental Health State Report Cards. One in five mothers experience maternal mental health conditions in the United States. The financial toll of untreated disorders is estimated to cost…
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New Federal Medicaid Work Reporting Rule Threatens Coverage for Vulnerable Americans
Statement by Joan Alker, Executive Director of the Georgetown University Center for Children and Families and Research Professor at the McCourt School of Public Policy: “This rule gives states a raw deal, but more importantly, puts health care at risk for people with illnesses and chronic conditions like cancer or a substance use disorder. It…
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Uninsurance Among Youngest Children on the Rise as Families Face Growing Economic Pressure
Today we released a report sharing the alarming news that the number of infants, toddlers and preschool-aged children going without insurance is now at the highest rate in nearly a decade and is rising sharply. Not only did 220,000+ more young children (birth up to age 6) become uninsured between 2022 and 2024 –they lost…
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Two Million Fewer Children are Enrolled in Medicaid Since Trump Took Office
Child uninsured rate likely on the rise Our state-by-state Medicaid/CHIP enrollment tracker now indicates that 2 million fewer children were enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) as of April 2026, as compared to January 2025 when President Trump took office. That steep drop in the number of children enrolled in Medicaid…
