How are H.R. 1 Cuts and Changes to Medicaid and SNAP Playing out in 2026 State Legislative Sessions So Far?

Following the enactment of the largest Medicaid cuts in history, we anticipated a flurry of Medicaid activity in state legislative sessions. State legislators were left to fill the budget holes made by H.R.1, figure out how to implement H.R.1-mandated policies like work reporting requirements, and (hopefully) mitigate some of the associated coverage losses. Ten state…

March 16, 2026

By

Jade Little

Blog

Prenatal Care: The Silent Maternal Health Emergency Hidden in New CDC Data

A new report from the Centers for Disease Control and Prevention (CDC) offers a look at concerning new trends in prenatal care access. From 2021-2024, prenatal care initiated during the first trimester of pregnancy declined, while those receiving care later or no prenatal care increased, as shown below. The share of pregnant women who received…

March 10, 2026

By

Tanesha Mondestin

and

Aubrianna Osorio

Blog

Florida Bill Would Waste Money on a Lose-Lose Plan to Punish Very Low-Income Parents

As readers of the SayAhhh! Health Policy blog know, states that have taken up the Affordable Care Act’s (ACA) Medicaid expansion are now mandated to impose a punitive work reporting requirement as of January 1, 2027. Florida has not taken up the expansion and covers very few adults, but Florida legislators are considering a bill…

February 20, 2026

By

Joan Alker

and

Jade Little

Research & Reports

Implementing Costly Medicaid Work Reporting Requirements: Who Will Foot the Bill?

Introduction The budget reconciliation bill enacted in July 2025 (H.R. 1) includes two major changes to federal Medicaid law that will impose large implementation costs on most states. One mandates the states that extend Medicaid coverage to low-income (“expansion”) adults require those adults to report 80 hours of work or community service per month. The other…

February 11, 2026

By

Andy Schneider

Blog

Self-Help Tools and Tutorials Are Critical to Implementing Medicaid Work Reporting Requirements

Last week we updated our scan of Medicaid renewal tutorials and self-help tools in advance of implementation of semi-annual renewals for the Medicaid expansion group starting in 2027. For all enrollees, not just expansion adults, it’s important for states to keep these resources updated and relevant. And it’s not too early to start thinking about…

February 6, 2026

By

Tricia Brooks

and

Antony Lin

Blog

Fact-Checking Dr Oz’ Claims About Rural Health Investments

CMS Administrator Mehmet Oz makes two statements in this short video that are not correct: Rural areas and small towns need assistance with health care affordability, quality and accessibility. The Rural Health Transformation Fund, despite its origin as a political maneuver to enable passage of the 2025 federal budget reconciliation law (HR1), means substantial help…

February 6, 2026

By

Adam Searing

Blog

CCF Welcomes Longtime Collaborator Steven Lopez to our Team

We are all looking for some good news in 2026 and we have some to share with you. Steven Lopez, MPP/MPH joined Georgetown University Center for Children and Families as a McCourt School of Public Policy Research Fellow. Steven has been a long-time friend and collaborator of CCF’s from one of his prior gigs at…

February 5, 2026

By

Joan Alker

Blog

Let’s Start a Conversation about Data to Monitor the Impact of H.R. 1’s Work Reporting Requirements

Monitoring the implementation of work reporting requirements in Medicaid will be incredibly important to assessing the policy’s impact, identifying bottlenecks or glitches in the system, and enabling rapid response to address problems. We have a baseline of data from the Medicaid performance indicators, which have been in place since 2014, and were expanded to more…

February 4, 2026

By

Tricia Brooks

Blog

CMS Issues Final Rule Implementing H.R. 1’s Prohibition of Certain Uniformity Waiver Provider Taxes

On January 29, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing the H.R. 1 provision prohibiting certain “uniformity waiver” provider taxes that states use to support their Medicaid programs. (The rule is scheduled to be published in the Federal Register on February 2, 2026). Nearly all states use taxes…

February 2, 2026

By

Edwin Park

Blog

CMS Quietly Releases Medicaid State Improper Payment Rates for 2025: How Did Minnesota Do?

With little fanfare, CMS earlier this month released a Fact Sheet on improper payments in Medicare, Medicaid, CHIP, and the Marketplaces in 2025. With even less fanfare, CMS this week posted Medicaid improper payment rates for 17 states, including Minnesota. To its credit, CMS did not conflate Medicaid improper payments with fraud against Medicaid. In the…

January 30, 2026

By

Andy Schneider

Blog

Maximizing the Use of Self-Help Resources Should Be a Priority as HR 1 Policies Are Implemented

As the 41 states that expanded Medicaid to low-income adults under the Affordable Care Act, approach the implementation of H.R. 1’s federally mandated semi-annual renewals, we thought it would be helpful to review how states handled the daunting task of outreach during the unwinding of the pandemic-era Medicaid continuous coverage provision. During the unwinding, we…

January 29, 2026

By

Tricia Brooks

,

Antony Lin

and

Natalie Lawson

Blog

House Republican Study Committee Pushes for Second Budget Reconciliation Bill and More Damaging Medicaid Cuts

On January 13, the House Republican Study Committee (RSC) unveiled its plan for a second budget reconciliation bill for this Congress, in addition to H.R. 1 (the “One Big Beautiful Bill Act” or P.L. 119-21) which was enacted on July 4, 2025. The plan includes a number of proposals to cut Medicaid, on top of…

January 22, 2026

By

Edwin Park

Blog

CMS Weaponizes Fraud Against Medicaid in Minnesota

[Editor’s Note: Read Part 2 of “CMS Weaponizes Fraud Against Medicaid in Minnesota series here.] On January 6, 2026, the Centers for Medicare & Medicaid Services (CMS) Administrator, Dr. Mehmet Oz, sent a letter to the Governor of Minnesota, Tim Walz, notifying him that his state’s Medicaid agency was “operating its program in substantial noncompliance”…

January 16, 2026

By

Andy Schneider

Blog

Maternal Health Field Lost a Courageous Leader Due to Complications of Childbirth

On January 1, 2026, Dr. Janell Green Smith of South Carolina died from childbirth complications at 31 years of age. Dr. Green Smith was a nurse-midwife, doctor of nursing practice, adjunct professor, maternal health professional and advocate. Dr. Green Smith developed severe pre-eclampsia during her pregnancy and delivered her daughter via cesarean section in late…

January 16, 2026

By

Tanesha Mondestin

Blog

School-Based Health Services Remain Critical to Keeping Kids Healthy in 2026: New Toolkit Offers a Guide

In Partnership With: Medicaid covers essential student health services, including mental and behavioral health care. From funding school health staffing, direct services and screening programs, to covering assistive equipment and technology for students with disabilities, Medicaid helps to ensure students are able to learn and thrive. As readers of Say Ahhh! know, earlier this year,…

December 17, 2025

By

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,

and

Blog

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…

December 15, 2025

By

Tricia Brooks

Blog

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…

December 9, 2025

By

Stacey Pogue

Blog

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…

November 21, 2025

By

Kelly Whitener

Blog

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…

November 14, 2025

By

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and

Blog

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…

November 4, 2025

By

Kay Johnson

and

Elisabeth Wright Burak

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