Montana Prepares to Implement Medicaid Work Requirements in July
Montana’s Department of Public Health and Human Services is preparing to implement new federal Medicaid work requirements beginning in July, with compliance checks occurring every six months as required under H.R.1. Individuals found noncompliant will not be disenrolled until after a three-month grace period ending in October, during which beneficiaries will receive notices and be referred to job support services. The policy requires most enrollees to complete 80 hours per month of “community engagement” activities, including work, education, or volunteering, representing a shift from the state’s prior income-based eligibility approach. State officials indicated the transition will require significant operational changes, including hiring additional staff to manage increased verification and exemption determinations, with estimated costs of $4.3M annually. While the policy has support among some lawmakers and voters, it has also raised concerns about administrative burden and potential coverage loss tied to reporting requirements (Montana Free Press, March 9).
Missouri Pilots Rural Health ToRCH Program
Missouri is piloting a new approach to rural healthcare delivery through its Transformation of Rural Community Health (ToRCH) program, which integrates medical care with social services to address non-clinical drivers of health for Medicaid beneficiaries. In communities like Sedalia, organizations have consolidated services into centralized hubs, allowing individuals to access support such as behavioral health referrals, utility assistance, and housing-related needs in one location. The program uses a shared technology platform to coordinate and track referrals across providers, improving follow-up and service connection. Early results show increased care coordination and improvements in some health outcomes, such as blood pressure control and behavioral health follow-ups. While the model has demonstrated early progress and is being considered for broader expansion, stakeholders note ongoing challenges in rural areas, including limited service capacity and workforce constraints, as well as uncertainty tied to future Medicaid funding reductions (Beacon News, March 10).
Minnesota Considers Eliminating Managed Care in Medicaid
Minnesota Governor Tim Walz has proposed significant changes to the state’s Medicaid and human services system, including eliminating managed care organizations and shifting to a fee-for-service model in which the state directly pays providers. The proposal would also transfer responsibility for determining Medicaid eligibility from counties to the state, aiming to simplify administration and improve oversight. Currently, most of Minnesota’s Medicaid enrollees receive coverage through private insurers in its managed care delivery system. The proposal comes amid ongoing concerns about fraud and administrative complexity in the state, though its impact on fraud prevention remains unclear. While the plan aligns with upcoming federal requirements, it has faced immediate opposition from Republican lawmakers and is unlikely to advance this session, with some stakeholders instead supporting a comprehensive study of the state’s human services structure (Minnesota Reformer, March 10).
Idaho House Republicans Introduce Medicaid Expansion Repeal Bill
On March 9, Representative Jordan Redman (R-Coeur d’Alene) introduced a Medicaid expansion repeal bill (HB 850), as an alternative to Governor Brad Little’s (R-ID) budget recommendation of making $22M in Medicaid cuts, including disability services and other service reductions. The bill was introduced shortly after legislators voted to postpone the Governor’s proposed Medicaid cuts. Currently, Medicaid expansion provides coverage for about 90,000 Idahoans, who wouldn’t otherwise be able to afford healthcare coverage. Included in the bill’s fiscal note is verbiage that following the repeal the Medicaid expansion population will qualify for tax credits to purchase insurance on the state’s exchange. If passed, Medicaid expansion would be repealed on January 1, 2028. As of March 10, the bill has been referred to the House Committee on Health & Welfare (Idaho Capital Sun, March 9).
West Virginia Department of Human Services Secretary Resigns
Alex Mayer has resigned as the Secretary of Department of Human Services (DoHS), effective March 15. Mayer was appointed by Governor Patrick Morrisey in February 2025, having previously served as South Dakota’s Chief of Children and Family Services. During his tenure in West Virginia, Mayer looked to improve the state’s foster care system and oversaw a statewide listening tour. In his place, Governor Morrisey has appointed DoHS deputy secretary Christina Mullins as acting secretary (West Virginia Watch, March 14; WV DoHS Newsroom, February 3, 2025).
New Indiana Law Makes Changes to MLTSS Program
In Indiana, Governor Mike Braun has signed House Bill 1277 (HB 1277) into law. The new law will make sizable changes to the state’s Medicaid managed long-term services and supports (MLTSS) program, PathWays for Aging. By September 1, 2026, the Family and Social Services Administration (FSSA) must apply for a new 1915(c) waiver to provide assisted living services and request an amendment to a current waiver to establish an individual cost limit that does not exceed the institutional cost of nursing facility services. The largest change will begin July 1, 2027, where Medicaid enrollees will be moved from managed care to a fee-for-service (FFS) delivery system if they receive nursing facility services for 100 consecutive days. Approximately 117,000 residents are served through PathWays, 21,000 of which receive services in nursing facilities. A study commissioned by the Indiana Health Care Association found that Indiana paid $91M more for MLTSS than it would have under FFS. Supporters of HB 1277 argued that these changes will reduce administrative costs while expanding access to different LTC settings. However, FSSA Secretary Mitch Roob argued differently, alleging that moving enrollees from MLTSS to FFS will not eliminate costs. HB 1277 will also result in several smaller operational changes, including lifting the current prohibition on lowering home health reimbursement rates on June 30, 2027 (McKnights Long Term Care News, March 15; The Purdue Exponent, March 9).
Connecticut Looks at Option to End Personal Care Attendant Program
Connecticut Governor Ned Lamont has proposed ending Community First Choice (CFC), a Medicaid program that provides personal care attendants (PCAs) to about 7,000 individuals across the state. The program allows participants to stay at home and in their communities instead of receiving institutionalized care. While in agreement with stakeholders that the program is generally cost effective, state officials stated that yearly costs and enrollment numbers have more than doubled, from $88.8M in 2018 to $371M in 2025, causing funds to be diverted from other HCBS programs to CFC. The governor proposes that CFC participants be transitioned to HCBS waiver programs, but CFC enrollees and other stakeholders oppose the move. CFC offers some additional program flexibilities compared to HCBS waivers and does not have a cap on the number of enrollees. Some DSS programs have e waiting lists of up to 10 years. Advocates argue that ending this vital home-care program will further strain this population (Connecticut Mirror, March 15).
