Certain States to Prohibit Self-Attestation of Medical Frailty Ahead of Schedule
Six states plan to implement stricter community engagement policies starting in 2027. Despite having the option to accept self-attestation of medical frailty in 2027, Arkansas, Indiana, North Carolina, North Dakota, New Hampshire, and Utah have either statutes or regulations that prevent the Medicaid agency from accepting this method of compliance. Ohio is in the process of implementing a proposed rule that will also prohibit self-attestation. Starting in 2028, all states subject to the community engagement requirements will not be able to accept self-attestation without additional documentation. The medical frailty definition for community engagement requirements remains contested, with 25 states and the District of Columbia pursuing a lawsuit against the federal government over its interpretation of medical frailty (Health Payer Specialist, August 12).
Washington Caregiver Union Pushes for Higher Medicaid Reimbursement Rates
The state of Washington and the labor union SEIU 775 are negotiating caregiver reimbursement rates that will affect about 80,000 workers as the state faces a projected budget shortfall heading into the 2027 legislative session. SEIU initially sought a 12% wage increase over two years, estimated to cost the state about $367M, but revised its proposal to a 3% increase next year and 5% the following year, with an estimated state cost of about $224M. The state has proposed no wage increases, though other contract costs would add about $60M to the state budget over the next two fiscal years.
Washington currently pays $37.42 per hour in Medicaid reimbursement for caregivers, including wages and benefits, while workers generally earn between $22 and $25 per hour. Under the state proposal, the Medicaid reimbursement rate would stay close to the current $37.42 per hour next year before increasing to $38.13 in FY2029, while the union is proposing $38.44 next year and $40.68 the following year. The parties have until October 1, 2026, to reach an agreement for inclusion in the governor’s proposed two-year budget, with the next rate-setting board meeting scheduled for August 24 (Washington State Standard, August 17).
Dartmouth Health Plans to End Tele-ICU and Tele-ED Services
Five Vermont hospitals could lose access to remote emergency and intensive care support as Dartmouth Health prepares to discontinue its Tele-ICU and Tele-ED services. The programs connect rural hospitals with specialists at Dartmouth Hitchcock Medical Center for critical care monitoring, emergency physician support, documentation, and patient transfers. In Vermont, Northwestern Medical Center and Southwestern Vermont Medical Center use Tele-ICU, while Brattleboro Memorial Hospital, Grace Cottage Hospital, Southwestern Vermont Medical Center, and Mt. Ascutney Hospital and Health Center use Tele-ED. Dartmouth Health said the programs are not financially sustainable at their current scale without external support but did not disclose their operating costs. The decision follows a $63.5M operating deficit reported in May 2026. Dartmouth Health has not set a final closure timeline and said it will work with participating hospitals to establish alternatives before ending the services (VT Digger, August 17).
Georgia Seeks Increased Funding to Keep Their Partial Expansion Program Afloat
On August 13, Georgia’s Board of Community Health announced that they have requested the federal government to increase the federal match from 67% to 90%, so it can continue to support Pathways to Coverage, its partial Medicaid expansion program. Under the program, low-income adults must complete 80 hours of work, school, or community service activities to be eligible for healthcare coverage. Previously, the only exemption under the program was for parents who are caregivers to a child under the age of 6, but enrollees are expected to increase by about 100,000 due to new federal guidelines that expand exemptions to individuals who are medically frail, former foster care individuals, and parents of children under the age of 13. The board alleges that the state will be unable to afford the program in the long term.
Pathways is being temporarily extended until the end of 2026, with a pending request to continue the program through 2030. The waiver amendment is open for public comment until September 14 (Georgia Recorder, August 14).
Arkansas Secretary of Human Services Relays Commitment to Medicaid Expansion Program
Arkansas Secretary of Human Services announced that the state will not consider ending Medicaid expansion at a meeting with the Arkansas Legislative Council’s Hospital, Medicaid, and Developmental Disabilities Study Subcommittee. During the meeting, Secretary Janet Mann said that she is confident CMS will grant the state’s two-year extension request of the ARHOME program. The state is currently weighing the options between moving its Medicaid expansion population to either managed care or fee-for-service (FFS). If the state chooses the managed care option, it will lower the amount of insurance premium tax revenue collected that is used to fund the state’s share of Medicaid expenditures. Moving to FFS would completely eliminate the revenue. If, however, CMS does not grant the temporary extension, enrollees could be moved to FFS on January 1 (Arkansas Advocate, August 17).
