Affordable Care Act

Texas, among several other states, filed a lawsuit to deem the Affordable Care Act (ACA) as unconstitutional. On June 17th the Supreme Court ruled to uphold the ACA. This is the third time the ACA has been questioned and upheld. 

American Rescue Plan Act

  • May 31st was the enrollment deadline for companies to submit their election notices to those eligible for the 100% COBRA subsidies
  • Those who are eligible for the subsidies have 60 days to submit the election notices, once received by the employer

Medicaid Expansion

  • Oklahoma expands as of July 1st
  • Georgia’s limited expansion is delayed by CMS due to work requirements
  • Missouri’s voter approved expansion is tangled up in courts with no funding so far

July 2021 Medicaid State of the Union                        


Due to the federal government no longer defending public charge officials, we expect more California residents to apply for Medi-Cal and Cal-Fresh programs. The Health Exchange enrollment was originally ending on May 15th, but per the Covered California website, enrollment is still open. It does not have an end date published.


The state is proposing a plan that has not been implemented with any other state so far. HB 21-1232, or the Colorado Option, was developed to implement a state-run health insurance option through the marketplace. Although very controversial and the law continues to change as it reaches each level of the legislative process, the concept is to lower premiums and create a more affordable option for the state’s residents.


Florida closed out legislative sessions with no base rate cuts to hospitals. Additionally, the state continues to take the lead in new health exchange enrollment due to the extended open enrollment timeframe. In fact, Florida continues to lead the pack with more health exchange enrollments than any other state.


The state was set to implement partial expansion which included work requirements for some low-income adults beginning July 1st, but that has since been paused due to push back from CMS. For now, the plan is to pause the implementation until August 1st, but there could be legal implications and a lot of push back.


HB 316, regarding anyone who is eligible to apply for Medicaid or purchase private health insurance, will be ineligible for county indigent or catastrophic healthcare programs. The law took effect July 1st, but it will not be fully implemented until 2023.  


The Department of Health and Human Services shared their intention to permanently withdraw Medicaid work requirements for Arizona and Indiana. The states have 30 days to appeal the decision, and it’s expected that Indiana will appeal the Gateway to Work requirement.


Franklin County Judge Phillip Shepherd tossed out contracts awarded to six health insurance companies, citing flaws in the state’s bidding process for the $8B in state Medicaid business.  The judge ordered the state to rebid the entire package which would make it the third time the state would have to seek bids from external health insurance companies.


The state released a request for proposals (RFP) for Medicaid Managed Care Organizations which are to be submitted by September 3rd. The RFP is asking for MCOs to provide sufficient behavioral health integration, delivery system reform, disaster planning and recovery, and accountability to name a few of the requirements. Some Medicaid members will start receiving Medicaid closure notices.

The state continues to keep recipients on Medicaid through the public health emergency (PHE), but it appears they are beginning the communication campaigns for these members once the PHE is over.


The state is in the middle of a legislative session and Medicaid expansion was on the agenda, but unfortunately both proposals to expand the program to childless adults were rejected. In May, a group called the Fairness Project worked on a campaign called “Yes on 76” which would create a ballot initiative for Medicaid expansion, however it has since been paused due to Mississippi Supreme Court’s decision to overturn another voter approved initiative. The group feels that even if the residents approve expansion, it will still not be supported by law makers.


Although Missouri voters approved Medicaid expansion through a ballot initiative, the legislation voted against funding the new program.

At this time there is no funding to support Medicaid expansion within the state. Lawsuits were filed and the decision is now headed to the Missouri Supreme Court.

North Carolina

The state transitioned to Managed Medicaid in early July. Research also indicates 62% of NC residents are not aware of the transition and may not have switched to a Managed Medicaid plans yet.


Medicaid expansion population applications opened June 1st to apply for Sooner Care with benefits for those who qualify being effective July 1st.

The state also has an 1115 waiver pending that was supposed be approved by July 1st, but it has not been approved by CMS yet. One of the biggest impacts of that approval is not allowing retro Medicaid for the expanded population. So far it is unclear if the current CMS administration will support that change.

The Oklahoma Supreme Court ruled that Governor Kevin Stitts’ plan to privatize much of the state’s Medicaid program is unconstitutional. The court determined the Oklahoma Health Care Authority did not have the legislative approval to move forward with the plan, dubbed Sooner Select.

South Carolina

The South Carolina Department of Health and Human Services (SCDHHS) is adding an additional managed care organization (MCO) to serve its Healthy Connections Medicaid members.

Although South Carolina is one of 12 states who has not expanded Medicaid coverage, the governor has expressed that the state will not amend its stance even with the additional dollars in play from the American Rescue Plan. 


CMS approved Tennessee’s 1115 Waiver to fund Medicaid through a block grant on January 8th, entitled TennCare III. In May, a group of 13 recipients (filed by the Tennessee Justice Center and King and Spalding LLP) filed a complaint in opposition of the new block grant funding.

The waiver also provides the return of 90 days of retro Medicaid but only for pregnant women and children. It does not include parent, caretakers or the aged, blind or disabled (ABD) population. This waiver went into effect on July 1st.

Lastly, the legislative session ended on a good note for postpartum moms. TennCare will extend postpartum coverage for new moms from 60 days to one year.


Governor Gregg Abbott has called for a special session beginning July 8th and one of the topics that could be up for discussion is a bill sponsored by Congressman Lloyd Doggett called “COVER Now Act”. The bill, which now has over 40 co-sponsors, is designed to allow Medicaid expansion to be passed by local city leaders instead of a state-wide approach. The idea is if some cities expand, it may provide an incentive for other areas to eventually expand.


Legislation and budget season have wrapped up for the state. The budget includes $5 million to increase caseworker salaries at the Utah Division of Child and Family Services. Originally there was a plan to merge the department of health and the department of human services, but that idea was rescinded.


This month, income-eligible pregnant women in Virginia are able to obtain Medicaid coverage regardless of their immigration status, and all pregnant women will now have postpartum coverage for 12 months.

Effective on July 1st, the state has started offering dental benefits for low income adults. In addition, due to the multitude of changes in the federal landscape, the state has decided to delay the transition of becoming a state-based health exchange by one year.