Today's deep dive: Oregon, Minnesota, New Mexico and Washington asked a federal court to stop HHS from cutting their Medicaid funding if they do not carry out H.R. 1's work and community-engagement rules. Here is the rest of today's news.
Most states plan hardship exceptions; Missouri opts out, Nebraska activates 14 counties Georgetown's Center for Children and Families reported Nov. 5 that most states told a February 2026 KFF/CCF survey they planned to offer the optional short-term hardship exception to Medicaid work reporting requirements. Since then, CMS has said a state that elects the exception must adopt all four qualifying events: high county unemployment, a federally declared disaster or emergency, a hospital or similar admission, or travel outside the area for medical care. Missouri announced in October that it will not adopt the exception for any of those events. Colorado told a recent MACPAC meeting it plans to add the exception later in 2027, not at go-live. Indiana law bars the exception entirely, and New Hampshire requires oversight-committee approval first. Nebraska, which launched work reporting on May 1 and has an approved state plan adopting all four events, is the first state CCF identifies as activating disaster, emergency and high-unemployment exceptions, in 14 counties for different months. Source: Georgetown University Center for Children and Families
Medicaid expansion back in play in Georgia, Kansas, Texas and Wisconsin Stateline reported Nov. 6 that midterm results have shifted the politics of Affordable Care Act Medicaid expansion in four of the 10 holdout states. Georgia Gov.-elect Keisha Lance Bottoms made full expansion central to her campaign and has called it a first-day priority. Wisconsin will have a Democratic governor and legislature; incoming Assembly leader Greta Neubauer said lawmakers will look at several coverage options and that expansion is complicated by federal work requirements and financing changes. In Texas, Gov.-elect Gina Hinojosa said she would push the legislature to expand Medicaid, with Democrats holding the governor's office and the House while Republicans retain the Senate. In Kansas, Democrat Cindy Holscher campaigned on expansion and held a narrow lead for governor as of Stateline's report, while votes were still being counted and Republicans were expected to keep majorities in both chambers. No state has enacted a new expansion bill since the election. Source: Stateline
CMS extends Arkansas ARHOME waiver through June 30, 2027 In a Nov. 4 letter, CMS told Arkansas Medicaid Director Janet Mann it had approved a temporary extension of the Arkansas Health and Opportunity for Me (ARHOME) section 1115 demonstration (project 11-W-00379/6) so the state and CMS can keep negotiating the renewal application Arkansas submitted on April 30, 2026. The demonstration will now expire on June 30, 2027. Current special terms and conditions, waivers, expenditure authorities and the existing budget-neutrality agreement continue during the extension. CMS noted that new section 1115(g) budget-neutrality rules, explained in State Medicaid Director Letter #26-003, apply to demonstration approvals, renewals and amendments beginning Jan. 1, 2027, and that Arkansas's renewal is expected to need certification by the CMS Chief Actuary. Arkansas DHS announced the approval Nov. 5 and described it as a six-month extension beginning Jan. 1, 2027. The department said talks about a new delivery model do not change the expansion-population community-engagement requirements, which had a soft launch on July 1 and are set for a full launch with penalties on Jan. 1, 2027. Source: Centers for Medicare & Medicaid Services