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The intersection between birthright citizenship and access to healthcare has become increasingly complex following recent legal and policy developments. On January 20, 2025, President Trump issued Executive Order 14160, “Protecting the Meaning and Value of American Citizenship” (“EO 14160”), directing federal agencies to limit recognition of citizenship at birth in certain cases where the child’s parents lack permanent legal status.Continue Reading Birthright Citizenship and Medicaid Coverage at a Constitutional Crossroads

Among the many sweeping changes to the Medicaid program included in the One Big Beautiful Bill Act (“OBBBA”), Congress established new statutory caps on state-directed payments (“SDPs”) in Medicaid managed care. SDPs have long served as a critical mechanism for states pursuing value-based payment (“VBP”) reforms, addressing network adequacy, and advancing health equity for underserved populations. OBBBA imposes explicit Medicare-based caps on new SDPs, time-limited exceptions for certain SDPs that were approved or in development on or before July 4, 2025, and a phased transition to new payment caps beginning January 1, 2028, that will reshape state payment policy tools to drive VBP, narrow disparities, and close gaps in access.[1] State Medicaid agencies, healthcare providers, patient advocacy groups, and other stakeholders should prepare to weigh in as the Centers for Medicare and Medicaid Services (“CMS”) proposes regulations to implement these changes in the coming months.Continue Reading State-Directed Payments, Value-Based Care, and the “One Big Beautiful” Bill: A Comprehensive Analysis

In June 2025, the U.S. House of Representatives introduced a budget reconciliation bill titled the One Big Beautiful Bill Act (OBBBA). The legislation proposes a number of administrative changes to existing federal health programs, including modifications to automatic enrollment procedures affecting individuals who qualify for both Medicare and Medicaid. The bill does not repeal current benefit programs but includes provisions that would revise the process through which certain low-income individuals access premium and cost-sharing assistance programs.Continue Reading Congressional Budget Proposal Includes Adjustments to Dual-Eligible Enrollment Pathways and Medicare Savings Program Rules

New York’s Medicaid financing strategy—particularly its use of a managed care organization (MCO) tax—has come under renewed federal scrutiny amid recent legislative proposals and regulatory developments. The federal reconciliation bill, known as the One Big Beautiful Bill Act (OBBBA), alongside newly proposed guidance from the Centers for Medicare & Medicaid Services (CMS), could significantly influence how New York and other states structure healthcare-related tax mechanisms used to draw down federal Medicaid matching funds.Continue Reading Understanding the Federal Reconciliation Bill’s Implications for MCO Tax Structure

On Thursday, May 22, 2025, the U.S. House of Representatives narrowly passed the One Big Beautiful Bill Act, a budget reconciliation bill introduced by House Republicans, by a 215-214 vote. The bill extends key provisions of the 2017 Tax Cuts and Jobs Act, currently set to expire at the end of 2025, and allocates additional funding for defense and other federal priorities. It also includes reductions in government spending and revised eligibility requirements for several federal aid programs.Continue Reading House-Passed Budget Bill – the One Big Beautiful Bill Act – Includes Major Changes to Medicaid

“Kicking Off Accountable Care” served as the theme for this year’s America’s Physician Groups’ (“APG”) Spring Conference, a three-day event packed with compelling speakers and breakout sessions focused on the state of accountable or value-based care. While the overall tone of the conference was optimistic, primarily being focused on the promises and expansion of value-based care models, there was also another theme which colored many of the presentations and breakout sessions: expect turbulent times.Continue Reading Takeaways from the America’s Physician Groups’ Spring Conference: Turbulent Times Call for Change and Innovation

On May 15, 2025, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule, entitled “Preserving Medicaid Funding for Vulnerable Populations – Closing a Health Care-Related Tax Loophole” to address a financing loophole that allows states to shift more Medicaid costs to the federal government than intended (the “Proposed Rule”). If finalized as proposed, states that received CMS-approved waivers for state healthcare-related taxes within the last year—including California, New York, Michigan, and Massachusetts—would be required to modify or eliminate those state taxes immediately or risk losing federal matching funds for expenditures paid using those tax revenues. Comments from stakeholders are due by July 14, 2025.Continue Reading Proposed Rule on Medicaid Tax Waivers: CMS Moves to Close a Loophole Shifting Costs to the Federal Government

The Administrator for the Centers for Medicare & Medicaid Services (CMS), Dr. Mehmet Oz, spoke to non-profit health system executives, investors, and industry observers this week at the 25th Annual Not-for-Profit Healthcare Investors Conference sponsored by Barclays, HFMA and the American Hospital Association. Dr. Oz outlined his vision for CMS – after joking that the difference between a “vision” and a “hallucination” is whether a person can bring others along with them – and addressed some of the critical policy issues related to Medicaid currently under debate in the United States Congress. Continue Reading CMS Administrator Outlines His Vision for CMS at NFP Healthcare Investors Conference

In a move signaling a major shift in federal priorities, the Centers for Medicare & Medicaid Services (“CMS”) recently announced it will limit federal funding for state Medicaid initiatives that support services beyond direct medical care. New policy guidance indicates that CMS intends to narrow the scope of the federal-state Medicaid partnership, refocusing matching funds on core healthcare services delivered to Medicaid beneficiaries. The timing is notable, as Congress and state Medicaid leaders brace for the potential of more significant cuts to federal funding for Medicaid in the upcoming federal budget reconciliation process.Continue Reading CMS to Withdraw Federal Medicaid Match for Workforce, Social Needs, and Infrastructure: What States, Health Care Providers and Community Organizations Need to Know

As budget negotiations heat up in Washington, Medicaid has emerged as a key target for cost-cutting measures. With policymakers looking to trim federal spending while maintaining commitments to Social Security and Medicare, Medicaid is one of the few major programs left on the table. Proposals floating around Capitol Hill include everything from block grants and per capita caps to stricter eligibility requirements and reductions in federal matching rates. These potential changes could fundamentally alter the structure of Medicaid, shifting more financial responsibility to states and reshaping access to care for millions of Americans.Continue Reading Medicaid in the Crosshairs What Restructuring Could Mean for States, Providers, and Beneficiaries

New York State has a long-standing commitment to supporting its most vulnerable populations through Medicaid-funded services for older adults and those requiring long-term care. However, rising costs and an increasingly complex healthcare landscape have created challenges that demand innovative solutions. As New York seeks to align its healthcare system with evolving needs, the time has come to adopt integrated care models that promote sustainability, efficiency, and improved outcomes.Continue Reading Building a Smarter Long-Term Care System in New York