How States Are Reckoning with Republican Health Reforms

·21 min·2 clips

States face $1 trillion in health cuts and must enforce Medicaid work requirements by 2027.

The episode begins with host Dan Gorenstein introducing the topic of state health policymakers grappling with the fallout from the Republican health reforms passed in July. He notes that 500 officials recently met in San Diego amid a stormy forecast for health care. Gorenstein interviews Hemi Tewarson, Executive Director of the National Academy for State Health Policy, who describes the past 90 days as a time of great growth for state leaders. They discuss the general mandate of state officials to manage programs, policies, and budgets. The conversation turns to specific provisions, starting with a $50 billion pool for rural health transformation, with applications due next month. Tewarson explains that states are considering reimagining payment models, such as global budgets for rural hospitals, or investing in infrastructure like broadband. Next, they address the deadline of January 1, 2027, for enforcing Medicaid work requirements. Tewarson highlights challenges in technology, with states needing software to verify employment, and concerns about vendor readiness. She also emphasizes the importance of building trust with Medicaid enrollees and leveraging programs like peer supports or apprenticeships. After a break, senior producer Leslie Walker joins to share vibes from the San Diego conference, describing it as bleak with officials worried about the accumulation of changes. She reports that one staffer spends hours daily on compliance, and states fear costs up to $200 million and errors that could trigger federal clawbacks. Walker also notes an influx of private sector companies seeking business. The episode concludes with Tewarson sharing her hopes for Medicaid modernization and fears about capacity and trust, along with advice for demoralized state workers.

As heard by us

A practical look at the technology and trust states will need to make Medicaid work requirements navigable.

Tradeoffs examines Medicaid work requirements through the practical questions state health policymakers are already facing as they prepare for rules that could require people to document work, volunteering, or school by January 1, 2027.

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Want to know what Medicaid work requirements feel like once they hit state technology, reporting, and trust?

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