THE BIG 3

1 EXPANSION ROADBLOCKS: GOP elected officials in Idaho, Nebraska, and Utah delayed full implementation of voter-approved Medicaid expansion and sought work requirements and other restrictions on eligibility.

2 WORK RULE CHALLENGES: U.S. District Judge James Boasberg overturned CMS approval for Medicaid work requirement waivers in Arkansas and Kentucky in March, then tossed New Hampshire’s waiver in July. A decision by a federal appellate court is pending, while five states have moved to suspend their work requirement.

3 BLOCK GRANTS ON THE HORIZON: Utah and Tennessee proposed Medicaid financing models setting per-capita caps on federal payments to the states, with the states pocketing any federal savings.