Please note: The following updates are current as of July 25, 2025, and are subject to change given the fluid nature of the legislative process. For any questions, please email admin@caresourcemission.com.
Throughout the second quarter of 2025, CareSource has remained focused on advocacy that delivers real impact. Across the country, our team has been actively working with policymakers across the aisle, meeting with legislators and engaging on key policies to help protect access and improve health outcomes for those we serve.
GEORGIA During Georgia’s 40-day legislative session, CareSource was a daily presence at the Capitol, tracking 197 bills and resolutions—eight of which had a direct impact on our mission.
Our advocacy efforts helped shape two key provisions in House Bill 197 that make the prior authorization process faster and less burdensome—both for providers and health plans—while still protecting patient care. Our engagement extended beyond the legislature as we met with the Georgia Department of Insurance to align on Marketplace priorities and connected with Department of Agriculture Commissioner Tyler Harper to discuss our growing commitment to rural Georgia.
CareSource also hosted lunch for Georgia’s Rural Caucus to elevate awareness of rural health needs and build bipartisan support.
INDIANA Throughout the 2025 Indiana General Assembly session, CareSource remained engaged on a number of key legislative efforts impacting Medicaid funding, managed care and pharmacy policy.
In the House, CareSource engaged on multiple omnibus health care bills, successfully advancing policies aimed at reducing health care costs:
We advanced cost-saving proposals through the biennial budget bill, House Enrolled Act (HEA) 1001, helping to ensure sustainable Medicaid funding.
We supported stronger language in HEA 1003, which strengthens site-of-service and site neutral payment policies, following hospital noncompliance with previously enacted laws.
We pushed back against language that would have significantly increased physician reimbursement in HEA 1004. The bill allows for a managed care assessment fee if the state obtains federal approval.
CareSource was also successful in minimizing the fiscal impact of two new bills introduced by the Senate:
Senate Enrolled Act (SEA) 2, which would reform the Medicaid and Healthy Indiana Plan (HIP) programs by introducing work requirements for the expansion population as part of a new HIP 3.0 waiver program. CareSource also advocated for greater flexibility in Managed Care Organization (MCO) marketing rules tied to the bill.
SEA 480, which would have essentially eliminated prior authorization and proposals to significantly increased dispensing fees for all pharmacies in SEA 140.
In both cases, we worked closely with stakeholders to scale back provisions that could have increased costs for members and the state.
MICHIGAN CareSource is actively engaging in budget discussions amid a newly divided state government following the 2024 elections. With the House now controlled by Republicans and the Senate by Democrats, legislative progress has become more complex.
We remain focused on advocating for key Medicaid funding priorities, including a FY24 rate adjustment supplemental, supplemental appropriations for FY25 and an increased baseline adjustment for FY26.
We’re also closely monitoring the Michigan Department of Health and Human Services (MDHHS) FY26 budget process. While the Senate has passed its version, the House’s recommendation is still pending.
Looking ahead, CareSource is evaluating participation in the upcoming MDHHS RFP for Prepaid Inpatient Health Plans (PIHPs), expected in summer 2025, with a planned service launch of October 2026.
NORTH CAROLINA
As North Carolina’s Medicaid landscape evolves, we continue to advocate for language supporting Provider-Led Entities (PLEs). Specifically, we are seeking a guarantee that at least two PLEs will receive contract awards in the upcoming procurement.
Supportive language is currently included in both the House and Senate budget proposals, though the versions differ slightly.
The final outcome will depend on what the House and Senate agree to during conference committee negotiations.
We anticipate this process may extend into October, as the legislature has not yet set a formal adjournment date.
WEST VIRGINIA
The recent legislative session concluded without any bills negatively impacting CareSource. Marketplace enrollment remains strong, with Advanced Premium Tax Credits (APTCs) continuing to play a critical role in making coverage affordable for West Virginians.
As the state enters a new phase of leadership, Governor Patrick Morrisey and changes in Senate leadership are bringing in new people and priorities.
CareSource is focused on cultivating relationships with the new administration and legislative leadership to ensure continued progress in support of our mission.
OHIO As Ohio’s biennial budget process took center stage, CareSource led the industry efforts to protect Medicaid from both funding cuts and policy proposals that would limit access for critical populations across the state.
In response to concerning policy language introduced by the House, CareSource successfully advocated for a final version of the budget that protected the integrity of the state’s upcoming Next Generation MyCare Ohio (FIDE-SNP) program.
While the Senate made key improvements to safeguard the FIDE-SNP model, its version—and the final version passed by the legislature—included more aggressive Medicaid funding reductions over the biennium.
At every step, our focus has been to preserve stability, protect access and ensure policy decisions reflect what works for those delivering and receiving care.
WISCONSIN CareSource continues to expand its presence in Wisconsin while advocating for key legislation that will protect affordable access to care and enable us to better serve our members through enhanced technology and resources.
During the 2025–2027 budget-writing process, we supported an increase to the reinsurance program cap, which will result in lower premiums for our Affordable Care Act (ACA) members. However, due to stalled budget negotiations, Wisconsin will continue to operate under existing funding levels until a new agreement is reached.
Our top legislative priority this quarter was Senate Bill 98, which facilitates the integration of CareSource and Common Ground Healthcare Cooperative. Our team held more than 50 meetings with legislators and stakeholders across the aisle to build support. The bill passed both the Senate and Assembly unanimously with bipartisan backing and now awaits the Governor’s signature.
As part of a coalition, we’ve been actively educating lawmakers on the potential cost impacts of Pharmacy Benefit Manager (PBM) reform proposals, helping to prevent costly mandates that could increase prices for our members.
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