State-by-State Policy & Advocacy Updates: Q1 2025

Please note: The following updates are current as of April 11, 2025 and are subject to change given the fluid nature of the legislative process. For any questions, please email admin@caresourcemissions.com. 

As the first quarter of 2025 comes to a close, our team has been hard at work advancing our members across the country—attending events, engaging in policy and budget discussions, sponsoring community outreach initiatives and actively monitoring legislative changes to ensure the collective CareSource Mission voice is heard.

ARKANSAS 

CareSource’s presence in Arkansas continues to grow, both in advocacy and meaningful community engagement. We’ve sponsored and participated in multiple events to continue to elevate our profile with decision-makers, community leaders and those we serve. 

• We hosted the “CareSource & Crawfish” reception in honor of the 95th General Assembly  
• We sponsored fantasy camp with Coach John Calipari and the Arkansas Razorbacks basketball team for youth in foster care.
• We supported a charity exhibition basketball game between the Kansas Jayhawks and the Arkansas Razorbacks with proceeds benefiting Arkansas Children’s Hospital.
• We sponsored “Hoops for Kids’ Sake,” a charity basketball tournament benefitting Big Brothers Big Sisters of Arkansas. 

GEORGIA 

Between the ongoing Medicaid RFP protest period and the state legislative session, Georgia has been a hotbed of activity. We continue to stay plugged into the protest process. This is an expected part of every procurement, but does require intense focus from our advocacy team. 

• We’re tracking several bills under consideration related to coverage mandates, utilization management and behavioral health. 
• We’re also supporting proposed changes to Georgia’s Medicaid work requirement program, Georgia Pathways. In addition to qualifying parenting as a work requirement, reporting requirements are being adjusted from monthly to annually, which would reduce administrative burdens on enrollees and CareSource.

INDIANA

It’s a big year for health care in the Hoosier State, and our team is staying closely engaged. Newly elected Governor Mike Braun is diligently advancing the health care priorities he campaigned on, while legislators continue to focus on addressing rising health care costs. The General Assembly is in a budget year—referred to as a long session—and must adjourn by April 29.

• We’re tracking major policy activity, including prior authorization reforms, site-neutral payments and changes to pharmacy reimbursement.
• Key proposals also include the creation of a managed care assessment fee and reforms to the Healthy Indiana Plan, the state’s Medicaid expansion program.

KENTUCKY

The Kentucky General Assembly adjourned its 2025 legislative session sine die on Friday, March 28. This year was a 30-day short session, with the bulk of the legislative activity compressed into a six-week period. 

• This session was successful in nearly every regard, as no bills were passed that cause significant impact to CareSource’s marketplace plan or potential Medicaid opportunities.
• Notable bills that did pass include a colorectal cancer screening and laboratory test coverage mandate, as well as changes to Medical Director signature requirements on denials.
  

MICHIGAN

Following the 2024 elections, Michigan is now the only legislative chamber to move into Republican control nationwide. With a split government, it will be difficult for either party to pass legislation. Despite the evolving political landscape, our team remains committed to protecting access to quality care for Michiganders.

• We’re actively monitoring budget negotiations, as the Legislature has yet to close the books for fiscal year 2024. The delay impacts a $55M state appropriation tied to over $200M in federal Medicaid funds, while Senate Republicans also consider reallocating resources toward infrastructure by reducing Medicaid spending.
• We’re pleased that the administration has maintained a collaborative stance on Medicaid policy, including the recently approved Section 1115 Reentry Services Demonstration waiver, which supports individuals transitioning from carceral settings back into the community. 
• The Michigan Department of Health and Human Services (MDHHS) recently launched a new initiative to expand access, improve quality and increase behavioral health care options for Medicaid beneficiaries. As part of this effort, MDHHS conducted a public survey to inform the competitive procurement of Pre-Paid Inpatient Health Plans (PIHPs), and HAP CareSource is exploring this opportunity. 

NEVADA

With a newly announced contract in Nevada, CareSource is laying the groundwork for a strong presence in the Silver State. Our sole mission is to improve the health of Nevada residents by leveraging local, physician experience to inform decision-making, align incentives, use data more effectively and reduce friction between the delivery and financing of health care. 

• We’re focused on behavioral health advocacy and strengthening strategic partnerships statewide.  
• CareSource Mission recently supported Behavioral Health Legislative Day, bringing awareness to the value of behavioral health care. 
• We’re meeting with behavioral health providers, community-based organizations and elected officials, highlighting the importance of behavioral health and how CareSource will work with providers and organizations to meet the needs of Nevada.

NORTH CAROLINA

CareSource NC team members have been on the ground meeting with House Representatives, Senators, the Department of Health and Human Services and other key stakeholders, telling the CareSource story and value we can bring to the state and how we can help meet the state’s priorities.

• While lawmakers are currently largely focused on budget, the legislation we’re monitoring includes Prior Authorization / ‘Gold Carding,’ Provider-led Entity-friendly language and restrictions on coverage mandate bills.
• We’re also actively advocating to expand the upcoming Medicaid RFP to be a competitive market by establishing a floor of the number of contracts awarded. 

OHIO 

As the biennial state budget process unfolds, we’re tracking key provisions impacting Medicaid and working behind the scenes on managed care, pharmacy benefits and broader healthcare policy.  

• We’re monitoring Federal Medical Assistance Percentage (FMAP) Trigger Language. If the FMAP rate drops below 90%, it would cut the Medicaid expansion coverage. However, a FMAP drop remains unlikely, and we expect the legislature to modify this language before it is finalized.
• We’re advocating to keep CareSource’s statewide MyCare Ohio (FIDE-SNP) expansion intact with no delays or programmatic changes.
• Legislators are starting to scrutinize the Single Provider Benefits Manager (SPBM) and the additional cost it has brought to the Medicaid program. 
• While enrollment in OhioRISE remains lower than expected, costs continue rising, drawing some legislative scrutiny.
• Provider Rate Adjustments are under review, with the proposed budget primarily impacting hospitals, behavioral health providers and nursing facilities.

WEST VIRGINIA

Following a 30-day recess in the gubernatorial inauguration year, the West Virginia Legislature is now in its 60-day session. 

• We’re closely monitoring bills addressing mental health parity, EMS billing, white bagging and cost-sharing mandates. 
• We’re also watching the impact of New House rules, which require bills referred to committee to be subject to a two-day process. First, a hearing will be held on the bill, followed by a markup and discussion of the bill on a separate day. This change has resulted in slower progress, with many bills having trouble getting out of the House chamber.

WISCONSIN

With the Wisconsin legislative session in full swing, our team has been busy meeting with all legislative leaders and every member of the Senate and Assembly Insurance Committees, plus certain individual legislators who serve our districts.

• We’re actively engaging on Senate Bill 98 and Assembly Bill 107, which would allow a cooperative to convert to a nonprofit service insurance corporation. If this legislation passes, it would facilitate CareSource’s expansion in the Wisconsin market, bringing greater access and choice to individuals and families who rely on managed care. 
• We’re also watching the Governor’s 2025–2027 budget closely as it proposes Medicaid expansion, prior authorization reforms and other Medicaid provisions. 
• A Pharmacy Benefit Manager (PBM) reform bill is expected soon, with some provisions that cause some concern for managed care operations including restrictions on mail-order prescriptions, minimum dispensing fees, prohibiting copay accumulator programs, any willing pharmacy and more.

Be a Part of Our Mission

With legislative sessions and policy discussions underway, CareSource Mission remains an unwavering advocate for policies, legislation, regulations and government programs that promote high-quality health outcomes through managed care. 

By supporting CareSource Mission, you’re supporting the future of accessible, equitable health care for communities across the country. Learn more about becoming a member and championing our cause.