On January 15, 2026, NGA convened Governors’ health advisors to review critical health policy developments for the year ahead, including federal grant funding and implementation of major Medicaid reforms. Key health policy trends included budget constraints, federal funding uncertainties, and health care cost challenges. Three areas of concern were Medicaid, behavioral health, and workforce issues. The call also included discussion on public health outbreaks, such as avian flu and measles, and the growing older adult population.
State Legislative Trends
Representatives from the National Conference of State Legislatures (NCSL) joined the call to share 2026 state legislative trends they are tracking, focusing on commercial health costs and coverage, the health care workforce, behavioral health, and public health. They highlighted key policy areas such as health system consolidation, state-based premium subsidies, prescription drug access, and vaccine requirements.
NCSL anticipates that Medicaid financing costs will remain a priority in 2026, with states facing budget shortfalls and scrutinizing program efficiency and eligibility changes. States will also make their voices heard in federal policy discussions and pursue population health priorities, with potential interest in advanced technologies and procurement policy. Representatives also discussed emerging trends like the role of private equity in health systems and the use of AI in health care.
Medicaid Implementation Challenges
Policy experts from the National Association of Medicaid Directors shared their perspective on Medicaid implementation, focusing on HR1, budget realities, and program integrity. Key concerns include the rapid implementation timeline for work requirements and eligibility redeterminations, which will require federal policy clarity, IT systems upgrades, and robust member outreach. Experts also addressed changes to the Payment Error Rate Measurement Program and restrictions on provider taxes and state-directed payments.
County-Level Perspectives
A legislative director from the National Association of Counties concluded the call with the county perspective on health policy. Counties are preparing local systems for HR1 implementation, aligning community engagement exemptions with verification requirements, and addressing uncompensated care. County priorities outside of HR1 include Medicaid reentry waivers, IMD reform, and the suspension of Medicaid benefits for individuals entering the local justice system.
