LA Medicaid Unwinding and Work Requirements
Key Questions
What is the projected Medicaid enrollment in Louisiana by February 2026?
Enrollment is expected to fall below 1.5 million. This decline will increase the uninsured rate at FQHCs to 11% or higher, creating significant budget pressure.
How will the new CMS proposal on state-directed payments impact LA FQHCs?
The proposal caps supplemental payments at Medicare rates with per-service application and a 10% annual phase-down after grandfathering. It targets $775B in savings and extends to all SDPs by 2029, threatening managed care revenue for FQHCs.
What are the key details of the finalized work requirements for Medicaid?
Starting January 2027, enrollees must complete 80 hours per month of work or community engagement. Broad exemptions apply for medically frail individuals, parents of children under 14, and homeless people, though stricter proof standards for frailty will increase coverage losses.
Enrollment below 1.5M (Feb 2026), FQHC uninsured to 11%+; CMS proposed rule to cap state-directed payments at Medicare rates (comment period ended July 21) with $775B savings target—directly threatens LA FQHC supplemental payments. Caps per service, not aggregate; 100% Medicare for expansion states; grandfathering with 10% annual phase-down; extension to all SDPs by 2029. Comment period closed; rule now in finalization. New CMS work requirements IFR (Jan 2027 start) with stricter medical frailty proof; CBO projects 5.2M coverage loss. LA FQHCs must prepare for coverage churn and revenue impact.