Medicaid and Counties: Understanding the Program and Why It Matters to Counties
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Blaire Bryant
Naomi Freel
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As Congress considers changes to the nation’s health care system, NACo urges them to consider implications of reforms that would merely shift costs to counties. Counties stand ready to work with Congress to identify strategies to strengthen our nation’s health system and provide high-quality coverage and access to care for all of their residents while being responsible stewards of local taxpayer dollars.
Download Report on Medicaid and Counties
Medicaid 101
Established in 1965, Medicaid is a federal entitlement program paid for by taxpayers that provides health and long-term care insurance to low-income families and individuals. Medicaid operates and is jointly financed as a partnership between federal, state and local governments.
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Protect the Federal-State-Local Partnership for Medicaid
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Federal Reforms to Medicaid Financing: What Counties Should Know
CMS requires state Medicaid suspension upon arrest versus termination
Effective January 1, 2026, federal law now requires states to suspend, rather than terminate, Medicaid coverage when an individual is incarcerated.
States submit Rural Health Transformation Program funding applications
On December 29, the Centers for Medicare & Medicaid Services (CMS) announced $50 billion in awards over 5 years to all 50 states under the Rural Health Transformation Program.
CMS issues new guidance on Medicaid Community Engagement Requirements
On December 8, the Centers for Medicare & Medicaid Services (CMS) released a Medicaid and CHIP Services Informational Bulletin (CIB) directing states on how to implement the Medicaid community engagement requirements enacted under Section 71119 of the One Big Beautiful Bill Act legislation (Public Law 119-21), or H.R. 1.
California county sales tax measure backfills federal healthcare cuts
Santa Clara County, Calif. will raise an estimated $330 million each year from a sales tax to backfill lose Medicaid funding.
County Countdown – Dec. 15, 2025
Every other week, NACo's County Countdown reviews top federal policy advocacy items with an eye towards counties and the intergovernmental partnership.