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Joan Alker

@joanalker1.bsky.social
3K followers 471 following 623 posts

ED of Georgetown Center for Children and Families and Research Professor at Georgetown University’s McCourt School of Public Policy; post mostly about Medicaid and CHIP. Proud member of the “Best for Last” club.

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Joan Alker @joanalker1.bsky.social · 01/10/2026
The state of Nebraska has released data on the 1st few months of Medicaid work reporting requirements Over 1,000 people have lost/been denied coverage Vast majority are losing not bcuz they aren't working but bcuz they can't get thru the red tape My new blog: ccf.georgetown.edu/2026/09/30/n...
ccf.georgetown.edu
Nebraska Releases First Data on Medicaid Work Reporting Requirement: As Expected, Coverage Losses Start to Mount Due to Red Tape
At a recent Medicaid Advisory Committee meeting, the state of Nebraska, the first in the nation to implement what will soon be a mandatory Medicaid work reporting requirement (WRR), shared the first d...
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Joan Alker @joanalker1.bsky.social · 28/09/2026
Friday PM big drop from CMS on Medicaid Section 1115 waivers and compliance with OBBA. Many states received "overlay" letters which include conforming change such as cutting all lawfully residing immigrants from Medicaid benefits as of 10/1 except (LPRs, Cuban/Haitian entrants, COFA migrants, 214)
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Joan Alker @joanalker1.bsky.social · 26/09/2026
I’m not sure I can even read this article - what more can be done by this Administration to make America unhealthier? But thank you @apoorvanyt.bsky.social and colleagues for your work.
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Edwin Park @edwincpark.bsky.social · 23/09/2026
From @brucelesley.bsky.social a comprehensive dismantling of the Paragon Institute's attempt to explain away a well over 2 million decline in #Medicaid and CHIP enrollment among children since the start of the Trump Administration even before most of H.R. 1's massive Medicaid cuts take effect.
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Joan Alker @joanalker1.bsky.social · 23/09/2026
A heartfelt thank you to @brucelesley.bsky.social and Jenny Rudisill for so thoroughly explaining why efforts to deny or ignore this Medicaid decline is just plain wrong.
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Liz Szabo @lizszabo.bsky.social · 23/09/2026
Vaccinating children is especially important early in life; infants have one of the highest hospitalization rates from Covid after the 65-plus age group. “Those are kids that have never been exposed to Covid,” he said, and vaccination can help prevent these severe outcomes.
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Edwin Park @edwincpark.bsky.social · 23/09/2026
It’s just not credible to directly compare administrative enrollment data to unadjusted Census survey data (as Trump Admin & the Paragon Institute do to falsely claim a big share of Marketplace enrollees are ineligible). You have to adjust for differences in how income & household size are counted.
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Joan Alker @joanalker1.bsky.social · 22/09/2026
@birdy.bsky.social has scooped the 1st data I have seen on Nebraska Medicaid work reporting requirements and it is worse than I expected. Incomplete data shows that 1,000 have explicitly lost/denied coverage and almost half of new applicants are not getting thru the red tape/ineligibility.
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Joan Alker @joanalker1.bsky.social · 18/09/2026
A second lawsuit has been filed with respect to the Trump Administration's flawed interpretation of the medically frail provision of the Medicaid work reporting requirement coming to a neighborhood near you on 1/1/27. Thank you to the plaintiffs and litigators!
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Edwin Park @edwincpark.bsky.social · 18/09/2026
My Georgetown CCF colleagues @adamsearing.bsky.social & @joanalker1.bsky.social on how residents of rural communities who rely on #Medicaid are at greater risk of being disenrolled and becoming uninsured due to H.R. 1's work reporting requirements: ccf.georgetown.edu/2026/09/14/r...
ccf.georgetown.edu
Rural Communities at Greater Risk of Harmful Impacts from New Medicaid Work Reporting Requirements
In 2025, Congress passed H.R. 1, legislation which requires work reporting requirements as a condition of Medicaid eligibility in the 41 states, including Washington, D.C., that have expanded coverage...
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Joan Alker @joanalker1.bsky.social · 18/09/2026
New blog from me and Aubrianna Osorio on Census data that came out this week. We're still missing key data. ccf.georgetown.edu/2026/09/18/c...
ccf.georgetown.edu
Census Bureau Releases Some New Data on Child Uninsured Rate, but Questions Remain
This week the U.S. Census Bureau released the Current Population Survey (CPS) Annual Social and Economic Supplement (ASEC) data, which examine poverty, income, health insurance and other trends for ca...
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Edwin Park @edwincpark.bsky.social · 18/09/2026
White House is expected today to tout its #Medicaid MFN drug pricing agreements under its GENEROUS model. Many key questions remain unanswered: (1) Can Rx companies pick and choose what products to offer? (2) How do MFN prices compare to existing rebates and will states actually see lower Rx costs?
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Joan Alker @joanalker1.bsky.social · 14/09/2026
We will be tracking the change in child uninsured rate from the Census CPS data coming tomorrow and have quick analysis. However, our usual work analyzing Census ACS data for our annual report is delayed b/c for the 1st time the ACS is not coming out this week. The Bureau has "delayed" the data 😜
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Cathy Hope @gothope.bsky.social · 14/09/2026
Unreliable mail service and less online connectivity means more barriers for residents of rural areas to overcome to comply with the new Medicaid rules. See new report by @adamsearing.bsky.social @joanalker1.bsky.social @georgetownccf.bsky.social ccf.georgetown.edu/2026/09/14/r...
ccf.georgetown.edu
Rural Communities at Greater Risk of Harmful Impacts from New Medicaid Work Reporting Requirements
In 2025, Congress passed H.R. 1, legislation which requires work reporting requirements as a condition of Medicaid eligibility in the 41 states, including Washington, D.C., that have expanded coverage...
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Joan Alker @joanalker1.bsky.social · 14/09/2026
Federal law protecting children from losing coverage is being violated in Florida and tens of thousands of kids are losing CHIP. The Trump Administration is not enforcing the law. Still no answers from DeSantis administration on KidCare disenrollments, challenges floridaphoenix.com/2026/09/14/s...
floridaphoenix.com
Still no answers from DeSantis administration on KidCare disenrollments, challenges • Florida Phoenix
The administration of Gov. Ron DeSantis is still not giving firm answers on when — or whether — it intends to expand a safety-net healthcare program for low-income children that the Florida Legislatur...
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Edward Swaine @edswaine.bsky.social · 13/09/2026
The WH and DHS seem to have decided that it's best not only to crater higher ed, but also to assess fees that'll directly deprive the federal and state gov'ts of tax revenues. It's not even killing the goose that laid the golden eggs; it's making sure the geese land elsewhere.
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Don Moynihan @donmoyn.bsky.social · 12/09/2026
Thanks to @joanalker1.bsky.social & @edwincpark.bsky.social for rebutting the editorial. A conservative think tank said lots of people on Medicaid are not working. The Post just went with that without sourcing the claim or methods or noting it contradicts multiple credible nonpartisan studies. Awful
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Joan Alker @joanalker1.bsky.social · 11/09/2026
Explore this gift article from The New York Times. You can read it for free without a subscription. www.nytimes.com/2026/09/09/o...
nytimes.com
Opinion | JD Vance Doesn’t Want to Help Married Parents. He Wants to Hurt Single Mothers. (Gift Article)
Redistributing money from single working parents to married ones is not a pro-family policy.
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Joan Alker @joanalker1.bsky.social · 11/09/2026
New on our blog: @edwincpark.bsky.social and I explain why a recent WaPo editorial in favor of stronger Medicaid work reporting requirements was unfortunately based on "data" that is fatally flawed. ccf.georgetown.edu/2026/09/09/r...
ccf.georgetown.edu
Right Wing “Data” Arguing for Medicaid Work Reporting Requirements is Fatally Flawed
We don’t usually write a blog like this that dissects the flawed methodology of the Foundation for Government Accountability (FGA) – a right-wing group that is well known for promoting work reporting ...
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Joan Alker @joanalker1.bsky.social · 01/09/2026
@georgetownccf.bsky.social is hosting a free webinar open to all on Medicaid Financing: Provider Taxes LOL. What a fun topic. But with new rules coming into place this may be the webinar for you. Its September 10th at 1p ET. Register here: georgetown.zoom.us/webinar/regi...
georgetown.zoom.us
Welcome! You are invited to join a webinar: Georgetown CCF Medicaid Financing Webinar Pt 2. After registering, you will receive a confirmation email about joining the webinar.
In June, we hosted a webinar on the basics of Medicaid financing, including how the federal-state partnership works, how federal funding is mandatory and not subject to annual appropriations, and how ...
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Joan Alker @joanalker1.bsky.social · 31/08/2026
Our Medicaid tracker is updated and # of kids enrolled since Jan 2025 in ths US is now ⬇️ 2.45 million. That's a lot. Why is this important? When Medicaid child enrollment declines, the # of uninsured kids typically goes up.
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Joan Alker @joanalker1.bsky.social · 28/08/2026
A preview of the chaos to come when Medicaid work reporting requirements sweep the nation in 2027. Nebraska which began implementing in June just got approval for counties to be exempt that had tornados, storms etc. last spring! www.centralnebraskatoday.com/2026/08/26/4...
centralnebraskatoday.com
Counties affected by wildfires, severe weather receive Temporary Disaster Hardship for Medicaid work requirements
NEBRASKA - The Nebraska Department of Health and Human Services (DHHS) announced today that recent federal act...
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Joan Alker @joanalker1.bsky.social · 28/08/2026
👀New: Monthly Medicaid/CHIP data is out from federal CMS and shows a 2 million drop in children from May 2025 to May 2026 -- a 5% decline in 1 yr.👀 This is very alarming because when the number of children covered by Medicaid goes down, the number of uninsured children goes up.
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Joan Alker @joanalker1.bsky.social · 28/08/2026
Gov. Spanberger issued an Executive Order on mitigating harm from Trump’s budget bill which will result in $2-6 billion loss of federal funding to VA annually. Virginia won't be able to cover federal SNAP, Medicaid funding cuts, governor warns cardinalnews.org/2026/08/26/v...
cardinalnews.org
Virginia won’t be able to cover federal SNAP, Medicaid funding cuts, governor warns
Gov. Abigail Spanberger issued an executive order aimed at protecting Virginians’ access to federal healthcare and food assistance programs.
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Joan Alker @joanalker1.bsky.social · 27/08/2026
Our new issue brief: How Are Parents Impacted By Medicaid Work Reporting Requirements? ccf.georgetown.edu/2026/08/26/h... via @GeorgetownCCF 👀 In 27 states + DC custodial parents should NOT lose Medicaid due to work reporting requirements coming 1/1/27.👀 Spread the word. Ask your state.
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Joan Alker @joanalker1.bsky.social · 24/08/2026
Our latest @georgetownccf.bsky.social report looks at uninsured rates for children under 3. The # is going up, and this is before Medicaid enrollment losses post-unwinding which have been huge. States in blue have highest rates. No baby should be uninsured. ccf.georgetown.edu/2026/08/18/h...
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Sharon Parrott @sharonparrott.bsky.social · 21/08/2026
The President’s threat of legal action against @amprog (CAP) marks another disturbing, anti-democratic effort to silence those with whom he disagrees. Our Constitution protects our right to engage in vigorous debate, debate that makes our nation stronger.
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Joan Alker @joanalker1.bsky.social · 20/08/2026
Would Gov. Brian Kemp really shut down his Pathways Medicaid program? georgiarecorder.com/2026/08/20/w...
georgiarecorder.com
Would Gov. Brian Kemp really shut down his Pathways Medicaid program? • Georgia Recorder
Patient advocates reacted with alarm this week at the suggestion by the administration of Gov. Brian Kemp that it could end Georgia Pathways to Coverage, his signature Medicaid program that gives heal...
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National Immigration Law Center @nilc.org · 17/08/2026
In this era of government-sanctioned cruelty and relentless attacks on immigrants, we're committed to fighting back & defending our communities. That's why we created a Solidarity Guide with ways you can protect your immigrant neighbors, your community & yourself. Read more: bit.ly/4bPRRcq
bit.ly
Solidarity Guide for Defending Immigrant Communities
This solidarity guide is designed to help everyone continue to fight back with practical guidance to help protect your immigrant neighbors, your community, and yourself.
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Joan Alker @joanalker1.bsky.social · 17/08/2026
The Washington Post editorialized in favor of Medicaid work requirements based on a garbage paper by the Foundation for Govt Accountability - a new low for the Post’s editorial board. FGA is the leading proponent of work requirements at state an fed level.
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Joan Alker @joanalker1.bsky.social · 17/08/2026
Very interesting. Georgia is requesting the full 90% Medicaid expansion match w/o full expansion. Both Obama and Trump 1 administations said no to similar requests. Georgia officials say new federal Medicaid rules threaten state’s partial expansion program georgiarecorder.com/2026/08/14/g...
georgiarecorder.com
Georgia officials say new federal Medicaid rules threaten state’s partial expansion program • Georgia Recorder
New federal guidelines would make the state’s Medicaid program financially unsustainable, state health officials said.
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Joan Alker @joanalker1.bsky.social · 14/08/2026
Nebraska is the first state to implement Medicaid work reporting requirements. NE Medicaid director (who came from right wing groups that promote them) just resigned as disenrollments are about to heat up. governor.nebraska.gov/gov-pillen-ann…
governor.nebraska.gov
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Edwin Park @edwincpark.bsky.social · 14/08/2026
Just to clarify, this is due to Trump Admin guidance from June that again goes far beyond what H.R. 1 required by making it difficult for states to renew existing #Medicaid waivers/apply for new ones. H.R. 1 only codified longstanding budget neutrality policy. ccf.georgetown.edu/2026/06/25/t...
ccf.georgetown.edu
Trump Administration Issues Section 1115 Medicaid Waiver Financing Guidance Which Goes Far Further Than H.R. 1 (Again)
On Friday, June 11 the Centers for Medicare and Medicaid Services (CMS) issued new guidance on the Secretary’s approach to implementing Section 1115(g) which was added to the Social Security Act by H....
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American Community Media @amcommmedia.bsky.social · 12/08/2026
ACoM News Briefing Recap | New Public Charge Rules Have Chilling Effects on Immigrants and Their Children New rules are raising fear and uncertainty among immigrant and mixed-status families. buff.ly/2fspvOi
americancommunitymedia.org
New Public Charge Rules Have Chilling Effects on Immigrants and Their Children
Experts explain the Trump administration’s expanded public charge rule, its impact on immigrant families and children, and the growing fear driving disenrollment from food, housing, and healthcare…
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Joan Alker @joanalker1.bsky.social · 13/08/2026
My new blog with @akohler.bsky.social has an important takeaway. Check w/ your state if you live in one of the 28. Almost All Custodial Parents, Caretaker Relatives Should Not be Impacted by Medicaid Work Reporting Requirements in 28 States ccf.georgetown.edu/2026/08/13/a... via @GeorgetownCCF
ccf.georgetown.edu
Almost All Custodial Parents, Caretaker Relatives Should Not be Impacted by Medicaid Work Reporting Requirements in 28 States
As states rush to implement complex new work reporting requirement provisions before January 2027, the new Interim Final Rule (IFR) released by the Centers for Medicare and Medicaid Services (CMS) has...
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Joan Alker @joanalker1.bsky.social · 08/08/2026
ccf.georgetown.edu/2026/07/30/c...
ccf.georgetown.edu
Change to Census Data Processing Methods Threatens Health Policy Research and Federal Data Systems
On June 4, 2026, the Commerce Department issued Department Administrative Order (DAO) 216-26, Disclosure Avoidance for Statistical Products, which bans a class of privacy techniques called “noise infu...
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Joan Alker @joanalker1.bsky.social · 06/08/2026
In more bad news, the data that we use every fall to assess child uninsured rates by state (ACS) has been delayed by the Census Bureau. www.linkedin.com/posts/joan-a...
linkedin.com
Census Bureau Releases Schedule for Income, Poverty and Health Insurance Statistics and Updates About the American Community Survey Estimates | Joan Alker
The data that we use every fall to calculate child coverage rates by state (ACS) for our annual report has been delayed by the U.S. Census Bureau. Not good news. https://lnkd.in/eTj-p2tK
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Joan Alker @joanalker1.bsky.social · 06/08/2026
Arkansas healthcare providers alarmed by potential end of state’s Medicaid expansion arkansasadvocate.com/2026/08/04/a...
arkansasadvocate.com
Arkansas healthcare providers alarmed by potential end of state's Medicaid expansion | Arkansas Advocate
The Trump administration’s decision not to renew Arkansas’ hybrid Medicaid expansion is alarming medical providers and experts who say the loss of insurance for thousands would be devastating and woul...
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Joan Alker @joanalker1.bsky.social · 06/08/2026
We’ve update our Medicaid enrollment tracker and the news for children isn’t good. Since January 2025 there has been a shocking drop of 2.3 million kids enrolled in Medicaid/CHIP. This means the child uninsured rate is likely going up.
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Joan Alker @joanalker1.bsky.social · 04/08/2026
More than numbers: Inside Indiana’s Medicaid enrollment decline www.newsfromthestates.com/article/more...
newsfromthestates.com
More than numbers: Inside Indiana’s Medicaid enrollment decline
KEY POINTS Indiana is among the top states for Medicaid enrollment drops — falling by more than 343,000 people in one year — a decline of 18.5%. Procedural closures outpaced determinations that benefi...
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Joan Alker @joanalker1.bsky.social · 03/08/2026
A must read - a preview of what’s to come en masse when Medicaid work reporting requirements start nationwide. A pregnant woman loses coverage by mistake.. long waits lines for the call center.. People are scared. nebraskapublicmedia.org/en/news/news...
nebraskapublicmedia.org
Nebraska becomes first state to disenroll Medicaid recipients under new work requirements
The first work requirement-related disenrollments begin in Nebraska on Saturday. While the state Medicaid director estimates this will impact 200 Nebraskans, advocates are concerned that the number wi...
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Edwin Park @edwincpark.bsky.social · 28/07/2026
From @joanalker1.bsky.social a CCF blog post on the Trump Administration finalizing its "public charge" rule which will reduce #Medicaid and CHIP enrollment among eligible children and lead to further increases in the child uninsured rate: ccf.georgetown.edu/2026/07/24/t...
ccf.georgetown.edu
Trump Administration Issues Final Public Charge Rule And Ignores Public Comments on the Harm to Children
On July 20, 2026, the U.S. Department of Homeland Security (DHS)  issued final regulations lifting current rules used to determine whether an immigrant is likely to become a “public charge”. The final...
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Joan Alker @joanalker1.bsky.social · 31/07/2026
Update: Witnesses for next week's hearing have been announced and they are: Brian Blase, Paragon Jonathan Ingram, Foundation for Govt Accountability our own Andy Schneider, Georgetown CCF...
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Joan Alker @joanalker1.bsky.social · 30/07/2026
New: Judge denied request from blue state AGs for a preliminary injunction to hold up parts of the Medicaid work requirement, but put the case on an expedited schedule and made clear that his ruling doesn’t pertain to the merits of the case Ruling here: storage.courtlistener.com/recap/gov.us...
storage.courtlistener.com
Order on Motion for Preliminary Injunction – #94 in Commonwealth of Massachusetts v. Oz (D. Mass., 1:26-cv-12962) – CourtListener.com
Judge Richard G. Stearns: ORDER entered denying 2 Motion for Preliminary Injunction. (RGS, law3) (Entered: 07/29/2026)
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Joan Alker @joanalker1.bsky.social · 29/07/2026
Sadly, children will continue to have to wait for health care they desperately need in Florida. Judge won’t order state to implement expanded access to KidCare floridaphoenix.com/2026/07/28/j...
floridaphoenix.com
Judge won't order state to implement expanded access to KidCare • Florida Phoenix
A state judge has refused to order Florida health care officials to implement a 2023 law that would allow as many as 68,000 uninsured children to access subsidized health insurance coverage through th...
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Joan Alker @joanalker1.bsky.social · 29/07/2026
My new blog: Short summary I like this bill. ccf.georgetown.edu/2026/07/28/s...
ccf.georgetown.edu
Senator Kim Introduces Bill to Cover All Children and Young Adults
Last week, Sen. Andy Kim (D-NJ) introduced a bill called the “MediKids Act” (S. 5037), described as “guaranteed healthcare for every child in America.” Original cosponsors were Sens. Booker (NJ), Duck...
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Joan Alker @joanalker1.bsky.social · 28/07/2026
New Senate Budget Ctte Chair, Sen. Ron Johnson (R-WI), has announced that his 1st hearing will be about Medicaid. Title: "Medicaid The Reality" Tuesday, August 4th at 10am No more info yet. www.budget.senate.gov/hearings/med...
budget.senate.gov
Medicaid: The Reality | U.S. Senate Committee On The Budget
The Official U.S. Senate Committee On The Budget
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Joan Alker @joanalker1.bsky.social · 28/07/2026
Today is the day that the request for a preliminary injunction in the case Massachusetts v Oz will be heard in Boston. This case is the D Ags suing the Trump Administration about the Medicaid work reporting requirements regulation and its divergence from statute.
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Bryce Covert @brycecovert.bsky.social · 24/07/2026
"Of the 2,173 Arkansas women who qualified for Medicaid to cover their pregnancies and births but did not qualify for regular Medicaid, only 145 had another insurance option lined up and waiting for them on day 61."
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Joan Alker @joanalker1.bsky.social · 24/07/2026
Postpartum women go without care as Arkansas holds out as lone state to deny them Medicaid arktimes.com/arkansas-blo...
arktimes.com
Postpartum women go without care as Arkansas holds out as lone state to deny them Medicaid - Arkansas Times
Guess which state is the only one in the country that doesn't extend Medicaid to postpartum mothers for a year.
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