Joan Alker
@joanalker1.bsky.social
ED of Georgetown Center for Children and Families and Research Professor at Georgetown University’s McCourt School of Public Policy; post mostly about Medicaid, CHIP and such... Visit our website at ccf.georgetown.edu
Pinned
Joan Alker
@joanalker1.bsky.social
· Nov 3
‘A Big Positive’: How One Company Plans to Profit From Medicaid Cuts
www.nytimes.com
An excellent piece of journalism here from the New York Times about just one large vendor, Equifax, who will profit from the new Medicaid work requirement that will cause people who desperately need health insurance to lose it while for profit companies benefit.
www.nytimes.com/2025/11/03/h...
www.nytimes.com/2025/11/03/h...
A remainder that this is a multi pronged attack on vaccines.
Last week - buried in new technical guidance from CMS - Sec Kennedy has dropped the requirements for states to report child and adolescent immunization rates for children covered by Medicaid + CHIP.
Last week - buried in new technical guidance from CMS - Sec Kennedy has dropped the requirements for states to report child and adolescent immunization rates for children covered by Medicaid + CHIP.
😱YIKES
New guidance from the Trump Administration's CMS cites Secretarial discretion to DROP mandatory state reporting of immunization rates for children + pregnant adults covered by Medicaid/CHIP
This is close to 1/2 the children in the US and more than 40% of births
medicaid.gov/federal-policy…
New guidance from the Trump Administration's CMS cites Secretarial discretion to DROP mandatory state reporting of immunization rates for children + pregnant adults covered by Medicaid/CHIP
This is close to 1/2 the children in the US and more than 40% of births
medicaid.gov/federal-policy…
https://medicaid.gov/federal-policy…
January 5, 2026 at 7:41 PM
A remainder that this is a multi pronged attack on vaccines.
Last week - buried in new technical guidance from CMS - Sec Kennedy has dropped the requirements for states to report child and adolescent immunization rates for children covered by Medicaid + CHIP.
Last week - buried in new technical guidance from CMS - Sec Kennedy has dropped the requirements for states to report child and adolescent immunization rates for children covered by Medicaid + CHIP.
NEW: 😱Secretary Kennedy has just WIPED OUT the child vaccination schedule with no input from pediatricians or even his hand-picked Advisory Committee on Immunization
One of the vaccines taken off is for meningitis. My sister almost died from meningitis years ago.
www.statnews.com/2026/01/05/c...
One of the vaccines taken off is for meningitis. My sister almost died from meningitis years ago.
www.statnews.com/2026/01/05/c...
Federal health officials slash recommended childhood vaccinations under Trump’s directive
The number of recommended childhood shots drops from 17 to 11.
www.statnews.com
January 5, 2026 at 7:17 PM
NEW: 😱Secretary Kennedy has just WIPED OUT the child vaccination schedule with no input from pediatricians or even his hand-picked Advisory Committee on Immunization
One of the vaccines taken off is for meningitis. My sister almost died from meningitis years ago.
www.statnews.com/2026/01/05/c...
One of the vaccines taken off is for meningitis. My sister almost died from meningitis years ago.
www.statnews.com/2026/01/05/c...
Reposted by Joan Alker
The Centers for Medicare and Medicaid Services (CMS), run by Oz and his boss, RFK Jr., will no longer require physicians to report vaccination rates.
Instead, they plan to start having doctors report if they’ve discussed “alternative” vaccine schedules.
Instead, they plan to start having doctors report if they’ve discussed “alternative” vaccine schedules.
CMS to stop requiring states to report childhood vaccination levels
www.cidrap.umn.edu
January 4, 2026 at 10:37 PM
The Centers for Medicare and Medicaid Services (CMS), run by Oz and his boss, RFK Jr., will no longer require physicians to report vaccination rates.
Instead, they plan to start having doctors report if they’ve discussed “alternative” vaccine schedules.
Instead, they plan to start having doctors report if they’ve discussed “alternative” vaccine schedules.
😱YIKES
New guidance from the Trump Administration's CMS cites Secretarial discretion to DROP mandatory state reporting of immunization rates for children + pregnant adults covered by Medicaid/CHIP
This is close to 1/2 the children in the US and more than 40% of births
medicaid.gov/federal-policy…
New guidance from the Trump Administration's CMS cites Secretarial discretion to DROP mandatory state reporting of immunization rates for children + pregnant adults covered by Medicaid/CHIP
This is close to 1/2 the children in the US and more than 40% of births
medicaid.gov/federal-policy…
https://medicaid.gov/federal-policy…
January 3, 2026 at 11:31 PM
😱YIKES
New guidance from the Trump Administration's CMS cites Secretarial discretion to DROP mandatory state reporting of immunization rates for children + pregnant adults covered by Medicaid/CHIP
This is close to 1/2 the children in the US and more than 40% of births
medicaid.gov/federal-policy…
New guidance from the Trump Administration's CMS cites Secretarial discretion to DROP mandatory state reporting of immunization rates for children + pregnant adults covered by Medicaid/CHIP
This is close to 1/2 the children in the US and more than 40% of births
medicaid.gov/federal-policy…
Reposted by Joan Alker
My latest blog unpacks new guidance from federal CMS
on Medicaid work reporting requirements.
Most key questions remain unanswered just 12 months away from disenrollments starting.
ccf.georgetown.edu/2025/12/11/c...
on Medicaid work reporting requirements.
Most key questions remain unanswered just 12 months away from disenrollments starting.
ccf.georgetown.edu/2025/12/11/c...
CMS Guidance on Medicaid Work Requirements Leaves States Hanging
CMS released preliminary guidance on H.R. 1’s mandatory Medicaid work requirements on December 8. The much-anticipated guidance fell far short of answering all the questions states need answe…
ccf.georgetown.edu
December 12, 2025 at 9:09 PM
My latest blog unpacks new guidance from federal CMS
on Medicaid work reporting requirements.
Most key questions remain unanswered just 12 months away from disenrollments starting.
ccf.georgetown.edu/2025/12/11/c...
on Medicaid work reporting requirements.
Most key questions remain unanswered just 12 months away from disenrollments starting.
ccf.georgetown.edu/2025/12/11/c...
All 50 states have been approved for funding from the Rural Health Transformation Fund.
www.cms.gov/newsroom/pre...
www.cms.gov/newsroom/pre...
CMS Announces $50 Billion in Awards to Strengthen Rural Health in All 50 States | CMS
CMS Announces $50 Billion in Awards to Strengthen Rural Health in All 50 States
www.cms.gov
December 29, 2025 at 6:32 PM
All 50 states have been approved for funding from the Rural Health Transformation Fund.
www.cms.gov/newsroom/pre...
www.cms.gov/newsroom/pre...
We've just submitted our public comments on the Trump Administration's proposed "Public Charge" rule.
This is a terrible proposal that we estimate could increase the # of uninsured children in the US by more than 25% -- primarily citizen kids would lose coverage.
ccf.georgetown.edu/2025/12/19/p...
This is a terrible proposal that we estimate could increase the # of uninsured children in the US by more than 25% -- primarily citizen kids would lose coverage.
ccf.georgetown.edu/2025/12/19/p...
Proposed Public Charge Rule Could Increase the Number of Uninsured Children by More than 25 Percent
Georgetown CCF just submitted our comments on the Trump Administration’s proposed rule to lift current rules used to determine whether an immigrant is likely to become a “public charge”. The proposed ...
ccf.georgetown.edu
December 19, 2025 at 10:25 PM
We've just submitted our public comments on the Trump Administration's proposed "Public Charge" rule.
This is a terrible proposal that we estimate could increase the # of uninsured children in the US by more than 25% -- primarily citizen kids would lose coverage.
ccf.georgetown.edu/2025/12/19/p...
This is a terrible proposal that we estimate could increase the # of uninsured children in the US by more than 25% -- primarily citizen kids would lose coverage.
ccf.georgetown.edu/2025/12/19/p...
Happy holidays (not!) to Medicaid expansion enrollees in Nebraska as the state becomes the 1st state to "go early" on the new punitive work reporting requirement.
70,000 will receive notification in the next 2 weeks; sounds like disenrollments will start in May.
www.1011now.com/2025/12/17/l...
70,000 will receive notification in the next 2 weeks; sounds like disenrollments will start in May.
www.1011now.com/2025/12/17/l...
Nebraska to become first state implementing Medicaid work requirements
Nebraska will become the first state in the nation to implement federal Medicaid work requirements, with enforcement beginning May 1, 2026, Governor Jim Pillen announced during a press conference with...
www.1011now.com
December 17, 2025 at 8:38 PM
Happy holidays (not!) to Medicaid expansion enrollees in Nebraska as the state becomes the 1st state to "go early" on the new punitive work reporting requirement.
70,000 will receive notification in the next 2 weeks; sounds like disenrollments will start in May.
www.1011now.com/2025/12/17/l...
70,000 will receive notification in the next 2 weeks; sounds like disenrollments will start in May.
www.1011now.com/2025/12/17/l...
@georgetownccf.bsky.social is hiring! We are looking for a Research Fellow (JD or MA required) to work on a new project tracking the implementation of Medicaid work reporting requirements. This will be a two year position.
Details available here: ccf.georgetown.edu/about-us/jobs/
Details available here: ccf.georgetown.edu/about-us/jobs/
Jobs
CCF is Hiring! Research Fellow The Georgetown University Center for Children and Families is seeking a legal/policy analyst for a new project focusing on state implementation of new federally-mandated...
ccf.georgetown.edu
December 16, 2025 at 11:17 PM
@georgetownccf.bsky.social is hiring! We are looking for a Research Fellow (JD or MA required) to work on a new project tracking the implementation of Medicaid work reporting requirements. This will be a two year position.
Details available here: ccf.georgetown.edu/about-us/jobs/
Details available here: ccf.georgetown.edu/about-us/jobs/
My latest blog unpacks new guidance from federal CMS
on Medicaid work reporting requirements.
Most key questions remain unanswered just 12 months away from disenrollments starting.
ccf.georgetown.edu/2025/12/11/c...
on Medicaid work reporting requirements.
Most key questions remain unanswered just 12 months away from disenrollments starting.
ccf.georgetown.edu/2025/12/11/c...
CMS Guidance on Medicaid Work Requirements Leaves States Hanging
CMS released preliminary guidance on H.R. 1’s mandatory Medicaid work requirements on December 8. The much-anticipated guidance fell far short of answering all the questions states need answe…
ccf.georgetown.edu
December 12, 2025 at 9:09 PM
My latest blog unpacks new guidance from federal CMS
on Medicaid work reporting requirements.
Most key questions remain unanswered just 12 months away from disenrollments starting.
ccf.georgetown.edu/2025/12/11/c...
on Medicaid work reporting requirements.
Most key questions remain unanswered just 12 months away from disenrollments starting.
ccf.georgetown.edu/2025/12/11/c...
A few thoughts on new Medicaid work req guidance from CMS
Topline it says v. little so states remain in a bind with huge demands and little guidance to go on.
But some takeaways:
1. Confirms that states will have access to 90/10 fed match for new IT systems (vendors are 😀).
🧵
Topline it says v. little so states remain in a bind with huge demands and little guidance to go on.
But some takeaways:
1. Confirms that states will have access to 90/10 fed match for new IT systems (vendors are 😀).
🧵
The Trump Administration has released preliminary guidance on mandatory Medicaid work requirements. We will read and share thoughts soon here and on our website ccf.georgetown.edu
medicaid.gov/federal-poli...
medicaid.gov/federal-poli...
medicaid.gov
December 8, 2025 at 11:05 PM
A few thoughts on new Medicaid work req guidance from CMS
Topline it says v. little so states remain in a bind with huge demands and little guidance to go on.
But some takeaways:
1. Confirms that states will have access to 90/10 fed match for new IT systems (vendors are 😀).
🧵
Topline it says v. little so states remain in a bind with huge demands and little guidance to go on.
But some takeaways:
1. Confirms that states will have access to 90/10 fed match for new IT systems (vendors are 😀).
🧵
Reposted by Joan Alker
Sens Cassidy and Crapo are circulating a health proposal that would do little to address the premium spikes millions of ACA marketplace enrollees will face starting Jan 1, and would further increase many people’s out of pocket costs for health care over time. www.axios.com/2025/12/08/s...
Scoop: Senate GOP chairs circulate health plan as ACA subsidies hang in the balance
Two key Republican chairmen circulated the plan as the GOP struggles to unite around health policies.
www.axios.com
December 8, 2025 at 9:03 PM
Sens Cassidy and Crapo are circulating a health proposal that would do little to address the premium spikes millions of ACA marketplace enrollees will face starting Jan 1, and would further increase many people’s out of pocket costs for health care over time. www.axios.com/2025/12/08/s...
The Trump Administration has released preliminary guidance on mandatory Medicaid work requirements. We will read and share thoughts soon here and on our website ccf.georgetown.edu
medicaid.gov/federal-poli...
medicaid.gov/federal-poli...
medicaid.gov
December 8, 2025 at 9:36 PM
The Trump Administration has released preliminary guidance on mandatory Medicaid work requirements. We will read and share thoughts soon here and on our website ccf.georgetown.edu
medicaid.gov/federal-poli...
medicaid.gov/federal-poli...
Reposted by Joan Alker
45 leading organizations are speaking up for children too young to speak for themselves. They urge CDC to reject ACIP's hepatitis B recommendation and instead retain the current, evidence-based approach. #HealthPolicy @ameracadpeds.bsky.social @marchofdimes.org @acog.org
www.aap.org/en/news-room...
www.aap.org/en/news-room...
December 6, 2025 at 1:33 PM
45 leading organizations are speaking up for children too young to speak for themselves. They urge CDC to reject ACIP's hepatitis B recommendation and instead retain the current, evidence-based approach. #HealthPolicy @ameracadpeds.bsky.social @marchofdimes.org @acog.org
www.aap.org/en/news-room...
www.aap.org/en/news-room...
Great new report on re Ohio + implementing new Medicaid work reporting requirements from @communitysolutions.bsky.social
State estimates 22% of expansion group (172k people) most at risk of losing coverage due to need for documentation‼️
cdn.prod.website-files.com/65b81e782aad...
State estimates 22% of expansion group (172k people) most at risk of losing coverage due to need for documentation‼️
cdn.prod.website-files.com/65b81e782aad...
cdn.prod.website-files.com
December 1, 2025 at 7:59 PM
Great new report on re Ohio + implementing new Medicaid work reporting requirements from @communitysolutions.bsky.social
State estimates 22% of expansion group (172k people) most at risk of losing coverage due to need for documentation‼️
cdn.prod.website-files.com/65b81e782aad...
State estimates 22% of expansion group (172k people) most at risk of losing coverage due to need for documentation‼️
cdn.prod.website-files.com/65b81e782aad...
In a rare spot of good news from federal CMS, the Iowa Medicaid 1115 waiver (this is their Medicaid expansion) was just extended for 1 year and the waiver of the important non-emergency medical transportation (NEMT) benefit will sunset 12/31/26.
medicaid.gov/medicaid/sec...
medicaid.gov/medicaid/sec...
medicaid.gov
December 1, 2025 at 5:43 PM
In a rare spot of good news from federal CMS, the Iowa Medicaid 1115 waiver (this is their Medicaid expansion) was just extended for 1 year and the waiver of the important non-emergency medical transportation (NEMT) benefit will sunset 12/31/26.
medicaid.gov/medicaid/sec...
medicaid.gov/medicaid/sec...
Reposted by Joan Alker
Just calculated our 2026 health insurance premium on the DC health exchange. It will be nearly a **300%** increase. We’d have to pay $50,590 for a family of 3, for a mid-range plan. Insane.
November 25, 2025 at 10:14 PM
Just calculated our 2026 health insurance premium on the DC health exchange. It will be nearly a **300%** increase. We’d have to pay $50,590 for a family of 3, for a mid-range plan. Insane.
These are the ridiculous things that happen in our country when a child is uninsured. Even short gaps in coverage put families at risk of huge, devastating medical bills.
I've been working on this issue for 20+ years now and I am tired of reading stories like this. We can do better.
I've been working on this issue for 20+ years now and I am tired of reading stories like this. We can do better.
Ambulance companies often negotiate with patients over large bills. “But you shouldn’t have to work so hard for it,” says an Ohio mom who was billed $9,250 for her toddler’s transport between hospitals.
kffhealthnews.org/news/article...
kffhealthnews.org/news/article...
Not Serious Enough To Turn on the Siren, Toddler’s 39-Mile Ambulance Ride Still Cost Over $9,000 - KFF Health News
After her son contracted a serious bacterial infection, an Ohio mother took the toddler to a nearby ER, and staffers there sent him to a children’s hospital in an ambulance. With no insurance, the fam...
kffhealthnews.org
November 26, 2025 at 2:02 AM
These are the ridiculous things that happen in our country when a child is uninsured. Even short gaps in coverage put families at risk of huge, devastating medical bills.
I've been working on this issue for 20+ years now and I am tired of reading stories like this. We can do better.
I've been working on this issue for 20+ years now and I am tired of reading stories like this. We can do better.
My latest blog on the dismal situation for kids in Florida.
Over 43,000 have lost CHIP this year in violation of federal law. No signs of Trump Administration enforcing it.
And the Gov still has not implemented a bipartisan CHIP expansion passed 2.5 yrs ago
ccf.georgetown.edu/2025/11/25/f...
Over 43,000 have lost CHIP this year in violation of federal law. No signs of Trump Administration enforcing it.
And the Gov still has not implemented a bipartisan CHIP expansion passed 2.5 yrs ago
ccf.georgetown.edu/2025/11/25/f...
Florida Leaders Have Failed to Implement Bipartisan Plan Approved Over 2 Years Ago to Help Families Afford Health Insurance for Their Children
Florida’s children are more likely to go without health insurance than children in most other states. In a rare display of bipartisan unity, the Florida Legislature recognized the need to address t…
ccf.georgetown.edu
November 26, 2025 at 1:44 AM
My latest blog on the dismal situation for kids in Florida.
Over 43,000 have lost CHIP this year in violation of federal law. No signs of Trump Administration enforcing it.
And the Gov still has not implemented a bipartisan CHIP expansion passed 2.5 yrs ago
ccf.georgetown.edu/2025/11/25/f...
Over 43,000 have lost CHIP this year in violation of federal law. No signs of Trump Administration enforcing it.
And the Gov still has not implemented a bipartisan CHIP expansion passed 2.5 yrs ago
ccf.georgetown.edu/2025/11/25/f...
ICYMI we have a great new resource to track state readiness to implement Medicaid work reporting requirements.
Despite the failure of this policy, most states are mandated to adopt it by 1/1/27
See how your state stacks up on 8 key performance indicators
ccf.georgetown.edu/2025/08/28/t...
Despite the failure of this policy, most states are mandated to adopt it by 1/1/27
See how your state stacks up on 8 key performance indicators
ccf.georgetown.edu/2025/08/28/t...
November 18, 2025 at 7:50 PM
ICYMI we have a great new resource to track state readiness to implement Medicaid work reporting requirements.
Despite the failure of this policy, most states are mandated to adopt it by 1/1/27
See how your state stacks up on 8 key performance indicators
ccf.georgetown.edu/2025/08/28/t...
Despite the failure of this policy, most states are mandated to adopt it by 1/1/27
See how your state stacks up on 8 key performance indicators
ccf.georgetown.edu/2025/08/28/t...
The Trump Administration rescinded the public charge rule last night which is very troubling -- we will see more uninsured citizen children because of the ongoing efforts by the Trump Administration to threaten mixed status immigrant families.
pifcoalition.org/resources/pr...
pifcoalition.org/resources/pr...
Public Charge Proposal Puts Millions at Risk, Advocates Warn - Protecting Immigrant Families
EL PASO, TEXAS — The U.S. Department of Homeland Security (DHS) released a proposal Monday to rescind current regulations concerning administration of federal immigration law’s “public charge” provisi...
pifcoalition.org
November 18, 2025 at 4:51 PM
The Trump Administration rescinded the public charge rule last night which is very troubling -- we will see more uninsured citizen children because of the ongoing efforts by the Trump Administration to threaten mixed status immigrant families.
pifcoalition.org/resources/pr...
pifcoalition.org/resources/pr...
While Medicaid is by far the biggest player for children's coverage, the Marketplace has become increasingly important.
New brief from @urbaninstitute.bsky.social finds that 453,000 children will become uninsured if subsidies expire.
ccf.georgetown.edu/2025/11/14/n...
New brief from @urbaninstitute.bsky.social finds that 453,000 children will become uninsured if subsidies expire.
ccf.georgetown.edu/2025/11/14/n...
New Data Highlight Risks to Children and Parents if Enhanced Marketplace Subsidies Expire
Marketplace subsidy enhancements which have been in place since 2021 are set to expire at the end of December 2025, and their fate is currently uncertain. Since 2014, when Affordable Care Act (ACA)…
ccf.georgetown.edu
November 18, 2025 at 4:40 PM
While Medicaid is by far the biggest player for children's coverage, the Marketplace has become increasingly important.
New brief from @urbaninstitute.bsky.social finds that 453,000 children will become uninsured if subsidies expire.
ccf.georgetown.edu/2025/11/14/n...
New brief from @urbaninstitute.bsky.social finds that 453,000 children will become uninsured if subsidies expire.
ccf.georgetown.edu/2025/11/14/n...
Important finding: 18% of immigrant parents report they’re avoiding signing up for government health care and other programs
This is the “chilling effect” in action which will lead to more uninsured kids
1/4 kids in U.S. have an immigrant parent; most kids are citizens
www.kff.org/immigrant-he...
This is the “chilling effect” in action which will lead to more uninsured kids
1/4 kids in U.S. have an immigrant parent; most kids are citizens
www.kff.org/immigrant-he...
KFF/New York Times 2025 Survey of Immigrants: Health and Health Care Experiences During the Second Trump Administration | KFF
This report, based on a KFF/New York Times survey from fall 2025, provides data on health and health care experiences of immigrant adults ages 18 and over in the current policy environment. Four in te...
www.kff.org
November 18, 2025 at 3:10 PM
Important finding: 18% of immigrant parents report they’re avoiding signing up for government health care and other programs
This is the “chilling effect” in action which will lead to more uninsured kids
1/4 kids in U.S. have an immigrant parent; most kids are citizens
www.kff.org/immigrant-he...
This is the “chilling effect” in action which will lead to more uninsured kids
1/4 kids in U.S. have an immigrant parent; most kids are citizens
www.kff.org/immigrant-he...
Our 20th anniversary @georgetownccf.bsky.social conference is a wrap with a surprise visit from Georgetown University’s official mascot Jack the Bulldog! He was a big hit.
W/ beloved colleagues Tricia Brooks and @edwincpark.bsky.social
W/ beloved colleagues Tricia Brooks and @edwincpark.bsky.social
November 15, 2025 at 2:22 PM
Our 20th anniversary @georgetownccf.bsky.social conference is a wrap with a surprise visit from Georgetown University’s official mascot Jack the Bulldog! He was a big hit.
W/ beloved colleagues Tricia Brooks and @edwincpark.bsky.social
W/ beloved colleagues Tricia Brooks and @edwincpark.bsky.social
Last day of our annual conference and we’re focusing on maternal health. Medicaid expansion, which is now under attack, has been a game changer for women of reproductive age.
November 14, 2025 at 9:15 PM
Last day of our annual conference and we’re focusing on maternal health. Medicaid expansion, which is now under attack, has been a game changer for women of reproductive age.