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SNA Public Policy News You Can Use – June 9, 2026

CMS Releases Community Engagement Requirement Interim Final Rule

On June 1, the Centers for Medicare & Medicaid Services (CMS) released the long-awaited interim final rule (IFR) on Medicaid Community Engagement Requirements (CER). Starting January 1, 2027, the One Big Beautiful Bill Act (OBBBA) will require certain individuals covered under the Medicaid expansion population, or through a comparable section 1115 waiver, to participate in community engagement activities. Major provisions in the IFR include the following:

  • Several groups are excluded from the requirement entirely, including pregnant individuals, veterans with a total disability rating, caregivers of young children or disabled individuals, former foster youth, American Indians and Alaska Natives, and those who are medically frail, among others.
  • Individuals can satisfy the requirement by working, volunteering, or participating in a work program for at least 80 hours a month, enrolling in an educational program at least half-time, or earning income equivalent to 80 hours at the federal minimum wage.
  • States have the option to provide temporary exceptions for individuals facing short-term hardships, such as a medical hospitalization, a presidentially declared disaster in their county, or high local unemployment rates.
  • States must verify compliance at application and renewal, and must give individuals 30 days to demonstrate they meet the requirement or qualify for an exemption before disenrolling them, with the option to reapply if coverage is lost.

This IFR constitutes one of the most significant modifications to the Medicaid program since the Affordable Care Act (ACA) and ranks among the most substantial Medicaid regulations in years. Comments are due on the rule by July 31, 2026. Healthsperien published a comprehensive summary of the rule and its implications, which can be found here.

Federal Momentum Behind Assisted Spelling for Autism Therapy

The Department of Health and Human Services (HHS) is facing growing pressure to fund “assisted spelling”– a communication method for nonverbal autistic individuals- despite the absence of scientific consensus supporting its efficacy. HHS Secretary Robert F. Kennedy Jr. appointed two self-described “spellers” to a 20-member federal autism advisory panel, which passed a resolution urging HHS to reimburse training in assisted spelling for individuals who request it. The technique involves nonverbal individuals pointing to letters on a board or keyboard while someone else holds or supports the board. Supporters argue it has unlocked communication for thousands of severely autistic people, but leading professional groups for autism science, as well as those representing psychologists and speech pathologists, point to research showing these methods are flawed or fraudulent, noting that the board holder may be consciously or unconsciously influencing the words, much like a Ouija board. 

Critics take issue with money being diverted away from interventions grounded in science to instead be used for debunked therapies, especially in an already underfunded disability landscape. They also have concerns that recipients of this therapy are not given access to evidence-based autism education. About a quarter of all autism diagnoses in the U.S. are considered severely autistic, meaning they need round-the-clock care or are mostly nonverbal. This is the latest in a long line of unproven autism treatments that the Make American Health Again (MAHA) movement has promoted, including camel milk, broccoli extract, stem cell injections obtained in Panama and India, hyperbaric oxygen chambers, and metal-leaching chemical infusions. This development carries significant implications for special education funding and Medicaid reimbursement policy, and the debate over its authenticity is already playing out in boards of education and courtrooms across the country where parents of nonverbal autist children are seeking funding for their children’s spelling lessons.

White House Proposes Rules Giving Political Appointees Control Over Federal Grants

The White House Office of Management and Budget (OMB) recently published a proposed rule that would give Trump administration officials greater authority over federal grant making. The more than 400-page proposal would require “senior appointees” at federal agencies to review and approve all discretionary grants, codifying a process the administration has already been carrying out since taking office. The rules would allow officials to cancel or deny grants deemed inconsistent with the president’s executive orders and policy priorities, a shift that critics say would replace the traditional scientific peer-review process with political loyalty. 

The proposal includes several other notable provisions, including bans on grants related to DEI initiatives, gender-affirming care, and voter registration activities, while also prohibiting agencies from excluding faith-based organizations from consideration. Notably absent from the proposal was an expected cap on indirect research cost reimbursement rates at 15 percent, which courts and Congress had previously blocked. However, the rules would generally prohibit the use of indirect cost funding for publishing articles in scientific journals, except in limited circumstances.

Study Analyzes Success of Ballot-Driven Medicaid Expansion

Since 2019, nine additional states have adopted the ACA’s optional Medicaid expansion, with seven of those expansions driven by voter ballot initiatives in Idaho, Maine, Missouri, Nebraska, Oklahoma, South Dakota, and Utah. This study found that these ballot-driven expansions increased Medicaid enrollment by 3.2 percentage points for nonelderly adults and reduced uninsurance by 2.2 percentage points. These gains were even more pronounced among low-income adults, who saw an increase in Medicaid coverage of 10.1 percentage points and a reduction in uninsurance by 6.2 percentage points. The coverage impacts were comparable to earlier conventional Medicaid expansions enacted by legislatures. 

While supporters argue that ballot initiatives better reflect public opinion, these expansions often faced resistance from elected officials who sought to delay, limit, or undermine implementation efforts. Before H.R.1 mandated work requirements, legislators in six of the seven ballot-expanded states promptly sought 1115 waivers to implement work requirements for their new Medicaid enrollees. Future ballot-driven expansions face significant structural barriers; Florida and Wyoming are the only remaining non-expansion states where the ballot initiative pathway exists, and each has a higher voting threshold for passage than previous efforts. Nevertheless, the findings affirm that direct democracy can be an effective tool for advancing health coverage in states where partisan politics have blocked legislative action

House Moves to Maintain SAMHSA Amid HHS Funding Cuts

The House has proposed its draft Health and Human Services (HHS) fiscal 2027 spending bill. The bill proposes to maintain funding for HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA), directly opposing a request from the administration to wholly eliminate the agency and absorb its function elsewhere.  

Despite maintaining the HHS’s current structure and protecting SAMHSA, significant cuts have been proposed. The draft bill would cut $33 million from mental health services, $21 million from substance use treatment services, and $37 million from substance use prevention services, totaling a $91 million reduction to SAMHSA funding. Other proposals in the HHS funding bill cut $2 billion for operating the Affordable Care Act (ACA) marketplace, eliminate funding for the Agency for Healthcare Research and Quality entirely, and reduce funding for the Centers for Disease Control and Prevention (CDC).  The cuts total a 4% reduction in DHHS funding. One notable exception to this trend is the bill’s proposed addition of $100 million to the National Institutes of Health (NIH) for health research. Democrats on the Appropriations Committee have released a memo attesting that the proposed spending bill and associated funding cuts will put the care of millions of Americans at risk. 

The Senate is working on its own HHS appropriations bill and will need to reconcile funding numbers with the House before it can be passed and signed into law.

What’s on Tap

Both chambers of Congress return to session this week, following the Senate’s passage of $69.5 billion budget reconciliation package to fund Immigration and Customs Enforcement (ICE) and Border Patrol through 2029. The House is expected to take up the package this week, where it is expected to pass and head to the President’s desk. The delay in passing the funding bill largely stemmed from the Department of Justice’s (DOJ) efforts to include a $1.8 billion fund to pay people they say were wrongly prosecuted by the Biden Administration’s DOJ. With the House taking up the legislation in the coming days, the end of the several months long fight over the Department of Homeland Security (DHS) funding is finally coming to a close after the longest shutdown in the Department’s history. Democrats delayed funding for DHS earlier this year after ICE activities led to the deaths of two U.S. citizens, resulting in a funding lapse of 76 days. 

Despite the reconciliation package to fund the remainder of DHS still needing to be advanced out of the House, several prominent GOP leaders have already begun laying the groundwork for a third reconciliation package ahead of the August recess. Unlike the package set to pass this week in the House, this hypothetical third reconciliation bill would be more akin to the first reconciliation package passed by this Congress – which resulted in the One Big Beautiful Bill Act. Republicans have indicated that they see this package as one of the final opportunities to advance priorities of the Trump Administration ahead of the midterm elections. Speaker Johnson (R-LA) has described the forthcoming package as a vehicle to target fraud, waste and abuse in the federal government. While there seems to be general support for such a legislative effort amongst the GOP conference, Speaker Johnson continues to grapple with a razor thin majority of two seats. Lawmakers also only have around six working weeks left before the August recess, in addition to members of Congress having to focus on their midterm elections as well. In parallel, both chambers still need to pass the majority of the FY2027 appropriations bills. 

The Trump Administration continued to wage its war on fraud in federal and state health programs last week, with the Department of Health and Human Services (HHS) Office of the Inspector General announcing it would not recertify Hawaii’s Medicaid Fraud Control Unit (MFCU). HHS cited the Hawaii MFCU not obtaining any indictments or convictions since 2022 as its rationale for choosing not to recertify the fraud-fighting department. The Trump Administration also noted that the state’s Medicaid funding had risen by 27 percent and the program’s enrollment also rose by 40 percent in that same time period but saw no increase in convictions. In response, Hawaii Attorney General Anne Lopez noted that their MFCU recovered more than $14 million in settlements and recoveries since 2021, in addition to filing criminal charges early this year against two people. The decision from HHS is closely followed by a House Budget Committee markup today on several anti-healthcare fraud bills, including one that would grant the federal government the authority to pause and segment payments, and require agencies to take corrective action prior to certifying a payment voucher if there is an identified risk of fraud or improper payment that would result in financial loss.

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