Coverage Losses and HCBS Policy Tracking
Health insurance coverage is once again leading in the news, with new accusations of fraud prompting the cancellation of coverage for 760,000 ACA enrollees. CMS has yet to release data backing these claims. This action comes off the heels of the 2025 General Accountability Office (GAO) report that showed an ongoing risk of brokers setting up fake enrollee accounts, with subsidies being paid to insurers on their behalf.
The administration has repeated a concern about the number of enrollees who haven’t used their insurance in the previous coverage year, i.e. they didn’t file any claims. It is important to note that more affordable insurance premiums are made possible by the need for a large pool of enrollees, where a high percentage of those individuals may use little to no coverage in a year. For people with higher rates of health care usage, including many disabled people, having affordable coverage is partially made possible by the balancing of the health insurance risk pool with these low/no usage consumers. Having low health care utilization is not the same as insurance fraud. It is unclear how many of the recently cancelled plans belonged to real people. If anyone you are working with has had their coverage cancelled or wonders if they did, there are steps you can take to check and appeal that decision if necessary.
These developments come after 2.2 million Americans already lost ACA coverage following the expiration of enhanced premium tax credits in 2025. CBPP’s Health Coverage Tracker shows these changes in coverage since the 2025 policy changes started going into effect. Meanwhile, the Census Bureau has recently released 2025 data pertaining to health insurance coverage nationwide. The Center on Budget and Policy Priorities (CBPP) has advised that this data may not reflect the full impact of HR1, which has yet to fully go into effect with Medicaid Work Requirements starting nationwide in January. In Nebraska, an earlier roll-out of work requirements is showing an increase in coverage denials, even without the new medical frailty rules in place.
New HCBS Resources for Advocates
Medicaid Home and Community-Based Services (HCBS) are what make community living possible for thousands of people across the United States. The Modern Medicaid Alliance has a new explainer on the importance of Home and Community-Based Services funding under Medicaid.
The Disability Rights Education & Defense Fund (DREDF) just released a guide explaining how community living and integration has been supported and defended in public life to date. It also offers an update on the federal changes that threaten to undermine independent living. When supporting someone with their Medicaid application, you’ll want to affirm that disability civil rights laws that protect community living are still in place, and offer support in accessing the available HCBS programs in your state. Check out this Medicaid directory to search for the HCBS programs available in your state.
- Interactive HCBS Policy Action Tracker, Trends Dashboard: To understand the trends impacting HCBS, explore the HCBS Policy Action Tracker developed by George Washington University for a visualization of the changes affecting home care nationwide. A mix of cuts and increases to Home and Community-Based Service programs are underway. This data is collected and presented by the HCBS Impacts Tracker Project, which features a comprehensive Google Sheet showing updated information about HCBS changes that are being proposed and enacted.
- The Caregiving Compendium: Policy Solutions to Support Family Caregivers: The National Academy of Social Insurance presented a webinar on the policy solutions that can support family caregivers. Check out the Caregiving Compendium Congressional briefing recording to learn about how care can be better supported as a critical part of the social insurance ecosystem in our nation. A new report from the General Accountability Office just asserted that unpaid caregiving would amount to over $1 trillion in market value if it was properly compensated. Valuing and supporting family caregivers is one important way to make HCBS possible.
- What to Know About the New 1915(c)(11) Waiver Authority: A new Medicaid waiver authority has been authorized under H.R. 1. Watch the HSRI Grassroots Project webinar on the new 1915(c)(11) waiver authority for an update on changes to HCBS happening this year. In this presentation, you’ll learn about this waiver’s focus, and the implementation steps for states.
Health Insurance 101 for Consumers
What’s the problem with health insurers? A new 3-part video series from KFF looks closely at the complicated question of health insurance affordability in our broader health system. Encourage your healthcare enrollees to watch this series to learn more about why premiums are increasing, and why prior authorization impacts care availability.
The NDNRC Newsletter is published weekly. Archives of our weekly updates are available on the NDNRC website. This newsletter is supported by the American Association on Health and Disability (AAHD). Sign up to become an AAHD member today to support ongoing projects like this.