Advantage+ Medicaid Policy Summit: Key Takeaways from Module 1 

The inaugural Advantage+ Medicaid Policy Summit, hosted by Artia Solutions—Powered by Petauri, brought together policy experts, state officials, manufacturers, and market access leaders for a one-day virtual event focused exclusively on the evolving Medicaid policy and drug pricing landscape. The Summit tackled everything from HR1 implementation and state budget realignment to 340B, Prescription Drug Affordability Boards, the Inflation Reduction Act, PBM reform, and the growing role of AI in Medicaid operations. This article focuses on the first module of the day, Medicaid Policy Foundations & Legislative Update, which set the tone for the rest of the day. 

The Ground Has Shifted 

The first module of the day was framed as a Medicaid refresher. It was really something else: a clear-eyed argument that the assumptions the industry has been operating under for the last decade no longer hold. Moderated by Michael Garner, Vice President of Policy & Strategy, with panelists Matt Dull (Co-President), Jackie Menzel (Senior Director, Policy & Strategy), and Sarah Lott (Analyst II, Policy & Strategy), the presentation made the case that Medicaid is entering a fundamentally different era.  

The most quotable line came from Jackie Menzel: “If the time after the Affordable Care Act was one of expansion, we are now on to contraction, and states have to pull back their programs in order to deal with budget deficits and federal cuts.”  

That framing matters. For over a decade, the operating assumption has been that Medicaid grows. It gets broader. It covers more people and more services. Strategies were built on that premise.  

That world is done. States have begun preparing for 2027 enrollment and eligibility changes, with California freezing undocumented adult enrollment and Nebraska implementing work requirements early.  

 

HR1: The Numbers That Change Everything 

The scale of the cuts is what lands hardest. Matt Dull put it in perspective: “Over $900 billion of federal funds are going to be taking out of the Medicaid program over the course of the next 10 years.” For context, “Total Medicaid expenditures in 2025 were 931 billion.”  

 The cut, spread over ten years, is roughly equivalent to one full year of current Medicaid spend. Cuts of this magnitude will reshape Medicaid, forcing states to make difficult decisions, especially as they overhaul how federal funding is secured to comply with new requirements.  

And it leaves states with only a handful of levers. “They typically fall into three options. One is reducing provider reimbursement rates or reducing or eliminating optional services or benefits or even restricting enrollment.”  

Optional benefits at risk include “dental coverage, adult vision, and non-emergency medical transportation. You could see some of the home and community-based long term care services be reduced or eliminated.”  

 

The Federal Perspective: Most of This Is Here to Stay 

Lauren Randall Buckley of Jeffrey J. Kimbell & Associates walked through the federal landscape. Michael Garner’s take on rollback prospects is worth sitting with. “It’s been very difficult to get congressional action. Once these get put into statute, unless litigation or other issues occur that nullify parts of it, trying to get something outside of the budget reconciliation process is going to be very difficult to unwind. Most of this is here to stay for a while.”  

The key figures from Lauren’s session tell the story: nearly $1 trillion in federal spending reductions; non-pregnant adults aged 19 to 64 who are not entitled to or enrolled in Medicare as the applicable individuals under community engagement; and litigation from 25 states and two governors challenging community engagement work requirements.  

Lauren also raised the medical frailty question that manufacturers haven’t fully processed. “There’s nothing I’m aware of in the rule that ties use of a particular medication to becoming a specified excluded individual under medical frailty.”  

Michael was direct about the downstream access implication. “To me, it raises a real access question as well. Do these ultimately put pressure on provider rates, especially for specialists, and do they simply ask: ‘Can I do it [see Medicaid patients] anymore without these higher reimbursements?’” 

 

1115 Waivers: The Old Playbook Is Gone 

One of the most consequential and least-covered pieces of HR1 concerns 1115 demonstration waivers. Jackie described the shift: “Prior to HR1, getting these approved was a policy negotiation with CMS. But under HR1, it’s an actuarial certification by the CMS chief actuary.”  

Her bottom line: “States are going to have to administer their programs much closer to the Medicaid statute, and there’s going to be less ability to innovate.”  

For manufacturers who have built strategies around state flexibility and demonstration innovation, that’s a significant shift in the risk equation. 

 

The Big Themes 

Boiled down, the first module of the day ended on a few themes worth carrying into the rest of the year: 

• Expansion is over. Contraction is here. Every strategy built on Medicaid growth needs a stress test. 

• Optional benefits are on the chopping block. Dental, vision, non-emergency medical transportation, and home and community-based services are all vulnerable. 

• State flexibility is narrower than it’s been in decades. The 1115 waiver era of experimentation is done. 

• Manufacturer access risk is rising, especially for specialty and rare disease. There’s high risk for chronic and mental health drugs because HR1 has the most impact on the Medicaid expansion population. Medical frailty exemptions are unclear, and rate pressure on specialists is real. 

• Rollback is unlikely. Most of this is here to stay. 

 

Interested in diving deeper into what was discussed during this session? Advantage+, Artia’s policy and strategy service, goes beyond providing a broad overview of Medicaid policy by analyzing how changes play out in individual states. Since each state has unique infrastructure and policy mechanics, the effects and responses to Medicaid changes vary widely. These differences also influence pharmaceutical product portfolios in distinct ways. For example, the implications for chronic disease drugs differ greatly from those for rare disease cell and gene therapies.  

With Advantage+, you’ll gain tailored insights into how evolving Medicaid policies specifically impact your products and strategic decisions. Reach out to the Policy & Strategy team at Artia Solutions—Powered by Petauri to learn more.