A LOOK AT NEW OR EXPANDED MEDICAID AND PUBLIC HEALTH PARTNERSHIPS FROM 2025: FINDINGS FROM A SURVEY OF STATE MEDICAID PROGRAMS

The following information was released by the Henry J. Kaiser Family Foundation:

Authors: Alisha Rao, Anna Mudumala, Elizabeth Hinton, and Cory Caldwell

Introduction

Medicaid is the primary program providing comprehensive coverage of health care to about 80 million low-income people in the U.S. Medicaid is an insurance program, not a population health system. It can only fund services for eligible individuals. The public health system in the U.S. is decentralized, with most authorities and programs delegated to the state and local levels. State and local public health agencies are responsible for protecting community health through surveillance, disease prevention, and policy development and enforcement. Local health departments frequently focus on service delivery (immunizations, screenings, maternal health, environmental health) and community outreach to address local health needs. Public health serves entire communities, not just insured individuals.

Medicaid agencies and state/local public health agencies work to advance the health of their communities, often with similar priorities serving common populations. However, there is often a lack of strong and sustained partnerships between Medicaid and public health agencies. Strengthening collaboration between Medicaid and public health could improve safety net services, help coordinate and leverage resources and financing, improve intervention targeting and outreach, and reduce system fragmentation.

To improve understanding of Medicaid and Public Health agency partnerships, the 25th annual Medicaid budget survey, conducted by KFF and Health Management Associates (HMA) in collaboration with the National Association of Medicaid Directors (NAMD), asked state Medicaid directors about new or enhanced initiatives involving public health implemented in FY 2025 or planned for FY 2026 across the following domains. (The survey did not capture the full scope of established Medicaid and Public Health agency partnerships across states, including initiatives implemented or expanded before FY 2025 FY 2026, nor all activity within these domains as states select which efforts to report.)

More than three quarters of responding states1 reported at least one new or expanded initiative implemented in FY 2025 or planned for FY 2026 (see Appendix), with maternal and child health and behavioral health emerging as areas of focus for newly implemented or expanded Medicaid and Public Health initiatives. Initiatives frequently fell into common areas, including data sharing, rural-focused initiatives, initiatives to improve access, and workforce initiatives.

Findings

States were asked to report only new or expanded Medicaid and Public Health initiatives implemented in FY 2025 or planned for FY 2026 under specific domains. Therefore, initiatives summarized and reported here do not represent a comprehensive look at all initiatives currently in place across states. State counts are not identified in the sections below, as open-ended questions often lead to underreporting. See Appendix for additional (high-level) state-by-state detail.

To track common themes across domains, state responses have been summarized (at a high-level) under the following subheadings, as applicable: "data sharing," "rural," "workforce," "access," and "other." State examples are included in text boxes under each domain. While the survey asked about workforce initiatives separately, "workforce" also emerged as a theme applicable to other domains. These initiatives are only summarized once (e.g., do not appear under the separate "workforce" domain if they also fell under another domain).

Maternal and Child Health

Conception through early childhood represents an important period for intervention to promote long-term health and other outcomes. More than one in four Medicaid/CHIP enrollees is a female in their reproductive years. Medicaid is the primary payer for about 41% of all births and provides coverage for 37% of all children in the U.S. Public health agencies often oversee maternal and child health surveillance, prevention, and early childhood initiatives to improve outcomes and reduce gaps in health outcomes and access.

States reported new or expanded maternal and child health initiatives in the following areas:

Data sharing. States reported cross-agency data sharing initiatives to strengthen maternal and child health surveillance.

Rural. States reported collaborative efforts to address rural maternal health needs, as individuals in rural areas face access challenges (lack of local obstetric services) and geographic barriers.

Workforce. Statesmentioned collaborating with public health agencies to certify and support community health workers (CHW), including doulas and other perinatal providers.

Access.

Transforming Maternal Health Model. States reported collaborating with public health agencies on implementing CMS's Transforming Maternal Health Model (TMaH), identifying collaboration as important to developing strategies to direct resources / interventions to high-need communities. CMS's TMaH model supports state Medicaid agencies in implementing evidence-based strategies to expand access to maternal care, integrate behavioral health and social determinants of health, and ensure care continuity in the postpartum period.2

Coverage expansions. States pointed to expansion of Medicaid coverage of maternal and child health services, such as doula and lactation services. Some described partnering with public health agencies to inform coverage expansions through shared data and collaborative program design.

MH/SUD expansions. States highlighted initiatives to integrate and/or expand mental health (MH) and/or substance use disorder (SUD) services for pregnant and parenting populations, including home visiting services for pregnant and postpartum individuals.

Other.

Interagency workgroups. States described leveraging interagency workgroups and committees to facilitate coordination and to advance maternal and child health priorities, including improving outcomes and addressing complex factors (e.g., social needs) that a single agency can't solve alone.

Box 1: State Examples of Maternal and Infant Health Initiatives

Data Sharing:

The Oklahoma Medicaid Birth Certificate Linkage Project is supported by an interagency agreement between the Oklahoma Health Care Authority (the state agency that administers the Medicaid program) and the Oklahoma State Department of Health. The project links vital records (birth certificate) data to Medicaid data to provide a more complete picture of pregnancy and birth outcomes of Medicaid enrollees.

Rural:

As part of a two-year HRSA-funded Maternity Care Deserts Policy Academy run by the National Academy for State Health Policy (NASHP), Kentucky Medicaid is working with the state's Department of Public Health to identify maternity care deserts in the state and to develop solutions to connect pregnant individuals to care. (Maternity care deserts are places with no hospitals or birth centers offering obstetric care and no obstetric providers.) The Kentucky Perinatal Quality Collaborative and other state organizations are also involved.

Workforce:

Massachusetts reported providing training and technical assistance to MassHealth (Medicaid) providers to support maternal health initiatives, including efforts to strengthen care coordination and outreach and to support implementation of state maternal health legislation (enacted in 2024) that aims to expand access to midwifery, birth centers, doulas, and postpartum home visiting services.

Access:

California's Department of Health Care Services was awarded $17 million in federal funding to implement CMS's Transforming Maternal Health Model in five counties in the Central Valley. The model will provide funding to transform three key areas: access to care, infrastructure, and workforce; quality improvement and safety; and whole person care delivery (i.e., customized care to meet an individual's unique needs). The Department of Health Care Services will work with managed care plans, providers, community-based organizations, and other partners to implement the model and to ensure alignment with the state's Birthing Care Pathway initiative, a broader statewide effort to improve maternity care and outcomes.

To improve maternal health outcomes, Illinois added doula and lactation support services (without requiring physician referral) to its Medicaid coverage. The Department of Public Health supported the coverage expansion, highlighting differences in maternal health outcomes by race and ethnicity in the state.

Louisiana reported the state Department of Health launched Project M.O.M. (Maternal Overdose Mortality) in May 2025. Project M.O.M. aims to reduce pregnancy-associated opioid overdose deaths through early identification and treatment of substance use disorder during pregnancy. The project will convene hospital and community partners and aims to align managed care plans and health care providers to improve access to care and treatment coordination.

Montana Medicaid is partnering with state public health to implement targeted case management and evidence-based home visiting for pregnant and postpartum individuals and parents of children ages 0-5 who meet high-risk criteria, including mental health/SUD criteria.

Other:

Arizona reported that its Medicaid agency will continue to strengthen its relationship with the state Department of Health Services through ongoing participation in health-focused workgroups and committees, including the Maternal Mortality Review Committee, Congenital Syphilis Collaborative, Perinatal and Infant Health Committee, Home Visiting Workgroup, among other groups and committees.

Children/Youth Mental Health

Early childhood and adolescence are important developmental periods that can influence long-term health. In recent years, there have been growing concerns about children's mental health and well-being. Medicaid provides health coverage for 37% of children in the U.S. and plays a significant role in funding school-based behavioral health services. Nearly one in five students attending public schools in the U.S. use school-based mental health services, underscoring how schools serve as an important access point for youth mental health treatment. Public health agencies may be involved in assessing the status of statewide and community early childhood mental health, developing policy and programming for youth and caregivers, encouraging participation in mental health programs, and partnering to maintain school-based behavioral health services.

States reported new or expanded children/youth mental health initiatives in the following areas:

Workforce. States reported working with public health agencies to connect PCPs to psychiatrist consultations, including initiatives specifically targeting rural areas.

Access. Statesreported collaborating with public health agencies on maintaining and increasing access to school-based services, which offer a convenient setting for delivering health services to students (overcoming transportation and other barriers), including mental health services.

Box 2: State Examples of Children/Youth Health Initiatives

Workforce:

Kentucky's Medicaid agency reported working with the Kentucky Department of Public Health on "KY MARK," an initiative that helps PCPs better manage children's mental health issues by partnering with University systems to connect primary care providers to child psychiatrists. The program aims to help PCPs develop the skills to treat/manage mental and behavioral health needs.

Access:

Massachusetts' Medicaid agency reported working with the state Department of Health on implementing school-based services and on conducting outreach. The Department of Health operates school-based health centers that provide comprehensive primary care and behavioral health services. The state's Medicaid program covers these services for Medicaid eligible youth.

New Hampshire reported cross-agency work to strengthen the system of care for children with behavioral health needs, aiming to create a comprehensive, coordinated network of behavioral health services and supports for children and families.

Opioid Use Disorder (OUD)

Opioids were involved in over 79,000 deaths in 2023. The opioid epidemic's impact remains widespread, with nearly three in ten adults (29%) reporting in a 2023 KFF poll that they or a family member experienced an opioid addiction. Medicaid is the primary source of coverage for adults with opioid use disorder (OUD), covering nearly half of all adults with OUD, over two-thirds of those receiving outpatient OUD treatment, and more than half of those receiving medication-based treatment. Public health departments have worked to reduce opioid overdoses through harm reduction strategies (e.g., naloxone distribution, fentanyl test strip distribution, syringe services) and data surveillance. The Centers for Disease Control (CDC) funds state and local health departments for drug overdose surveillance through its Overdose Data to Action (OD2A) program.

States reported new or expanded OUD initiatives in the following areas:

Data sharing. States reported engaging public health partners in strategic planning and data sharing initiatives (e.g., matching Medicaid records with OUD data) to understand state and local OUD impacts and prevent future OUD deaths.

Access. States reported initiatives focused on addressing opioid use disorder among pregnant and parenting populations. These initiatives have been captured and discussed under the "Maternal and Child Health" domain above.

Box 3: State Examples of Opioid Use Disorder Initiatives

Data Sharing:

Arizona reported data sharing with the public health agency's drug overdose fatality review committee that works across state agencies to determine how system changes may help prevent overdose deaths.

DC reported matching and sharing Medicaid records with OUD death data to engage public health partners in strategic planning.

Lead Screening

Exposure to lead can seriously harm a child's health, including damage to the brain and nervous system, which may lead to slow growth and development, learning and behavior problems, and hearing and speech problems. The federal government has estimated that more than half of children with elevated blood lead levels are eligible for Medicaid. Federal law requires that all children enrolled in Medicaid receive blood lead screening tests at age 12 months and 24 months. In addition, children between 36 and 72 months with no record of a previous blood lead screening test must receive one. While Medicaid cannot be used to abate or for remediation of environmental damage, states are required to provide medically necessary diagnostic and treatment services for children identified with elevated blood lead levels. Medicaid programs can leverage public health expertise in outreach, education, surveillance, and data analysis, strengthening identification of populations at risk of lead exposure and expanding the reach and effectiveness of Medicaid services.

States reported new or expanded lead screening initiatives in the following areas:

Data sharing. States described maintaining data-sharing agreements with public health agencies to monitor lead screening rates, close care gaps, and better coordinate interventions.

Other. States reported working with public health agencies to develop lead screening guidance for providers and/or managed care plans.

Box 4: State Examples of Lead Screening Initiatives

Data Sharing:

Maines Medicaid and public health agencies share blood lead level testing data and coordinate technical assistance and communications to PCPs to increase blood lead testing rates. The Medicaid agency incorporated blood lead testing into an alternative payment model for primary care services (called Primary Care Plus) that emphasizes primary care quality and incentivizes providers to improve testing, screenings, and immunizations, including blood lead testing for children enrolled in Medicaid.

Other:

Arizona reported thatitsMedicaidagency works closely with the state Department of Health's elevated blood lead level program to increase screening rates, identify children with elevated blood lead levels, and provide information to managed care plans for follow-up testing and treatment.

DC reported its Healthy Homes Program and Childhood Lead Poisoning Prevention Program moved from its Department of Energy and Environment to the DC Department of Health, streamlining efforts in risk mitigation from lead poisoning, asthma, and pest infestation, providing comprehensive home assessments and case management in one place, ensuring a closer link between environmental housing factors and direct public health intervention.

Wisconsin reported that public health staff are routinely included in Medicaid agency meetings with managed care plans to help identify potential quality improvement activities, including activities related to lead screening and environmental intervention.

Infectious Disease

Infectious diseases threaten public health, causing morbidity, mortality, and economic disruption. Recent outbreaks of vaccine-preventable and emerging diseases highlight the need for coordinated prevention, surveillance, and response efforts. States are required to provide comprehensive preventive care to children through the EPSDT benefit. States are required by (federal) law to cover certain preventive services for adults eligible under the ACA's Medicaid expansion. Medicaid plays a key role in disease prevention by facilitating access to vaccines for children, adolescents, and adults. CMS and the Centers for Disease Control and Prevention (CDC) jointly run the Vaccines for Children program, which provides vaccines to Medicaid and CHIP-enrolled youth. State and local public health agencies lead disease surveillance, outbreak response, and vaccine administration. They provide guidance, education, and outreach to high-risk populations, coordinating with Medicaid to ensure prevention efforts reach eligible individuals

States reported new or expanded infectious disease initiatives in the following areas:

Data sharing. States reported collaborating with state public health agencies on disease-specific efforts (e.g., sharing and analyzing HIV data to guide outbreak response and enhance access to care) as well as broader data sharing initiatives with public health agencies to improve coordination and population health monitoring.

Workforce. States reported collaborative initiatives, including training and service coordination, to strengthen the local response capacity of public health teams and clinical providers.

Access. States highlighted cross-agency efforts aimed at maintaining vaccine access and aligning coverage policy with public health recommendations.

Box 5: State Examples of Infectious Disease Initiatives

Data Sharing:

DC's Medicaid agency shared data with DC Health to support continuity of care for individuals with HIV following implementation of Medicaid eligibility policy changes effective January 1, 2026 that resulted in coverage changes for certain adults.

The North Carolina Division of Public Health's Immunization Registry is collaborating with the state's Health Information Exchange (HealthConnex) to draw patient immunization data into the registry. This integration allows providers to access a consolidated record of immunizations administered across the state, regardless of where the vaccines were given.

Workforce:

Maine's Medicaid agency reported working closely with the Public Health agency on HIV outbreak response to coordinate services and training for local response teams and providers.

Workforce

Health care provider shortages can reduce access to care and lead to poor health outcomes. Provider shortages are a particular challenge in low-income and rural communities. Community health workers (CHWs), doulas, and other community-linked providers, often play a role in bridging gaps in care, connecting individuals to services, and addressing health related social needs. Medicaid provides coverage for eligible enrollees by reimbursing providers directly for services or paying managed care plans to deliver services. Public health agencies provide significant safety net clinical care, operating at the state and local level and often bridging gaps in care for underserved populations, including the uninsured.

States reported new or expanded workforce initiatives in the following areas:

Rural. States reported collaboration on workforce initiatives spurred by the introduction of the Rural Health Transformation Program, introduced by the 2025 reconciliation law. This program (also referred to as the "Rural Health Fund") provides $50 billion in funding for state grants that can be used to support rural areas in a variety of ways, including to pay for health care services, expand the rural health workforce, promote care interventions, and provide technical assistance with system transformation. However, over time reductions in funding to Medicaid (due to reconciliation law) are likely to exceed funding from the Rural Health Fund.

Other.

Provider certification or initiatives to attract and retain providers. States reported working with public health agencies on initiatives to attract and retain (e.g., through loan repayment, training, and certification programs) providers and on provider certification initiatives.

Multi-agency committees. States reported participating in multi-agency workforce committees that include public health agency staff.

Box 6: State Examples of Workforce Initiatives

Rural:

Illinois specifically mentioned cross-agency collaboration at the Rural Health Fund application stage, while other states (including New Hampshire and Wyoming) described future and anticipated collaboration on workforce recruitment funded by the Rural Health Fund.

Other:

Indiana mentioned its state Health Workforce Council which brings together state agencies (including the Department of Health and Medicaid agency), legislators, health care experts, and industry leaders to coordinate health workforce-related policies, programs, and initiatives.

Massachusetts' Medicaid agency reported partnering with the state Department of Public Health on the implementation and monitoring of the HRSA-funded Massachusetts Loan Repayment Program for health care professionals.

Nevada's Medicaid agency reported continued collaboration with the state's Division of Public and Behavioral Health to support the development of training and certification for enrolled Medicaid providers delivering behavioral health services.

The findings from this brief are drawn from the 25th annual budget survey of Medicaid officials conducted by KFF and Health Management Associates (HMA), in collaboration with the National Association of Medicaid Directors (NAMD). Cory Caldwell is a Senior Policy Analyst at NAMD.

Appendix

Endnotes

Florida, Kansas, and Mississippi did not respond to the 2025 survey. ↩'

Fifteen states have been selected to participate and are eligible to receive up to $17 million in funding to support implementation and technical assistance activities.