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The Trump administration is preparing to release guidelines soon for requiring Medicaid recipients to work, according to sources familiar with the plans, a major shift in the 50-year-old program. The guidelines will set the conditions for allowing states to add work requirements to their Medicaid programs for the first time, putting a conservative twist on the health insurance program for the poor. (Sullivan, 1/5)

Kaiser Health News: Maine Voters Chose Medicaid Expansion. Why Is Their Governor Resisting?

At least 70,000 low-income Maine residents like Donna Wall should gain Medicaid health insurance because of the ballot measure that passed last fall. Advocates collected signatures to put the question to voters, and, in November, Maine became the first state to get approval at the ballot box to expand Medicaid, passing with 59 percent approval. But even though voters here in Maine decided to expand Medicaid, the law’s fate is unclear. Republican Gov. Paul LePage has said that opening up the program to more poor adults threatens the state’s financial stability and that lawmakers shouldn’t raise taxes to pay for it. (Varney, 1/5)

[Gov. Paul] LePage and some Republicans — including most of the party’s gubernatorial candidates — have made it clear that they want to find a way to block Medicaid expansion. ... [Assistant House Majority Leader Jared] Golden said expansion proponents’ strategy is to watch for signs that the LePage administration is not moving forward with expansion and, if not, to sue him. “The organizations that banded together to support Question 2 feel like they have a bullet-proof legal argument,” he said. (Cousins, 1/4)

Gov. Kim Reynolds acknowledged Thursday that Iowa's decision to hire private companies to manage the state's $5 billion Medicaid program has had a rocky start, but she insisted steps are underway to fix troubles that have generated widespread complaints from patients and health care providers. The Republican governor also indicated that while input from the Iowa Legislature is welcome, she doesn’t necessarily believe the problems will require the passage of special bills targeted at the issue. However, Iowa House Speaker Linda Upmeyer, R-Clear Lake, bluntly warned that lawmakers’ patience is waning with Medicaid managed care, which serves 600,000 low-income and disabled Iowans. (Petroski, 1/4)

Thanks to efforts to reduce Arkansas' Medicaid spending and enrollment, Gov. Asa Hutchinson said, his request for federal and state funding for the program during the fiscal year that starts July 1 will be about $478 million lower than what he had first planned. The reduction would bring the budget for the state Medicaid program in fiscal 2019 to about $7.5 billion -- about $55 million less than the state budgeted this fiscal year. (Davis, 1/5)

Arkansas' governor on Thursday touted an 11 percent drop in the state's Medicaid rolls over the past year as he prepared for another potential fight in the Legislature to keep the state's hybrid Medicaid expansion alive. Gov. Asa Hutchinson and Department of Human Services officials said that enrollment in the state's Medicaid program dropped by more than 117,000 people from 2017 to 2018. Nearly 59,000 of that came from the state's hybrid expansion, which uses Medicaid funds to purchase private insurance for low-income residents. (Demillo, 1/4)

Medicaid, the biggest consumer of dollars in the state's General Fund, expects to carry forward $53 million into next year, offsetting the need for an increase in state funding for 2019. Medicaid Commissioner Stephanie Azar made a presentation today at a legislative budget hearing in Montgomery. Lawmakers are preparing for their annual session, which starts Tuesday. A key task will be to pass a state budget for 2019. (Cason, 1/4)

To reverse new eligibility restrictions for the Medicare Savings Program, which uses Medicaid funds to pay medical expenses that Medicare doesn’t cover for poor seniors and the disabled, legislators needed to find about $54 million this fiscal year. Estimates are those restrictions, if not reversed, could eliminate or reduce benefits for as many as 113,000 residents. (Phaneuf, 1/4)