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New York’s Medicaid program expenses are running at least $3 billion over budget, but the administration of Gov. Andrew Cuomo has so far said little about its plans to deal with the issue. Administration officials are three weeks past their legal deadline to release a midyear budget report, which will include details about the overruns. The delay in disclosure has left advocates and lawmakers wondering about Mr. Cuomo’s plans for the Medicaid program—the state’s largest expenditure—and the possibility of immediate service cuts. (Vielkind, 11/20)

California is expected to have a $7 billion budget surplus next year, but lawmakers were urged Wednesday not to spend all of it because a sizable chunk depends on an upcoming decision by the Trump administration as it feuds with state Democratic leaders. ... However, nearly $2 billion of the initial $7 billion projected surplus depends on whether the Trump administration lets California tax organizations that manage the state’s Medicaid plans. (Beam, 11/20)

The $7-billion surplus would be in addition to an expected $18.3 billion in “rainy day” reserves that must be set aside for an economic downturn and another $900 million that will be earmarked to assist social services programs in the event that recession pressures mount. The LAO report assumes the first signs of a recession appear in early 2021. Any acceleration or delay of that economic weakening could substantially change the size of the projected cash reserves. (Myers, 11/20)

California’s congressional leaders urged the U.S. House leadership Tuesday not to cut off supplemental Medicaid payments to hospitals because doing so could jeopardize care for millions. These supplemental payments, known as disproportionate share allotments, provide “an essential funding source helping safety-net hospitals serve the uninsured and underinsured residents of their communities,” a group of 47 legislators stated in a letter to House Speaker Nancy Pelosi and House Minority Leader Kevin McCarthy. (Anderson, 11/20)

State officials sent the overhaul about a week after CMS Administrator Seema Verma vowed to soon release federal guidance allowing states to pursue Medicaid spending caps. The state's plan would apply to people traditionally covered by the program, including children, pregnant women, poor seniors in nursing homes and people with disabilities. (Pradhan, 11/20)

Imposing block grants in Medicaid has long been a major conservative goal and has been encouraged by the Trump administration, but it is not clear if the administration alone has the legal authority to allow such drastic changes. Administration officials had drafted a guidance that would make it easier for states to apply for a capped payment or block grants, but the document was quietly removed from the White House Office of Management and Budget last week. (Weixel, 11/20)

When Idaho’s Legislature voted to expand Medicaid coverage for people in the state, a key debate involved whether to require some recipients to work to receive benefits. Republicans, who favored the requirement, gained a key ally—the “Opportunity Solutions Project,” a little-known new group with opaque funding. While Republicans found the organization’s suggestions on how to make “workfare” a success useful, opponents of the idea felt very differently. (Stein, 11/21)

Ohio Medicaid’s largest Medicaid managed-care provider has dramatially shrunk its pharmacy network by dropping Walgreens. But despite promises of new transparency, neither the agency has done much to explain the change. (11/21)