Perspectives

Timely commentary on Medicaid policy developments, CMS actions, published reporting, implementation choices, and emerging operational issues.

All Posts

Perspectives

Oct 9, 2026

Minnesota’s Medicaid Evidence Test

Federal claims. Defensible decisions. Proof that corrections work.

Ralph Choate

The First H.R. 1 Medicaid Fiscal-Control Test Arrived October 1—Before the Work Requirements Do

Perspectives

Oct 8, 2026

The First H.R. 1 Medicaid Fiscal-Control Test Arrived October 1—Before the Work Requirements Do

October 1 showed why Medicaid eligibility accuracy must survive verification, notice, system, and federal-claiming processes.

Ralph Choate

Before 2027: What Recent State Medicaid Control Failures Are Warning Us About

Perspectives

Oct 1, 2026

Before 2027: What Recent State Medicaid Control Failures Are Warning Us About

A practical readiness test—and a companion checklist—for proving Medicaid corrective actions work.

Ralph Choate

Perspectives

Sep 27, 2026

Beyond Integration

Building Reliable Eligibility Decisions Through Better Controls

Ralph Choate

The PERM Corrective-Action Gap: Fixing the Error Is Not the Same as Proving the Fix Worked

Perspectives

Sep 20, 2026

The PERM Corrective-Action Gap: Fixing the Error Is Not the Same as Proving the Fix Worked

GAO’s new review of Medicaid eligibility errors raises a larger management question: are states using PERM’s error evidence to prove that corrective actions actually change the result?

Ralph Choate

The First H.R. 1 Medicaid Fiscal-Control Test Arrives October 1—Before the Work Requirements Do

Perspectives

Sep 8, 2026

The First H.R. 1 Medicaid Fiscal-Control Test Arrives October 1—Before the Work Requirements Do

PERM Insights & Perspectives | Perspective | Updated October 7, 2026

Ralph Choate

PERM Measures Medicaid and CHIP, but H.R. 1 Puts Them on Different Fiscal Paths

Perspectives

Aug 27, 2026

PERM Measures Medicaid and CHIP, but H.R. 1 Puts Them on Different Fiscal Paths

The same eligibility-control failure can affect both programs, but Medicaid's 3% disallowance threshold and newly constrained good-faith waiver create a different federal recovery regime.

Ralph Choate

October 1 Changes the Federal Matching Rules. Eligibility Systems Have to Be Ready First.

Perspectives

Aug 27, 2026

October 1 Changes the Federal Matching Rules. Eligibility Systems Have to Be Ready First.

New Medicaid and CHIP federal funding limits for certain noncitizens turn status verification, case evidence, and system logic into immediate fiscal-control issues.

Ralph Choate

2027 Is a Dual Eligibility-Control Change, Not a Single Work-Requirement Project

Perspectives

Aug 27, 2026

2027 Is a Dual Eligibility-Control Change, Not a Single Work-Requirement Project

Six-month redeterminations and community-engagement verification will arrive on the same operating platform—and states should govern them as one control environment.

Ralph Choate

2027 Is Not the Work-Requirement PERM Test. It May Be the Rehearsal.

Perspectives

Aug 26, 2026

2027 Is Not the Work-Requirement PERM Test. It May Be the Rehearsal.

CMS will make RY2027 an eligibility-only PERM cycle while states prepare for new Medicaid community-engagement requirements. The timelines do not directly overlap—but the operational lesson does.

Ralph Choate