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The Trump administration announced stricter financial oversight for Medicaid demonstration waivers, requiring certification from the CMS chief actuary to ensure programs do not increase federal spending. Starting January 1, 2024, states must provide detailed spending analyses and align applications with Medicaid statute objectives, reversing prior policies that expanded waiver flexibility.

The Trump administration announced stricter financial oversight for state Medicaid demonstration waivers, requiring certification from the CMS chief actuary to ensure budget neutrality. Starting January 1, 2024, applications must include detailed spending analyses and align with Medicaid statute objectives, reflecting a broader crackdown on state Medicaid spending.

The Trump administration announced stricter financial oversight for state Medicaid demonstration waivers, requiring certification from the CMS chief actuary to ensure budget neutrality. States must now provide more spending analyses and documentation, with applications denied if they increase federal spending or deviate from projected costs.