Policy Impact Scenarios

Policy Impact Scenarios

This page is built for state agencies, provider networks, and community coalitions planning for Medicaid policy shifts. It stress-tests where coverage loss could hit hardest, where access may deteriorate first, and which operational levers are most likely to reduce harm.

Policy Context (As of February 21, 2026)

• U.S. Congress shows H.R.1 enacted as Public Law 119-21 (signed July 4, 2025).
• CMS implementation guidance says community engagement/work requirement policy begins January 1, 2027 (or earlier for opting states).
• CRS (with CBO scoring) reports large projected Medicaid coverage effects tied to community engagement provisions.

Sources:

• Congress bill page (H.R.1 / Public Law 119-21)
• CMS implementation resource hub
• CMS community engagement implementation page
• CRS summary with CBO estimates
• Urban Institute state estimate discussion
• KFF implementation analysis

Provenance

Methodological Guardrails

Access Risk Early-Warning Index

-- See SQL blocks above in this page: state_category_mix, risk_inputs, risk_scored

Citation: risk_scored derived from medicaid.spending_by_state, medicaid.state_er_ratio, and medicaid.spending_by_state_category.

Scenario Simulator: State, County, and Entity Impact

TX County Hotspots

TX Service-Line Impact

TX Entity Exposure Proxy (Provider Specialty)

-- See SQL blocks above in this page: state_impact, county_impact, category_impact, specialty_impact

Citation: state_impact, county_impact, category_impact, and specialty_impact use medicaid.spending_by_state, medicaid.spending_by_county, medicaid.spending_by_state_category, and medicaid.state_provider_specialty.

State Readiness + Administrative Burden Tracker

Action Playbooks by User Type

Sensitivity + What This Does Not Prove

Citation: scenario_assumptions, sensitivity_national, and playbook_actions are explicit planning assumptions layered on descriptive claims aggregates.

Reproduce This Page

cd dashboard
export EVIDENCE_SOURCE__medicaid__token="<your_motherduck_token>"
export EVIDENCE_SOURCE__medicaid__database="medicaid"
npm run sources
npm run build
npm run preview
# then open http://localhost:3000/policy-impact