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Compare any states side by side, see who shares your playbook — work requirements, 340B, budgets, immigrant coverage, labor signals — and look ahead with the foresight calendar. Every claim primary-sourced.
59
Jurisdictions
1,754
Intelligence items
51
States with signals
38
Foresight events
Intel updated 2026-07-20 · signals 2026-06-12
What these states share
The strategic read
In common: California and New York are running the same play — work requirements: building for 2027.
Divergence: But they diverge on work requirements: California and New York are building for 2027; Georgia is live now.
Watch together: 2026-06-15 — California budget deadline — MCO-tax standoff
| Metric | California Deep dashboard | New York State page | Georgia State page |
|---|---|---|---|
| Health centers | 213 | 73 | 36 |
| Sites | 1,960 | 885 | 466 |
| Patients (UDS 2024) | See deep dashboard | 2,488,314 | 750,212 |
| Medicaid % | — | 53.5% | 25.7% |
| Uninsured % | — | 12.7% | 25.6% |
| Medicaid expansion | Expanded | Expanded | Non-expansion |
| NP scope | — | Full practice | Restricted |
| Medicaid program | Medi-Cal | New York Medicaid | Georgia Medicaid |
| Primary Care Assoc. | CPCA | CHCANYS | GPCA |
| Resilience snapshot | Own engine on its dashboard | 8 strong32 stable31 watch2 exposed | 1 strong16 stable16 watch3 exposed |
| Work requirements | Building for 2027 CMS 'Emmy' rails + county systems; ~5.6M CHC patients exposed nationally — CA most by volume | Building for 2027 Jan 1, 2027 via NY State of Health; 12-month continuous eligibility for MAGI adults ends July 1, 2026; up to 800K exposed | Live now Pathways to Coverage: 16,782 active enrollees (<5% of ~359K potential); waiver expires Dec 31, 2026 → must conform to H.R.1 |
| 340B | Bill advancing AB 1460 (contract-pharmacy protection) — June 24 Senate Health hearing; WA's June 9 win is its freshest precedent | Bill advancing S.1913 anti-discrimination act passed the Senate 48-12 June 4 → Assembly Health | — |
| Budget direction | Mixed Signed June 29: MCO tax renewed and the ~$1B UIS-PPS clinic cut delayed 12 months to July 1, 2027 — but ~2M UIS enrollees shift to fee-for-service Jan 1, 2027 (a two-stage cliff) | Backfiller $80M FQHC Medicaid rate increase enacted in a $1.5B provider package; MCO tax permanent at 0.35% — but no Essential Plan backfill (~450K lose July 1) | Mixed 5% Medicaid primary-care rate increase + 124 residency slots, but reinsurance cut $50M and Gateway upgrade rejected |
| Immigrant coverage | Capping UIS enrollment freeze is in effect; adult dental and major State-Only PPS reductions were postponed to July 1, 2027 | — | — |
| RHTP year-1 award | — | — | $218.8M |
| Labor signal | Deepest tracked labor landscape: SEIU-UHW ballot war (Nov 3), NUHW/UAPD organizing wave, Peak-Vista-style NLRB actions — see /strategy/labor-relations | — | — |
| Tracked intel | 372 items · newest 2026-12-31 | 23 items · newest 2026-07-06 | 29 items · newest 2026-05-31 |
Latest from California
2026-12-31 · CA DHCS
2026-07-19 · San Francisco Public Works / Department of Public Health
2026-07-16 · Mountain Valleys Health Centers
Latest from New York
2026-07-06 · Gothamist (NY DOH projection)
2026-04-06 · New York State Bar Association / Manatt
2026-03-23 · New York State Department of Health
Latest from Georgia
2026-05-31 · GeorgiaPathways.org (open-records data tracker)
2026-04-21 · Healthbeat Atlanta
2026-04-01 · NACHC
Every value is backed by a primary-sourced item in that state's feed. Tap a row for the notes; tap a state to add it to the comparison.
| State | Work req | 340B | Budget | Immigrant | RHTP | Labor |
|---|---|---|---|---|---|---|
| Building for 2027 | Bill advancing | Mixed | Capping | — | Yes | |
| — | — | Mixed | Restricting | — | — | |
| Building for 2027 | Bill advancing | Backfiller | — | — | — | |
| — | — | Mixed | — | — | — | |
| — | Bill advancing | Mixed | Ended | — | — | |
| — | Law upheld | — | Capping | — | — | |
| Least stringent | Bill died | — | — | $202M | — | |
| Building for 2027 | — | Unresolved | — | $193M | — | |
| Building for 2027 | — | Mixed | — | — | Yes | |
| Building for 2027 | FQHCs exempted | — | — | $206.9M | — | |
| Building for 2027 | — | — | Restricting | — | — | |
| Building for 2027 | — | Unresolved | Restricting | $213M | Yes | |
| Live now | — | Mixed | — | $218.8M | — | |
| Building for 2027 | — | Cutter | — | — | Yes | |
| Building for 2027 | Law passed | Unresolved | — | $173M | — | |
| Building for 2027 | — | Cutter | — | — | — | |
| Building for 2027 | — | Cutter | Capping | $200.1M | Yes | |
| Mitigating | — | Mixed | — | $216.3M | — | |
| — | En banc rehearing | — | — | — | — | |
| — | Law upheld | — | — | — | — | |
| — | — | Backfiller | — | — | — | |
| — | — | Unresolved | — | $200M | — | |
| — | — | Mixed | — | $206.9M | — | |
| Mitigating | — | Backfiller | Backfilling | $197.3M | — | |
| Building for 2027 | Study group | Backfiller | Restricting | — | — | |
| Mitigating | En banc rehearing | — | — | $168.2M | — | |
| Early enforcer | Law upheld | Mixed | — | $209M | — | |
| Building for 2027 | — | — | Restricting | $223.5M | — | |
| — | — | Mixed | — | $203.4M | — | |
| Building for 2027 | Law upheld | Backfiller | Backfilling | — | — | |
| — | Expiring | — | — | $221M | — | |
| — | Law upheld | — | — | — | — | |
| Building for 2027 | Bill died | — | — | $203.7M | — | |
| Early enforcer | — | — | — | $209M | — | |
| Early enforcer | — | Mixed | — | $186M | — | |
| Building for 2027 | — | Backfiller | — | $156.2M | — | |
| Building for 2027 | — | — | — | — | — | |
| Building for 2027 | — | Backfiller | — | $195M | — | |
| — | — | Backfiller | Backfilling | — | — | |
| — | — | Backfiller | Ended | — | — | |
| Building for 2027 | — | — | — | — | — | |
| Mitigating | — | — | — | $195.7M | — | |
| Building for 2027 | — | — | — | $180M | — | |
| Building for 2027 | — | — | — | $189.4M | — | |
| Early enforcer | — | — | — | — | — | |
| Building for 2027 | — | Backfiller | — | $272M | — | |
| Early enforcer | — | Cutter | — | $233.5M | Yes | |
| Building for 2027 | — | Backfiller | — | $204M | — | |
| Building for 2027 | — | — | — | $157M | — | |
| Early enforcer | Struck down | — | — | $199M | — | |
| Building for 2027 | — | — | — | $205M | — |
States grouped by a shared strategy, structure, or situation. Tap any state to add it to the comparison.
States pairing the federal mandate with explicit protections: data-first verification, FQHC cost-sharing exemptions, homeless exemptions, constitutional shields.
States standing up systems, staffing, and member notices for the federal 80-hour mandate.
The edge cases the rest of the country is watching: Georgia's live program, Nebraska's early enforcement, Ohio's least-stringent design.
Contract-pharmacy laws upheld in court (5th Cir: LA+MS; 8th Cir: AR; WA's June 9 win) or FQHCs carved out of cuts (IN).
En banc rehearings (MD, WV), bills advancing (NY, CA), study committees (VA), expirations (KS), and the struck-down cautionary tale (ND).
States putting their own money behind the safety net after H.R.1 (NY's $80M FQHC raise, OR's first-in-nation backfill law, CT, NM, MN).
Rate cuts landing (CO), structural losses (NJ), and a June-30 budget deadline now passed — CA and VA signed at the wire, while chronically-late states like PA ran past it unresolved.
Backfilling (OR, NM) vs capping (CO, WA, CA) vs ending/phasing out (MN, IL, DC) — the same federal law, opposite state answers.
Where health-center labor relations are moving: NLRB orders, layoff waves, and California's full tracked landscape.
Never expanded Medicaid — uninsured patients are the biggest payer, and the dominant cliff is ACA premium-credit expiry, not the Medicaid FMAP cut.
Where the most FQHC patients and organizations are concentrated — the biggest absolute exposure to every federal change.
Large $50B Rural Health Transformation Program allocations with rolling sub-grant deadlines — high-velocity news.
FY budgets and MCO-tax standoffs all resolving the same end-of-June week — a concentrated decision window.
Tightly coordinated region (the Bi-State PCA spans NH + VT); all currently backfilling the safety net.
Highest Medicaid dependence, deeply rural, and carrying the heaviest overdose burden — shared exposure to every coverage change.
Rural, frontier-access challenged, and RHTP-heavy — several are also Medicaid work-requirement early movers.
Shared OCHIN Epic footprint, progressive coverage posture, and HHS Region 10 — natural peers for tech and policy.
Border health systems share immigrant-care, language-access, and cross-border patient dynamics.
Mostly non-expansion, high uninsured share, and frozen PPS rates — the toughest reimbursement terrain in the country.
HHS Region 5 — large industrial-Midwest FQHC base with several active 340B fights.
Dated deadlines, cliffs, and implementations — through the Dec 31, 2026 triple cliff and the Jan 1, 2027 federal mandate.
June 2026
California budget deadline — MCO-tax standoff
GREAT Health Phase 4 competitive grants open (FQHCs eligible)
RHTP sub-grant deadline
Rural Health Hub Anchor applications due ($216.3M program)
RHTP Community Health Worker + Food-is-Medicine grant round closes (clinics eligible)
RHTP sub-grant deadline
Council's decisive FY2027 budget vote — Alliance reopening + $800K FQHC grants ride on it
AB 1460 (340B) Senate Health hearing
RHTP Digital Health Modernization grants due — FQHCs explicitly eligible
Federal work-requirement member-outreach window opens (states must notify June 30 – Aug 31)
State budget deadlines — CHC line item (PA), ACA bridge (VA), Sherrill's first NJ budget (defunds several free clinics)
State 340B protections expire
ACO Community Partners contracts expire (200 care-management jobs)
CMS MCO-tax transition approval lapses (~$1.1B exposure)
July 2026
Medicaid work requirements go live early — the nation's 2nd and 3rd enforcing states (after NE)
Essential Plan cliff — ~450K lose coverage, no state backfill
SB 525 FQHC minimum-wage step to $22/hour
2% Medicaid provider rate cut + $1,100 Cover All Coloradans dental cap
RHTP sub-grant deadline; FQHC 340B exemption takes effect
Pharmacist Medicaid billing opens (vaccines, tests, antivirals, contraceptives)
RHTP sub-grant deadlines: KS $9.5M emerging technology (incl. AI) · OK $2.8M behavioral health
TN RHTP 'Service Line & Co-Location' grant closes — the clearest FQHC integrated-care expansion play
South Carolina RHTP Year-1 grant decisions due ($200M award)
August 2026
Work-requirement notification letters begin
September 2026
Formal work-requirement outreach/notices
Federal discretionary health-center funding expires (FY cliff #1)
October 2026
Federal Medicaid eligibility restriction for refugees/asylees/parolees
RHTP year-1 funds must be fully awarded or risk federal clawback
RHTP year-1 commitment deadline ($193M)
November 2026
340B work-group report due to four committees
Ballot measures: CA's three-measure healthcare war; SD Amendment I expansion condition
December 2026
Iowa work requirements begin — a month early, with zero optional hardship exemptions
Medicaid Spending Commission report — 3 weeks before the federal cliff
ND + ID work requirements begin a day ahead of the federal deadline
THE TRIPLE CLIFF: Community Health Center Fund (~$4.6B/yr) expires — no reauthorization bill exists; GA Pathways waiver + CA CalAIM 1115 + CA MCO tax also expire
January 2027
Federal 80-hour Medicaid work requirements — full implementation deadline (every expansion state)
March 2027
First work-requirement coverage terminations
July 2027
State-Only (UIS) PPS transition + adult dental rollback (~2M) + SB 525 $25 step
Download the dataset
59 jurisdictions compared · 1,754 primary-sourced, real-dated intelligence items · strategy signals · foresight calendar through January 2027. Free in exchange for your email — it subscribes you to the weekly FQHC Intel Brief (unsubscribe anytime).
Methodology: health center, site, patient, and payer-mix data come from HRSA UDS 2024; expansion, NP scope, and PCA from the state policy registry; resilience is a percentile signal (not a prediction); and every strategy signal is backed by a primary-sourced item in that state's feed. Where we don't hold a verified value, we show “—” rather than guess. Enhanced dashboards add labor, jobs, and regional intelligence where deeper coverage exists.