Changes to Medicaid eligibility and financing, Connecticut’s certificate-of-need overhaul and Maryland’s new hospital staffing framework are among the healthcare-related laws set to take effect Oct. 1.
Here are seven federal and state-specific laws to know:
Federal
1. Medicaid eligibility narrows for many lawfully present noncitizens. Starting Oct. 1, Section 71109 of HR 1 limits federal funding for full Medicaid and Children’s Health Insurance Program benefits to U.S. citizens and nationals, lawful permanent residents, Cuban and Haitian entrants, and Compact of Free Association migrants, according to CMS implementation guidance published in June. Other noncitizens, including refugees and asylees, can still get emergency Medicaid. States that elected the CHIPRA 214 option can also keep covering lawfully residing children and pregnant women. For hospitals, CMS said the limits do not apply during presumptive eligibility periods, so services provided then still qualify for federal funding.
2. The enhanced federal match for emergency Medicaid ends. Beginning Oct. 1, Section 71110 of HR 1 caps the federal matching rate for emergency Medicaid services for noncitizens who are ineligible for full coverage because of immigration status at each state’s regular federal medical assistance percentage, according to the law text. Before the law, expansion states received the enhanced 90% expansion match for these services, the American Medical Association noted. Now expansion states will receive their regular match rate, as non-expansion states already do. The law also gives CMS $1 million in fiscal 2026 to implement the change.
3. New Medicaid provider tax limits begin. For fiscal years beginning on or after Oct. 1, Section 71115 of HR 1 replaces the uniform 6% hold harmless threshold for healthcare-related taxes with limits tied to each state’s existing taxes. In non-expansion states, thresholds are frozen at the level of taxes enacted and imposed as of July 4, 2025. In expansion states, the threshold for most classes of services is the lower of that frozen level or a declining cap, which starts at 5.5% in fiscal 2028 and drops to 3.5% by fiscal 2032.
Connecticut
4. The state overhauls its certificate-of-need program. Public Act 26-68, the state budget bill approved May 26, creates a new CON framework within the Department of Public Health that takes effect Oct. 1, though most requirements do not apply until July 1, 2027. A three-member panel will make all final CON decisions. The law defines a change of ownership to include acquisitions of 25% or more of a healthcare facility’s assets, equity or voting shares, and real estate deals involving 20% or more of a hospital’s total assets. It also does not require review for some activities, including relocating a facility within the same town or within 10 miles if the move will not substantially change the payer mix or patient population.
5. Hospitals face new financial assistance policy requirements. Starting Oct. 1, Public Act 26-68, the state budget bill approved May 26, requires hospitals to include a clear notice on or with each billing statement that financial assistance may be available and that patients can apply at no cost. The notice must be in plain language in English and Spanish, and hospitals must also post it on their websites. Each hospital must also have a written financial assistance policy that spells out eligibility criteria, how patient charges are calculated, and which other providers in the hospital are covered. Starting Jan. 1, 2027, hospitals with financial assistance programs must treat patients enrolled in the Supplemental Nutrition Assistance Program, the Nutrition Program for Women, Infants and Children, or Temporary Assistance for Needy Families as meeting income eligibility requirements.
6. Hospitals become protected areas from civil arrest. Starting Oct. 1, Public Act 26-14 (SB 397), signed by Gov. Ned Lamont May 4, bars peace officers, including federal law enforcement officers, from detaining or arresting people for civil offenses in protected areas unless the person is the subject of a judicial warrant. Protected areas include licensed hospitals and urgent care centers, along with their grounds, garages and parking lots, including garages and lots that are not next to the building. Schools, places of worship and social services sites such as domestic violence shelters and drug and alcohol treatment facilities are also covered. Anyone harmed by a violation can sue in state Superior Court for damages or injunctive relief.
Maryland
7. The Safe Staffing Act sets up hospital staffing committees. The Safe Staffing Act of 2026 (SB 411), signed by Gov. Wes Moore April 28, takes effect Oct. 1. Hospitals must form clinical staffing committees by July 1, 2027. At hospitals with 150 or fewer beds, committees will have three managers and two employees; at larger hospitals, five managers and four employees. Hospitals must develop clinical staffing plans by July 1, 2027, and implement them by July 1, 2028. Nurses and other frontline staff can bring complaints to the committee when unit assignments do not follow the plan. Hospitals must post their plans and daily staffing data on patient units, and starting July 1, 2030, they must report annually to the Maryland Health Care Commission.
