State Medicaid Directive #26-003 RE: Budget Neutrality & Certification By The Chief Actuary Of CMS For Section 1115 Medicaid Demonstration Projects

On June 11, 2026, the Centers for Medicare & Medicaid Services (CMS) sent a state Medicaid directive (SMD) #26-003, regarding budget neutrality and certification by the Chief Actuary of CMS for Section 1115 Medicaid demonstration projects. This directive implements new statutory requirements for Section 1115 Medicaid demonstration projects. Effective for demonstrations approved on or after January 1, 2027, the directive requires the CMS Chief Actuary to independently certify that every 1115 project will not increase federal Medicaid expenditures . . .