Health care advocates and state officials labeled the past year “stressful,” “frustrating” and “crazy” — from a jarring transition in federal policies under the Trump administration to an ongoing state financial crisis that limits progress in boosting access to care.
And while the legislature and advocates took steps to mitigate some of the impacts of the new federal health policies, many are ready to leave 2025 behind.
“I wouldn’t replay 2025 again,” said Gene Ransom, CEO for MedChi, the Maryland State Medical Society. “But it could have been a lot worse.”
That said, many of the stressors that plagued Maryland’s 2025 health care landscape will reemerge or influence policy in upcoming years.
As lawmakers look ahead to the 2026 session, here are some of the major points in health care this past year that could have continuing implications in coming years.
HR 1 health care overhaul
Sen. Clarence Lam (D-Anne Arundel and Howard) pointed to the rapid and wide-ranging changes to federal health care operations as a major point of frustration for the health system in Maryland.
“It’s just been a crazy year when it comes to health care because of all the federal policy changes,” Lam said.
Senate Finance Committee Chair Pamela Beidle (D-Anne Arundel) agreed.
“We couldn’t even begin to anticipate all of the things that were going to happen,” she said.
One of the biggest blows came in the form of the budget reconciliation bill, HR 1, often referred to as the “One Big Beautiful Bill Act.”
Among its sweeping changes, the legislation will usher in new requirements to qualify for Medicaid, the joint federal and state health care plan often used by lower-income families.
About 330,000 Marylanders are part of the “expansion population” and would be subject to new work requirements to qualify for coverage, which would take effect no later than 2028. Opponents argue that most recipients are already working, and that they are more likely to be tripped up by the increased paperwork that will be needed to prove that they are fulfilling the 80-hour-per-month requirement.
“There’s going to be people who are going to lose their care,” Beidle said. “It’s really going to be sad, because if they don’t pay for their health insurance … they’re going to be at our hospitals which are already really overcrowded.”
Lam said that the legislature was able to correctly predict some of the policy changes that President Donald Trump’s administration had in store and put some state-level protections in place during the 2025 session.
The General Assembly created laws to mandate insurance companies cover certain vaccinations, regardless of federal changes that weaken recommendations for some shots including for COVID-19.
The Legislature also correctly assumed that Congress would not extend a popular health care tax credit on plans purchased through Affordable Care Act marketplaces before it expires at the end of the year. Lawmakers were able to move some funding to help offset that financial impact to some of the lowest-income families using the state marketplace, though others will likely see their monthly health care costs increase regardless.
But Lam says complying with HR 1 will create hurdles for the state in future years.
“The HR 1 bill that passed puts at risk a lot of the gains we’ve made when it comes to expanding coverage for Medicaid patients. Things like work requirements and burdens and documentation are now all being imposed on a population that is just struggling to put food on the table with the rising cost of everything,” Lam said. “They are now being required to jump through a lot of hoops just to maintain their health coverage.”
Full speed ‘AHEAD’
The state’s current hospital payment system called the Total Cost of Care model will end on Dec. 31. What will replace it is a new system referred to as the AHEAD model – a hospital payment system that was first negotiated last year under the Biden administration and then revamped under the Trump administration.
State health officials had been in negotiations with the Trump administration since the start of the year. In the months since, state and federal officials have gone back and forth about how much authority Maryland should have in dictating hospital rates.
“Every week it changed,” Beidle said. “Once they finally got it signed … the hospitals had a very short time to sign the participation agreements. And there were some last-minute changes for that. I think the unknown made it really difficult.”
State documents even show a name change for the new hospital payment model. Under the Biden administration “AHEAD” stood for “Advancing All-Payer Health Equity Approaches and Development.” The new agreement changes that to “Achieving Healthcare Efficiency through Accountable Design,” reflecting a move away from the state’s current “all-payer” model that allows health care costs to be consistent across all types of insurance.
Among many changes under the new agreement, Maryland is set to lose its ability to set hospital rates under Medicare, an authority it has held for over 40 years. Losing that authority could complicate how the state keeps costs consistent across health care plans, meaning that people on private plans, Medicare or Medicaid may pay different prices for the same type of care down the line.
The new agreement keeps much of the state’s hospital payment system in place for two years, giving officials time to implement larger policy changes.
Ransom says the two-year timeframe gives the health care system a chance to take “a deep breath.”
“Two years of stability is nice,” he said. “But there’s still a lot of work to do — a lot of complexity that has not been worked out.”
Seniors notified of Medicare Advantage plans ending
Thousands of senior Marylanders were shocked to learn that their Medicare Advantage plans would not be available for the upcoming year, leaving them to scramble to find other plans that may be more expensive, or go without.
About a quarter of Maryland Medicare recipients use a program called Medicare Advantage that helps retirees use a private insurer for additional health coverage such as vision, dental and transportation assistance that the standard Medicare plans may not offer.
But insurance companies say offering Medicare Advantage plans is uniquely costly in Maryland. Insurers are fleeing the state or reducing their coverage.
Industry experts say as many as 100,000 Medicare recipients in Maryland will have to scramble to find a new health care plan by the end of the year or risk losing coverage at an age where many require costly medical care.
Under the AHEAD agreement, Maryland officials are tasked with finding ways to stabilize the Medicare Advantage market. Those talks are likely to begin in the upcoming session.
“We’re going to be dealing with the Medicare Advantage issue, which has turned out to be a really big issue for this year,” Beidle said.
Budget deficit looms once again
Laura Howell, CEO for the Maryland Association of Community Services, fears that a more than $1.4 billion deficit in the coming year could mean another round of intense advocacy to ensure that any cuts to funding don’t impact developmental disability resources.
Advocates, family members, and care takers came out in droves last session to stave off what was originally proposed to be over $400 million in cuts to the Developmental Disabilities Administration. Advocates were able to claw back close to $300 million in cuts and got program reductions to a level they said was regrettable but survivable, at least.
“The big question becomes, what are we looking at for the ‘27 budget?” Howell said. “I think the administration has made it pretty clear that they want to be working with the developmental disability advocates going into this session and during session.”
“We’re looking at an overall deficit, so we worry what that will mean for the DDA budget,” she said. “But I do think there is more communication with us than there was going into last session.”
But Beidle warned throughout the health care system, the tight financial outlook for the state could create challenges.
“It’s a money issue. It’s going to be tough year for funding – whether it’s DDA or Medicaid Advantage or the hospitals,” she said. “If the money’s not there, it’s not there.”
