NATIONAL CONFERENCE OF STATE LEGISLATURES
NCSL Capitol to Capitol
State-federal legislation news and updates from NCSL.
Oct. 20, 2026
Happening this week: The Rural Health Transformation Program reported on its first year of funding state rural health activities. And the Centers for Medicare & Medicaid Services issued guidance on reporting direct care worker compensation.
WASHINGTON WATCH: WHAT STATES NEED TO KNOW
How States Are Using Rural Health Transformation Program Funds
A new report details the awards the program issued in its first year of funding state rural health activities. The Centers for Medicare & Medicaid Services distributed baseline funding of $100 million to every state, with additional funds awarded based on rural population, specific policy actions and the number of individuals eligible for Medicare and Medicaid. Up to $40 billion in remaining program funds will be allocated over the next four years based on each state’s progress toward its submitted initiatives.
The Government Accountability Office released a report documenting what CMS did to implement the rural health program and its plans to monitor states’ activities.
► CMS | RHTP Obligated Funds Report
STATE-FED AT YOUR FINGERTIPS
Spotlight on HCBS Workforce: New CMS Guidance and ANCOR Report | New federal guidance and workforce data are drawing attention to Medicaid home- and community-based services financing and the direct care workforce. CMS issued guidance on implementing a new reporting requirement for direct care worker compensation, along with technical specifications for the states. Meanwhile, a new report from the American Network of Community Options and Resources, a national association representing community-based disability service providers, found continued staffing challenges among organizations serving people with intellectual and developmental disabilities.
The two developments underscore an ongoing issue for states: the intersection of Medicaid HCBS financing, the direct care workforce and beneficiaries’ access to services.
► Medicaid | Home and Community Based Services Provisions
► ANCOR | 2026 The State of America’s Direct Support Workforce Crisis
NCSL Questions Proposed Head Start Changes | In comments submitted to the Administration for Children and Families, NCSL raises questions about proposed changes to the administrative cost cap, comprehensive service requirements and access for children with the greatest challenges. NCSL noted concerns about program quality, access and financial sustainability and the implications for states.
NCSL Opposes Proposed Screen-Time Limits in E-Rate Program | NCSL supports the Universal Service Fund’s E-Rate program and its core mission of ensuring universal, affordable access to broadband internet in schools and libraries. In comments submitted to the Federal Communications Commission, NCSL urged the agency not to impose screen-time limits that could conflict with state laws or interfere with state authority over education.
► NCSL | NCSL Comments on Proposed Rule on the E-Rate Program
📅 Upcoming NCSL Events
Virtual Events
Oct. 20-21 | NCSL Base Camp 2026
Nov. 17 | Town Hall: A Post-Election Analysis
In-Person Meetings
Nov. 5 | NCSL Post-Election Forum: Results, Trends and What’s Next, Washington, D.C.
Jan. 14-16 | Executive Committee, LSCC and NCSL Foundation Board Meeting, New Orleans
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About Capitol to Capitol
Capitol to Capitol was established in 1994 to provide up-to-date information on important federal legislation. NCSL is committed to enhancing the role of states and state legislatures in the federal system.
