delete PART 431—STATE ORGANIZATION AND GENERAL ADMINISTRATION
Regulation mandates administrative requirements for state Medicaid agencies, including single agency designation, electronic record-keeping, public access to policies, Beneficiary Advisory Council with escalating quotas (10% to 25% by 2027), and extensive reporting/oversight duties.
Imposes substantial unfunded mandates forcing states to divert healthcare resources into bureaucratic compliance. The escalating BAC quota requirement alone creates costly administrative structures with rigid procedural requirements unrelated to patient outcomes. These federal dictates violate Tenth Amendment federalism principles, stifle state innovation, and represent the hidden $14,000-per-household regulatory burden that distorts investment in actual care delivery.