States of Innovation: June 2025

As the Congressional budget reconciliation process advances, states continue their efforts highlighting the value of Medicaid. Colorado, Maine, New Jersey, New York, Oregon, Pennsylvania and Washington published updated analyses about the impact of federal proposals on Medicaid enrollment and their state budgets, while states including California, Maryland, New Jersey, North Carolina, Oregon and Pennsylvania continue to highlight for Congressional leadership and members of their community the implications of Medicaid cuts. Meanwhile, State-Based Marketplaces and leadership in Colorado, Maryland, Massachusetts, New Jersey, New York, Pennsylvania and Washington are highlighting the value of Marketplace coverage and calling out the combined impacts of Congressional proposals, the recently finalized Marketplace Integrity Rule and the scheduled expiration of the enhanced premium tax credits (ePTCs) on Marketplace affordability and flexibility. State insurance regulators in Maryland, Minnesota, Oregon, Pennsylvania, Rhode Island and Vermont are emphasizing the urgency to extend Marketplace affordability with the ePTCs, as health insurers are filing significant increases to requested rate changes for 2026 due to federal policy changes and uncertainty.

In June, states continued to react to federal policy, with North Carolina reaffirming its commitment to serving everyone who calls 988 for crisis care after the elimination of federal funding for LGBTQ+ youth. Wisconsin Medicaid is continuing COVID-19 vaccine coverage for children and pregnant individuals following changes to the Centers for Disease Control and Prevention (CDC) guidance. California, Oregon and Washington condemned the dismissal of the Advisory Committee on Immunization Practices (ACIP) at the CDC, and California and Washington issued statements about their commitment to protecting personal data for immigrants after the announcement that enrollee data was shared with the Department of Homeland Security. 

Also in June, states received state plan amendment and waiver approvals from CMS, including Minnesota, New Mexico, Oregon, South Dakota, Washington, and Wyoming to allow Indian Health Service and Tribal clinics to provide Medicaid services in homes, schools, and other community locations. Iowa submitted a request to implement Medicaid work requirements, and the District of Columbia posted for public comment a section 1331 Blueprint to create a Basic Health Program for low-income individuals up to 200% of the federal poverty level.

States also advanced policies to improve affordability and address costs: Indiana lawmakers enacted healthcare cost reform bills to lower prices, increase price transparency, and eliminate anti-competitive practices and Oregon enacted strict limitations to regulate private equity in healthcare. Maine and Oregon prohibited the inclusion of medical debt in consumer reports. In an effort to expand access to care, Colorado improved access to lower cost prescriptions, Delaware passed protections for gender-affirming care and New Mexico invested in rural healthcare providers.

Other state actions in June included Arizona and California hosting forums for community engagement, Virginia passing legislation to protect maternal and infant health, and Oklahoma addressing reproductive and women’s health by increasing access to a six month supply of prescription birth control. To improve mental and behavioral health, Montana is providing housing support services and North Carolina is delivering substance-use disorder support for residents impacted by Hurricane Helene. 

Accessibility

Nevada’s Aging and Disability Services Division launched a new brand identity. In an effort to better serve Nevadans across all ages and abilities, the Nevada Aging and Disability Services Division (ADSD) has launched a new brand identity. The new brand features a logo, visuals, and voice that aim to reflect ADSD’s commitment to inclusivity, dignity and support for all Nevadans. The goal of the rebranding is to inform as many Nevadans as possible about ADSD’s services and programs and comes after months of research, community engagement, and collaboration with stakeholders to ensure that the new identity resonates with the diverse populations the division serves.

Affordability and Efforts to Address Cost

Indiana lawmakers enacted healthcare cost reform bills focused on pricing, transparency, and antitrust issues. Governor Mike Braun signed 10 healthcare bills to lower prices, increase price transparency, and eliminate the anti-competitive practices and misaligned incentives that drive up hospital prices. Governor Braun also signed two executive orders aimed at reducing the market influence of hospitals. For more on these initiatives, check out this blog from Georgetown University’s Center for Health Insurance Reforms, which summarizes Indiana’s recent legislative and administrative activity to improve healthcare affordability.

Oregon passed legislation with strict limitations to regulate private equity in healthcare. Governor Tina Kotek signed into law SB 951, to strengthen the state’s prohibition on the corporate practice of medicine by limiting private equity and other corporate involvement in medical practice management. The legislation institutes new limits on how management services organizations can operate with physician-owned practices in the state and limits the use of non-compete agreements. SHVS recently published a toolkit for states on regulating financialization in the healthcare system.

Oregon created a committee to develop cost reduction and cost growth reduction policies. A pair of new Oregon Health Authority (OHA) reports find healthcare costs continue to grow faster than the state and national economies. In light of concerns regarding the growth of healthcare costs in the state, the Oregon Health Policy Board, a citizen-led body that oversees OHA, created the Committee on Health Care Affordability and its related Industry Advisory Committee. 

Vermont passed legislation to control healthcare costs through payment and delivery system reforms. Governor Phil Scott signed into law S.126 which enacts healthcare payment and delivery system reforms to achieve transformation of and structural changes to Vermont’s healthcare system. Under the new law, the state will implement reference-based pricing for hospitals and develop an integrated statewide Health Care Delivery Plan, as well as create two new advisory committees on healthcare delivery and primary healthcare.

Community Engagement

Arizona Medicaid is hosting online forums to inform the community and gather feedback on upcoming initiatives. The Arizona Health Care Cost Containment System (AHCCCS) is hosting several virtual sessions for stakeholders to provide input on the future of AHCCCS health plans. Sessions will include an overview of AHCCCS, and participants will be asked to share insights that can help inform the future of Medicaid and AHCCCS Complete Care contracts in Arizona. Each session is tailored to receive input from specific audiences, including members, behavioral health providers, physical health providers, and health plans.

California is accepting applications for its Medi-Cal Voices and Vision Council. The Department of Health Care Services (DHCS) is now accepting applications to join the Medi-Cal Voices and Vision Council. This new stakeholder group offers a dedicated space for Medi-Cal members and stakeholders to provide direct, informed, and meaningful feedback about the Medi-Cal program to DHCS leadership. 

As a reminder, SHVS published an issue brief on how to fairly compensate Beneficiary Advisory Council (BAC) members for their time and expertise without adversely affecting their eligibility for Medicaid. SHVS also published template materials designed to support state agencies in recruiting members for the BAC. States can customize the content of the materials, which include a recruitment flyer, social media graphics, core messages, website copy, and newsletter copy.

Expanding Access to Care

Colorado passed legislation to expand access to lower-cost prescriptions through the 340B Drug Pricing Program. Governor Jared Polis signed legislation that will allow healthcare providers to access lower-cost prescription drugs for patients without limitations. SB25-071 prohibits pharmaceutical manufacturers and other related entities from imposing limitations or restrictions on covered hospitals, contract pharmacies, federally qualified health centers, or other facilities participating in the federal 340B Drug Pricing Program. Manufacturers may not require covered entities or pharmacies to submit health information unless it is directly related to a claim under a federal healthcare program.

Delaware is protecting access to gender-affirming care and expanding access to prescription medications. Governor Matt Meyer signed an executive order that adds further protections for gender-affirming care providers and patients. Executive Order 11 makes Delaware a shield state for providers, prohibiting state agencies from cooperating with investigations, subpoenas, or legal actions initiated in other states against individuals or providers involved in gender-affirming care that is legal in Delaware. It also bars professional licensing boards in Delaware from penalizing providers solely for delivering such care. Additionally, Governor Meyer signed Senate Bill 180, which gives authority to the Board of Pharmacy to modernize Delaware’s licensure system, including specific provisions to better prepare for and manage emergencies. The legislation makes it easier for pharmacies to distribute prescriptions efficiently and timely for patients.

New Mexico is funding providers through the Rural Health Care Delivery Fund. Governor Michelle Lujan Grisham announced that rural healthcare providers may apply for the $20 million available from the Rural Health Care Delivery Fund allocated earlier this year as part of the governor’s commitment to expanding healthcare in New Mexico.   

Oregon is expanding access to cell and gene therapies. Starting January 1, 2026, Oregon will expand access to lower-cost cell and gene therapies for Medicaid enrollees through the Cell and Gene Therapy Access Model. Under this model, CMS will negotiate with drug manufacturers on behalf of states, tying treatment prices to specific outcomes such as improved access to innovative treatment, improved health as well as reductions in healthcare costs and burdens to state Medicaid programs. 

Extending Marketplace Affordability

Colorado’s Division of Insurance is estimating significant losses in coverage if Congress fails to extend the enhanced premium tax credits (ePTCs). The Colorado Division of Insurance revised the expected impact on Colorado’s reinsurance program in the event Congress fails to extend ePTCs. Federal inaction combined with the provisions in the budget reconciliation bill is estimated to lead to as many as 110,000 Coloradans losing access to health insurance. Governor Jared Polis wrote to Colorado’s Congressional delegation urging them and Congress to help keep thousands of Coloradans on their healthcare coverage.

Maryland insurers requested a 17.1% average rate increase for 2026 individual market coverage. The Maryland Insurance Administration announced it received the 2026 proposed premium rates from carriers. In the individual market, carriers are requesting an average rate change of 17.1%, the highest rate increase since implementation of Maryland’s reinsurance program, reflecting the anticipated loss of ePTCs. If Congress were to extend the ePTCs, rate increases would instead reflect an overall average rate change of 7.9%.

Minnesota insurers proposed average rate increases from 7% to 26% in the individual market. The Minnesota Department of Commerce announced that health insurers have submitted their proposed increased rates for 2026 plans available to Minnesotans who buy individual or small group health insurance. The Department highlighted that federal policy shifts are driving uncertainty in the market, which is contributing to higher proposed rates. Insurers have proposed average increases ranging from 7% to 26% in the individual market, and average proposed increases range from 7% to 17% for small group plans. 

Oregon issuers requested an average rate increase of 9.7% in the individual market. The Oregon Division of Financial Regulation (DFR) announced that issuers have submitted proposed 2026 rates for individual and small group plans. In the individual market, six companies submitted rate change requests for a weighted average increase of 9.7%. In the small group market, eight companies submitted rate change requests for a weighted average increase of 11.5%. The rate filings reference uncertainty and other changes for some insurers. For example, two insurers include a 2.7% impact due to prescription drug tariffs. DFR, which approves all rate request changes, will inquire further with insurers about ongoing uncertainty at the federal level, including further tariffing of prescription drugs and medical equipment, key changes in laws and subsidies, and additional cost drivers that may be felt by consumers.

Pennsylvania is warning of higher health insurance costs if Congress does not extend the ePTC. The Pennsylvania Insurance Department announced that health insurers are requesting average premium increases for plan year 2026 coverage of 19% in the individual market and 13% in the small group market. In their filings, insurers highlight the requested increases are due to the rising cost of healthcare and the end of the ePTCs.

Rhode Island insurers requested the highest increases in the state in over a decade. The Office of the Health Insurance Commissioner released the requested rate increases from health insurers for plan year 2026 coverage. The average rate increases range from 21.2% to 28.9% in the individual market, 20.3% to 22.2% in the small group market, and 13.5% to 26.4% in the large group market. The expiration of the ePTCs are driving the rate increases.

Vermont’s two participating carriers announced a requested 23.6% and 6.2% increase in the individual market. Vermont Green Mountain Care Board, tasked with reviewing health insurance premium rates in the large group and individual and small group markets, announced the 2026 premium rate filings. Requested rate increases from the two participating carriers included a 23.6% and 6.2% increase in the individual market and a 13.7% and 7.5% increase in the small group market. The proposed rates for the individual market reflect increases due to the anticipated loss of federal ePTCs. 

For more information about early 2026 rate filings demonstrating significant rate increases, see this blog from Georgetown University’s Center for Health Insurance Reforms.

Highlighting the Value of Medicaid

California published evidence on the success of its Medicaid waiver program to provide community supports to enrollees. The California Department of Health Care Services released data showing that Medi-Cal Community Supports are successful and cost-effective. The data illustrate that Community Supports are reducing avoidable emergency department visits, hospital stays, and long-term care use while showing strong early signs of cost savings. All 12 Community Supports studied are reducing costs, and of these, nine have already demonstrated cost-effectiveness within the initial study period. The remaining three are projected to reach that threshold over a longer study period.

California raised concerns about the One Big Beautiful Bill Act, including the elimination of coverage for 3.4 million Californians. Governor Gavin Newsom highlighted the impact of healthcare cuts in the House reconciliation bill, including terminating coverage for up to 3.4 million Californians, a reduction of  $22 billion in federal funding as a result of coverage losses due to work requirements, a cut of at least $4 billion annually for California’s coverage of undocumented residents using state-funds, restricting vital funding mechanisms like provider taxes, and a shut down of Planned Parenthood.

Colorado updated estimates of the potential impact of budget reconciliation provisions. The Colorado Department of Health Care Policy & Financing published updated estimates of the impact of potential federal changes to the Medicaid program, including work requirements for the expansion population, changes to provider taxes and state directed payments, more frequent eligibility redeterminations, and other proposals. Governor Jared Polis, hospital leaders, and healthcare advocates urged Congress to reconsider Medicaid cuts, highlighting that the bill would be devastating to Colorado, resulting in coverage losses for families and children, shutting down Colorado’s rural hospitals and healthcare providers, and increasing the cost of healthcare for everyone.

Maine released estimates of the impact of federal Medicaid reductions. The Maine Department of Health and Human Services published an updated summary of proposed federal changes in the House budget bill and the impact on Maine, including the penalty on federal match due to Maine’s coverage of immigrant populations, work requirements, the moratorium on provider taxes, and the prohibition of federal payments for family planning services and reproductive healthcare.

Maryland state partners convened a roundtable to discuss proposed federal cuts. Maryland state officials, healthcare and human service providers, healthcare plans, and community organizations gathered for a roundtable discussion about the proposed federal budget cuts that could impact essential benefits for Marylanders and could lead to more than 130,000 Marylanders losing Medicaid coverage and 66,000 Marylanders losing Marketplace coverage. In conversation about the threat that the cuts pose to families and the state’s economy, state officials warned about the potential to exacerbate health disparities, increase poverty, and produce strain on local resources, including increased strain on emergency services, higher rates of food insecurity, and potential closures of healthcare facilities.

Minnesota is highlighting individuals touched by its Medicaid program. The Minnesota Department of Human Services published a webpage highlighting the faces of Minnesota’s Medicaid program. The page features stories from the Minnesotans enrolled in the program, their families, and the healthcare providers and county workers employed by the program. Additionally, the Minnesota Department of Health released findings from a new statewide survey which shows 8 in 10 respondents opposed federal cuts to Medicaid. Other survey results include: 93.4% of respondents support government-provided health coverage for people who lose job-related coverage; only 15.6% thought the changes being considered in Congress would improve the health of people on Medicaid; of those who supported reducing money put toward Medicaid expansion, about a quarter (27.3%) changed their minds when they learned states might not be able to make up the amount and 20 million people would lose coverage nationally. 

New Jersey modeled the impact of the House-approved reconciliation proposals and Governor Murphy met with constituents who will be impacted. The New Jersey Department of Human Services published a summary of House-approved Medicaid cut impacts on New Jersey, which has been posted on a webpage with information on how the House bill will impact the Medicaid and SNAP program in New Jersey. Governor Phil Murphy urged the Senate to oppose the budget reconciliation bill, and held a second roundtable discussion with Medicaid recipients whose lives would be impacted by the House-approved budget bill.

New York released data showing the reconciliation proposals would increase the number of uninsured. Governor Kathy Hochul released data showing the impact of the House Budget Bill on New York families, disrupting health coverage for millions of New Yorkers, increasing the number of uninsured by 1.5 million and terminating $13.5 billion in annual funding from New York’s healthcare system. The state also published a new visualization of impacts by congressional district. Governor Kathy Hochul issued a letter to Senate Majority Leader John Thune outlining the impact that the House’s budget would have on New Yorkers, and joined Congressman Hakeem Jeffries to sound the alarm. 

North Carolina Governor Josh Stein urged the U.S. Senate to protect the health and well-being of North Carolinians. Governor Josh Stein sent a letter to U.S. Senators Tillis and Budd laying out the consequences of the U.S. House budget reconciliation bill for North Carolina families. The letter highlights how the bill, along with impending expiration of enhanced premium tax credit subsidies, could cause nearly half a million North Carolinians to lose their healthcare.

Oregon published estimates showing 200,000 Medicaid members could lose healthcare coverage. Governor Tina Kotek convened a roundtable to hear directly from rural Oregon healthcare experts, providers, and food system specialists about the impact of proposed cuts to Medicaid and SNAP. Additionally, the Oregon Health Authority published new estimates of the impact of the proposed federal requirements and funding cuts to Medicaid, showing an estimated 200,000 members could lose healthcare under the new rules and become uninsured.

Pennsylvania highlighted the role of Medicaid in supporting the state’s economy and keeping people healthy. Department of Human Services Secretary Dr. Val Arkoosh, Insurance Commissioner Michael Humphreys, and Pennie Executive Director Devon Trolley highlighted the importance of Medicaid in providing healthcare coverage to millions of Pennsylvanians amid proposed federal cuts to the program, which would terminate coverage for more than 300,000 Pennsylvanians. Governor Josh Shapiro published an analysis of the impacts of the budget reconciliation bill on Medicaid and SNAP in the state, including estimates of coverage losses by county. Shapiro administration officials joined rural health leaders at Wayne Memorial Hospital to express concerns about the devastating effects of the proposed cuts on rural Pennsylvanians and healthcare providers.

Washington announced between 200,000 and 320,000 Washingtonians are projected to lose Medicaid coverage. The Washington Health Care Authority published an updated analysis of the impact of federal proposals on Medicaid in the state, including imposing a work requirement as a criteria for eligibility, a reduction in federal match for certain populations, a reduction of state directed payments and provider taxes, and cost-sharing requirements. Governor Bob Ferguson joined healthcare workers and advocates to urge Congress to abandon the proposed cuts.

SHVS and Manatt Health published a toolkit to assist states in their efforts to model the impact of the provisions under consideration by Congress. As the bill makes its way through Congress, SHVS continues to publish updated estimates of the impact to state Medicaid coverage and expenditures:

• Senate-Passed H.R. 1: Updated Estimates on Impact to State Medicaid Coverage and Expenditures, Hospital Expenditures, Including Impacts by Congressional District
• Assessing the 50-State Medicaid Coverage and Expenditure Impacts of the Senate Version of the One Big Beautiful Bill Act
• Assessing the 50-State Medicaid Expenditure Impacts of the Senate Finance Committee Bill Compared to H.R.1

Additionally, SHVS continues to track the states that are publicly reporting their own estimates of proposed cuts to Medicaid. SHADAC will continue to regularly monitor published estimates from states, updating the expert perspective.

For those looking to learn more about how the cuts being discussed in Congress would impact children, a recent episode of Heather Howard’s podcast the Princeton Pulse explores how proposed cuts would impact the health, development and future prosperity of the more than 37 million children who rely on Medicaid and CHIP.

Highlighting the Value of Marketplace Coverage

Colorado warned that the budget reconciliation bill could result in the loss of $620 million in tax credits to Coloradans. Kevin Patterson, CEO of Connect for Health Colorado, the state’s official health insurance Marketplace, is highlighting how the budget reconciliation bill would jeopardize health coverage in Colorado and cause 112,000 people—43% of those currently enrolled through Connect for Health Colorado—to lose coverage.

Maryland’s State-Based Marketplace estimates 70,000 Marylanders could lose coverage. The Maryland Health Benefit Exchange is highlighting the impact of the House budget reconciliation bill on state residents enrolled in Marketplace coverage, including increased premium costs for 250,000 enrollees and barriers to enrollment. The elimination of auto-enrollment could result in 43,000 individuals losing coverage, while 24,000 legally present individuals would no longer be eligible. 

Massachusetts’ State-Based Marketplace reported a 40% increase in enrollment in 2024. The Massachusetts Health Connector published its 2024 annual report to the state legislature highlighting the activities and accomplishments of the Marketplace, including reaching more than 360,000 members. Additionally, the new 2024 to 2028 Strategic Plan focuses on simplifying processes, improving user experiences, and making coverage more affordable, particularly for those with chronic conditions.

New Jersey’s Department of Banking and Insurance is warning of the devastating impacts of the reconciliation bill. Department of Banking and Insurance (DOBI) Commissioner Justin Zimmerman sent a letter to New Jersey’s Congressional delegation warning of the devastating impacts of the budget reconciliation bill on access to quality, affordable health coverage. DOBI created a fact sheet that explains the impact of the Congressional budget reconciliation bill on New Jerseyans statewide. 

New York highlighted the impact on consumers of eliminating ePTCs. Governor Katy Hochul announced that the elimination of ePTCs alone will increase the net cost of coverage across the state by an average 38% for 140,000 low-income individuals and families purchasing coverage through the Marketplace. More than 240,000 New Yorkers would experience increased premiums from the elimination of ePTCs and additional changes due to the budget reconciliation bill.

Pennsylvania’s State-Based Marketplace and Insurance Department urged Congress to vote against the reconciliation bill. The Pennsylvania Insurance Department and Pennie, the state’s official health insurance Marketplace, sent a joint letter to members of the U.S. Senate and House of Representatives urging them to vote against the budget reconciliation bill. The letter outlined the loss of affordable coverage for as many as 270,000 Pennsylvanians. 

Washington’s Health Benefit Exchange warned that more than 400,000 Washingtonians will lose coverage. The Washington Health Benefit Exchange is highlighting that the budget reconciliation bill paired with the loss of enhanced premium tax credits would result in more than 400,000 people being predicted to lose coverage in Washington.

Leadership of State-Based Marketplaces continue to voice opposition to the budget reconciliation bill. On June 2 and June 27, Directors from State-Based Marketplaces (SBMs) across the country (California, Colorado, Connecticut, the District of Columbia, Idaho, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia and Washington) sent a letter to the Senate describing how the budget reconciliation bill restricts access to health insurance and imposes unprecedented restrictions and administrative barriers for consumers to access private health insurance. The SBM Directors also joined Marketplace enrollees, small business owners, and healthcare providers to discuss the impacts of the budget reconciliation bill on Marketplaces and the healthcare system. A recording of the press conference is available here. 

SHVS recently hosted a webinar reviewing proposed changes in the House reconciliation bill to policies governing the Affordable Care Act Marketplace and what they might mean for health insurance Marketplace and Division of Insurance officials. Additionally, SHVS continues to track the State-Based Marketplaces that are publicly reporting their estimates of the impact of the budget reconciliation bill, the scheduled expiration of the enhanced premium tax credits, and the 2025 Marketplace Integrity and Affordability rule.

Maternal and Infant Health

Michigan recorded the lowest rate of infant mortality in its history. The Michigan Department of Health and Human Services (MDHHS) announced that Michigan has reached the lowest recorded infant mortality rate in state history. MDHHS also hosted the eighth annual Maternal Infant Health Summit to convene a multidisciplinary group of state and national partners and share ideas on how to continue efforts to improve the health of Michigan moms and babies. 

Pennsylvania worked with insurance companies to cover postpartum depression medication. The Pennsylvania Insurance Department announced that the largest health insurers operating in the state are taking steps to expand coverage for medications used to treat postpartum depression and related maternal mental health conditions. After working with the Department to expand coverage, the largest Pennsylvania health insurers in the individual and small group insurance markets will cover the FDA approved fast-acting postpartum medication for plan year 2026.

Virginia passed “safety bundle” legislation to protect mothers and babies during birth. Governor Glenn Youngkin signed legislation that requires all hospitals, licensed birthing centers, and free-standing emergency departments to adopt standardized protocols, known as “safety bundles,” for identifying obstetric emergencies for both inpatient and outpatient care.

For information on how states can leverage payment to improve maternal health outcomes, see the SHVS issue brief Maternal Health Providers: Enhancing Health Equity Through Payment Parity.

Medical Debt

Delaware held a roundtable discussion focused on solutions to protect residents from medical debt. Governor Matt Meyer convened a roundtable to confront the growing crisis of medical debt in Delaware. Joined by legislative leaders, national experts, state agency officials, and individuals personally impacted by medical debt, the discussion focused on the urgent need to protect Delawareans from the financial and emotional burdens of unpaid medical bills. Governor Meyer strongly supports Senate Bill 156, which would prohibit medical debt from appearing on credit reports.

Illinois approved $15 million to continue funding the state’s medical debt relief program. Governor JB Pritzker signed the state’s fiscal year 2026 state budget package, which includes $15 million for the state’s medical debt relief program. To date, the program has provided over $330 million in debt relief for more than 290,000 Illinoisans.

Maine passed legislation to prohibit the inclusion of medical debt on consumer reports. Governor Janet Mills signed legislation to strengthen consumer protections by prohibiting the inclusion of medical debt on consumer reports. Consumers whose medical debt is reported in violation of the new amendments can seek civil remedies against the medical creditor, debt collector, debt buyer, or consumer reporting agency that reported the medical debt

Oregon passed legislation to prohibit the inclusion of medical debt on consumer reports. Governor Kotek signed into law a bill prohibiting the inclusion of medical debt in consumer reports. The law is expansive to include medical debt that is owed to healthcare providers, as well as owed to credit cards issued for the purpose of covering medical expenses.

For more information on state efforts to prohibit medical debt reporting and eliminate existing debt, see the SHVS expert perspective Mapping State Efforts to Address Medical Debt and a Health Affairs Forefront article which examines the burgeoning trend of state efforts to cancel medical debt for just pennies on the dollar. SHVS also published a state spotlight profiling North Carolina’s Comprehensive Medical Debt Relief and Reform Incentive Program.

Mental and Behavioral Health

California shared the numbers of youth accessing virtual behavioral health services. The California Department of Health Care Services released an Impact Update on BrightLife Kids and Soluna, two free virtual behavioral health services platforms available to all California children, youth, and families through the Children and Youth Behavioral Health Initiative. As of May 2025, more than 319,000 youth and families have used the apps, more than 62,000 coaching sessions have been completed, and more than 70% of users consider it their first and only source of professional mental health support.

Montana is providing housing support services for Montanans with behavioral health needs. Governor Greg Gianforte announced the launch of a new Medicaid-funded service to support eligible Montanans with housing-related needs as part of the state’s Healing and Ending Addiction through Recovery and Treatment (HEART) program. Tenancy supports include assistance with locating and applying for housing, developing individualized housing support plans, navigating landlord relationships, and connecting to community resources. Funding is also available through the program to help cover security deposits and application fees. Additionally, Governor Gianforte announced $2.5 million in grants have been awarded to 10 recipients across the state to support rural counties and tribes as they design and implement targeted, locally-developed initiatives to support behavioral health needs within their communities.

North Carolina is providing substance-use disorder support for people recovering from Hurricane Helene. North Carolina Health and Human Services Secretary Dev Sangvai toured western North Carolina to highlight the work of the Hope4NC program, which is delivering critical mental health and substance-use disorder support for communities in western North Carolina affected by Hurricane Helene. Between September 2024 and May 2025, Hope4NC has supported western North Carolinians and delivered more than 11,300 individual or group counseling services and supportive contacts, more than 200,000 assessments, referrals and media outreach contacts, and answered more than 7,300 calls to their free, confidential 24/7 helpline.

New Jersey is leveraging opioid settlement funds to develop temporary housing and case management services. Human Services Commissioner Sarah Adelman announced the award of over $3.67 million in contracts, funded by opioid settlement funds, to develop temporary housing and case management services in a supportive environment for adults recently discharged from inpatient settings and unhoused with a substance-use disorder. Additionally, the New Jersey Opioid Recovery and Remediation Advisory Council released its inaugural Strategic Plan, a comprehensive five-year roadmap to guide the equitable and data-driven investment of opioid settlement funds across the state. 

New Mexico convened the first meeting of the Behavioral Health Reform Executive Committee. The New Mexico Health Care Authority and the Administrative Office of the Courts held the inaugural meeting of the Behavioral Health Reform Executive Committee established under Senate Bill 3. The statute brings together all three branches of government and community leaders to reshape New Mexico’s behavioral health system. The Executive Committee will guide the law’s implementation and develop strategies to ensure transparency, regional equity, and meaningful public engagement.

Mitigating the Health Effects of Climate Change

New York is providing free air conditioners to eligible New Yorkers enrolled in the state’s Essential Plan with persistent asthma. Governor Kathy Hochul announced the launch of the Essential Plan Cooling Program, an affordability initiative that provides free air conditioners to eligible New Yorkers who are enrolled in the state’s Essential Plan and live with persistent asthma, to help reduce heat-related health risks and improve quality of life during the hottest months of the year. For more information about New York’s Essential Plan, see SHVS’ state spotlight.

For more information on state efforts to mitigate the health impacts of extreme heat, see this Health Affairs Forefront article.

Reproductive and Women’s Health

New York awarded funding to abortion care providers across the state. Governor Hochul announced more than $24 million in state grants for abortion healthcare services under the New York State Abortion Access Program. The Program provides financial support to healthcare providers across the state, ensuring that patients can access safe and supportive abortion services within their communities.

Oklahoma expanded access to prescription birth control for a six month supply. The Oklahoma legislature approved legislation, which went into effect without the governor’s signature, which provides expanded access to birth control. The law, which takes effect November 1, requires insurance companies that provide coverage for contraception to allow women to obtain six months of birth control at one trip to the pharmacy.

States React to Federal Policy

North Carolina reaffirmed the state’s commitment to serving LGBTQ+ youth. Following the announcement that the U.S. Department of Health and Human Services will eliminate federal funding for the 988 Suicide and Crisis Lifeline service dedicated to LGBTQ+ youth services, Kelly Crosbie (NCDHHS Director of Mental Health, Developmental Disabilities and Substance Use Services) issued a statement that everyone can and should still call 988, including members of the LGBTQ+ community. 

Washington’s Health Benefit Exchange commented on CMS’ 2025 Marketplace Integrity and Affordability Final Rule. Ingrid Ulrey, CEO of the Washington Health Benefit Exchange, released a statement following the publication of CMS’ 2025 Marketplace Integrity and Affordability Final Rule, highlighting that the rule, along with imminent Congressional action and the potential expiration of the enhanced premium tax credits, is a perfect storm for nearly 300,000 Washingtonians who rely on Washington’s Marketplace. SHVS published a regulatory analysis which summarizes the provisions of the rule and highlights considerations for state officials.

Wisconsin announced it will continue to cover COVID-19 vaccines for eligible Medicaid enrollees. DHS continues to recommend the current COVID-19 vaccine during pregnancy and for every person six months and older to protect from serious COVID-19 illness and to prevent spreading it to others. Wisconsin Medicaid will also continue to cover the current COVID-19 vaccine for eligible Medicaid members, including children and individuals who are pregnant. 

Wisconsin and Michigan reminded hospitals they must provide lifesaving care for pregnancies under the Emergency Medical Treatment and Labor Act. The Wisconsin Department of Health Services (DHS) issued a statement assuring Wisconsinites that under state and federal laws, hospitals must provide appropriate emergency care, including abortion care. This clarification comes following a June 3 statement made by CMS to rescind July 2022 guidance on enforcing the Emergency Medical Treatment and Labor Act (EMTALA) as it relates to pregnancy. Additionally, Governor Gretchen Whitmer and the Michigan Department of Licensing and Regulatory Affairs sent a notice to hospitals reiterating their responsibility to continue providing adequate and appropriate reproductive care to patients.

California and Washington issued statements on the use of Medicaid enrollee data. The California Department of Health Care Services (DHCS) issued a statement about its commitment to protecting the privacy and well-being of all Medi-Cal members. Recent reports have raised concerns about how federal agencies may be using Medicaid data and DHCS contacted CMS to seek clarification on whether any Medi-Cal member data had been shared with other federal agencies, what specific data may have been involved, and for what purpose. DHCS has not yet received confirmation that data sharing occurred. DHCS posted updated frequently asked questions (FAQs) on Medi-Cal immigrant eligibility in response to recent reports that have raised concerns about how federal agencies may be using Medicaid data. Additionally, the Washington Health Care Authority (HCA) issued a statement about the use of Medicaid client data, stating that HCA was not consulted by CMS about the sharing of information with other federal agencies, including those involved in immigration enforcement, and were not given an opportunity to review or object. HCA stated that protecting the privacy of all of all enrollees, regardless of their immigration status, is central to its mission, and HCA “is reviewing whether we have any recourse related to this gross misuse of our data.”

California, Oregon and Washington condemned the dismissal of the Advisory Committee on Immunization Practices. Governors Gavin Newsom, Tina Kotek, and Bob Ferguson issued a joint statement condemning the dismissal of all members of the Advisory Committee on Immunization Practices (ACIP) at the CDC and reiterated their states’ commitment to following the science to protect public health. 

Pennsylvania urged HHS to protect access to lifesaving vaccines. Ahead of the first ACIP meeting under the Trump administration, Governor Shapiro, Pennsylvania Secretary of Health Dr. Debra Bogen and Pennsylvania Insurance Commissioner Michael Humphreys urged HHS Secretary Robert F. Kennedy, Jr. to protect Pennsylvania families by ensuring timely access to vaccines.

Waiver and State Plan Amendments, Requests and Approvals

Alabama is seeking public comment on the State of Alabama Independent Living Waiver renewal. The Alabama Medicaid Agency is seeking public comments on the proposed renewal application for the State of Alabama Independent Living (SAIL) Waiver. The SAIL Waiver provides individuals with specific diagnoses and related illnesses home and community-based services in the community who would otherwise require nursing facility care.

The District of Columbia released for public comment a section 1331 Blueprint to create a Basic Health Program. The District of Columbia’s Health Benefit Exchange Authority published a section 1331 BHP Blueprint for a 30-day public comment period before it will submit the Blueprint to CMS for approval. Section 1331 of the Affordable Care Act gives states the option to establish a Basic Health Plan (BHP) for low-income residents up to 200% of the federal poverty level, who are not Medicaid eligible and would otherwise be eligible to purchase coverage through the Marketplace. See here for the Blueprint, and see here for an overview of the District’s plan for the BHP, including continuity of coverage, no out-of-pocket costs, and comprehensive essential health benefits.

Iowa submitted a request to implement Medicaid work requirements. The Iowa Department of Health and Human Services has submitted a request to amend the Iowa Health and Wellness Plan (IHAWP) section 1115 demonstration to incorporate work requirements as a condition of maintaining eligibility for IHAWP enrollees ages 19 to 64 who are not otherwise exempt. The demonstration will continue to authorize dental benefits for adults and children through a managed care delivery system known as a Prepaid Ambulatory Health Plan, cost sharing, premiums, a waiver of non-emergency medical transportation, and waiving retroactive eligibility for certain enrollees.

Maryland was approved to expand behavioral health and home and community-based services. The Maryland Department of Health received CMS approval to expand access to behavioral health and home and community-based services for children and youth. The federal approval is for an amendment to Maryland’s 1915(i) state plan, which gives the state the authority to provide home and community-based services for children and youth with serious emotional disturbances.

Nebraska received approval to provide SUD services in institutions for mental disease. CMS approved a five-year extension to the “Nebraska Substance Use Disorder (SUD) Program Section 1115 Demonstration” which will allow the state to continue receiving federal financial participation for SUD services provided to enrollees in institutions for mental disease.

CMS approved state plan amendments in six states to allow Indian Health Service and Tribal clinics to provide Medicaid clinic services beyond the physical clinic. The states approved include Minnesota, New Mexico, Oregon, South Dakota, Washington and Wyoming to allow Indian Health Service and Tribal clinics to provide services in homes, schools, and other appropriate community locations.