States of Innovation: October 2025
The November 5 deadline for the Rural Health Transformation Program (RHTP) applications dominated state activity in October, and SHVS documented how nearly all states solicited public input to inform their transformation plans. SHVS also published a summary of themes that emerged from stakeholder input and is now tracking which states have released their RHTP applications.
A significant challenge for states in October was the looming expiration of the enhanced premium tax credits (ePTCs) and its impact on Marketplace premiums. To make the case for extending Marketplace affordability numerous states highlighted the increase in costs for consumers as a result of Congress failing to extend the ePTCs, including Colorado where premiums are set to increase on average 101% and Wisconsin where premiums will also double.
Other state action related to affordability and efforts to address cost included California announcing insulin pens will now be available to consumers at $11 a pen as a result of the state contracting for its own affordable insulin. Minnesota also took steps to reduce fraudulent Medicaid billing. Three states–Delaware, New Jersey, and North Carolina–announced progress in reducing the burden of medical debt.
States also took steps in October to protect vaccine access in light of changes at the federal level. The most significant action was the announcement of the Governors Public Health Alliance by governors in 15 states. New Jersey and Pennsylvania announced the state’s Medicaid programs will continue to cover vaccines, while Washington authorized healthcare personnel to provide vaccines without a prescription. Colorado and Missouri also reacted to federal policy by launching websites to share information about the impact of H.R.1 on Medicaid.
Also in October several states sought feedback through community engagement. California and Missouri held their first Medicaid Advisory Committee and Beneficiary Advisory Council meetings, while Arizona hosted roundtables aimed at improving the Medicaid procurement process. Other state action in October included additional funding for aging and long-term care, efforts to leverage artificial intelligence and technology, coverage for justice-involved populations and non-citizens, expanding access to care, health equity, maternal and infant health, mental and behavioral health, reproductive and women’s health and services for individuals with disabilities.
Affordability and Efforts to Address Cost
California will make insulin pens available to consumers at $11 a pen. Governor Gavin Newsom announced that California’s CalRx Insulin Glargine in pen form will be available to consumers for a suggested retail price of not more than $55 per five-pack of pens (average cost of $11 per pen) beginning January 1, 2026. California is the first state contracting for its own affordable insulin. Through an agreement secured by Civica Rx–a nonprofit generic drug manufacturer–with Biocon Biologics, Californians will have access to an interchangeable biosimilar insulin glargine pen offered under the CalRx brand and pricing.
California passed legislation to regulate pharmacy benefit managers. Governor Newsom signed SB 41 regulating pharmacy benefit managers to prevent inflated prescription drug prices, including prohibiting the practice of spread pricing, requiring manufacturer rebates to be passed through to health plans, and allowing only administrative fee charges to be assessed to health plan and health insurer clients.
California will require health plans to report on prior authorization. Governor Newsom signed SB 306 which will require health plans to report data to California’s Department of Managed Health Care and Department of Insurance on how often they approve or deny different treatments under prior authorization. The departments will be charged with analyzing the data, and by 2027, insurers will no longer be able to require prior authorization for procedures and other treatments that are approved at least 90% of the time.
Minnesota is taking steps to reduce fraudulent Medicaid billing. Governor Tim Walz announced a third-party audit of Medicaid billing to detect suspicious billing activity. Payments for certain high-risk Medicaid services will be paused for up to 90 days while the audit is conducted. Pre-payment review will initially impact 14 services identified as high-risk for billing irregularities or fraud. Additionally, the Minnesota Department of Human Services (DHS) announced that Medicaid providers who have not billed for services in more than a year will be disenrolled from the Medicaid program as DHS tightens oversight and works to ensure program integrity.
Aging and Long-Term Care
Michigan’s budget invests in programs to help seniors and people with disabilities stay in their homes. Governor Gretchen Whitmer signed the state’s fiscal year 2026 budget into law. Investments in healthcare include $4.5 billion in continued Medicaid funding for programs that help seniors and people with disabilities remain in their homes and communities for as long as possible.
Artificial Intelligence and Technology
New Mexico launched an app residents can use to apply for or renew their Medicaid coverage. The New Mexico Health Care Authority launched the YesNM mobile app that allows New Mexicans to apply for and manage their Medicaid, food assistance, and other essential benefits directly from their smartphones or tablets. The app streamlines the application process and makes it easier to renew benefits, report changes, upload documents, and track case status.
New York is piloting AI training for state employees. Governor Kathy Hochul announced an artificial intelligence (AI) training pilot program specifically designed for the New York state workforce to use AI responsibly. The pilot program is guided by the state’s Office of Information Technology Services and comprised of volunteer users from state agencies with missions that span health, human services, public safety, state operations and infrastructure. The results of the pilot will provide insights and experiential learnings to guide and inform the next phase of AI adoption within the state government.
Community Engagement
Arizona is seeking feedback from the community on its procurement process. AHCCCS retained an independent consultant to facilitate three open roundtable discussions aimed at improving the AHCCCS procurement process. The meetings are intended to be informal and are open to the public; AHCCCS encourages participation from all community members with an interest in the procurement process.
California launched its Medicaid Advisory Committee. The Department of Health Care Services launched the Medi-Cal Voices and Vision Council which serves as the state’s Medicaid Advisory Committee (MAC) and brings together Medi-Cal members, caregivers, providers, community-based organizations, advocacy groups, and county partners to shape the future of Medi-Cal policies, programs, and implementation. The Voices and Vision Council held its inaugural meeting alongside the established Medi-Cal Member Advisory Committee, which serves as the state’s Beneficiary Advisory Council (BAC), to launch a new collaborative structure that brings together lived experience and system expertise to shape Medi-Cal policy. For an overview of the requirements for the BAC and MAC, SHVS published an expert perspective on the relevant sections of the Final Medicaid Access Rule.
Massachusetts established a commission to identify opportunities to engage people with disabilities. Governor Maura Healey signed an executive order re-establishing the Governor’s Special Advisory Commission on Disability Policy. The commission will work to improve opportunities for people with disabilities in the Commonwealth to provide input on policy and program development across state agencies.
Missouri held its first Beneficiary Advisory Council meeting. The Missouri Department of Social Services MO HealthNet Division (MHD) convened the inaugural meeting of its MO HealthNet Community Connection (MCC). The MCC formally serves as MHD’s BAC.
Montana is recruiting BAC members. The Department of Public Health and Human Services is recruiting members for the new Beneficiary Advisory Council as an opportunity for Medicaid enrollees, their families, and caregivers to provide direct feedback on the state’s Medicaid program.
As a reminder, SHVS published template materials states can use to recruit BAC members.
Coverage for Justice-Involved Populations
Montana launched a reentry program for incarcerated individuals. Governor Greg Gianforte announced the launch of the Healing and Ending Addiction through Recovery and Treatment (HEART) Initiative Reentry Program, following the Centers for Medicare & Medicaid Services’ approval of the state’s Section 1115 demonstration waiver amendment request. The new program provides Medicaid services to eligible individuals with behavioral health needs starting 30 days before their release from incarceration.
North Carolina announced a new program to connect people with serious mental illness to services. The North Carolina Department of Health and Human Services (NCDHHS) and First Lady Anna Stein hosted an event to highlight NC Forensic Assertive Community Treatment Teams (NC FACT), a new program designed to help people with severe mental illness released from detention access mental healthcare, housing support, and other services. The new service will assist eligible individuals after release from jail or prison by providing individualized, wraparound assistance addressing both mental health and practical needs.
Coverage for Non-Citizen Populations
California is studying the impact of coverage for non-citizens on health outcomes. Department of Insurance Commissioner Ricardo Lara commissioned San Diego State University to conduct a comprehensive fiscal and economic impact study of California’s Medi-Cal coverage and Covered California expansions for undocumented Californians. The study will provide critical data regarding California’s investment in immigrant healthcare, including the estimated number of undocumented Californians covered by health insurance programs and overall health outcomes for this community.
Washington created an Immigration Sub-Cabinet on immigration. Governor Bob Ferguson announced an executive order that creates the Immigration Sub-Cabinet, tasked with coordinating on immigration and related issues such as data privacy and healthcare access for immigrant communities.
Expanding Access to Care
Arizona is providing Medicaid coverage of Traditional Health services as of October 1. AHCCCS announced the launch of Medicaid-covered Traditional Healing services beginning October 1, 2025. Traditional Healing is a system of care deeply rooted in the cultural traditions of Tribal communities and reflects a holistic approach to health and wellness that embraces the physical, spiritual, emotional, and cultural needs of a person.
Extending Marketplace Affordability
Colorado published an analysis of increases in premiums due to the expiration of the enhanced premium tax credits (ePTCs). Connect for Health Colorado analyzed the Division of Insurance’s release of final approved premiums for plan year 2026. Analysis shows a statewide approximate net average premium increase of 101% for 2026 due to Congressional inaction to extend the ePTCs. Without the extension of ePTCs, approximately 80,000 Coloradans are expected to lose coverage.
Kentucky’s governor highlighted the increase in costs for Kentuckians if ePTCs expire. Governor Beshear and Congressman McGarvey urged Congress to extend the enhanced premium tax credits to ensure healthcare remains affordable for nearly 100,000 Kentuckians with Marketplace plans, who will see as much as 37% higher costs in 2026 if Congress does not act.
Maryland emphasized the importance of maintaining access to affordable coverage. Governor Wes Moore visited Montgomery County to uplift state-based health insurance resources and support amid the federal government shutdown. The governor highlighted the importance of extending the enhanced premium tax credits and ensuring Marylanders maintain access to affordable health coverage.
Minnesota announced final rates for 2026. The Minnesota Department of Commerce announced the finalized rates for plan year 2026, with individual market coverage at a rate increase of 21.5%. Without the state’s reinsurance program extension, the individual market would have faced a 69% rate increase. The announcement underscores the critical importance of both state reinsurance programs and federal premium subsidies.
New Mexico increased the income cap on state subsidies for Marketplace coverage. Governor Lujan Grisham signed emergency legislation to shield New Mexicans from federal cuts following a special legislative session. House Bill 2 removes income caps for state-subsidized health insurance, allowing New Mexicans earning above 400% of the federal poverty level to receive state assistance for Marketplace coverage. Senate Bill 1 transfers $50 million to the Rural Health Care Delivery Fund to support rural hospitals and clinics.
New York consumers started receiving notices of increased premiums. Governor Hochul highlighted that 140,000 impacted New Yorkers are now receiving notices about rising premiums given the scheduled expiration of the ePTCs, with an average increase of 38% next year. The governor called on Congress to extend the subsidies to prevent thousands of New Yorkers from losing coverage. NY State of Health is informing enrollees how they benefit from the American Rescue Plan and Inflation Reduction Act, which provided the ePTCs that will expire on December 31, 2025, unless Congress acts to extend them.
Oregon announced final rates for 2026. The Oregon Division of Financial Regulation finalized the 2026 health rates with a weighted average increase of 9.7% in the individual market. However, due to the expiring ePTCs, most Marketplace enrollees will see significant increases in their net premiums, with some individuals facing increases as much as 300% to 400%.
Pennsylvania’s rates are increasing by 21.5%. The Pennsylvania Insurance Department released the final health insurance rates for 2026 with an average weighted increase of 21.5% in the individual market due to new federal rules and the scheduled expiration of ePTCs. Without congressional action, many Pennsylvanians will face significantly higher health insurance costs.
Washington expects 80,000 people to drop coverage if ePTCs are not extended. The Washington Office of the Health Insurance Commissioner announced health insurers have been approved to sell plans for 2026 in the individual market at a rate change of 21%. Approximately 80,000 people are expected to drop coverage if ePTCs are not extended.
Wisconsin released rates for 2026. Governor Evers and Insurance Commissioner Houdek released 2026 plan year rates showing healthcare coverage costs will skyrocket for many Wisconsinites if Congress fails to extend the ePTCs. Many Wisconsinites will see their premiums double, and some seniors will see increases of over $30,000 per year.
Health Equity
Connecticut launched a health equity dashboard. The Connecticut Office of Health Strategy launched the Connecticut Health Equity Dashboard, an interactive tool that brings together information about health outcomes and social and health drivers to support targeted interventions to improve health outcomes and reduce health disparities. The dashboard provides county-level data on various health indicators and social determinants of health.
Maternal and Infant Health
California passed legislation increasing access to birthing centers. Governor Newsom signed a series of bills to expand health services and resources for women, including SB 863 to increase accessibility to alternative birth centers, AB 1406 requiring a statewide study on midwife education and scope of practice, and AB 2193 expanding perinatal and infant care services to rural communities.
Medical Debt
Delaware will no longer allow medical debt to be included on consumer credit resorts. A new Delaware law that took effect on October 27 will ensure that medical debt can no longer be included on consumer credit reports. Senate Bill 156 was signed in July alongside a state initiative to leverage $500,000 in state funds to eliminate up to $50 million in medical debt for eligible Delawareans.
New Jersey is providing a fifth round of debt relief. Governor Phil Murphy announced that the state is delivering a fifth round of medical debt relief, impacting over 48,000 New Jersey residents who collectively owed $59 million in medical debt. To date, the initiative has forgiven $1.3 billion in medical debt for over 780,000 New Jerseyans.
North Carolina has relieved medical debt totaling $6.5 billion. Governor Josh Stein and NCDHHS Secretary Sangvai announced that more than $6.5 billion in medical debt has been relieved for more than 2.5 million North Carolina residents over the past year, through North Carolina’s Medical Debt Relief Program. For more information about North Carolina’s medical debt relief program, see this SHVS State Spotlight.
As a reminder, SHVS is tracking state efforts to address medical debt through cancellation initiatives and state prohibitions on the inclusion of medical debt on credit reports.
Mental and Behavioral Health
New Mexico is evaluating how to better serve Medicaid enrollees with mental illness. The state announced it is funding an evaluation to identify additional opportunities to augment healthcare and social services for Medicaid members with serious mental illness or substance-use disorders.
North Carolina is creating a new training program for community-based behavioral health clinics. NCDHHS announced the creation of the AdvaNCe Health Together Learning Community, a new training and collaboration model to help Community Behavioral Health Clinics prepare to meet certification standards.
Protecting Vaccine Access
Governors in 15 states announced the launch of the Governors Public Health Alliance. The 15 states (California, Colorado, Connecticut, Delaware, Guam, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, New York, North Carolina, Oregon, Rhode Island, and Washington) made the announcement at the GovACT Alliance meeting. The alliance will serve as a coordinating hub for governors and their public health officials to share best practices, coordinate responses to public health challenges, and advocate for policies that improve health outcomes.
Michigan reminded plans they must still cover COVID-19 vaccines at no cost to consumers. The Michigan Department of Insurance and Financial Services issued a bulletin to remind health insurers that plans in the individual and small group markets are required to continue to cover COVID-19 vaccines at no cost to consumers, following changes to federal vaccine policy.
New Jersey will continue to cover COVID-19 through Medicaid. In a letter to Medicaid providers, the Department of Human Services clarified that FamilyCare, New Jersey’s Medicaid program, will continue to cover COVID-19 vaccines and encourage vaccination for eligible individuals.
New York will continue to allow pharmacists to administer COVID vaccines. Governor Hochul announced an extension of executive order 52, which allows pharmacists to continue administering COVID vaccines to all age groups, providing convenient access for all New Yorkers who wish to be vaccinated.
North Carolina is allowing pharmacists to test and treat for flu. State Health Director Dr. Larry Greenblatt issued standing orders to allow pharmacists at retail locations to test for and treat influenza, effective October 1, 2025. This expands access to flu testing and treatment by allowing pharmacists to prescribe antiviral medications for eligible patients without requiring a separate physician visit.
Pennsylvania took steps to protect access to vaccines and address misinformation. Governor Josh Shapiro signed an executive order that directs the Pennsylvania Department of Health to establish a state-based safety net to protect children’s access to vaccines and creates a Vaccine Education Workgroup to combat misinformation. The Pennsylvania Department of Human Services affirmed that Pennsylvania’s Medicaid program will continue to support access to safe, effective vaccinations at no out-of-pocket cost for Pennsylvanians enrolled in Medical Assistance.
Washington authorized healthcare personnel to provide vaccines without a prescription. The Washington Department of Health has issued a statewide vaccine standing order authorizing qualified healthcare personnel to vaccinate individuals aged six months and older against COVID-19, influenza, and other vaccine-preventable diseases without an individual prescription.
Reproductive and Women’s Health
California is making up for the loss of federal funding for Planned Parenthood. Governor Newsom announced investments of over $140 million to support Planned Parenthood health centers given the loss of federal Title X family planning funding through H.R.1. The state funding will help ensure continued access to reproductive health services for Californians.
California also passed legislation to protect abortion providers. Governor Newsom signed legislation to protect access to reproductive care. AB 260 offers providers the option to prescribe abortion care medication anonymously to protect patient and provider privacy. AB 1525 shields attorneys assisting with access to reproductive care from State Bar discipline.
New York is providing state funds to Planned Parenthood to make up for the loss of federal funds. Governor Hochul is allocating state funds to cover lost federal funding to Planned Parenthood affiliates in New York to protect access to healthcare services, including reproductive healthcare, following cuts to Title X federal funding.
Services for Individual With Disabilities
Arizona will allow families of individuals with intellectual and developmental disabilities to request additional services. Governor Katie Hobbs directed the Arizona Health Care Cost Containment System (AHCCCS) to establish an exception process for individuals enrolled in the Arizona Division of Developmental Disabilities program. The initiative aims to increase flexibility for Arizonans with intellectual and developmental disabilities by allowing families who document that they need more direct care or habilitation service hours than assessed to request reviews for extraordinary care needs. AHCCCS and the Arizona Department of Economic Security will host virtual sessions to help families understand the changes.
Maryland is consolidating programs that serve people with developmental disabilities. The Maryland Department of Health announced that it is consolidating its three Medicaid waiver programs managed by the Developmental Disabilities Administration into a single Medicaid waiver program called Community Pathways. The change aims to make services faster and easier to access, offer more consistent, person-centered support, and enhance the overall system.
States React to Federal Policy
Colorado created a website dedicated to changes resulting from H.R.1. The Department of Health Care Policy & Financing launched a new webpage specific to H.R.1, which provides information on the federally mandated changes to Medicaid, including educational resources for enrollees, providers, and community partners.
Missouri launched a website to provide updates on the impact of H.R.1 on Medicaid. The Department of Social Services announced the launch of two new webpages designed to keep Missourians informed throughout the implementation of federal and state changes, including H.R.1. The H.R.1 webpage serves as a central hub for updates on how the legislation impacts Missouri’s Medicaid program.