States of Innovation: November 2025
The Rural Health Transformation Program (RHTP) remained a major focus of state activity in November, with the Centers for Medicare & Medicaid Services announcing that all 50 states submitted applications. State Health and Value Strategies (SHVS) continued to update our expert perspective featuring an interactive map identifying states that have formally announced their submission and/or publicly released their application materials. The map also includes links to the publicly-available material. State-specific activity related to the RHTP included New Hampshire establishing a new office to oversee rural health initiatives and Oklahoma recruiting an RHTP director.
Federal policy and funding changes continued to be a central concern for many states in November. As states react to federal policy, Connecticut took steps to appropriate funding for an emergency reserve to offset federal cuts to health and human services, while North Carolina’s Governor requested the legislature convene a special legislative session to secure Medicaid funding and prevent program reductions. Rhode Island established the Federal Compliance Advisory Group to analyze potential impacts of federal actions on Medicaid, the Supplemental Nutrition Assistance Program, and HealthSource RI, the state’s official health insurance Marketplace.
States also took significant steps to strengthen services for children and youth. Michigan launched a competitive procurement for its Healthy Kids Dental program, while Ohio rolled out Mobile Response and Stabilization Services statewide, making no-cost crisis intervention available to all children and young adults under age 21. As open enrollment (OEP) continued, 10 states publicly reported on Marketplace enrollment, and SHVS continued to update our expert perspective tracking real-time 2026 State-Based Marketplace (SBM) enrollment data.
Other state action in November included initiatives related to affordability and efforts to address cost; aging and long-term care; community engagement; expanding access to care; health equity; maternal and infant health; medical debt; mental and behavioral health; mitigating the health effects of climate change; protecting vaccine access; and waiver and state plan amendments, requests, and approvals.
Affordability and Efforts to Address Cost
Arizona expanded access to affordable prescription drugs through the launch of AZRx. Governor Katie Hobbs and the Arizona Department of Health Services launched AZRx, an initiative that allows Arizonans to save money on their prescription drugs. Arizonans can sign up for a discount card through ArrayRx, the multistate public pharmacy collaborative that Arizona joined earlier this year through the governor’s executive order. The discount card is available at no cost to Arizona residents and helps Arizonans save up to 80% on their medications.
Indiana issued recommendations to improve Medicaid-funded Applied Behavior Analysis therapy. Indiana Family and Social Services Administration Secretary Mitch Roob announced the recommendations of the Applied Behavior Analysis (ABA) Working Group, convened earlier this year to address the rapid growth and sustainability challenges of Medicaid-funded ABA therapy. The Working Group issued five interdependent recommendations to protect access, improve quality, and ensure sustainability: align ABA utilization with clinical evidence; ensure high-quality care and optimal outcomes; establish sustainable rates; strengthen program management and oversight; and support a sustainable ecosystem for ABA.
Oregon hosted a hearing on prescription drug pricing concerns. The Oregon Department of Consumer and Business Services’ Division of Financial Regulation (DFR) hosted a public hearing on prescription drug prices on December 4. The Division created a survey for consumers to share their stories about rising prescription drug prices and DFR invited speakers to talk about biosimilars and their marketing and challenges and ideas for financing drugs that create issues for traditional insurance financing models.
Aging and Long-Term Care
Connecticut released a new guide to help residents navigate dementia care. Governor Ned Lamont announced the release of a new Connecticut guide for navigating dementia care. Developed by the Connecticut Department of Public Health and the Connecticut Department of Aging and Disability Services, the guide was created to provide people living in Connecticut with information on resources to support someone living with Alzheimer’s or dementia.
Michigan sought public input to inform development of its multi-year State Plan on Aging. The Michigan Department of Health and Human Services (MDHHS) Bureau of Aging, Community Living, and Supports is seeking public input regarding the needs and gaps in programs and services that impact quality of life for older residents, to inform the development of a multi-year State Plan on Aging.
Community Engagement
California awarded $145.5 million to organizations across the state to expand community-based services. Governor Gavin Newsom announced $145.5 million in awards to organizations across the state to support specialized, community-based services. The awards are part of the Providing Access and Transforming Health (PATH) Capacity and Infrastructure, Transition, Expansion, and Development (CITED) initiative, which helps local providers grow their ability to deliver whole-person, community-based care. These investments support services and programs, including in-person care coordination, housing support, and other vital resources.
Expanding Access to Care
North Carolina expanded support for veterans and their families. The North Carolina Department of Health and Human Services (NCDHHS) announced extended hours for NCServes and the launch of AskMeNC, two initiatives that expand access to care for North Carolina’s veterans and their families. These efforts strengthen the state’s coordinated network of support and underscore NCDHHS’s commitment to ensuring the more than 600,000 veterans who live in North Carolina have timely access to mental healthcare, housing, employment, and peer support services.
Health Equity
North Carolina released a cancer prevention plan focused on reducing disparities and improving outcomes. The North Carolina Department of Health and Human Services has released A Statewide Call to Action to Reduce Cancer in North Carolina: 2025-2030 North Carolina Cancer Plan to address the complex factors and impacts of cancer that affect North Carolinians. The plan emphasizes reducing disparities among underserved and rural communities that experience higher rates of cancer, disability and death.
Oregon appointed a director to guide statewide inclusion efforts. The Oregon Health Authority (OHA) has appointed Dr. Steven Nakana as the new permanent director of OHA’s Equity & Inclusion Division. The appointment underscores OHA’s commitment to creating systems where everyone can thrive, guided by shared values and responsibility.
Marketplace Enrollment
Ten states are reporting 2026 open enrollment data. As open enrollment (OEP) is underway, understanding the impact of the scheduled expiration of the enhanced premium tax credits and other recent federal legislative and regulatory policy changes on Marketplace coverage uptake is crucial. SHVS published an expert perspective which will serve as a one-stop resource for tracking real-time 2026 State-Based Marketplace (SBM) enrollment data. Ten states (CA, CO, CT, KY, MA, ME, MN, NM, NY & PA) are reporting this information, and SHADAC will continue to update this tracker throughout OEP to reflect the latest developments in SBM reporting. SHVS also published an issue brief which outlines priority strategies for SBMs to monitor the impact of federal policy changes on affordability and coverage, including by leveraging targeted consumer surveys.
Maternal and Infant Health
Michigan expanded access to perinatal support by increasing Medicaid-enrolled doulas statewide. The Michigan Department of Health and Human Services (MDHHS) announced it now has more than 1,000 doulas on the MDHHS Doula Registry, surpassing the state’s goal to have 500 doulas registered by 2028. More than 700 of these doulas have become Medicaid-enrolled providers, ensuring families in every Michigan county have access to at least one doula serving Medicaid-eligible families.
New York released a report on maternal mental health. Governor Kathy Hochul announced the release of New York’s first-ever maternal mental health report detailing the challenges pregnant women are facing and recommendations for improvements statewide. In addition to the report, the state also made available funding to help OBGYN and family medicine practices support perinatal pregnant women with behavioral health needs and is hosting a series of virtual roundtables to discuss maternal mental health issues.
Medical Debt
Illinois eliminated nearly $430 million in medical debt through its first year of statewide relief efforts. Governor JB Pritzker announced that the Illinois Medical Debt Relief Program has erased nearly $430 million in medical debt during its first year, benefitting 357,800 Illinoisans across all 102 counties. To date, Illinois has allocated approximately $2.8 million of the $15 million reappropriation in the fiscal year 2026 state budget for medical debt forgiveness. SHVS has updated our expert perspective tracking state medical debt cancellation efforts.
North Carolina urged national credit agencies to strengthen consumer protections. Governor Josh Stein hosted a roundtable discussion to hear from advocates, faith leaders, practitioners, and patients about the burden of living with medical debt and highlight the state’s medical debt relief program (see this SHVS state spotlight for more information). Governor Stein also sent a letter to the three major national Credit Reporting Agencies urging them to recommit publicly to their policies of not including certain medical debt in credit reports and highlighted the benefits of eliminating all medical debt from consumers’ credit reports entirely.
Mental and Behavioral Health
Kentucky expanded support for substance-use recovery by certifying additional Recovery Ready Communities. Governor Andy Beshear announced that four additional Kentucky counties have been certified as Recovery Ready Communities, expanding access to assistance for substance-use disorders (SUD) for 219,000 Kentuckians. The Recovery Ready Communities Certification Program offers local officials, recovery advocates, and citizens the opportunity to evaluate their community’s current SUD treatment programs and interventions in a framework that is designed to maximize positive public health outcomes among Kentuckians suffering from SUD.
Michigan is offering grants to support community-based mobile crisis intervention programs. MDHHS issued a competitive grant funding opportunity for crisis response initiatives that would establish or expand community-based mobile crisis intervention services. The purpose of the program is to provide increased behavioral health crisis services across the state for all Michigan residents, regardless of location, diagnosis or insurance status. A total of approximately $9.5 million in funding is available, and MDHHS anticipates issuing up to nine awards.
New Mexico invited applications for funding to expand mental health and substance-use disorder services statewide. The New Mexico Health Care Authority issued a notice of funding opportunity for behavioral health regions across the state to apply for immediate funding to expand mental health and substance-use disorder services statewide. Up to $26 million will be awarded to New Mexico’s behavioral health regions to support immediate investment addressing one or more of four critical behavioral health access shortages, including: residential treatment continuum of care, crisis continuum of care, medication assisted treatment for justice-involved individuals, or prenatal and perinatal substance-use disorder treatment programs.
Mitigating the Health Effects of Climate Change
Oregon found declines in air quality are correlated with increases in respiratory and mental health visits. New data published by the Oregon Health Authority (OHA) show that when air quality worsens in Oregon, more people visit emergency departments and urgent care clinics for breathing-related illnesses and mental health conditions. The findings come from OHA’s newly updated Air Quality & Health Outcomes data dashboard, which tracks near-real-time health trends across the state. The data reveal clear connections between days with high levels of smoke or pollution and spikes in visits for asthma, chronic obstructive pulmonary disease (COPD), anxiety and other respiratory or stress-related symptoms. For information on state efforts to mitigate the health impacts of climate change, see this Health Affairs Forefront article.
Protecting Vaccine Access
Massachusetts authorized local health personnel to administer the influenza vaccine under a new standing order. The Massachusetts Department of Public Health (DPH) has issued a new standing order authorizing qualified health personnel in local boards of health to administer the influenza vaccine to eligible individuals this respiratory virus season, based on DPH’s recommendations.
New Jersey launched statewide pediatric clinics offering no-cost COVID-19 and flu vaccines. The New Jersey Department of Health has launched a coordinated effort to enhance availability and access to COVID-19 and flu vaccines for those who want to receive them. Pediatric COVID and flu vaccine clinics will be hosted at a wide range of locations across the state for children ages six months and older. These clinics will provide no-cost vaccinations, regardless of insurance status.
Public Health
Colorado strengthened interagency collaboration to bolster cross-sector readiness for zoonotic, foodborne, and other public health threats. The Colorado Department of Agriculture, the Colorado Department of Public Health and Environment, and Colorado Parks and Wildlife announced the signing of a new memorandum of understanding (MOU) to enhance interagency cooperation and information sharing. The MOU strengthens the ability of Colorado’s health, agriculture and wildlife agencies to collaboratively address a wide range of concerns, including zoonotic diseases, foodborne illness outbreaks, and bioterrorism threats.
Rural Health
Arizona’s Medicaid agency announced its support of the state’s application to the federal Rural Health Transformation Program. The Arizona Health Care Cost Containment System announced its support of Governor Katie Hobbs’ submission of Arizona’s application to the federal Rural Health Transformation Program (RHTP).
New Hampshire established a new office to oversee initiatives to improve affordability and access in rural communities. Following the state’s submission for RHTP funds, Governor Kelly Ayotte established the Governor’s Office of New Opportunities & Rural Transformational Health (GO-NORTH) to oversee the state’s efforts to make healthcare more affordable and accessible to improve health outcomes in rural communities.
Oklahoma is recruiting a director to lead RHTP implementation, evaluation, and stakeholder engagement. The Oklahoma State Department of Health is seeking to hire a director for its RHTP. The director will oversee all aspects of program implementation, evaluation, and stakeholder engagement to ensure the program’s goals are met on time and within budget.
West Virginia highlighted its RHTP application through a series of public appearances. Governor Patrick Morrisey concluded a series of appearances throughout West Virginia promoting the state’s application for the RHTP. The governor highlighted programs that aim to enhance access to quality, affordable healthcare and foster economic growth throughout the state.
Indiana and South Carolina each hosted meetings to provide an overview of their RHTP application. The Indiana Department of Health hosted a working group meeting to provide an overview of the state’s RHTP application. Agenda items included an overview of the timeline and governance structure, as well as application initiatives and key priorities, including a plan for the state to distribute regional grants that mirror the RHTP at the state level. The South Carolina Department of Health and Human Services hosted a webinar to review the state’s RHTP application. South Carolina developed its RHTP application and outcomes-driven initiatives by leveraging longstanding relationships with state agencies, healthcare providers, advocates, community leaders and local and state officials.
Services for Children and Youth
California demonstrated early success in expanding school-based behavioral health services. The Department of Health Care Services announced that the Children and Youth Behavioral Health Initiative Fee Schedule program, which allows local educational agencies to sign up to participate in a reimbursement pathway for mental health and substance-use screenings, treatment, and case management, is demonstrating early positive results. Schools and their partners have received more than $1.8 million in new funding for services provided to more than 5,000 students.
Michigan launched a competitive procurement for its Healthy Kids Dental program. The Michigan Department of Health and Human Services announced the launch of a competitive procurement for the Healthy Kids Dental contract. Healthy Kids Dental is a dental benefit program for children with Medicaid and covers dental services such as X-rays, cleanings, fillings, extractions, sealants and more at no cost to families.
Ohio expanded youth behavioral health support by making Mobile Response and Stabilization Services available statewide at no cost. Governor Mike DeWine announced that immediate in-person help for youth experiencing a behavioral health crisis is now operating statewide in all 88 counties. Prior to this expansion, the Mobile Response and Stabilization Services (MRSS) program was only available in 56 Ohio counties. MRSS is available at no cost for children and young adults aged 20 and under who are experiencing mental, emotional, or behavioral distress.
States React to Federal Policy
Connecticut took steps to appropriate funding to offset federal cuts to health and human services. Governor Ned Lamont announced that he has signed a declaration enabling the Connecticut General Assembly to adopt legislation appropriating the funding necessary to create an emergency reserve that will facilitate the state response to millions of dollars in federal cuts toward health and human services. This includes cuts made through H.R.1, the impact of the federal government shutdown and future shutdowns, and any potential future federal reductions.
North Carolina’s governor requested a special legislative session to secure funding and prevent program cuts to Medicaid. Governor Josh Stein requested an extra session of the North Carolina General Assembly on November 17, 2025, to fund Medicaid. The North Carolina Department of Health and Human Services first alerted the General Assembly’s Fiscal Research Division in May 2025 that more money would be needed to keep the Medicaid program whole, but cuts went into effect on October 1. Governor Stein previously sent a letter to the General Assembly laying out three options to reverse the cuts to the state’s Medicaid program: a) fully funding the program at $319 million in recurring funds, b) partially funding the program at $190 million in recurring funds and delaying cuts until at least January 1, 2026, or c) using non-recurring funds from the $500 million Medicaid Contingency Reserve to fill the funding gap.
Rhode Island formed an advisory group to assess potential impacts of federal actions on Medicaid, SNAP, and HealthSource RI. The Rhode Island Executive Office of Health and Human Services, in consultation with the Office of Governor Dan McKee, formed the Federal Compliance Advisory Group in July 2025 to assist in the review and analysis of potential impacts of any federal actions related to the Medicaid program, Supplemental Nutrition Assistance Program (SNAP), as well as the health insurance exchange, HealthSource RI. The advisory group announced it submitted a report to the Governor’s Office and the General Assembly and a summary of the report is also available.
Waiver and State Plan Amendments, Requests and Approvals
Nebraska submitted a waiver amendment to secure federal funding for short-term care and medical respite programs. Nebraska submitted an amendment to its Substance Use Disorder Program Section 1115 Demonstration seeking federal matching funds for services provided to individuals with serious mental illness or severe emotional disturbance who are short-term residents in facilities. The amendment also proposes adding medical respite care for adults who are homeless or at risk of homelessness and recovering from acute physical health conditions after discharge.