States of Innovation: January 2026
January 2026 started off strong with states continuing their efforts to achieve better, more affordable, and more equitable health for all. Following updates to the U.S. childhood immunization schedule, a handful of states–Colorado, Maryland, Massachusetts, Michigan and New Jersey–reaffirmed their commitment to preserving vaccine access. States continued to respond to federal policy with South Dakota creating a webpage with information about the impact of H.R.1 on Medicaid enrollees and California releasing its plan for H.R.1 implementation. Many states focused on rural health by engaging with stakeholders and sharing implementation updates related to their Rural Health Transformation Programs.
States also took important steps to expand access to care, such as Massachusetts, which eliminated prior authorization for many routine essential services and New Jersey which adopted rules to improve healthcare integration for outpatient facilities. State efforts to improve affordability included Virginia’s new governor signing a series of executive orders to reduce healthcare costs for Virginians. Two states provided updates on their respective medical debt relief initiatives, with Arizona cancelling $642 million and New Jersey completing the final round of relief, totaling $1.6 billion in medical debt relief.
Following the expiration of the federal enhanced premium tax credits (ePTCs), two additional states announced they would leverage state dollars to extend Marketplace affordability: Connecticut and Massachusetts. With the conclusion of the open enrollment period, State-Based Marketplaces in Colorado, Maryland, Nevada, Oregon and Washington released initial Marketplace enrollment data with early metrics suggesting two emerging trends: overall enrollment is lagging behind previous years, and consumers are increasingly trading comprehensive coverage for less generous coverage plans with lower premiums.
Other state action in January included initiatives related to artificial intelligence and technology, maternal and infant health, Medicaid innovations, mental and behavioral health, public health, supporting the healthcare workforce, and waiver and state plan amendments, requests and approvals.
Affordability and Efforts to Address Cost
Colorado’s public option is saving Coloradans money. The Colorado Division of Insurance shared a new, independently-conducted analysis by Mathematica, showing that on average, Colorado Option plans have lower premiums in many counties and lower out-of-pocket spending by enrollees. The analysis was required by the bill that established the Colorado Option and is meant to assess the impact of the Colorado Option on health plan enrollment in the individual and small-group health insurance markets, health insurance affordability in those markets, and health equity.
Massachusetts is establishing a Health Care Affordability Working Group. Governor Maura Healey announced the creation of a Health Care Affordability Working Group charged with advancing proposals to reduce healthcare costs across the system, ultimately reducing costs for people and businesses across the state. The Working Group will focus on the underlying drivers of high healthcare costs—including administrative waste, pricing practices and system inefficiencies—and will develop actionable recommendations for lowering costs while protecting access and quality.
Virginia seeks to improve healthcare affordability. Governor Abigail Spanberger signed a series of day-one executive orders, including one that orders all executive branch agencies to submit reports within 90 days identifying immediate, actionable budgetary, regulatory, or policy changes that would reduce costs for Virginians in areas including healthcare. And an executive order that establishes an Interagency Health Financing Task Force to develop a unified financing strategy to maximize federal funding and strengthen Virginia’s healthcare infrastructure.
Washington released a report on private equity in healthcare. The Office of the Insurance Commissioner published a report that provides a data snapshot of private equity trends and investments in Washington’s healthcare system. The report is intended to inform the Washington state legislature and state organizations as they consider policies to improve healthcare affordability, access, quality, and transparency. The report highlights data on private equity-backed deals by healthcare service category. SHVS has published a toolkit for states on regulating financialization in the healthcare system.
Artificial Intelligence and Technology
Colorado is using technology to improve health-related data sharing across the state. Lieutenant Governor Dianne Primavera, the Colorado Office of eHealth Innovation, and the Colorado Smart Cities Alliance launched the eHealth Solutions Challenge, a statewide innovation initiative designed to help identify, vet, and pilot emerging technology solutions to improve health-related data sharing across systems and sectors. The eHealth Solutions Challenge connects participating governmental and intergovernmental agencies with innovative solution providers and offers up to $150,000 in seed funding to demonstrate promising technologies.
Maryland is leveraging artificial intelligence (AI) to strengthen the delivery of public services. Governor Wes Moore announced that Maryland state agency projects have been awarded two grants—totaling more than $2.6 million over two years—that will fund AI projects that aim to help Marylanders better access public services. Through a $1.2 million award, the Maryland Department of Human Services, Maryland Department of Health, Maryland Benefits, and the Maryland Health Benefit Exchange are leading a multi-state project that will develop AI tools to streamline work verification for SNAP and Medicaid.
Expanding Access to Care
Massachusetts is streamlining prior authorizations. Governor Maura Healey announced that the Division of Insurance is issuing updated regulations to streamline prior authorization practices, including eliminating prior authorization for many routine and essential services. These changes will reduce unnecessary delays and cut administrative burdens to make it easier, cheaper and faster for people to get the medications and care they need.
New Jersey adopted rules to improve healthcare integration for outpatient facilities. The New Jersey Department of Health announced the adoption of rules creating a single, integrated license for outpatient healthcare facilities. The rules address a complex regulatory regime that has impeded healthcare providers’ ability to offer coordinated physical and behavioral health. Under the previous, fragmented regulatory system, facilities offering primary care, mental health, and substance-use disorder treatment services in a single location were required to secure three separate licenses, each with different regulatory requirements.
Extending Marketplace Affordability
Connecticut’s new state subsidy program will protect consumers from the expiration of the enhanced premium tax credits. Access Health CT, the state’s official health insurance Marketplace, announced it will offer a special enrollment period for eligible consumers to enroll in the new state subsidy. Households with an annual income between 100% and 200% of the federal poverty level (FPL) will receive a state subsidy to replace 100% of the expired federal enhanced premium tax credit (ePTC) amounts and households with an annual income over 400% and up to 500% FPL will receive a state subsidy to replace 50% of the expired ePTCs.
Massachusetts Marketplace enrollees will see little to no premium increases due to the state-based subsidy program. Governor Maura Healey announced a new investment of state funds into the ConnectorCare program, increasing affordability for Massachusetts residents after the loss of ePTCs on the Marketplace. Nearly 75% of Massachusetts Health Connector customers will see no increase in premiums with the new funding.
Highlighting the Value of Marketplace Coverage
New Mexico is highlighting the stories of Marketplace enrollees. BeWell, New Mexico’s official health insurance Marketplace, is lifting up the voices of enrollees about what affordable insurance means to them through a public dashboard where enrollees can write their stories. BeWell is also lifting up consumer voices in a new video available on Youtube.
Marketplace Enrollment
Colorado Marketplace enrollment declined slightly for 2026. Connect for Health Colorado, the state’s official health insurance Marketplace, announced that after five consecutive years of record growth, enrollment in health coverage through the Marketplace for plan year 2026 dropped 2%. Despite rising costs due to less federal financial assistance, 277,228 Coloradans enrolled in health insurance, with 69% of customers receiving financial help to lower the cost of their monthly premiums, thanks to a new affordability program that the state rolled out for 2026.
Maryland’s state premium assistance program softened the blow of the loss of ePTCs on enrollment for 2026. The Maryland Health Benefit Exchange announced that a total of 255,612 consumers enrolled during the open enrollment period–up 3% from last year, as the state’s new premium assistance program replaced some or all of the expired federal financial help for those under 400% FPL, with those under 200% FPL receiving the most help.
Nevada’s new public option for 2026 accounted for 10% of total enrollment. Nevada Health Link, the state’s official health insurance Marketplace, announced that open enrollment period for Plan Year 2026 concluded with 104,286 Nevadans enrolling in comprehensive health coverage, including the new public option, known as Battle Born State Plans, which accounted for 10% of total enrollments. Of the 104,286, there were 63,563 Nevadans who actively shopped, showing a 32% increase in engagement of active enrollments from last year’s open enrollment.
Oregon’s Marketplace saw a decline in enrollment for 2026. The Oregon Health Authority announced that 118,372 people in Oregon enrolled in Marketplace coverage during open enrollment, which dipped about 15%. Nearly 60% of enrollees who applied for financial assistance received help in 2026, compared to 80% in 2025. Marketplace enrollment partners reported that increased premiums led some individuals and families to delay enrollment, select plans with higher out-of-pocket costs, or forgo coverage altogether.
Washington Marketplace consumers canceled their coverage more than any year prior due to higher costs. The Washington Health Benefit Exchange announced that more than 290,000 Washingtonians selected a plan for 2026 health and dental insurance through the Marketplace during open enrollment, with around 40,000 fewer Washingtonians receiving premium tax credits in 2026 than 2025. A record number of customers also cancelled their coverage for the coming year during this open enrollment: over 28,000 customers in 2026 compared to a little more than 20,000 customers in 2025.
SHVS published an expert perspective examining preliminary open enrollment data from select State-Based Marketplaces. Early metrics indicate that overall enrollment is lagging behind previous years, and consumers are increasingly trading comprehensive coverage for less generous coverage plans with lower premiums. For more information, see SHVS’ State-Based Marketplace 2026 Open Enrollment Reporting Tracker.
Maternal and Infant Health
New Jersey expanded support for families with newborns. The New Jersey Department of Children and Families announced that the Family Connects NJ program—the state’s Universal Nurse Home Visiting program—has been expanded to support more families welcoming home a newborn in six new counties. The service is now available in all of South Jersey, and most of Central and North Jersey, with program rollout on track to reach statewide implementation next year.
Oregon announced $25 million to protect maternity care. Governor Tina Kotek announced a coordinated effort with the Oregon Health Authority (OHA) and the Hospital Association of Oregon to stabilize and sustain labor and delivery services across the state. OHA will distribute $25 million following input from impacted hospitals: $15 million will provide stabilization payments to smaller, rural hospitals that offer maternity services and $10 million will be invested in larger hospitals through Diagnosis-Related Group rates.
Medicaid Innovations
California Medicaid is developing the infrastructure of community-based organizations. The California Department of Health Care Services announced that 139 organizations have successfully completed capacity-building projects designed to strengthen their ability to deliver Enhanced Care Management (ECM) and Community Supports, cornerstones of California Advancing and Innovating Medi-Cal. These projects expanded ECM and Community Supports by training hundreds of new staff, investing in electronic health records, and developing peer-led outreach models.
Nebraska is leveraging its Medicaid Managed Care Excess Profit Fund for domestic violence services. The Department of Health and Human Services announced that funding will become available in the Medicaid Managed Care Excess Profit Fund which will allow Nebraska to move forward with funding domestic violence support services. A total of $3 million will be distributed to Nebraska’s statewide network of providers serving survivors of domestic and sexual violence.
Medical Debt
Arizona has erased $642 million in medical debt to date. Governor Katie Hobbs announced that 141,000 more Arizonans have had their medical debt erased. To date this effort, which is a partnership between the Hobbs administration and the national nonprofit Undue Medical Debt, has eliminated $642 million in medical debt for more than 485,000 people across Arizona. SHVS has updated our expert perspective tracking state medical debt cancellation initiatives.
New Jersey completed its medical debt relief initiative, canceling $1.6 billion. The Murphy administration announced its final round of medical debt relief, for an estimated 60,000 New Jersey residents. The initiative resulted in approximately $1.6 billion in medical debt eliminated for over 907,500 New Jersey residents, initially utilizing a $10 million grant in Fiscal Year 2024.
Mental and Behavioral Health
New Mexico is investing in behavioral health. New Mexico has approved $24.4 million in funding to expand behavioral health services statewide, allowing communities to address gaps in care while longer-term regional plans are developed. The funding was authorized under Senate Bill 3 and will be administered by the New Mexico Health Care Authority.
Protecting Vaccine Access
Colorado reaffirmed its commitment to vaccine access. Following updates to the U.S. childhood immunization schedule, the Colorado Department of Public Health and Environment (CDPHE) issued a statement reaffirming its commitment to evidence-based vaccination guidance and continued access to preventive care. CDPHE recommends that families and providers follow the 2025 Recommended Child and Adolescent Immunization Schedule issued by the American Academy of Pediatrics.
Maryland is safeguarding vaccine access. Department of Health Secretary Dr. Meena Seshamani issued a statement that Maryland’s childhood vaccine schedule will continue to follow the guidance of the American Academy of Pediatrics. Governor Moore announced the Vax Act as part of the governor’s legislative agenda. The proposed legislation would establish new authority for the secretary of the Maryland Department of Health to issue official recommendations for immunizations based on science and clinical guidance.
Massachusetts will continue to align with the American Academy of Pediatrics childhood immunization schedule. Governor Maura Healey announced that the Massachusetts Department of Public Health has issued evidence-based childhood immunization recommendations. The state continues to recommend the full routine pediatric vaccination schedule endorsed by the American Academy of Pediatrics.
Michigan advised residents that childhood vaccines remain available at no cost.The Michigan Department of Health and Human Services issued a statement reiterating Chief Medical Executive Dr. Natasha Bagdasarian’s standing recommendation advising healthcare providers and families to follow the child and adolescent immunization schedule produced by the American Academy of Pediatrics or the American Academy of Family Physicians. The Michigan Department of Insurance and Financial Services and MDHHS also advised Michiganders that most health insurance plans will continue to cover childhood vaccines without cost-sharing.
New Jersey is protecting vaccine access and affordability. Governor Phil Murphy signed legislation updating New Jersey’s laws to ensure immunization guidance is state-based and aligns health insurance coverage requirements with that guidance. The New Jersey Department of Health (NJDOH) announced a comprehensive update to the state’s vaccine regulations. Now, NJDOH will consider the recommendations of the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Physicians, in addition to ACIP’s recommendations.
Public Health
Alabama is combatting HIV. The Alabama Department of Public Health announced a request for proposals for funding the Ending the HIV Epidemic (EHE) initiative. EHE is a national strategy to reduce new HIV infections by 90% by 2030.
Maryland is providing hospitals with increased funding amid high rates of respiratory illness. Governor Wes Moore announced $164 million in hospital surge funding to support access to care amid high rates of respiratory illness in Maryland. Funding will help cover increased operational costs and provide budget flexibility to manage the high volume of influenza, RSV, and COVID-19 cases.
New York is building a new public health laboratory. Governor Hochul announced that construction is underway for a new $1.7 billion public health laboratory to transform New York’s ability to detect, prevent, and respond to emerging threats.
Rural Health
Alaska hosted a Rural Health Transformation convening. The Alaska Department of Health hosted a three-day RHTP convening in January to help healthcare providers, Tribal partners, community organizations, and other stakeholders prepare for implementation of the state’s RHTP.
Colorado will host a webinar with updates on RHTP. The Department of Health Care Policy & Financing (HCPF) will host a webinar on February 11, during which experts will provide an update on the RHTP, discuss the impact on hospitals of H.R.1 and other changing federal policies, and discuss HCPF’s budget reductions.
Michigan is establishing an RHTP Advisory Council. The Michigan Department of Health and Human Services (MDHHS) is seeking members to serve on the Rural Health Transformation Advisory Council. MDHHS is looking for individuals and organizations with experience, insight and a strong commitment to improving rural health.
Montana’s RHTP Advisory Committee held its first meeting. The first meeting of the Rural Health Transformation Program (RHTP) Stakeholder Advisory Committee was Thursday, January 22. The committee was established to provide guidance to the Department of Public Health and Human Services to support effective implementation of the RHTP initiatives.
New Hampshire appointed a Director of the Governor’s Office of New Opportunities & Rural Transformational Health. Governor Kelly Ayotte announced the appointment of Donnalee Lozeau as Director of the Governor’s Office of New Opportunities & Rural Transformational Health (GO-NORTH), which will administer New Hampshire’s RHTP.
New Jersey published a directory of vendors and their proposals for RHTP activities. The New Jersey Department of Health (NJDOH) published a Rural Health Transformation Program Vendor Resource Directory, aimed at connecting vendors and key RHTP stakeholders to accelerate implementation. NJDOH also released the request for applications.
North Carolina held an RHTP town hall. Governor Josh Stein and North Carolina Health and Human Services hosted a virtual town hall on Friday, January 16, to discuss North Carolina’s Rural Health Transformation Program.
West Virginia launched a new RHTP webpage and is recruiting staff. The West Virginia Department of Health (DH) announced the official launch of health.wv.gov, the department’s newly redesigned website serving as a central hub for information on the RHTP. DH also announced it is seeking a leadership team to implement the RHTP.
States React to Federal Policy
California is publicizing its plans for H.R.1 implementation. The California Department of Health Care Services (DHCS) announced the release of a plan outlining the state’s approach to implementing new federal requirements under H.R.1. The plan provides details on upcoming changes, guiding principles for implementation, and resources for members and stakeholders to prepare for transitions. About two million Medi-Cal members, primarily within the new adult expansion group, are at risk of losing health coverage due to these federal changes.
Connecticut is leveraging its Emergency State Response Reserve in response to federal funding reductions. Governor Ned Lamont announced that his administration has submitted a supplemental plan to the Connecticut General Assembly to use funding from the Emergency State Response Reserve in response to federal funding reductions. The supplemental plan totals $18.7 million and will support food assistance, Medicaid assistance, youth mental health services, and children’s wraparound services.
Minnesota is appealing CMS’ decision to withhold $2 billion in Medicaid investments. The Minnesota Department of Human Services is appealing a decision by the Trump administration to withhold over $2 billion in annual Medicaid funding for Minnesota. The state formally appealed the CMS decision and the federal agency must now set a date for a hearing.
Oregon notified the public of federal actions related to data privacy for immigrants.The Oregon Health Authority (OHA) shared an update on the federal use of health data following a federal court ruling which allows CMS to start sharing limited information with Immigration and Customs Enforcement. In the update, OHA explains it is following CMS requirements while also limiting the transfer of sensitive information as much as possible.
South Dakota created a webpage on H.R.1. The Department of Social Services created a page dedicated to sharing information about the impacts of H.R.1 on South Dakota Medicaid. The page provides a summary of the Medicaid provisions of H.R.1 based on which Medicaid or CHIP population they apply to.
Supporting the Healthcare Workforce
Michigan is increasing access to dental care with dental therapists. In an effort to increase access to dental care for Michigan residents, the Michigan Department of Health and Human Services is assisting with the development of a dental therapy training program. Dental therapists are licensed providers trained to deliver routine dental care including exams, cleanings and fillings under a dentist’s supervision. Because they focus on a limited set of procedures, training is faster and more affordable than traditional dental school–three to six years compared to eight years.
New Mexico is investing in the primary care workforce. The New Mexico Health Care Authority announced $1 million in grant funding available to support the primary care provider workforce, including by establishing or expanding residency programs and developing new primary care workforce training pathways.
New York is providing student loan forgiveness to healthcare professionals serving high-need populations. Governor Kathy Hochul announced the launch of the Health Care Access Loan Repayment (HEALR) program, a $48.3 million initiative designed to expand access to care for Medicaid members and uninsured individuals across New York State. The HEALR program will provide significant financial incentives to healthcare professionals who commit to serving high-need populations, addressing critical workforce shortages while reducing barriers to essential health services in underserved communities.
Waiver and State Plan Amendments, Requests and Approvals
Michigan requested an extension for its 1115 waiver. Michigan submitted a request to extend the Flint Michigan Section 1115 demonstration. Michigan requests approval of a five-year extension for the demonstration with no changes. The state seeks to maintain uninterrupted coverage and services for children up to age 21 and pregnant women affected by lead exposure from the Flint water system.
Mississippi submitted a state plan amendment. The Mississippi Division of Medicaid submitted a state plan amendment seeking to update the reimbursement rates for Autism Spectrum Disorder (ASD) services, effective December 1, 2025.
Oregon is seeking public comments on six 1915(c) waivers. The Oregon Department of Human Services Office of Developmental Disabilities Services seeks public comment on updates to its six 1915(c) Medicaid waivers. Changes include making it easier for children with low incomes to access waiver services and fewer forms for enrollees to sign.