States of Innovation: February 2026
February 2026 highlighted states’ efforts to expand access, strengthen public health, and address affordability. States reported success with efforts to extend Marketplace affordability through state based subsidies to make up for the loss of enhanced premium tax credits. Connecticut reported record enrollment aided by Temporary Premium Assistance, and New Mexico reported a 17% increase in health insurance enrollment driven by its Health Care Affordability Fund. States also continued to react to federal policy, with New Jersey, Virginia, and Washington creating webpages to explain Medicaid changes under H.R.1. Efforts to protect public health included New York joining the World Health Organization’s Global Outbreak Alert and Response Network, and Colorado announcing its intent to do so.
Rural health remained a focus as Alabama, Alaska, Colorado, Delaware, Kansas, and West Virginia advanced their Rural Health Transformation Programs through requests for applications, stakeholder engagement, and leadership updates. States also focused on expanding access to care, including Montana launching a blood pressure toolkit program and Nebraska offering free medications to quit tobacco use.
Several states advanced mental and behavioral health, with Maryland reporting a fourth year of declining overdose deaths and Michigan funding Recovery Community Centers and Organizations. States also invested in engaging communities, including New York’s Choose Healthy Life program and Oregon’s $25 million in public health equity grants to support community-led, culturally responsive initiatives.
Other state action in February included initiatives related to affordability and efforts to address cost; artificial intelligence and technology; coverage for non-citizen populations; Marketplace enrollment; medical debt; preventing gun violence; protecting vaccine access; reproductive and women’s health; services for children and youth; supporting the healthcare workforce; and waiver and state plan amendments, requests and approvals.
Affordability and Efforts to Address Cost
Connecticut released a 2026 Healthcare Cabinet Report. The Office of the State Comptroller released a 2026 Healthcare Cabinet Report aimed at providing a roadmap to fortify and protect the state’s healthcare ecosystem amid the loss of federal subsidies and major changes to Medicaid and SNAP.
New Mexico passed a bill to boost revenue for the Health Care Affordability Fund. The New Mexico Senate passed House Bill 4 to increase revenue to the state’s Health Care Affordability Fund, sending the measure to Governor Michelle Lujan Grisham, who intends to sign it. The bill comes as expiring federal tax credits and Medicaid cuts threaten to price tens of thousands of New Mexicans out of coverage.
Artificial Intelligence and Technology
Arizona shared an update on its Medicaid Enterprise System Modernization Program. The Arizona Health Care Cost Containment System (AHCCCS) shared an update on its Medicaid Enterprise System Modernization Program, which includes efforts to enhance several systems which prevent and detect fraud, waste, and abuse within Medicaid services; the launch of a streamlined way to engage with AHCCCS through a new Customer Service System; and more.
Community Engagement
New York announced $6.5 million to expand community wellness events. Governor Kathy Hochul announced $6.5 million in increased funding to support Choose Healthy Life, a program dedicated to expanding access and strengthening health services in underserved communities through the Black church. Through its network of 30 Black churches, Choose Healthy Life has engaged more than 200,000 New Yorkers by hosting community wellness events and providing health screenings, vaccinations and preventative health services.
Oregon awarded $25 million in grants to support community-led, culturally responsive initiatives. The Oregon Health Authority (OHA) has awarded $25 million in public health equity grants to 125 nonprofit organizations to support work on community-led and culturally and linguistically responsive programs. The funding is through OHA’s Partnerships for Community Health Program.
Coverage for Non-Citizen Populations
Colorado issued a statement on Medicaid data shared with CMS. The Colorado Department of Health Care Policy & Financing (HCPF) issued a statement on Medicaid data shared with CMS, noting that while HCPF does not share information with federal immigration officials, it cannot directly control what CMS shares. The statement explains that according to a recent court ruling, CMS may share information about people who are not lawfully residing in the U.S. but cannot share information about anyone who is lawfully in the U.S.
Expanding Access to Care
Montana launched the Library Blood Pressure Toolkit program. The Department of Public Health and Human Services has partnered with the state library to launch the Library Blood Pressure Toolkit program. Free toolkits are now available for checkout—similar to borrowing a book—at 25 participating libraries. Each kit features an automated blood pressure cuff, a pedometer to track physical activity, a personal measurement log, and a comprehensive directory of clinical and community resources.
Nebraska is offering free quit medications to eligible residents. The Nebraska Department of Health and Human Services announced that the Nebraska Tobacco Quitline is offering free quit medications to eligible Nebraskans. To qualify, participants must be Nebraska residents age 18 or older, enroll in the Nebraska Tobacco Quitline, and complete at least one free coaching session.
New York enacted medical aid in dying legislation. Governor Hochul signed legislation S.138/A.136 that will allow medical aid in dying to be available to terminally ill New Yorkers with less than six months to live.
Extending Marketplace Affordability
Connecticut reported record Marketplace enrollment aided by Temporary Premium Assistance. Access Health CT, the state’s official health insurance Marketplace, announced a record number of residents enrolled during the state’s open enrollment period. The state’s Temporary Premium Assistance, announced in December, helped lessen the impact of the expired enhanced premium tax credits.
New Mexico reported a 17% increase in health insurance enrollment, driven by its Health Care Affordability Fund. The New Mexico Health Care Authority announced that health insurance enrollment increased 17% in New Mexico. The enrollment increase, the largest in the nation, is driven by New Mexico’s Health Care Affordability Fund, which has helped keep premiums and out-of-pocket costs low despite federal subsidy reductions.
Marketplace Enrollment
Maine reported preliminary data showing declining Marketplace enrollment and growing affordability pressures. CoverME.gov, the state’s official health insurance Marketplace, announced preliminary data from the 2026 open enrollment period indicate declining enrollment and increased affordability pressures that may affect coverage stability for consumers and the broader health insurance system.
Minnesota reported an 8% drop in MNsure enrollment. MNsure, the state’s official health insurance Marketplace, announced that enrollment fell by 8% during the open enrollment period and a record-setting number of Minnesotans contacted MNsure to navigate the changes in premiums. MNsure saw an 87% increase in the number of enrollees who switched health insurance plans this year.
Pennsylvania’s Marketplace reported one in five enrollees dropped coverage. Pennie, the state’s official health insurance Marketplace, concluded its 2026 open enrollment period with enrollment totaling around 486,000 and with adverse effects from unprecedented cost increases as a result of the expiration of enhanced premium tax credits. A doubling of premium costs caused around 85,000 Pennsylvanians to drop coverage.
Washington Marketplace customers encountered doubled or tripled premiums during OEP. The Washington Health Benefit Exchange released its preview report outlining preliminary data and outcomes from open enrollment for 2026. Nearly 39,000 fewer customers received advance premium tax credits during this open enrollment than last year and many experienced a doubling or tripling of their premiums.
Medical Debt
Illinois erased over $1.1 billion in medical debt for more than half a million residents. Governor Pritzker announced that the state has erased over $1.1 billion in medical debt for more than half a million Illinoisans through the Illinois Medical Debt Relief Program. Illinois will continue to use the remaining program funds—approximately $5 million—to acquire and relieve outstanding, un-payable medical debt.
SHVS has updated our map tracking state medical debt cancellation efforts.
Mental and Behavioral Health
Maryland reported a 26% drop in drug overdose deaths last year. Governor Wes Moore announced the latest provisional data from Maryland’s Overdose Data Dashboard, which show that drug overdose deaths decreased by 26% last year, marking the fourth consecutive year of reported decreases in the state.
Michigan is seeking letters of interest for grants to develop Recovery Community Centers and Organizations. The Michigan Department of Health and Human Services is requesting letters of interest from organizations interested in grant funding to develop Recovery Community Centers and Recovery Community Organizations. The grants, funded through the State of Michigan Opioid Healing and Recovery Fund, are intended to help organizations cover start-up and early operational costs.
New Mexico enacted legislation to reform mental health crisis intervention. Governor Michelle Lujan Grisham signed Senate Bill 3, which reforms mental health crisis intervention by clarifying the legal definitions of “harm to self” and “harm to others” that govern when someone in crisis can receive involuntary treatment.
North Carolina released a report on its 2024–2029 mental health strategic plan. The North Carolina Department of Health and Human Services (NCDHHS) released a report detailing progress increasing access to quality mental health, developmental disability, and substance-use services. The year-one progress report on the NCDHHS Division of Mental Health, Developmental Disabilities and Substance Use Services 2024-2029 strategic plan highlights achievements in seven priority areas.
Preventing Gun Violence
California awarded $107 million to communities to prevent gun violence. Governor Gavin Newsom announced an additional $107 million in awards to communities to prevent gun violence. With 42 grants to cities, counties, community-based organizations, and tribal governments across California, the funding will support proven, community-driven strategies to reduce shootings, homicides, and retaliatory violence.
New York announced nearly $21 million for street outreach programs to reduce gun violence. Governor Kathy Hochul announced nearly $21 million to support SNUG Street Outreach programs, an evidence-based violence prevention initiative that works to reduce gun violence and save lives in 14 communities across the state. Governor Hochul also announced that communities participating in New York State’s Gun Involved Violence Elimination initiative reported the lowest levels of shooting incidents on record last year.
Protecting Vaccine Access
New York endorsed the childhood and adolescent immunization schedule recommended by the American Academy of Pediatrics. The New York State Department of Health and the New York City Department of Health announced their official endorsement of the 2026 childhood and adolescent immunization schedule recommended by the American Academy of Pediatrics (AAP).
15 states filed a multi-state lawsuit over changes to the national childhood immunization schedule. AZ, CA, CO, CT, DE, MD, ME, MI, MN, NJ, NM, OR, PA, RI & WI filed a multi-state lawsuit against the federal government for the Department of Health and Human Services (HHS) and the Center for Disease Control’s (CDC) decision to overhaul the national childhood immunization schedule.
As a reminder, SHVS published an expert perspective on HHS and CDC’s changes to the childhood immunization schedule and considerations for states as well as a toolkit to help states support continued vaccine access and maximize flexibility on the ground.
Public Health
California reported a third consecutive annual decline in sexually transmitted infections. The California Department of Public Health announced that the number of reported sexually transmitted infections (STIs) in California decreased for the third consecutive year.
Colorado announced plans to join the World Health Organization’s Global Outbreak Alert and Response Network. Governor Jared Polis announced that Colorado will pursue joining the World Health Organization’s (WHO) Global Outbreak Alert and Response Network (GOARN).
New York joined the WHO’s GOARN. Governor Kathy Hochul announced that the New York State Department of Health joined the WHO’s GOARN, strengthening the state’s role in global public health preparedness and response.
Reproductive and Women’s Health
California is providing $90 million in emergency funds to support Planned Parenthood. Governor Gavin Newsom signed SB 106, granting $90 million in one-time emergency funds for Planned Parenthood and other clinics providing reproductive healthcare services following the funding prohibition in H.R.1. This announcement follows the $145 million California has provided to support Planned Parenthood since last fall.
Pennsylvania allocated $3 million to continue providing free period products in schools. The Pennsylvania Departments of Health and Education announced that $3 million allocated in the 2025/2026 budget will be distributed to continue to provide free period products in schools. The funding will be directed to more than 750 Pennsylvania school districts, intermediate units, career and technical centers, and brick-and-mortar charter schools.
Rural Health
Alabama convened the first meeting of its Rural Health Transformation Advisory Group. Governor Kay Ivey announced the first meeting of the Alabama Rural Health Transformation Advisory Group, which she established by executive order to advance policy development and implementation of Alabama’s Rural Health Transformation Program (RHTP).
Alaska opened the first letter of interest period for its RHTP. The Alaska Department of Health (DOH) announced that the first letter of interest (LOI) registration period for Alaska’s RHTP is now open. Organizations may submit an LOI through March 11, 2026. DOH also hosted a webinar on the state’s approach to implementing the RHTP. A recap document, Q&A, and slide deck are available.
Colorado announced plans to build stakeholder engagement processes as part of its RHTP. The Department of Health Care Policy & Financing announced that as part of the RHTP, it will be building out a set of stakeholder engagement, community collaboration and statewide grant support processes.
Delaware opened requests for proposals for four initiatives under its RHTP. Governor Matt Meyer announced that requests for proposals (RFPs) are now open for four initiatives under Delaware’s RHTP plan. Additional RFPs are expected to be released in the spring.
Kansas posted requests for applications for its first RHTP grants. The Kansas Department of Health and Environment posted requests for applications for its first two grant opportunities under the RHTP: the Regional Partnership and the Rural Emergency Hospital Conversion/Transformative Capital Investment grant programs.
West Virginia announced new executive leadership for its RHTP. The West Virginia Department of Health announced the official launch of new executive leadership for the RHTP.
As a reminder, SHVS is tracking state RHTP implementation; this expert perspective identifies the state agencies leading RHTP work and includes links to state RHTP webpages.
Services for Children and Youth
California launched a campaign to promote early and regular dental care. The Department of Health Care Services is coordinating a statewide Smile, California bilingual outreach campaign to help children and families understand the importance of early and regular dental care and to encourage the use of free Medi-Cal Dental preventive services.
California provided $2.2 million to support youth mental health in fire-impacted communities. Governor Gavin Newsom and LA Rises announced $2.2 million in funding for UCLA Health’s Sound Body Sound Mind program, which will support the deployment of proven mental health interventions in communities impacted by the Eaton and Palisades fires to enhance overall resilience, well-being, and health. With this new funding, 33 schools impacted by the fires will receive comprehensive support, supporting an estimated 30,000 students.
States React to Federal Policy
New Jersey launched a webpage to explain federal Medicaid changes under H.R.1. The Department of Human Services has created a webpage explaining federal changes to Medicaid as part of H.R.1 and how enrollees can prepare for changes.
New York announced a series of roundtables to address H.R.1 implementation. New York State of Health (NYSOH) announced that United Hospital Fund (UHF) will be hosting a series of roundtables dedicated to addressing the implementation challenges presented by H.R.1.
Virginia launched a webpage detailing the new Medicaid work reporting requirements. The Department of Medical Assistance Services created a webpage on new Medicaid work reporting requirements.
Washington created webpages explaining H.R.1 impacts. The Washington State Health Care Authority created a webpage on H.R.1 impacts for legislators, partners, and other stakeholders. Additionally, the changes coming to Apple Health webpage contains information for Medicaid enrollees on how H.R.1 may impact their coverage.
SHVS recently hosted a webinar on communicating the new work reporting requirements under H.R.1.
Supporting the Healthcare Workforce
Michigan announced a grant for summer camps to introduce students to nursing careers. The Michigan Department of Health and Human Services issued a competitive grant funding opportunity to introduce primary and secondary school students to nursing through summer camp experiences. The purpose of the programs is to support the creation of new and expansion of existing nursing-focused camps, particularly in rural communities, to increase early exposure to nursing careers and strengthen the future workforce.
New Mexico enacted legislation to allow physicians from other compact states to practice more easily. Governor Lujan Grisham signed Senate Bill 1, which allows physicians licensed in other compact states to practice in New Mexico more easily. This will help address the state’s healthcare workforce shortage and improve access to care, particularly in rural and underserved areas. Forty-three states, including those bordering New Mexico, participate in the licensure compacts.
Oregon is issuing $4 million in grants to retain and recruit behavioral health providers. Governor Tina Kotek announced that the Oregon Health Authority is issuing $4 million in grants to organizations to help retain and recruit behavioral health providers in high-need communities across Oregon.
South Dakota enacted legislation to support rural healthcare recruitment. Governor Larry Rhoden signed HB 1043, a bill to support rural healthcare recruitment. Governor Rhoden previously signed HB 1044, which appropriates funding for the RHTP. HB 1043 further supports the governor’s rural healthcare efforts by making an appropriation to reimburse healthcare professionals who have complied with the requirements for rural recruitment assistance programs.
Waiver and State Plan Amendments, Requests and Approvals
Florida submitted an 1115 demonstration. The state submitted a request for a new five-year Medicaid section 1115 demonstration entitled “Florida Institutions for Mental Disease Section 1115 Demonstration.” This demonstration aims to provide coverage of services based in institutions of mental diseases, such as substance-use detoxification, recovery support services, and psychiatric treatment, for individuals enrolled in Medicaid diagnosed with serious mental illness or serious emotional disorder and/or substance-use disorder.