April 2026: States advance affordability, coverage, and rural health transformation initiatives
In April 2026, a major area of state activity involved affordability and efforts to address healthcare costs. Prominent developments in this area included Alabama’s elimination of preventive care copays, Kansas’ oversight legislation related to pharmacy benefit managers, and Nevada’s hospital price transparency tool. Also notably, states invested in services for individuals with disabilities. New York announced a $25 million investment to improve healthcare access for people with developmental disabilities, while Pennsylvania strengthened the rights and protections for individuals with disabilities and autism. Meanwhile, Oklahoma advanced Marketplace innovations, receiving federal approval for a transition to a State-Based Exchange.
As states continued implementing the Rural Health Transformation Program (RHTP) in April 2026, activity expanded from initial setup into broader execution, with states advancing procurement processes, advisory structures, and public engagement efforts. Florida, Montana, Nebraska, Nevada, North Dakota, South Carolina, Texas, and West Virginia were among those actively rolling out funding opportunities, while Connecticut and Missouri focused on stakeholder outreach.
Other key topic areas included aging and long-term care; community engagement; coverage for justice-involved populations; expanding access to care; health equity; Marketplace enrollment; maternal and infant health; medical debt; mental and behavioral health; preventing gun violence; public health; reproductive and women’s health; services for children and youth; state responses to federal policy; supporting the healthcare workforce; and waiver and state plan amendments, requests, and approvals.
Affordability and Efforts to Address Cost
Alabama enacted legislation to eliminate copays for certain preventive screenings. Governor Kay Ivey signed several bills to improve the availability and delivery of healthcare services, including HB300 and SB19 which eliminate co-payments for breast cancer examinations and prostate cancer screenings, respectively.
Kansas enacted legislation to strengthen oversight of pharmacy benefit managers. Governor Kelly signed Senate Bill 20, which regulates Pharmacy Benefit Managers (PBMs). Senate Bill 20 enacts several changes to current PBM practices, including granting the Kansas Insurance Commissioner increased authority to regulate PBMs, ensuring all pharmacies are reimbursed using the National Average Drug Acquisition Cost, mandating that drug rebates pass through to health plans, and banning spread pricing.
Nevada launched an online tool to increase transparency in hospital pricing. Governor Joe Lombardo announced the launch of the Nevada Hospital Price Finder, a new online tool designed to give Nevadans clear, upfront access to hospital pricing information statewide.
Oregon is hosting community forums to gather input on prescription drug affordability. The Oregon Prescription Drug Affordability Board is hosting a series of community forums in April and May to hear from people about the high cost of prescription drugs and the effect it has on their lives and budgets.
Pennsylvania reported that its external review process has overturned many denied insurance claims. The Pennsylvania Insurance Department (PID) announced that, since 2024, the Commonwealth-run Independent External Review process has overturned about 48% of eligible claims, meaning hundreds of Pennsylvanians received healthcare benefits their insurers originally refused to cover.
Virginia enacted multiple healthcare reforms to improve affordability and access. Governor Abigail Spanberger signed several bills to make healthcare more affordable and accessible: SB669 reforms the practices of pharmacy benefit managers (PBMs); SB405 invests in Virginia’s healthcare workforce through nursing scholarships and loan programs; HB220 eliminates additional fees on healthcare premiums; and HB60 prohibits insurance discrimination for individuals taking pre-exposure prophylaxis (PrEP) for HIV prevention.
Aging and Long-Term Care
Georgia is gathering input for its forthcoming State Plan on Aging. The Georgia Department of Human Services’ Division of Aging Services is hosting Community Conversations to seek feedback for the 2028-2031 State Plan on Aging this spring.
Michigan is seeking public input on its updated State Plan on Aging. The Michigan Department of Health and Human Services Bureau of Aging, Community Living, and Supports (ACLS) has developed the State Plan on Aging for fiscal years 2027 to 2029 and is seeking public comment on the updated plan. The ACLS Bureau conducted a comprehensive needs assessment and engaged older adults, their family members, and key partners through community conversations, interviews, and a statewide survey.
Community Outreach and Engagement
Alabama is collecting public input on community health priorities. The Alabama Department of Public Health wants to hear from state residents about health issues they believe are the most important in their communities. The 2026 Community Health Opinion Survey is a component of the State Health Assessment that identifies health issues and challenges at the community level.
Coverage for Justice-Involved Populations
California released a report on its justice-involved reentry initiative. The California Department of Health Care Services released the impact report on the first year of California’s Justice-Involved Reentry Initiative. This first-in-the-nation program provides targeted Medi-Cal services to incarcerated individuals up to 90 days before release. In its first year, the initiative delivered more than 159,000 billable pre-release services and prescriptions and enrolled more than 24,000 incarcerated individuals in Medi-Cal prior to release.
Expanding Access to Care
Alabama is easing provider collaboration and streamlining licensing. Governor Ivey signed several bills to improve the availability and delivery of healthcare services, including HB605 to provide limited antitrust protections to allow collaboration between healthcare providers, and HB156 which streamlines state license approval of out-of-state physician assistants.
California urged federal action to expand coverage access and reduce barriers to essential healthcare services. Governor Gavin Newsom called on the U.S. Department of Health and Human Services to resume its review of current benchmark plan applications, approve California’s proposal to expand access to IVF and other essential services, and withdraw a proposed rule that would create new financial barriers to expanded coverage.
Kentucky enacted legislation supporting improved healthcare services and coverage for specific medical needs. Governor Andy Beshear signed House Bills 393 and 510 and Senate Bill 97 to support healthcare relating to Alzheimer’s disease, organ donation, and healthcare coverage for prosthetics and orthotics.
Health Equity
Illinois launched an awareness campaign of public health’s role in promoting health equity. The Illinois Department of Health (IDPH) launched a “30 Days of Public Health” initiative to raise awareness of the role they play in promoting health equity across Illinois. IDPH debuted new public service advertisements and creative content to highlight public health services and community programs.
Marketplace Enrollment
New Jersey reported significant health coverage losses linked to the expiration of federal premium tax credits. The Department of Banking and Insurance announced that cost increases due to the expiration of the federal enhanced premium tax credits (ePTCs) has resulted in nearly 70,000 people, or 14% of those initially enrolled in health plans through Get Covered New Jersey, to drop their coverage since the end of the open enrollment period in January.
New York reported declining Marketplace enrollment and reduced financial assistance following the expiration of federal premium tax credits. NY State of Health published a health coverage report as of January 31, 2026, which details enrollment trends given the expiration of the ePTCs. Approximately 50,000 fewer New Yorkers—20% of total qualified health plan (QHP) enrollment—are receiving financial assistance to purchase QHP coverage for 2026 as compared to 2025.
Marketplace Innovations
Oklahoma received federal approval to transition to a State-Based Exchange. The Oklahoma Insurance Department (OID) received a conditional approval letter from CMS to operate a State-Based Exchange on the federal platform (SBE-FP) beginning May 1, 2026. CMS will continue to provide technical assistance to OID as it works toward carrying out all required functions of an SBE-FP.
Maternal and Infant Health
Pennsylvania launched a strategic plan to improve maternal health and reduce disparities. The Shapiro Administration unveiled Pennsylvania’s Maternal Health Strategic Action Plan, “Healthy Moms, Vibrant Futures”. The comprehensive multi-agency plan is the first in Pennsylvania and contains strategic goals, data and research, ongoing work, and recommendations to combat maternal health disparities.
Virginia enacted legislation to expand maternal healthcare services. Governor Spanberger signed a package of legislation to improve and expand healthcare coverage for Virginia mothers and families: HB1400 increases access to maternal mental healthcare screenings; HB1403 directs the Department of Health to develop a reporting system to better track Severe Maternal Morbidity; HB425 expands Medicaid reimbursements to include remote monitoring of pregnant women; and HB1353 directs the Commissioner of Health to assess a future statewide maternal health safety initiative.
Virginia’s Marketplace added pregnancy as a qualifying life event. Virginia’s Insurance Marketplace announced that pregnancy is now a qualifying life event for a special enrollment period.
Medical Debt
Maine enacted protections against medical debt collection practices affecting wages and home ownership. Governor Janet Mills signed LD 2129, legislation to prohibit medical debt collectors from placing a lien on a person’s home or garnishing their wages. The new law builds on earlier legislation that prohibited medical debt from appearing on consumer credit reports.
SHVS has updated our map tracking state medical debt cancellation efforts.
Mental and Behavioral Health
Arizona is hosting webinars to discuss proposed updates to behavioral health services. The Arizona Health Care Cost Containment System will host two informational webinars to share proposed updates to applied behavior analysis (ABA) services. The first session is for ABA providers and provider associations. The second session is geared towards families, caregivers, and community advocates.
California reported expanded access to free behavioral health services through its statewide digital platforms. The Department of Health Care Services released its 2025 BrightLife Kids and Soluna Impact Report, detailing how California’s free behavioral health platforms have reached more than 500,000 users, including children, youth, young adults, and families, across all 58 California counties.
Kentucky expanded mental health and eating disorder coverage and strengthened patient protections. Governor Andy Beshear signed legislation to enhance coverage for Kentuckians suffering from mental health conditions or eating disorders. House Bill 178 defines a psychiatric collaborative care model seeking reimbursement and coverage for mental health treatments. House Bill 169 requires health plans to cover the costs associated with the diagnosis and treatment of eating disorders and prohibits insurers from using body mass index as the sole standard for coverage denial. Senate Bill 122 updates the involuntary hospitalization statute to protect the rights of Kentuckians with mental illnesses.
North Carolina invested in substance-use services and community-based treatment programs. The Department of Health and Human Services (NCDHHS) announced a $5.7 million investment to increase access to substance-use services. Twelve community-based organizations were awarded funding to provide services in rural areas, crisis co-response teams, treatment and prevention for youth, transitional and recovery housing, peer support, mobile outreach, and other evidence-based treatments.
Preventing Gun Violence
New York announced funding for community-based violence prevention and youth support initiatives. Governor Hochul announced $5 million in funding available through the new Havens of Opportunity, Peace and Empowerment (HOPE) initiative in communities with high rates of gun violence in New York City. Awards will enable organizations to establish and enhance safe, supportive, and trusted neighborhood havens for youth and families.
Virginia enacted legislation aimed at improving public safety. Governor Spanberger signed legislation to enhance public safety and prevent gun violence. Among the package of bills, HB248 improves law enforcement coordination by permitting professionals from multiple agencies to jointly respond to behavioral health calls.
Public Health
Washington acted to strengthen disease outbreak monitoring and response efforts. Governor Bob Ferguson announced Washington state is joining the World Health Organization’s (WHO) Global Outbreak Alert and Response Network (GOARN), a coordinated worldwide partnership dedicated to monitoring and responding to global disease outbreaks.
Reproductive and Women’s Health
Pennsylvania affirmed reproductive healthcare rights. Governor Josh Shapiro released a statement in response to Commonwealth Court of Pennsylvania’s decision in Allegheny Reproductive Health Center vs. Pennsylvania Department of Human Services, which affirms a fundamental right to reproductive autonomy and finds that under Pennsylvania law, a state ban on Medicaid coverage for most instances of abortion care is unconstitutional.
Virginia expanded telemedicine access and established protections for contraception access. Governor Spanberger signed HB425, which expands access to telemedicine services for women experiencing high-risk pregnancies or women 35 years of age or older on Medicaid, and HB6, which establishes the right to contraception.
Rural Health
SHVS published How States Are Using the RHTP to Advance Food Is Medicine Interventions, highlighting select state initiatives and activities that propose leveraging the Rural Health Transformation Program (RHTP) to advance Food Is Medicine and other food and nutrition interventions.
SHVS also continues to track state RHTP implementation; this expert perspective identifies the state agencies leading RHTP work.
Alaska provided an update on its rural health transformation efforts, highlighting a new webinar series. The Alaska Department of Health posted an update on its Rural Health Transformation Program (RHTP): the Alaska Community Foundation received 1,795 letters of interest from 864 unique organizations. DOH also announced RHTP Impacts, a new interactive webinar series.
Arizona launched a new RHTP website. Governor Katie Hobbs announced the launch of the official Arizona RHTP website.
Connecticut is updating stakeholders on its RHTP efforts and formed a RHTP leadership team. The Connecticut Department of Social Services (DSS) announced a webinar to update stakeholders on the Rural Health Transformation Program (RHTP) on April 13. DSS also announced the formation of the Rural Health Transformation Program (RHTP) leadership team, naming four experienced public health professionals to guide the initiative.
Florida released its first round of RHTP procurement opportunities. The Agency for Health Care Administration announced the release of the first round of procurement opportunities related to the RHTP.
Idaho is expanding staffing to support implementation of its RHTP. The Idaho Department of Health and Welfare (DHW) is hiring for multiple positions to support the RHTP, recruiting professionals across program management, finance, grants, and project coordination.
Louisiana established new leadership and advisory structures to guide RHTP implementation. Governor Jeff Landry signed an executive order establishing the Office of Rural Health Transformation and Sustainability within the Louisiana Department of Health. The Governor also announced the formation of the RHTP Advisory Council to guide implementation.
Missouri received federal approval and funding for its RHTP and is conducting stakeholder outreach efforts. The Missouri Department of Social Services announced that CMS approved $216 million in year one funding for the state’s RHTP. DSS is inviting rural healthcare providers, community-based organizations, and other stakeholders to participate in a series of informational RHTP webinars.
Montana is seeking proposals and launching new resources to support implementation of its RHTP. The Department of Public Health and Human Services announced it is seeking proposals to launch and implement the Rural Health Center of Excellence (CoE), as part of the RHTP. The CoE will be driven by three primary objectives: data-driven strategy, long-term sustainability, and performance incentives. A centralized website page with resources to help vendors navigate the request for proposals has also been created.
Nebraska is advancing RHTP implementation through new regional advisory applications and workforce incentive funding opportunities. The Nebraska Department of Health and Human Services (DHHS) is seeking applications for each of the six newly established RHTP Health Care Advisory Regions (HCARs) in Nebraska. DHHS also opened RHTP applications for the Nebraska Rural Health Workforce Incentive Program on April 15, 2026. This program will provide financial incentives to support healthcare professionals in relocating to, or continuing to serve in, rural Nebraska counties.
Nevada is seeking applicants and providing guidance for RHTP-funded initiatives. The Nevada Health Authority (NVHA) is currently seeking applicants for initiatives funded through the RHTP. NVHA also posted a frequently asked questions document related to the requests for applications.
North Carolina appointed new leadership to oversee implementation of its RHTP. NCDHHS announced Maggie Woods as the RHTP Director to lead North Carolina’s effort in transforming healthcare and access for more than 3.5 million rural North Carolinians.
North Dakota announced new RHTP grant opportunities focused on community health and wellness. North Dakota Health and Human Services announced $3.6 million in three new RHTP grant opportunities, including a Zero Hour Physical Education initiative, community gardens projects, and community-based walking programs.
Oklahoma provided an update on its RHTP implementation and related engagement efforts. The Oklahoma State Department of Health posted an update on its RHTP program, including programmatic, operational, and public engagement efforts.
Pennsylvania launched a webpage to share RHTP funding opportunities. The Pennsylvania Department of Human Services created a webpage listing RHTP funding opportunities.
Rhode Island submitted a budget amendment outlining planned use of RHTP funding. Governor Dan McKee announced he has submitted a budget amendment reflecting anticipated spending for state fiscal years 2026 and 2027 under Rhode Island’s $156 million year 1 award from the RHTP, following recent final approval from CMS.
South Carolina advanced its RHTP efforts through stakeholder engagement, guidance materials, and grant application opportunities. The South Carolina Department of Health and Human Services (SCDHHS) hosted a stakeholder meeting on the RHTP, providing an overview of the state’s vision and goals, as well as the grant opportunities. SCDHHS also posted a frequently asked questions document on the RHTP as well as applications for grants offered under four of the state’s RHTP initiatives: Connections to Care, Wellness Within Reach, Leveling Up, and Shoring Up to Sustainability. Applications are being accepted through June 1, 2026.
Texas is deploying RHTP funding to support programs focused on prevention and wellness. Governor Greg Abbott announced the Texas Health and Human Services Commission is making $60 million in initial federal funding available through the RHTP to rural hospital districts to create or improve community-based prevention, wellness, and nutrition programs.
Utah is surveying potential applicants ahead of its upcoming RHTP grant cycle. The Utah Department of Agriculture & Food is surveying potential applicants to the Rural Health Transformation Grant Program, which will open a grant cycle in the coming months.
West Virginia authorized federal funding to launch its RHTP. Governor Patrick Morrisey signed Senate Bill 570, officially authorizing the use of federal funds to launch the RHTP. The Department of Health will begin releasing competitive awards on a rolling basis, focusing initially on the workforce pipeline, recruitment, and community-based nutrition challenges.
Services for Children and Youth
Kansas updated eligibility rules to protect children’s access to affordable health coverage. Governor Laura Kelly signed Senate Bill 271, bipartisan legislation that permanently updates the income eligibility requirements for Kansas’ CHIP and protects access to affordable health coverage for Kansas children.
Services for Individuals with Disabilities
New York announced funding to expand health equity and improve healthcare access for people with developmental disabilities. Governor Kathy Hochul announced 30 awards for a total $25 million investment to help address health equity for people with developmental disabilities. The initiative prioritizes expanding access to dental care, improving physical diagnostic space to better accommodate wheelchairs, creating sensory-friendly areas for neurodiverse patients, and improving access to specialty physical health services.
Pennsylvania strengthened protections for individuals with disabilities and autism. Governor Josh Shapiro signed three executive orders to strengthen the rights and protections of Pennsylvanians with disabilities and autism. The executive orders reaffirm the Commonwealth’s disability nondiscrimination policy, establish new data privacy protections, reauthorize the Developmental Disabilities Council, and create a new Governor’s advisory commission focused solely on people with disabilities.
States React to Federal Policy
Minnesota warned that significant Medicaid funding at risk could severely impact healthcare access. The head of Minnesota’s Medicaid program is cautioning that despite CMS approval of the state’s corrective action plan, $3.1 billion in federal Medicaid funding is still at risk. An analysis by the Minnesota Department of Human Services demonstrates how the cuts will impact the entire state, potentially devastating rural healthcare providers.
Montana launched a website to help residents understand upcoming Medicaid changes resulting from H.R.1. The Department of Public Health and Human Services announced the launch of a new website designed to help Montanans navigate upcoming changes to the state’s Medicaid program as a result of H.R.1.
Nebraska responded to CMS’ request to accelerate Medicaid provider revalidation. The Nebraska Department of Health and Human Services announced it will comply with CMS’ requests to accelerate provider revalidation activities and develop a comprehensive, long-term strategy to ensure only qualified and legitimate providers participate in Medicaid.
Supporting the Healthcare Workforce
Alabama enacted legislation supporting the EMS workforce. Governor Ivey signed SB269, HB116, and HB182, related to EMS payment, tuition reimbursement, and licensure, respectively.
New Jersey eliminated practice restrictions for most advanced practice nurses. Governor Mikie Sherrill signed legislation to eliminate selective restrictions for advanced practice nurses (APNs) practicing in New Jersey. APNs with extensive clinical experience are able to continue independently providing primary and behavioral healthcare services.
Virginia invested in the nursing workforce. Governor Spanberger signed SB405, investing in Virginia’s healthcare workforce through nursing scholarships and loan programs.
Waiver and State Plan Amendments, Requests and Approvals
Connecticut requested renewal of its Medicaid waiver to continue supporting substance-use disorder treatment. Connecticut submitted a request to CMS to renew the Connecticut Substance Use Disorder Section 1115(a) demonstration for five years. The proposed renewal will allow Connecticut to continue using Medicaid and CHIP funding to reimburse institutions for mental diseases (IMDs) for treatment provided to individuals with substance-use disorders. The renewal request also incorporates proposals to address social determinants of health and implement a reentry demonstration initiative.
Minnesota received approval to extend its Medicaid waiver supporting substance-use disorder treatment. CMS approved a five-year extension of the “Minnesota Substance Use Disorder System Reform” section 1115 demonstration. This extension allows the state to continue receiving federal financial participation for Medicaid services provided to enrollees primarily receiving treatment and/or withdrawal management services for a substance-use disorder while in facilities meeting the definition of an IMD.