State updates as of October 10, 2025.

State updates as of October 3, 2025.

State updates as of September 26, 2025.

On August 22, a federal District Court judge in Maryland stayed, on a nationwide basis, the implementation of several provisions in the Centers for Medicare & Medicaid Services  “Marketplace Integrity” final rule. Some of the stayed provisions are effective immediately, creating the need for immediate implementation decisions by states. This expert perspective describes the impacted provisions.

State updates as of September 19, 2025.

On July 4, 2025, President Trump signed budget reconciliation legislation (H.R.1) into law. It made sweeping changes to healthcare programs, cut Medicaid spending by $911 billion over 10 years, and will lead to significant coverage losses. To address rural health concerns stemming from these cuts, H.R.1 includes $50 billion for a Rural Health Transformation Program (RHTP). This expert perspective highlights state action to create a transformation plan and prepare to apply for the RHTP, including issuing Requests for Information and other efforts to educate the public and gather stakeholder input.

State updates as of September 12, 2025.

On September 4, 2025, the U.S. Department of Health and Human Services (HHS) released guidance expanding eligibility for catastrophic health plans. HHS’ guidance significantly expands the universe of individuals eligible for these plans, with potential implications for consumers’ access to premium tax credits, states’ individual insurance markets, and premiums for both catastrophic and individual market plans.

State updates as of September 5, 2025.

H.R.1, signed into law on July 4, makes dramatic changes to the Medicaid and Marketplace coverage landscape. These changes include provisions that scale back access to health coverage for many lawfully residing non-citizens, estimated to leave 1.3 million more immigrants uninsured. This expert perspective describes the provisions, which eliminate the availability of premium tax credits (PTCs) and federally-funded Medicaid and CHIP coverage for many non-citizens who have been eligible for these programs for years, and eliminate PTCs for the lowest income, lawfully present non-citizens who are subject to a waiting period before they qualify for Medicaid or CHIP.