The Centers for Disease Control and Prevention (CDC) Acting Director Jim O’Neill recently released a decision memorandum overhauling the CDC’s Childhood and Adolescent Immunization Schedule. While these updates do not have immediate implications for health coverage of vaccines, the CDC’s recommendations have significant ripple effects in state policy, professional practice, and the public consciousness. This expert perspective reviews the background on the administration’s actions preceding the updates, the changes to the childhood immunization schedule, and considerations for states. 

State updates as of January 9, 2026.

State updates as of December 19, 2025.

As of December 12, 43 states have shared either their full Rural Health Transformation Program (RHTP) application or a summary of their proposal. States aligned their submissions with the five RHTP strategic goals outlined by CMS: (1) Make Rural America Healthy Again, (2) Sustainable Access, (3) Workforce Development, (4) Innovative Care, and (5) Technology Innovation. While there are similarities in the applications, there are also notable differences in the specific initiatives and activities proposed across states. This expert perspective explores select themes from the publicly-available applications and summaries.

State updates as of December 12, 2025.

On December 8, the Centers for Medicare & Medicaid Services issued a Center for Medicaid & CHIP Services Informational Bulletin (CIB) providing initial guidance to states as they implement Medicaid work reporting requirements under H.R.1. Although the guidance generally tracks the requirements of H.R.1 and incorporates several important clarifications, it remains high-level and stops short of addressing the many operational questions states must resolve as they implement these major changes. This expert perspective summarizes the CIB and highlights where open questions remain.

As the 2026 open enrollment period 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. State-Based Marketplaces (SBMs) have historically provided enrollment updates throughout open enrollment to offer early insights into enrollment trends and the challenges consumers may face. This expert perspective serves as a one-stop resource for tracking real-time 2026 SBM open enrollment data and SHADAC will continue to update this tracker throughout open enrollment to reflect the latest developments in SBM reporting.

State updates as of December 5, 2025.

State updates as of November 21, 2025.

On November 14, the Centers for Medicare & Medicaid Services (CMS) issued preliminary guidance interpreting H.R.1’s new limits on Medicaid provider taxes. This expert perspective provides an overview of CMS’ guidance and key considerations for states as they look to implement H.R.1’s provider tax-related provisions.