States of Innovation: February 2025
In February, as a federal budget resolution took shape, states engaged in Medicaid defense, reacting to potential reductions in federal Medicaid matching funds and evaluating the potential impact to their states. The governors of Colorado, Nevada, North Carolina, and Wisconsin each urged Congress to consider the impacts of proposed cuts on their states. Illinois’ governor brought together stakeholders to showcase a commitment to protecting Medicaid. Colorado, New Jersey, and Nevada released reports estimating the impact of potential federal Medicaid reductions, and Minnesota published fact sheets and a communications toolkit highlighting both the impact of Minnesota’s Medicaid program and the potential impact of changes to the Medicaid program that are being discussed at the federal level.
States also worked to enhance coverage for justice-involved populations, with California expanding its reentry initiative to prisons statewide and North Carolina investing in community-based diversion programs and reentry services. Several State-Based Marketplaces including California, Connecticut, Georgia, Illinois, and New Jersey announced that they concluded the 2024-2025 open enrollment period with record-breaking levels of enrollment, thanks to state Marketplace innovations and the federal enhanced premium tax credits, which are set to expire at the end of this year.
Meanwhile, a handful of states were approved or sought approval for waiver amendments and requests, with Florida receiving approval to expand its Behavioral Health and Supportive Housing Assistance Pilot, Minnesota seeking approval to provide reentry services, and North Dakota seeking public comment on a state plan amendment to provide additional in-home and community-based services.
February saw several states move to protect reproductive and women’s health, including Connecticut announcing new programs to expand access to contraception and New York enacting legislation to protect the privacy of providers who prescribe abortion medication. States also continued work on maternal health: Arkansas enacted legislation to establish prenatal presumptive Medicaid eligibility and California released a plan to improve maternity care for Medicaid enrollees.
Illinois announced that its debt relief program has erased more than $345 million in medical debt for nearly 270,000 residents, and New Jersey announced a third round of medical debt elimination, totaling $246 million in debt eliminated so far. Action to expand access to care included Louisiana expanding access to urgent mobile care to reduce emergency room utilization, and both New York and North Carolina investing in direct care staff to improve the quality of care for people with disabilities.
Throughout February, states continued to focus on mental and behavioral health with New York establishing new network adequacy regulations for behavioral health services and Oregon launching a pilot program to improve the accessibility and uptake of substance-use care in emergency care settings. States also took steps to increase access to services for children and youth–Massachusetts is investing in school districts to improve student access to behavioral and mental health services and Wisconsin is taking action to protect children from further hazardous lead exposure.
Accessibility
New Jersey is issuing grants to increase accessibility for people with disabilities . New Jersey Human Services announced $3.5 million in funding over two years for nonprofits and local county or municipal government agencies through the 2025 Inclusive Healthy Communities Grant Program (IHC) to help communities across New Jersey support the health and wellbeing of individuals with disabilities.
Coverage for Justice-Involved Populations
California expanded its reentry initiative to prisons statewide. The Department of Health Care Services, the California Department of Corrections and Rehabilitation, and California Correctional Health Care Services announced the expansion of the Justice-Involved Reentry Initiative to prisons statewide. The initiative allows eligible incarcerated individuals to enroll in Medi-Cal and receive a targeted set of services during the 90 days prior to their release.
North Carolina is investing in community-based diversion programs and reentry services. The North Carolina Department of Health and Human Services announced more than $11 million in funding to community-based diversion programs and reentry services that strengthen support for people involved in the justice system. The funding will support the expansion of the Law Enforcement Assisted Diversion (LEAD) program and referrals to community-based services and supports, with an emphasis on regions or localities that have historically lacked the resources to operate these programs. Additionally, funds will ensure people involved in the justice system, including those reentering their communities, have access to housing and supported employment services tailored to their needs.
Expanding Access to Care
Louisiana is expanding access to mobile urgent care to reduce emergency room utilization. The Louisiana Department of Health’s (LDH) Medicaid program is launching an emergency room utilization reduction pilot program. The pilot program extends medical services from LDH’s six Medicaid managed care organizations to patient residences via urgent mobile care provided by Acadian Health. The pilot program will provide mobile urgent treatment for an array of non-life-threatening medical conditions, including sickle cell disease and other chronic diseases.
New York is investing in direct care staff to improve the quality of care for people with disabilities. Governor Kathy Hochul announced nearly $850 million in updated reimbursement rates for residential and day service providers licensed by the New York State Office for People With Developmental Disabilities. These resources will enable provider agencies to offer higher wages for direct care staff, which are critical to improving the quality of care for people with disabilities.
North Carolina is investing in direct support professionals to support people with disabilities. As part of its Direct Support Professional Workforce Plan, the North Carolina Department of Health and Human Services announced $3 million to recruit and retain direct support professionals. This workforce is critical in helping people with intellectual and developmental disabilities live, work and thrive in communities of their choice. They provide a wide range of supports from daily tasks like bathing, eating and taking medications to connecting people with community resources and opportunities.
Marketplace Innovations
California newly enrolled a record 345,711 Californians during open enrollment. Covered California, the state’s official health insurance Marketplace, announced that 345,711 Californians newly selected a plan for 2025 during open enrollment, bringing overall enrollment to a record-high of nearly two million consumers.
Connecticut reported a record number of 151,151 Connecticut residents enrolled in coverage for 2025. Access Health CT, the state’s official health insurance Marketplace, reported a record number of 151,151 Connecticut residents enrolled in health and dental insurance for 2025 during the open enrollment period. The figure includes 41,165 residents enrolled in the no-cost Covered CT Program. Access Health CT also announced its new BusinessPlus platform to help Connecticut business owners manage health benefits more efficiently. BusinessPlus provides access to Individual Coverage Health Reimbursement Arrangements (ICHRAs) and will launch this summer.
Georgia’s open enrollment concluded with over 1.5 million enrollees. Insurance and Safety Fire Commissioner John F. King announced that Georgia Access, the state’s official health insurance Marketplace, concluded the 2025 open enrollment period enrolling over 1.5 million consumers, including 225,000 new consumers who were not previously enrolled in coverage through HealthCare.gov.
Illinois experienced a record 17% increase in enrollment during open enrollment. Governor JB Pritzker, the Illinois Department of Insurance, and Get Covered Illinois, the state’s official health insurance Marketplace, announced a record high 17% jump in enrollment numbers for the 2025 open enrollment period. Nearly 466,000 Illinoisans enrolled in Get Covered Illinois Marketplace plans.
New Jersey hit an all-time record enrollment for 2025 health coverage. Governor Phil Murphy and Department of Banking and Insurance Commissioner Justin Zimmerman announced that Get Covered New Jersey, the state’s official health insurance Marketplace, hit an all-time record enrollment with more than a half a million New Jerseyans signed up for 2025 health coverage. This represents nearly a 30% increase compared to last year’s open enrollment period.
Maternal Health
Arkansas passed legislation to establish prenatal presumptive Medicaid eligibility. Governor Sarah Huckabee Sanders signed legislation which establishes prenatal presumptive Medicaid eligibility, reimbursements for doulas and community health workers, and established pregnancy-related Medicaid coverage for specific treatments.
California released a plan to improve maternity care for Medicaid enrollees. The Department of Health Care Services released the Birthing Care Pathway (BCP) report, a comprehensive plan to improve maternity care for Medi-Cal members. This roadmap covers the journey of all pregnant and postpartum Medi-Cal members from conception through 12 months postpartum, aiming to make care accessible, equitable, and patient-centered. The BCP prioritizes reducing maternal mortality and morbidity, addressing health disparities, improving access and coordination, and modernizing payment models.
Pennsylvania hosted a roundtable to inform the state’s Maternal Health Strategic Plan. The Pennsylvania Department of Drug and Alcohol Programs Secretary Dr. Latika Davis-Jones, along with leadership from the departments of Human Services and Health, joined substance-use disorder (SUD) treatment providers, those with lived experience, local government and judicial officials for a roundtable discussion to seek feedback on the development of the state’s Maternal Health Strategic Plan specific to the SUD-related care for pregnant and postpartum individuals.
For information on how states can leverage payment to improve maternal health outcomes, see the SHVS issue brief Maternal Health Providers: Enhancing Health Equity Through Payment Parity.
Medicaid Defense
Colorado’s governor urged Congress to reject proposed cuts to Medicaid. Governor Jared Polis spoke with members of Congress, urging them to reject the $880 billion proposed cuts to Medicaid. The Colorado Department of Health Care Policy & Financing also prepared estimates of the impact of potential federal Medicaid reductions to Colorado. Among other impacts, the report notes that reducing the current expansion population enhanced federal match from 90% to 50% would translate to over $1 billion reduction in federal matching funding annually, impacting the 377,019 Coloradans covered through the expansion population. The report also notes that 96% of Colorado Medicaid’s budget goes to pay care providers, with only 4% going to administration, and that Medicaid is the most efficiently run health plan in Colorado.
Illinois’ governor brought together stakeholders to showcase a commitment to protecting Medicaid. Governor JB Pritzker convened leaders and advocates to raise awareness about the critical importance of Medicaid for Illinois families following the passage of the House Republican’s budget resolution targeting Medicaid.
Minnesota published fact sheets and a communications toolkit highlighting the potential impact of changes to the Medicaid program that are being discussed at the federal level. The Minnesota Department of Human Services released new fact sheets and a communications toolkit about the state’s Medicaid program and Basic Health Program, MinnesotaCare. The fact sheets offer a comprehensive look at the people who receive Medicaid and MinnesotaCare services, how these programs support the state’s healthcare providers and highlight the potential impact of changes to the Medicaid program that are being discussed at the federal level.
New Jersey released a report on the impact of potential reductions in federal Medicaid matching funds to provider pay, eligibility and benefits. The New Jersey Department of Human Services released a report evaluating the impact of potential reductions in federal Medicaid matching funds to the state. New Jersey considered proposals to: remove the Federal Medical Assistance Percentage (FMAP) floor, eliminate the 90% federal match for the Medicaid expansion population, and impose per capita caps on Medicaid funding, and noted the changes have significant potential effects on provider pay, eligibility and benefits.
Nevada’s governor warned Congress that proposed cuts to Medicaid could destabilize the healthcare system. Governor Joe Lombardo sent a letter to Congress regarding the potential impact of proposed changes to Medicaid funding, warning that the cuts could spell financial trouble for the state and destabilize the healthcare system. Also, the Nevada Department of Health and Human Services (DHHS) sent a written response to the state senate regarding federal legislation impacting Nevada’s state budget and healthcare coverage. The letter, which was written in response to a legislative request, provides estimates about the impact of federal proposals to change the FMAP, set per capita caps, and changes to provider taxes. DHHS also released a report on the estimated impact of potential federal Medicaid reductions to Nevada. Among other impacts, the report notes that a reduction from 90% FMAP for the expansion population to traditional FMAP would translate to a reduction of $1.858 billion in federal matching funds over the next two years, impacting the 300,000 Nevadans covered under expansion. The report also notes that a reduction in a provider tax from a six to a four percent tax would reduce revenue for children’s behavioral health by $30 million in state revenues over two years and lists state options if there are federal reductions, including eligibility and benefit reductions and provider reimbursement rate reductions.
North Carolina’s governor urged Congress to change course on proposed federal cuts to the Medicaid program. Governor Josh Stein sent a letter to Congressional leaders urging them to change course on proposed federal cuts to the Medicaid program and laying out what’s at stake in North Carolina. The letter describes how, in 29 mostly rural counties, 40% or more of the population depends on Medicaid for healthcare. The letter also explains that a cut to the enhanced federal match for the expansion population would trigger an immediate end to expansion leaving 640,000 residents without coverage.
Wisconsin’s governor released a letter detailing the impact of potential cuts to the Medicaid program in congressional districts. Governor Tony Evers released an open letter to Congressional Republicans, which includes the impact of potential cuts to the Medicaid program in their congressional districts. Cuts to the program would have serious implications for the health and wellbeing of Wisconsinites, including more than 757,000 people and a loss of more than $9 billion in funding in their districts.
Medicaid Innovations
Massachusetts is funding community-based organizations that provide health-related social needs services. The Healey-Driscoll Administration announced it is awarding $10 million to 37 community-based organizations that provide housing and nutrition support services across the state. The funds are intended to help awardees expand and enhance technology and operations to work effectively with MassHealth Accountable Care Organizations (ACOs) in order to provide health-related social needs services to members. ACOs are groups of doctors, hospitals, and other healthcare providers that coordinate high-quality care for MassHealth members.
Nebraska announced new features available on the state’s online Medicaid application. The Nebraska Department of Health and Human Services launched two new features on the iServe Nebraska Portal to improve accessibility for Medicaid renewals and home and community-based services (HCBS) waiver applications. The new features are designed to help Nebraskans renew Medicaid online for the upcoming year; apply for HCBS waivers online; update contact information; and manage benefits, services, and supports.
Medical Debt
Illinois announced additional medical debt elimination as part of the state’s Medical Debt Relief Pilot Program. Governor JB Pritzker announced two additional rounds of medical debt cancellations in the state’s Medical Debt Relief Pilot Program which was established last year. This brings the program’s total erased debt to more than $345 million for nearly 270,000 Illinois residents.
New Jersey announced a third round of medical debt elimination, totaling over $26 million. Governor Phil Murphy announced that over 20,000 New Jersey residents are set to benefit from a third round of medical debt elimination, totaling over $26 million. As a result of the state’s partnership with Undue Medical Debt, $246 million has been eliminated for 147,000 residents so far.
North Carolina received approval to continue its debt relief initiative. The North Carolina Department of Health and Human Services received approval from CMS to continue the Healthcare Access and Stabilization Program that makes hospital incentives for the state’s medical debt relief initiative possible. This new approval supports the state’s work to relieve more than $4 billion in medical debt for nearly two million North Carolinians for an additional year.
For more information on state efforts to prohibit medical debt reporting and eliminate existing debt, see the SHVS expert perspective Mapping State Efforts to Address Medical Debt and a Health Affairs Forefront article which examines the burgeoning trend of state efforts to cancel medical debt for just pennies on the dollar. SHVS also published a state spotlight profiling North Carolina’s Comprehensive Medical Debt Relief and Reform Incentive Program.
Mental and Behavioral Health
Illinois created a new Division of Behavioral Health and Recovery. Governor Pritzker issued an executive order to combine the Illinois Department of Human Services (DHS) Division of Mental Health and the Division of Substance Use Prevention and Recovery to create the Division of Behavioral Health and Recovery. The new division, which aims to address an overlap in patients who receive services from both divisions, remains part of DHS.
Maryland saw a dramatic decrease in the number of fatal overdoses in 2024. Maryland Governor Wes Moore announced that the number of fatal overdoses in Maryland decreased dramatically in 2024. According to preliminary data from Maryland’s Overdose Data Dashboard, there were 1,553 fatal overdoses reported in Maryland last year—a 38% decrease from the 2,511 fatal overdoses reported in 2023. However, health department officials note that disparities in overdose are still present among minoritized communities in Maryland, and that work must continue to ensure all communities are connected to care.
Michigan launched a mapping tool for individuals seeking substance-use disorder treatment services. To help individuals seeking substance-use disorder treatment (SUD) services, the Michigan Department of Health and Human Services (MDHHS) launched a SUD mapping tool. Providers can be searched by ZIP code, city or county, as well as types of services needed including inpatient, outpatient and medication-assisted treatment, and whether the provider accepts Medicaid.
New Mexico enacted legislation to improve behavioral health services. Governor Michelle Lujan Grisham signed legislation to improve behavioral health services across New Mexico. Senate Bill 1 establishes a dedicated trust fund to provide sustainable, long-term financing for behavioral health programs. Senate Bill 2 creates a behavioral health executive committee to coordinate statewide reform efforts through a regionalized approach based on local needs assessments.
New York established new network adequacy regulations for behavioral health services. Governor Kathy Hochul announced that new network adequacy regulations for behavioral health services will now entitle New Yorkers to an initial appointment for behavioral healthcare within 10 business days of the request, or seven calendar days following hospital discharge. Insurers unable to meet these timeframes will have to offer out-of-network mental health or substance-use disorder coverage without increasing the cost for the consumer.
Oregon is launching a pilot program to increase access to substance-use care in emergency care settings. The Oregon Health Authority is launching a six-month pilot program in partnership with the Oregon Public Health Institute and the Public Health Institute Bridge Center to improve the accessibility and uptake of substance-use care in emergency care settings. The program will train emergency responders to provide medication assisted treatment for opioid-use disorder in the field, before transporting patients to the hospital to bridge them to ongoing care. It will also equip emergency departments in these counties with the training and support to implement and improve 24/7 substance-use services.
Preventing Gun Violence
Michigan has distributed more than 56,800 free gun locks. As the state recognizes the one-year anniversary of Michigan’s secure storage law going into effect, MDHHS announced that more than 56,800 free gun locks have been distributed.
New York announced $20.7 million for community outreach programs to reduce gun violence. Governor Kathy Hochul announced $20.7 million to support SNUG Street Outreach programs that work to reduce gun violence and save lives in 14 communities across the state. These grants to community-based organizations and hospitals fund outreach workers, hospital responders, social workers and case managers who work with individuals at risk of gun violence, connecting them with support and services.
For more information on gun violence prevention, check out this episode of the Princeton Pulse which discusses a public health approach focused on firearm safety and injury prevention.
Reproductive and Women’s Health
Connecticut announced new programs to expand access to contraception. Governor Ned Lamont and Connecticut Consumer Protection Commissioner Bryan T. Cafferelli announced that a training program for licensed pharmacists who want to be able to prescribe contraception directly to customers is now available in Connecticut. Additionally, the state’s first vending machines providing access to emergency contraception and other over-the-counter medications are also now available.
Massachusetts released a Q&A to help providers and consumers understand their reproductive access rights. The Division of Insurance developed a Q&A to help explain Massachusetts laws regarding insurance coverage for abortion and abortion-related care. The Q&A is intended for insurance companies, providers, pharmacists, and consumers to understand the reproductive access rights provided under state law.
New Jersey established an advisory council on communicable diseases. Governor Phil Murphy signed an executive order establishing an advisory council on HIV, sexually transmitted infections (STIs), and viral hepatitis to help bolster the state’s efforts to uplift public health. The advisory council will bring together government officials and members of the public with a mandate to tackle these pressing communicable disease threats to public health with specific attention to the disproportionate impact of HIV, STIs, and viral hepatitis on New Jersey’s Black, Hispanic, Latino, and LGBTQIA+ communities.
New York is protecting the privacy of providers who prescribe abortion medication. Governor Kathy Hochul signed legislation to enable providers who prescribe medications used to perform abortions to request that the dispensing pharmacy print the name of their practice on prescription labels instead of their personal name.
Services for Children and Youth
Maryland is expanding access to school-based mental health services. The Maryland Department of Health announced it is expanding access to school-based mental health services for children and youth. The expansion allows Local Education Agencies to offer certain behavioral health services to all students enrolled in Medicaid. Previously, Medicaid payment for these services was limited to Medicaid-enrolled students who have an approved Individualized Education Plan or Individualized Family Service Plan.
Massachusetts is investing in school districts to improve student access to behavioral and mental health services. The Healey-Driscoll administration announced it is awarding $5.5 million in grants to 60 school districts, educational collaboratives and charter schools across Massachusetts to improve student access to behavioral and mental health services and support.
North Carolina is strengthening support for children and families. The North Carolina Department of Health and Human Services (NCDHHS) is investing $3 million to expand access to Child First, an evidence-based, early childhood intervention program proven to reduce the risk of child maltreatment and prevent young children and families from entering the foster care system. This initiative is part of the department’s broader $835 million investment to transform behavioral health. NCDHHS is also launching a Child First Learning Collaborative to assess the program’s effectiveness, support successful implementation and help to inform the department’s future investments in evidence-based, community-based services.
Wisconsin is taking action to protect children from further hazardous lead exposure. Governor Tony Evers announced approval of the Wisconsin Department of Health Services’ emergency rule to strengthen standards to protect more kids from further lead exposure. This change allows more kids and their families to be eligible for services to identify sources of lead exposure through an environmental investigation of the child’s home, as well as other nursing and medical follow-up actions.
Waiver and State Plan Amendments, Requests and Approvals
Florida received approval to expand its Behavioral Health and Supportive Housing Assistance Pilot. CMS approved an amendment to the “Florida Managed Medical Assistance (MMA)” section 1115 demonstration. Approval of this amendment gives the state authority to (1) expand its Behavioral Health and Supportive Housing Assistance Pilot to two additional regions; (2) provide voluntary populations who enroll into MMA or the dental managed care program a choice of MMA managed care plans and dental managed care plans; (3) provide coverage of behavior analysis services through managed care instead of the fee-for-service delivery system; (4) provide coverage of non-emergency dental services provided in an ambulatory surgical center or hospital through dental managed care plans instead of MMA plans; and (5) incorporate specialty products into comprehensive managed care plans.
Minnesota is seeking approval to provide reentry services. Minnesota submitted a request for a new five-year demonstration to provide reentry services to people leaving carceral settings and expand both pre-release care planning and Medicaid eligibility and enrollment supports for people returning to the community from incarceration.
North Dakota is seeking public comment on a state plan amendment to provide additional in-home and community-based services. North Dakota Health and Human Services is seeking public comment on a five-year renewal to the state’s Medicaid 1915(i) state plan amendment. The amendment would allow Medicaid to pay for additional in-home and community-based services for qualifying children and adults with mental health conditions, substance-use disorders and/or brain injuries.